Send Friend (2004) FDFRNDOL-1WV 1.0 Send a friend to us. We'll thank you both with cash! 5 for you. 10 for your friend! Easy-to-follow instructions: 1. 2. 3. Give one of the forms below to a friend and make copies to refer more friends.* Have your friend go online to hrblock.com/friend to prepare his taxes. Thanks for choosing H&R Block and referring your friends. Act today and get paid! *Refer a Friend Terms and Conditions: For each person you refer to H&R Block that is a new H&R Block customer and purchases qualifying online products or services between 1/1/2005 and 4/15/2005 using your unique Web address provided to you by H&R Block, you and your referred person are eligible to receive awards as follows: 5.00 to you and 10.00 to your friend when that friend purchases H&R Block's do- it- yourself Young Adult, Standard or Premium tax preparation service; or 10.00 to you and 20.00 to your friend when that friend purchases either H&R Block's Signature or Online Drop- off tax preparation service. You are limited to five referrals total (a maximum of 50.00), and you will receive only one referral award per federal tax return prepared using H&R Block that you refer. Offer valid only for new H&R Block referrals and not for any person that used H&R Block online or office tax preparation software or services for their prior year tax return. Checks for the award amounts will be mailed to you approximately 6 weeks after 4/15/2005. This offer may not be combined with any other gift or referral offer. H&R Block associates are not eligible to receive referral awards. Valid only in the United States. Offer expires 4/15/2005. Do It Yourself 1. 2. 3. For each friend you refer who files his taxes through H&R Block, we'll send both of you a check. Visit hrblock.com/friend. As a new online client you'll get 10! Your friend who gave you this form will get 5! Choose your online tax program. File your taxes through hrblock.com/friend and get paid! Do your taxes online with H&R Block. Please mail 5 to: 420 WEST ALABAMA APT 7 HOUSTON TX 77006 Your Tax Pro: Client ID 02D8FE4CB610488897B72ED0F8312308 *Refer a Friend Terms and Conditions: For each person you refer to H&R Block that is a new H&R Block customer and purchases qualifying online products or services between 1/1/2005 and 4/15/2005 using your unique Web address provided to you by H&R Block, you and your referred person are eligible to receive awards as follows: 5.00 to you and 10.00 to your friend when that friend purchases H&R Block's do- it- yourself Young Adult, Standard or Premium tax preparation service; or 10.00 to you and 20.00 to your friend when that friend purchases either H&R Block's Signature or Online Drop- off tax preparation service. You are limited to five referrals total (a maximum of 50.00), and you will receive only one referral award per federal tax return prepared using H&R Block that you refer. Offer valid only for new H&R Block referrals and not for any person that used H&R Block online or office tax preparation software or services for their prior year tax return. Checks for the award amounts will be mailed to you approximately 6 weeks after 4/15/2005. This offer may not be combined with any other gift or referral offer. H&R Block associates are not eligible to receive referral awards. Valid only in the United States. Offer expires 4/15/2005. Do your taxes online with H&R Block. As a new online client you'll get 10! Your friend who gave you this form will get 5! Do It Yourself 1. Visit hrblock.com/friend. 2. Choose your online tax program. 3. File your taxes through hrblock.com/friend and get paid! Please mail 5 to: 420 WEST ALABAMA APT 7 HOUSTON TX 77006 Your Tax Pro: Client ID 02D8FE4CB610488897B72ED0F8312308 *Refer a Friend Terms and Conditions: For each person you refer to H&R Block that is a new H&R Block customer and purchases qualifying online products or services between 1/1/2005 and 4/15/2005 using your unique Web address provided to you by H&R Block, you and your referred person are eligible to receive awards as follows: 5.00 to you and 10.00 to your friend when that friend purchases H&R Block's do- it- yourself Young Adult, Standard or Premium tax preparation service; or 10.00 to you and 20.00 to your friend when that friend purchases either H&R Block's Signature or Online Drop- off tax preparation service. You are limited to five referrals total (a maximum of 50.00), and you will receive only one referral award per federal tax return prepared using H&R Block that you refer. Offer valid only for new H&R Block referrals and not for any person that used H&R Block online or office tax preparation software or services for their prior year tax return. Checks for the award amounts will be mailed to you approximately 6 weeks after 4/15/2005. This offer may not be combined with any other gift or referral offer. H&R Block associates are not eligible to receive referral awards. Valid only in the United States. Offer expires 4/15/2005. Do your taxes online with H&R Block. As a new online client you'll get 10! Your friend who gave you this form will get 5! Do It Yourself 1. 2. 3. Visit hrblock.com/friend. Choose your online tax program. File your taxes through hrblock.com/friend and get paid! Please mail 5 to: 420 WEST ALABAMA APT 7 HOUSTON TX 77006 Your Tax Pro: Client ID 02D8FE4CB610488897B72ED0F8312308 *Refer a Friend Terms and Conditions: For each person you refer to H&R Block that is a new H&R Block customer and purchases qualifying online products or services between 1/1/2005 and 4/15/2005 using your unique Web address provided to you by H&R Block, you and your referred person are eligible to receive awards as follows: 5.00 to you and 10.00 to your friend when that friend purchases H&R Block's do- it- yourself Young Adult, Standard or Premium tax preparation service; or 10.00 to you and 20.00 to your friend when that friend purchases either H&R Block's Signature or Online Drop- off tax preparation service. You are limited to five referrals total (a maximum of 50.00), and you will receive only one referral award per federal tax return prepared using H&R Block that you refer. Offer valid only for new H&R Block referrals and not for any person that used H&R Block online or office tax preparation software or services for their prior year tax return. Checks for the award amounts will be mailed to you approximately 6 weeks after 4/15/2005. This offer may not be combined with any other gift or referral offer. H&R Block associates are not eligible to receive referral awards. Valid only in the United States. Offer expires 4/15/2005.
Advantage (2004) FDADVICE-1WV 1.0 prepared for: JAY L. JAMESON date prepared: 03/31/2005 Today's Savings In simple terms, the Marginal Tax Rate is the tax rate you pay on your last dollar of taxable income. It's the highest federal tax bracket that affects your tax calculation. The Effective Tax Rate is the percentage of your total income that you paid in taxes. For 2004, your Marginal Tax Rate is 15% and your Effective Tax Rate is 9%. Filing, Refund and Balance Due Information Tax Return Refund / efile / Mail To (Balance Due) Summary Federal See the Filing Checklist for mailing instructions. 438.00 Refund/(Bal Due) 438.00
Advantage (2004) FDADVICE-2WV 1.0 Looking Ahead - Opportunities and Advice Save for retirement or a home with a Roth IRA: You may want to consider opening a Roth IRA (Individual Retirement Arrangement), in which you can contribute up to 4,000 (4,500 if age 50 or older) for the 2005 tax year. Unlike traditional IRA contributions, Roth contributions aren't tax deductible, but you can make qualified withdrawals of your contributions without paying taxes or penalties. (Non-qualified withdrawals of earnings will be subject to penalty and tax.) After the account has been funded for at least five years, you may be able to make a qualified withdrawal of up to 10,000 tax-and-penalty free (lifetime limit) from a Roth IRA for the purchase of a first home. Make sure you understand all the qualification restrictions before opening a Roth IRA. If you would like to open a Roth IRA, contact your financial institution. If you would like more information about how to buy a home, contact a lender or call H&R Block Mortgage's First-Time Homebuyer Program at 1-866-30-HOME-1.. Save cash for emergencies: To protect yourself against emergencies, you should try to have at least 90 days' worth of income set aside. If you save 159 each month, you would have 3,808 set aside after two years Start Saving Now: The sooner you start saving, the more time you'll have for your nest egg to grow. If you set aside just 50 each month at an interest rate of 4%, you would have nearly 3,400 after five years. Keep doing this for 25 years, and you'll have nearly 26,000. Put the same money aside in a tax-deferred account such as an IRA, and you'll get even more bang for your bucks. A dependent doesn't have to be a child or relative: You can claim anyone who lives in your home, has less than 3,200 in income from taxable sources, and receives at least 50% of his or her support from you. If a dependent is related to you (by blood, marriage or adoption), he or she doesn't even have to live with you. Life Changes Impact Your Taxes: Getting married or divorced, getting a promotion, having a baby, buying a home or becoming self-employed are just a few life events that can affect your taxes. If your life situation changes - or if you would like to manage the size of your refund next year - fill out a new Form W-4 to give to your employer. Paying the minimum on credit cards can cost you: Paying the minimum balance on your credit card each month costs more than you think. If you have a 1,000 balance with a credit card that charges 18%, it will take over 7.5 years to pay off if you make 20 payments each month. It will cost you over 800 in interest. Pay just 30 more than the minimum due each month, and it will only take four years and cost 310 in interest. If you need help, you may contact the National Foundation for Credit Counseling at http://www.nfcc.org or by calling 1-800-388-2227. For more information about tax, mortgage and financial services call 1-800-HRBLOCK or visit hrblock.com.
Client Sum (2004) FDBASUM-1WV 1.0 2004 Tax Return Summary Federal Year over Year Comparison INCOME Year 2004 Year 2003 Change() Wages, salaries, tips Capital gain (loss) Total income 26,115 (668) 25,447 26,115 (668) 25,447 ADJUSTED GROSS INCOME Total income less total adjustments 25,447 25,447 TAXABLE INCOME Standard deductions Exemptions Taxable income 4,850 3,100 17,497 4,850 3,100 17,497 TAX COMPUTATION Income tax Tax before credits 2,264 2,264 2,264 2,264 OTHER TAXES Total tax 2,264 2,264 PAYMENTS Federal withholding 2,702 Total payments 2,702 2,702 2,702 REFUND Overpayment 438 438 Refund due 438 438 OTHER COMPUTATIONS Alternative minimum taxable income 25,447 Marginal tax bracket 15% Effective tax bracket 9% Filing status Single 25,447 For more information about tax, mortgage and financial services call 1-800-HRBLOCK or visit hrblock.com.
Client Sum (2004) FDBASUM-2WV 1.0 Client Services Name Date of Birth SSN Relationship Number of Months Supported JAY L. JAMESON September 17,1966 308-88-8093 SELF N/A For more information about tax, mortgage and financial services call 1-800-HRBLOCK or visit hrblock.com.
8453OL(D) (2004) FD8453OD-1WV 1.0 Declaration Control Number (DCN) 0 0 5 Perjury Statement - - Under penalties of perjury, I declare that I have examined this return, including any accompanying statements and schedules and, to the best of my knowledge and belief, it is true, correct, and complete. Consent to Disclosure I consent to allow my Intermediate Service Provider, transmitter, or Electronic Return Originator (ERO) to send my return/form to IRS and to receive the following information from IRS: 1) acknowledgment of receipt or reason for rejection of transmission; 2) refund offset; 3) reason for any delay in processing or refund; and, 4) date of any refund. Tax Return Signature/Consent to Disclosure On-Line Self Select PIN without Direct Debit I am signing this Tax Return and Electronic Funds Withdrawal Consent, if applicable, by entering my Self Select PIN below. Taxpayer's PIN: Taxpayer's Date of Birth: Taxpayer's Prior Year Adjusted Gross Income: Spouse's PIN: Spouse's Date of Birth: Spouse's Prior Year Adjusted Gross Income: 74735 09/17/1966 15,995 Date: 03/31/2005 Rev 10/11/2004
personalized tax filing advice for: This checklist has been customized for you based on the method you're using to file your 2004 tax return. The statements below are designed to help guide you through the steps you will take to file your return. filing checklist for your 2004 federal tax return Prepared On: 03/31/2005 Return Prepared: 1040 quick summary Gross Income Adjusted Gross Income Total Deductions Total Taxable Income 25,447 25,447 7,950 17,497 Total Tax Total Payments Refund Amount Amount You Owe 2,264 2,702 438 0 to file your 2004 federal tax return, simply follow these instructions STEP 1 - Once your e-filed return has been accepted, you will receive an e-mail STEP 2 - Keep a copy Print a copy of the return for your records. Please attach a copy of each W-2, W-2G, 1099G and 1099R to your return. NOTE: Since you are filing your return electronically and you chose to use an electronic signature, you do not mail your return. For more information about tax, mortgage and financial services call 1-800-HRBLOCK or visit hrblock.com
1040 (2004) FD1040-1WV 1.25 Form 1040 Label Use the IRS label. Otherwise, please print or type. Presidential Election Campaign Filing Status Department of the Treasury - Internal Revenue Service For the year Jan. 1-Dec. 31, 2004, or other tax year beginning X, 2004, ending 308-88-8093 If the qualifying person is a child but not your dependent, enter this Check only 3 Married filing separately. Enter spouse's SSN above & full name below. child's name here. one box. 5 Qualifying widow(er) with dependent child (see page 17) Boxes checked 6a Yourself. If someone can claim you as a dependent, do not check box 6a on 6a and 6b Exemptions b Spouse No. of children on 6c who: c Dependents: (2) Dependent's (3) Dependent's (4) if qual. lived with you relationship to child for (1) First name Last name social security number you child tax cr. did not live with you due to divorce or separation If more than four Dependents dependents, on 6c not see page 18. entered above Add numbers d Total number of exemptions claimed on lines above Income Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld. If you did not get a W-2, see page 19. Enclose, but do not attach, any payment. Also, please use Form 1040- V. Adjusted Gross Income U.S. Individual Income Tax Return 420 WEST ALABAMA APT. 7 HOUSTON, TX 77006 1 2 7 8a 9a 10 11 12 13 14 32 33 b b 15a 16a 17 18 19 20a 21 22 23 24 25 26 27 28 29 30 31 34a 35 36 Note. Checking "Yes" will not change your tax or reduce your refund. Do you, or your spouse if filing a joint return, want 3 to go to this fund? Single Married filing jointly (even if only one had income) X 1 Wages, salaries, tips, etc. Attach Form(s) W-2 Taxable interest. Attach Schedule B if required Tax- exempt interest. Do not include on line 8a Ordinary dividends. Attach Schedule B if required Qualified dividends (see page 20) Taxable refunds, credits, or offsets of state and local income taxes (see page 20) Alimony received Business income or (loss). Attach Schedule C or C-EZ Capital gain/(loss). Attach Sch D. If not required check here Other gains or (losses). Attach Form 4797 IRA distributions Pensions and annuities Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E Farm income or (loss). Attach Schedule F Unemployment compensation Social security benefits Other income. List type and amount (see page 24) Educator expenses (see page 26) fee-basis government officials. Attach Form 2106 or 2106-EZ Tuition and fees deduction (see page 29) Health savings account deduction. Attach Form 8889 Moving expenses. Attach Form 3903 b Recipient's SSN (99) b Taxable amt IRS Use Only - Do not write or staple in this space., 20 OMB No. 1545-0074 Head of household (with qualifying person). (See page 17.) b Taxable amt Add the amounts in the far right column for lines 7 through 21. This is your total income Certain business expenses for reservists, performing artists, and IRA deduction (see page 26) Student loan interest deduction (see page 28) One-half of self-employment tax. Attach Schedule SE Self-employed health insurance deduction (see page 30) Self-employed SEP, SIMPLE, and qualified plans Penalty on early withdrawal of savings Alimony paid Add lines 23 through 34a 15a 16a 20a Subtract line 35 from line 22. This is your adjusted gross income KBA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 75. 4 8b 9b b Taxable amt 23 24 25 26 27 28 29 30 31 32 33 34a Your social security number Spouse's social security number You must enter your SSN(s) above. You Yes 7 8a 9a 10 11 12 13 14 15b 16b 17 18 19 20b 21 22 35 36 Important! X No Spouse Yes No 1 26,115. (668.) 25,447. 25,447. Form 1040 (2004)
Form 1040 (2004) Tax and Credits Standard Deduction for - People who checked any box on line 38a or 38b or who can be claimed as a dependent, see page 31. All others: Single or Married filing separately, 4,850 Married filing jointly or Qualifying widow(er), 9,700 Head of household, 7,150 Other Taxes 37 Amount from line 36 (adjusted gross income) 38a Check You were born before January 2, 1940, Blind. Total boxes if: Spouse was born before January 2, 1940, Blind. checked 38a b 39 40 41 42 If your spouse itemizes on a separate return or you were a dual-status alien, see pg 31 & check here 38b Itemized deductions (from Schedule A) or your standard deduction (see left margin) Subtract line 39 from line 37 If line 37 is 107,025 or less, multiply 3,100 by the total number of exemptions claimed on line 6d. If line 37 is over 107,025, see the worksheet on page 33 Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0-43 Tax. Check if any tax is from: a Form(s) 8814 b Form 4972 44 Alternative minimum tax (see page 35). Attach Form 6251 45 Add lines 43 and 44 46 Foreign tax credit. Attach Form 1116 if required 46 47 Credit for child and dependent care expenses. Attach Form 2441 47 48 Credit for the elderly or the disabled. Attach Schedule R 48 49 Education credits. Attach Form 8863 49 50 Retirement savings contributions credit. Attach Form 8880 50 51 Child tax credit (see page 37) 51 52 Adoption credit. Attach Form 8839 52 53 Credits from: a Form 8396 b Form 8859 53 54 Other credits. Check applicable box(es): a Form 3800 b Form 8801 c Specify 54 55 Add lines 46 through 54. These are your total credits 56 Subtract line 55 from line 45. If line 55 is more than line 45, enter -0-57 Self-employment tax. Attach Schedule SE 58 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 60 Advance earned income credit payments from Form(s) W-2 61 Household employment taxes. Attach Schedule H 308-88-8093 Page 2 25,447. 37 39 40 41 42 43 44 45 55 56 57 58 59 60 61 4,850. 20,597. 3,100. 17,497. 2,264. 2,264. 2,264. Payments If you have a qualifying child, attach Schedule EIC. Refund Direct deposit? See page 54 and fill in 72b, 72c, and 72d. Amount You Owe Third Party Designee Sign Here Joint return? See page 17. Keep a copy for your records. Paid Preparer's Use Only 62 63 64 65a 66 67 68 69 70 71 b 72a 73 74 75 b d Add lines 56 through 61. This is your total tax Federal income tax withheld from Forms W-2 and 1099 2004 estimated tax payments & amount applied from 2003 return Earned income credit (EIC) Nontaxable combat pay election Excess social security and tier 1 RRTA tax withheld (see page 54) Additional child tax credit. Attach Form 8812 Amount paid with request for extension to file (see page 54) Other payments from: a Form 2439 b Form 4136 c Add lns 63, 64, 65a, & 66 through 69. These are your total payments Amount of line 71 you want refunded to you Account number Designee's name 113000023 c Type: X 005746070713 Form 8885 If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid Routing number Do you want to allow another person to discuss this return with the IRS (see page 56)? 2,702. (PIN) Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date Your occupation Daytime phone number Preparer's signature Firm's name (or yours if self-employed), address, and ZIP code Checking Amount of line 71 you want applied to your 2005 estimated tax Estimated tax penalty (see page 55) 65b Spouse's signature. If a joint return, both must sign. Date Date Savings Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55 For Info Only-Do not file For Info Only-Do not file 1040 (2004) FD1040-2WV 1.25 63 64 65a 66 67 68 69 73 75 Phone no. ASST MEDIA RELA Spouse's occupation Check if self-employed Yes. Complete the following. EIN Phone no. 62 70 71 72a 74 2,264. 2,702. 438. 438. X Personal ID number Preparer's SSN or PTIN No Form 1040 (2004)
1040-Sch D&1 (2004) FDD-1WV 1.13 SCHEDULE D (Form 1040) Department of the Treasury Internal Revenue Service (99) Name(s) shown on Form 1040 Part I 1 (a) Description of property (Example: 100 sh. XYZ Co.) Attach to Form 1040. See Instructions for Schedule D (Form 1040). Attachment Use Schedule D-1 to list additional transactions for lines 1 and 8. Sequence No. 12 (b) Date acquired (Mo., day, yr.) Capital Gains and Losses Short-Term Capital Gains and Losses - Assets Held One Year or Less (c) Date sold (Mo., day, yr.) (d) Sales price (see page D-6 of the instructions) (e) Cost or other basis (see page D-6 of the instructions) OMB No. 1545-0074 Your social security number 308-88-8093 (f) Gain or (loss) Subtract (e) from (d) 2 Enter your short-term totals, if any, from Schedule D-1, line 2 2 3 Total short- term sales price amounts. Add lines 1 and 2 in column (d) 3 4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 4 5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 5 6 Short- term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover Worksheet on page D- 6 of the Instructions 6 ( ) 7 Net short- term capital gain or (loss). Combine lines 1 through 6 in column (f) 7 Part II Long-Term Capital Gains and Losses - Assets Held More Than One Year (a) Description of property (b) Date (c) Date sold (d) Sales price (e) Cost or other acquired (see page D-6 of basis (see page D-6 8 (Example: 100 sh. XYZ Co.) (Mo., day, yr.) (Mo., day, yr.) the instructions) of the instructions) (f) Gain or (loss) Subtract (e) from (d) 9 10 11 12 Enter your long-term totals, if any, from Schedule D-1, line 9 Total long- term sales price amounts. Add lines 8 and 9 in column (d) Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from Forms 4684, 6781, and 8824 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 9 10 11 12 13 Capital gain distributions. See page D-1 of the instructions 13 14 Long- term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover Worksheet on page D- 6 of the Instructions 14 15 Net long- term capital gain or (loss). Combine lines 8 through 14 in column (f). Then go to Part III on page 2 15 ( 668. ) (668.) KBA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule D (Form 1040) 2004
1040-Sch D&1 (2004) FDD-2WV 1.13 Schedule D (Form 1040) 2004 308-88-8093 Page 2 Part III Summary 16 Combine lines 7 and 15 and enter the result. If line 16 is a loss, skip lines 17 through 20, and go to line 21. If a gain, enter the gain on Form 1040, line 13, and then go to line 17 below 16 (668.) 17 Are lines 15 and 16 both gains? Yes. Go to line 18. No. Skip lines 18 through 21, and go to line 22. 18 Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet on page D-7 of the instructions 18 19 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet on page D-8 of the instructions 19 20 Are lines 18 and 19 both zero or blank? Yes. Complete Form 1040 through line 42, and then complete the Qualified Dividends and Capital Gain Tax Worksheet on page 34 of the Instructions for Form 1040. Do not complete lines 21 and 22 below. No. Complete Form 1040 through line 42, and then complete the Schedule D Tax Worksheet on page D- 9 of the instructions. Do not complete lines 21 and 22 below. 21 If line 16 is a loss, enter here and on Form 1040, line 13, the smaller of: The loss on line 16 or (3,000), or if married filing separately, (1,500) 21 ( 668. ) Note. When figuring which amount is smaller, treat both amounts as positive numbers. 22 Do you have qualified dividends on Form 1040, line 9b? X Yes. Complete Form 1040 through line 42, and then complete the Qualified Dividends and Capital Gain Tax Worksheet on page 34 of the Instructions for Form 1040. No. Complete the rest of Form 1040. Schedule D (Form 1040) 2004