MARIE EXTENDED QUINCY & THOMAS MORRISON 3300 BOWIE DR EUGENE, OR INCOME TAX RETURN

MARIE EXTENDED QUINCY & THOMAS MORRISON 3300 BOWIE DR EUGENE, OR 97401 2017 INCOME TAX RETURN

PRACTICE LAB 15 PRACTICE LAB WAY WASHINGTON DC 20005 (202) 202-2022 MARIE EXTENDED A QUINCY & THOMAS MORRISON 3300 BOWIE DR EUGENE OR 97401 (541) 954-6666 Preparer No.: 995 Client No. : XXX-XX-4500 Invoice Date: 12/24/2017 INVOICE Description Amount PREPARATION OF 2017 FEDERAL/STATE FORMS & WORKSHEETS: FORM 1040 SCHEDULE B (INTEREST & DIVIDENDS) SCHEDULE EIC (EARNED INCOME CREDIT) FORM W-2 (WAGES AND TAX) FORM W-2G (GAMBLING WINNINGS) FORM 1099-R (RETIREMENT DISTRIBUTIONS) (2) SIMPLIFIED GENERAL RULE WORKSHEET SSA WORKSHEET FORM 8879 (E-FILE SIGNATURE AUTHORIZATION) FORM 8863 (EDUCATION CREDIT) OR STATE RESIDENT RETURN Total Invoice $0.00 Amount Paid $0.00 Balance Due $0.00

TAX YEAR: 2017 PROCESS DATE: 12/24/2017 CLIENT : 047-00-4500 MARIE EXTENDED A QUINCY BIRTH DATE : 01/21/1950 / Age: 67 SPOUSE : 048-00-4907 THOMAS MORRISON BIRTH DATE : 03/15/1955 / Age: 62 ADDRESS : 3300 BOWIE DR PREPARER : 995 : EUGENE OR 97401 Home : (541) 954-6666 PREPARER FEE: Work : - ELECTRONIC : Cell : - TOTAL FEES : STATUS : 2 FED TYPE: Electronic Mail ST TYPE : Regular Tax E-MAIL : NONE@TAXSLAYERPRO.COM DEPENDENT NAME BIRTH DATE AGE SSN RELATIONSHIP MONTHS DANNY MORRISON 11/03/2000 17 049-00-4907 SON 12 BART MORRISON 05/28/1996 21 060-00-4906 SON 12 LISTING OF FORMS FOR THIS RETURN FORM 1040 FORM W-2 FORM W-2G FORM SSA-1099 (SOCIAL SECURITY BENEFITS) FORM 1099-R (RETIREMENT DISTRIBUTIONS) SCHEDULE B (INTEREST/DIVIDEND INCOME) SCHEDULE EIC (EARNED INCOME CREDIT) FORM 8863 (EDUCATION CREDITS) FORM 8879 (E-FILE SIGNATURE AUTHORIZATION) OR STATE RESIDENT RETURN * QUICK SUMMARY * SUMMARY FEDERAL OR RESIDENT FILING STATUS TOTAL INCOME TOTAL ADJUSTMENTS ADJUSTED GROSS INCOME DEDUCTIONS EXEMPTIONS TAXABLE INCOME TAX CREDITS PAYMENTS EARNED INCOME CREDIT REFUND AMOUNT DUE 2 50112 0 50112 13950 16200 19962 2064 1560 6134 99 5729 0 2 50112-28606 21506 9394 0 12112 715 0 1364 8 1364 0

CLIENT : MARIE EXTENDED QUINCY 047-00-4500 SPOUSE : THOMAS MORRISON 048-00-4907 PREPARER : 995 DATE : 12/24/2017 * W-2 INCOME FORMS SUMMARY * T/S EMPLOYER WAGES FED WITH FICA MED TAX STATE WITH ST 1. T MEGA DENTAL AS 12241 1934 759 177 935 OR TOTALS... 12241 1934 759 177 935 * W-2G INCOME FORMS SUMMARY * [T/S] PAYER GROSS WINNING FED WITH STATE WITH ST 1. S OREGON LOTTERY 500 0 0 TOTALS... 500 0 0 * 1099-R INCOME FORMS SUMMARY * [T/S] PAYER GROSS DIST TAXABLE AMT FED WITH STATE WITH 1. T BOXER INVESTMENT 12000 12000 1200 0 2. T OFFICE PERS MAN 17585 16215 0 0 TOTALS... 29585 28215 1200 0 * FORM SSA-1099 INCOME FORMS SUMMARY * [T/S] PAYER SSA BENEFITS FED WITH PREMIUMS 1. T U.S. 12477 1000 1539 TOTALS... 12477 1000 1539

b Employer identification number (EIN) 04-1111111 c Employer s name, address, and ZIP code MEGA DENTAL ASSOCIATES 3205 KYLE COURT TAMPA FL 33602 a Employee s social security number 047-00-4500 OMB No. 1545-0008 Safe, accurate, FAST! Use Visit the IRS website at www.irs.gov/efile 1 Wages, tips, other compensation 2 Federal income tax withheld 12241 1934 3 Social security wages 4 Social security tax withheld 12241 759 5 Medicare wages and tips 6 Medicare tax withheld 12241 177 7 Social security tips 8 Allocated tips d Control number 9 Verification code 10 Dependent care benefits e Employee s first name and initial Last name Suff. MARIE EXTENDED A QUINCY 3300 BOWIE DR EUGENE OR 97401 11 Nonqualified plans 12a See instructions for box 12 C 13 Statutory employee 14 Other f Employee s address and ZIP code 15 State Employer s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name OR 141000000 12241 935 Retirement plan Third-party sick pay o d e 12b C o d e 12c C o d e 12d C o d e Form W-2 b Employer identification number (EIN) Wage and Tax Statement 2017 a Employee s social security number OMB No. 1545-0008 Safe, accurate, FAST! Use Department of the Treasury Internal Revenue Service Visit the IRS website at www.irs.gov/efile 1 Wages, tips, other compensation 2 Federal income tax withheld c Employer s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tips d Control number 9 Verification code 10 Dependent care benefits e Employee s first name and initial Last name Suff. 11 Nonqualified plans 12a See instructions for box 12 C o d e 13 Statutory employee 12b C o d e 14 Other 12c C o d e 12d C o d e f Employee s address and ZIP code 15 State Employer s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Retirement plan Third-party sick pay Form W-2 Wage and Tax Statement 2017 Department of the Treasury Internal Revenue Service

Form 8879 Department of the Treasury Internal Revenue Service IRS e-file Signature Authorization Return completed Form 8879 to your ERO. (Do not send to IRS.) Go to www.irs.gov/form8879 for the latest information. OMB No. 1545-0074 2017 Submission Identification Number (SID) Taxpayer s name Spouse s name Social security number MARIE EXTENDED A QUINCY 047-00-4500 Spouse s social security number THOMAS MORRISON 048-00-4907 Part I Tax Return Information Tax Year Ending December 31, 2017 (Whole dollars only) 1 Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4; Form 1040NR, line 37)................................ 1 50112 2 Total tax (Form 1040, line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61).. 2 504 3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040, line 64; Form 1040A, line 40; Form 1040EZ, line 7; Form 1040NR, line 62a)................... 3 4134 4 Refund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 13a; Form 1040-SS, Part I, line 13a; Form 1040NR, line 73a)........................... 4 5729 5 Amount you owe (Form 1040, line 78; Form 1040A, line 50; Form 1040EZ, line 14; Form 1040NR, line 75) 5 Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return) Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements for the tax year ending December 31, 2017, and to the best of my knowledge and belief, it is true, correct, and accurately lists all amounts and sources of income I received during the tax year. I further declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent. Taxpayer s PIN: check one box only I authorize to enter or generate my PIN ERO firm name as my signature on my tax year 2017 electronically filed income tax return. X PRACTICE LAB 1 4 5 0 0 Enter five digits, but don t enter all zeros I will enter my PIN as my signature on my tax year 2017 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. Your signature Date 12/24/2017 Spouse s PIN: check one box only I authorize to enter or generate my PIN ERO firm name as my signature on my tax year 2017 electronically filed income tax return. X PRACTICE LAB 1 4 9 0 7 Enter five digits, but don t enter all zeros I will enter my PIN as my signature on my tax year 2017 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. Spouse s signature Date 12/24/2017 Part III Practitioner PIN Method Returns Only continue below Certification and Authentication Practitioner PIN Method Only 3 6 9 2 5 8 9 8 7 6 5 ERO s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. Don t enter all zeros I certify that the above numeric entry is my PIN, which is my signature for the tax year 2017 electronically filed income tax return for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns. ERO s signature Date IRS 12/24/2017 ERO Must Retain This Form See Instructions Don t Submit This Form to the IRS Unless Requested To Do So For Paperwork Reduction Act Notice, see your tax return instructions. QNA Form 8879 (2017)

Form 1040 Department of the Treasury Internal Revenue Service (99) U.S. Individual Income Tax Return 2017 OMB No. 1545-0074 IRS Use Only Do not write or staple in this space. For the year Jan. 1 Dec. 31, 2017, or other tax year beginning, 2017, ending, 20 See separate instructions. Your first name and initial Last name Your social security number MARIE EXTENDED A QUINCY 047-00-4500 If a joint return, spouse s first name and initial Last name Spouse s social security number THOMAS MORRISON 048-00-4907 Home address (number and street). If you have a P.O. box, see instructions. 3300 BOWIE DR City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). EUGENE, OR 97401 Apt. no. Foreign country name Foreign province/state/county Foreign postal code Filing Status Check only one box. Exemptions If more than four dependents, see instructions and check here 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 a box below will not change your tax or refund. You Spouse 1 Single 4 Head of household (with qualifying person). (See instructions.) 2 x Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, enter this 3 Married filing separately. Enter spouse s SSN above child s name here. and full name here. 5 Qualifying widow(er) (see instructions) 6a X Yourself. If someone can claim you as a dependent, do not check box 6a..... Boxes checked } on 6a and 6b b X Spouse........................ No. of children 2 c Dependents: (2) Dependent s (3) Dependent s (4) if child under age 17 on 6c who: (1) First name Last name social security number relationship to you qualifying for child tax credit lived with you (see instructions) did not live with 2 DANNY MORRISON 049-00-4907 SON you due to divorce or separation (see instructions) BART MORRISON 060-00-4906 SON Dependents on 6c not entered above Add numbers on d Total number of exemptions claimed................. lines above Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2............ 7 8a Taxable interest. Attach Schedule B if required............ 8a 12241 100 Attach Form(s) 9 a Ordinary dividends. Attach Schedule B if required........... W-2 here. Also attach Forms b Qualified dividends........... 9b b Tax-exempt interest. Do not include on line 8a... 8b 300 9a W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes...... 10 1099-R if tax 11 Alimony received..................... 11 was withheld. 12 Business income or (loss). Attach Schedule C or C-EZ.......... 12 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here 13 If you did not 14 Other gains or (losses). Attach Form 4797.............. 14 get a W-2, see instructions. 15 a IRA distributions. 15a b Taxable amount... 15b 12000 16 a Pensions and annuities 16a 17585 b Taxable amount... 16b 16215 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 18 Farm income or (loss). Attach Schedule F.............. 18 19 Unemployment compensation................. 19 20 a Social security benefits 20a 12477 b Taxable amount... 20b 9056 21 Other income. List type and amount GAMBLING WINNINGS 21 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income 22 500 50112 23 Educator expenses........... 23 Adjusted 24 Certain business expenses of reservists, performing artists, and Gross fee-basis government officials. Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889. 25 26 Moving expenses. Attach Form 3903...... 26 27 Deductible part of self-employment tax. Attach Schedule SE. 27 28 Self-employed SEP, SIMPLE, and qualified plans.. 28 29 Self-employed health insurance deduction.... 29 30 Penalty on early withdrawal of savings...... 30 31 a Alimony paid b Recipient s SSN 31a 32 IRA deduction............. 32 33 Student loan interest deduction........ 33 34 Reserved for future use.......... 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 35................... 36 37 Subtract line 36 from line 22. This is your adjusted gross income..... 37 50112 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. QNA Form 1040 (2017) 0 0 4

Form 1040 (2017) Page 2 38 Amount from line 37 (adjusted gross income).............. 38 50112 39a Tax and Check X You were born before January 2, 1953, Blind. Total boxes { } if: Spouse was born before January 2, 1953, Blind. checked Credits 39a 1 b If your spouse itemizes on a separate return or you were a dual-status alien, check here 39b Standard Deduction for People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions. All others: Single or Married filing separately, $6,350 Married filing jointly or Qualifying widow(er), $12,700 Head of household, $9,350 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin).. 40 41 Subtract line 40 from line 38................... 41 42 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions 42 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-.. 43 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44 45 Alternative minimum tax (see instructions). Attach Form 6251......... 45 46 Excess advance premium tax credit repayment. Attach Form 8962........ 46 47 Add lines 44, 45, and 46................... 47 48 Foreign tax credit. Attach Form 1116 if required.... 48 49 Credit for child and dependent care expenses. Attach Form 2441 49 50 Education credits from Form 8863, line 19..... 50 51 Retirement savings contributions credit. Attach Form 8880 51 52 Child tax credit. Attach Schedule 8812, if required... 52 53 Residential energy credit. Attach Form 5695..... 53 54 Other credits from Form: a 3800 b 8801 c 54 55 Add lines 48 through 54. These are your total credits............ 55 56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0-...... 56 57 Self-employment tax. Attach Schedule SE............... 57 Other 58 Unreported social security and Medicare tax from Form: a 4137 b 8919.. 58 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required.. 59 Taxes 60 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 X..... 61 62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62 63 Add lines 56 through 62. This is your total tax............. 63 Payments 64 Federal income tax withheld from Forms W-2 and 1099.. 64 65 2017 estimated tax payments and amount applied from 2016 return 65 If you have a qualifying child, attach Schedule EIC. Refund Direct deposit? See instructions. Amount You Owe Third Party Designee Sign Here Joint return? See instructions. Keep a copy for your records. Paid Preparer Use Only 66a Earned income credit (EIC).......... 66a b Nontaxable combat pay election 66b 67 Additional child tax credit. Attach Schedule 8812..... 67 68 American opportunity credit from Form 8863, line 8... 68 1000 69 Net premium tax credit. Attach Form 8962...... 69 70 Amount paid with request for extension to file..... 70 71 Excess social security and tier 1 RRTA tax withheld.... 71 72 Credit for federal tax on fuels. Attach Form 4136.... 72 73 Credits from Form: a 2439 b Reserved c 8885 d 73 74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments..... 74 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 b Routing number X X X X X X X X X c Type: Checking Savings d Account number X X X X X X X X X X X X X X X X X 77 Amount of line 75 you want applied to your 2018 estimated tax 77 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions 78 79 Estimated tax penalty (see instructions)....... 79 Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No Designee s Phone Personal identification name no. number (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 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. QUINCY 047-00-4500 Your signature Date Your occupation Daytime phone number 12/24/17 DENTAL ASST 541-954-6666 Spouse s signature. If a joint return, both must sign. Date Spouse s occupation If the IRS sent you an Identity Protection PIN, enter it 12/24/17 RETIRED here (see inst.) Print/Type preparer s name Preparer s signature Date PTIN Check if self-employed PRACTICE LAB Firm s name Firm s EIN Firm s address 15 PRACTICE LAB WAY WASHINGTON DC 20005 Phone no. 202-202-2022 Go to www.irs.gov/form1040 for instructions and the latest information. Form 1040 (2017) QNA 60 1500 4134 FORM 1099 1000 99 13950 36162 16200 19962 2064 2064 1560 504 504 6233 5729 5729 12/24/2017 S12345678 -

SCHEDULE A (Form 1040) Department of the Treasury Internal Revenue Service (99) Name(s) shown on Form 1040 Medical and Dental Expenses Taxes You Paid Interest You Paid Note: Your mortgage interest deduction may be limited (see instructions). Gifts to Charity If you made a gift and got a benefit for it, see instructions. Itemized Deductions Go to www.irs.gov/schedulea for instructions and the latest information. Attach to Form 1040. MARIE EXTENDED QUINCY & THOMAS MORRISON Caution: Do not include expenses reimbursed or paid by others. 1 Medical and dental expenses (see instructions)..... 1 11830 2 Enter amount from Form 1040, line 38 2 50112 3 Multiply line 2 by 10% (0.10)............ 3 5011 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0-........ 4 5 State and local (check only one box): a X Income taxes, or b General sales taxes }........... 5 1335 6 Real estate taxes (see instructions)......... 6 7 Personal property taxes............. 7 8 Other taxes. List type and amount 8 9 Add lines 5 through 8...................... 9 10 Home mortgage interest and points reported to you on Form 1098 10 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions and show that person s name, identifying no., and address 11 12 Points not reported to you on Form 1098. See instructions for special rules................. 12 13 Reserved.................. 13 14 Investment interest. Attach Form 4952 if required. See instructions. 14 15 Add lines 10 through 14..................... 15 16 Gifts by cash or check. If you made any gift of $250 or more, see instructions................ 16 2175 17 Other than by cash or check. If any gift of $250 or more, see instructions. You must attach Form 8283 if over $500... 17 18 Carryover from prior year............ 18 19 Add lines 16 through 18..................... 19 Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. See instructions........ 20 Job Expenses and Certain Miscellaneous Deductions Other Miscellaneous Deductions Total Itemized Deductions 21 Unreimbursed employee expenses job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. See instructions. 21 22 Tax preparation fees............. 22 23 Other expenses investment, safe deposit box, etc. List type and amount 23 24 Add lines 21 through 23............ 24 25 Enter amount from Form 1040, line 38 25 26 Multiply line 25 by 2% (0.02).......... 26 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0-...... 27 28 Other from list in instructions. List type and amount GAMBLING LOSSES TO AMOUNT WON 400 28 29 Is Form 1040, line 38, over $156,900? X No. Your deduction is not limited. Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, line 40. Yes. Your deduction may be limited. See the Itemized Deductions Worksheet in the instructions to figure the amount to enter. }.. OMB No. 1545-0074 2017 Attachment Sequence No. 07 Your social security number 047-00-4500 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 1040. Schedule A (Form 1040) 2017 QNA 29 6819 1335 2175 400 10729

SCHEDULE B (Form 1040A or 1040) (Rev. October 2017) Department of the Treasury Internal Revenue Service (99) Name(s) shown on return Interest and Ordinary Dividends Attach to Form 1040A or 1040. Go to www.irs.gov/scheduleb for instructions and the latest information. OMB No. 1545-0074 2017 Attachment Sequence No. 08 Your social security number MARIE EXTENDED QUINCY & THOMAS MORRISON 047-00-4500 Part I Amount Interest (See instructions and the instructions for Form 1040A, or Form 1040, line 8a.) Note: If you received a Form 1099-INT, Form 1099-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. Part II Ordinary Dividends 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see the instructions and list this interest first. Also, show that buyer s social security number and address ARCHES STARLING BANK 100 2 Add the amounts on line 1................... 2 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815...................... 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a...................... 4 Note: If line 4 is over $1,500, you must complete Part III. 5 List name of payer 1 Amount 100 100 (See instructions and the instructions for Form 1040A, or Form 1040, line 9a.) 5 Note: If you received a Form 1099-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. Part III Foreign Accounts and Trusts (See instructions.) 6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a...................... 6 Note: If line 6 is over $1,500, you must complete Part III. You must complete this part if you (a) had over $1,500 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. 7 a At any time during 2017, 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 114, Report of Foreign Bank and Financial Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those requirements...... b If you are required to file FinCEN Form 114, enter the name of the foreign country where the financial account is located 8 During 2017, 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 3520. See instructions......... Yes No For Paperwork Reduction Act Notice, see your tax return instructions. Schedule B (Form 1040A or 1040) 2017 QNA X X

SCHEDULE EIC (Form 1040A or 1040) Department of the Treasury Internal Revenue Service (99) Name(s) shown on return Before you begin: Earned Income Credit Qualifying Child Information Complete and attach to Form 1040A or 1040 only if you have a qualifying child. Go to www.irs.gov/scheduleeic for the latest information. 1040A.......... 1040 OMB No. 1545-0074 2017 Attachment Sequence No. 43 Your social security number MARIE EXTENDED QUINCY & THOMAS MORRISON 047-00-4500 See the instructions for Form 1040A, lines 42a and 42b, or Form 1040, lines 66a and 66b, to make sure that (a) you can take the EIC, and (b) you have a qualifying child. Be sure the child s name on line 1 and social security number (SSN) on line 2 agree with the child s social security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child s social security card is not correct, call the Social Security Administration at 1-800-772-1213. EIC! CAUTION You can't claim the EIC for a child who didn't live with you for more than half of the year. If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details. It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child. Qualifying Child Information 1 Child s name If you have more than three qualifying children, you have to list only three to get the maximum credit. 2 Child s SSN The child must have an SSN as defined in the instructions for Form 1040A, lines 42a and 42b, or Form 1040, lines 66a and 66b, unless the child was born and died in 2017. If your child was born and died in 2017 and did not have an SSN, enter Died on this line and attach a copy of the child s birth certificate, death certificate, or hospital medical records showing a live birth. 3 Child s year of birth 4 a Was the child under age 24 at the end of 2017, a student, and younger than you (or your spouse, if filing jointly)? Child 1 Child 2 Child 3 First name Last name First name Last name First name Last name DANNY MORRISON Year If born after 1998 and the child is younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5. Go to line 5. 049-00-4907 Yes. 2 0 0 0 No. Go to line 4b. BART MORRISON Year If born after 1998 and the child is younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5. X Go to line 5. 060-00-4906 1 9 9 6 Yes. No. Go to line 4b. Year If born after 1998 and the child is younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5. Go to line 5. Yes. No. Go to line 4b. b Was the child permanently and totally disabled during any part of 2017? Yes. No. Yes. No. Yes. No. Go to line 5. The child is not a qualifying child. Go to line 5. The child is not a qualifying child. Go to line 5. The child is not a qualifying child. 5 Child s relationship to you (for example, son, daughter, grandchild, niece, nephew, eligible foster child, etc.) 6 Number of months child lived with you in the United States during 2017 SON SON If the child lived with you for more than half of 2017 but less than 7 months, enter 7. If the child was born or died in 2017 and 12 months your home was the child s home for more than half the time he or she was alive Do not enter more than 12 during 2017, enter 12. months. For Paperwork Reduction Act Notice, see your tax return instructions. QNA 12 months Do not enter more than 12 months. months Do not enter more than 12 months. Schedule EIC (Form 1040A or 1040) 2017

Form 8863 Department of the Treasury Internal Revenue Service (99) Name(s) shown on return! CAUTION Education Credits (American Opportunity and Lifetime Learning Credits) Attach to Form 1040 or Form 1040A. Go to www.irs.gov/form8863 for instructions and the latest information. OMB No. 1545-0074 2017 Attachment Sequence No. 50 Your social security number MARIE EXTENDED QUINCY & THOMAS MORRISON 047-00-4500 Complete a separate Part III on page 2 for each student for whom you're claiming either credit before you complete Parts I and II. Part I Refundable American Opportunity Credit 1 After completing Part III for each student, enter the total of all amounts from all Parts III, line 30. 1 2 Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er)............. 2 180000 3 Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you're filing Form 2555, 2555-EZ, or 4563, or you're excluding income from Puerto Rico, see Pub. 970 for the amount to enter...... 3 4 Subtract line 3 from line 2. If zero or less, stop; you can't take any education credit................... 4 5 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er)................. 5 6 If line 4 is: Equal to or more than line 5, enter 1.000 on line 6............ Less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to at least three places)..................... 50112 129888 20000 }.... 6. 1 000 2500 7 Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet the conditions described in the instructions, you can't take the refundable American opportunity credit; skip line 8, enter the amount from line 7 on line 9, and check this box.... 7 8 Refundable American opportunity credit. Multiply line 7 by 40% (0.40). Enter the amount here and on Form 1040, line 68, or Form 1040A, line 44. Then go to line 9 below.......... 8 Part II Nonrefundable Education Credits 9 Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions) 9 2500 1000 1500 10 After completing Part III for each student, enter the total of all amounts from all Parts III, line 31. If zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19.......... 10 11 Enter the smaller of line 10 or $10,000.................... 11 12 Multiply line 11 by 20% (0.20)....................... 12 13 Enter: $132,000 if married filing jointly; $66,000 if single, head of household, or qualifying widow(er)............. 13 14 Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you're filing Form 2555, 2555-EZ, or 4563, or you're excluding income from Puerto Rico, see Pub. 970 for the amount to enter........ 14 15 Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0- on line 18, and go to line 19............... 15 16 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er)................. 16 17 If line 15 is: Equal to or more than line 16, enter 1.000 on line 17 and go to line 18 Less than line 16, divide line 15 by line 16. Enter the result as a decimal (rounded to at least three places).............................. 17. 18 Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) 18 19 Nonrefundable education credits. Enter the amount from line 7 of the Credit Limit Worksheet (see instructions) here and on Form 1040, line 50, or Form 1040A, line 33.......... 19 For Paperwork Reduction Act Notice, see your tax return instructions. 1500 Form 8863 (2017) QNA

Form 8863 (2017) Page 2 Name(s) shown on return Your social security number MARIE EXTENDED QUINCY & THOMAS MORRISON 047-00-4500! CAUTION Complete Part III for each student for whom you're claiming either the American opportunity credit or lifetime learning credit. Use additional copies of page 2 as needed for each student. Part III Student and Educational Institution Information. See instructions. 20 Student name (as shown on page 1 of your tax return) 21 Student social security number (as shown on page 1 of your tax return) DANNY 049-00-4907 22 Educational institution information (see instructions) a. Name of first educational institution b. Name of second educational institution (if any) LANE COMMUNITY COLLEGE (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. (2) Did the student receive Form 1098-T from this institution for 2017? (3) Did the student receive Form 1098-T from this institution for 2016 with box 2 filled in and box 7 checked? Yes Yes If you checked No in both (2) and (3), skip (4). However, you must complete (4) if you're claiming the American opportunity credit. (4) If you checked Yes in (2) or (3), enter the institution's employer identification number (from Form 1098-T). 23 Has the Hope Scholarship Credit or American opportunity credit been claimed for this student for any 4 tax years before 2017? 24 Was the student enrolled at least half-time for at least one academic period that began or is treated as having begun in 2017 at an eligible educational institution in a program leading towards a postsecondary degree, certificate, or other recognized postsecondary educational credential? See instructions. 25 Did the student complete the first 4 years of postsecondary education before 2017? See instructions. 26 Was the student convicted, before the end of 2017, of a felony for possession or distribution of a controlled substance?! CAUTION 4000 EAST 30TH AVE EUGENE OR 97405 35-1111111 X X No No (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. (2) Did the student receive Form 1098-T from this institution for 2017? (3) Did the student receive Form 1098-T from this institution for 2016 with box 2 filled in and box 7 checked? Yes Yes If you checked No in both (2) and (3), skip (4). However, you must complete (4) if you're claiming the American opportunity credit. (4) If you checked Yes in (2) or (3), enter the institution's employer identification number (from Form 1098-T). Yes Stop! Go to line 31 for this student. X No Go to line 24. Yes Go to line 25. No Stop! Go to line 31 for this student. Yes Stop! Go to line 31 for this student. Yes Stop! Go to line 31 for this student. No Go to line 26. No No No Complete lines 27 through 30 for this student. You can't take the American opportunity credit and the lifetime learning credit for the same student in the same year. If you complete lines 27 through 30 for this student, don't complete line 31. American Opportunity Credit 27 Adjusted qualified education expenses (see instructions). Don't enter more than $4,000..... 27 28 Subtract $2,000 from line 27. If zero or less, enter -0-................. 28 29 Multiply line 28 by 25% (0.25)........................ 29 30 If line 28 is zero, enter the amount from line 27. Otherwise, add $2,000 to the amount on line 29 and enter the result. Skip line 31. Include the total of all amounts from all Parts III, line 30, on Part I, line 1. 30 Lifetime Learning Credit 31 Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts III, line 31, on Part II, line 10......................... 31 QNA X X X 4000 2000 500 2500 Form 8863 (2017)

Supporting Statements for SCHEDULE A Client : QUINCY 047-00-4500 Medical and Dental Expenses Description of Expense Amount Medical and Dental Insurance 4039 Amount Paid to Doctors, Dentists, Eye Doctors, etc. 7650 Prescription Medicine, Drugs, or Insulin 115 Mileage (150 miles x 0.170) 26 TOTALS: 11830

MARIE EXTENDED QUINCY & THOMAS MORRISON 047-00-4500 Worksheet 2. Applying the Deduction Limits Keep for your records If the result on any line is less than zero, enter zero. For other instructions, see Instructions for Worksheet 2. Step 1. Enter any qualified conservation contributions (QCCs). 1. If you are a qualified farmer or rancher, enter any QCCs eligible for the 100% limit 2. Enter any QCCs not entered on line 1. Don't include this amount on line 3, 4, 5, 6, or 8 Step 2. List your other charitable contributions made during the year. 3. Enter your contributions to 50% limit organizations. (Include contributions of capital gain property if you reduced the property s fair market value. Don t include contributions of capital gain property deducted at fair market value.) Don t include any contributions you entered on line 1 or 2 4. 5. Enter your contributions to 50% limit organizations of capital gain property deducted at fair market value Enter your contributions (other than of capital gain property) to qualified organizations that aren t 50% limit organizations 6. Enter your contributions for the use of any qualified organization. (But don t enter here any amount that must be entered on line 8.) 7. Add lines 5 and 6 8. Enter your contributions of capital gain property to or for the use of any qualified organization. (But don t enter here any amount entered on line 3 or 4.) Step 3. Figure your deduction for the year and your carryover to the next year. 9. Enter your adjusted gross income 10. Multiply line 9 by 0.5. This is your 50% limit 1 2 3 4 5 6 7 8 9 10 2175 50112 25056 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. Contributions to 50% limit organizations Enter the smaller of line 3 or line 10 Subtract line 11 from line 3 Subtract line 11 from line 10 Contributions not to 50% limit organizations Add lines 3 and 4 Multiply line 9 by 0.3. This is your 30% limit Subtract line 14 from line 10 Enter the smallest of line 7, 15, or 16 Subtract line 17 from line 7 Subtract line 17 from line 15 Contributions of capital gain property to 50% limit organizations Enter the smallest of line 4, 13, or 15 Subtract line 20 from line 4 Subtract line 17 from line 16 Subtract line 20 from line 15 Other contributions Multiply line 9 by 0.2. This is your 20% limit Enter the smallest of line 8, 19, 22, 23, or 24 Subtract line 25 from line 8 Add lines 11, 17, 20, and 25 Subtract line 27 from line 10 Enter the smaller of line 2 or line 28 Subtract line 29 from line 2 Subtract line 27 from line 9 32. Enter the smaller of line 1 or line 31 32 33. Add lines 27, 29, and 32. Enter the total here and on Schedule A (Form 1040), line 16 or line 17, whichever is appropriate 33 34. Subtract line 32 from line 1 35. Add lines 12, 18, 21, 26, 30, and 34. Carry this amount forward to Schedule A (Form 1040) next year 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 22881 2175 15034 22881 15034 22881 15034 10022 2175 22881 47937 34 35 2175 2175 Carryover QNA

QUINCY 047-00-4500 Credit Limit Worksheet Complete the credit limit worksheet to figure the amount to enter on line 19. 1. 2. 3. Enter the amount from Form 8863, line 18... Enter the amount from Form 8863, Line 9... Add lines 1 and 2... 1. 2. 3. 1500 1500 4. Enter the amount from: Form 1040, line 47; or Form 1040A, line 30... 4. 2064 5. 6. 7. Enter the total of your credits from either: Form 1040, lines 48 and 49, and Schedule R, line 22; or Form 1040A, lines 31 and 32... Subtract line 5 from line 4... Enter the smaller of line 3 or line 6 here and on Form 8863, line 19.... 5. 6. 7. 60 2004 1500 QNA

MARIE EXTENDED QUINCY & THOMAS MORRISON 047-00-4500 Before you begin: If you are the beneficiary of a deceased employee or former employee who died before August 21, 1996, include any death benefit exclusion that you are entitled to (up to $5,000) in the amount entered on line 2 below. More than one pension or annuity. If you had more than one partially taxable pension or annuity, figure the taxable part of each separately. Enter the total of the taxable parts on Form 1040, line 16b. Enter the total pension or annuity payments received in 2017 on Form 1040, line 16a. 1. Enter the total pension or annuity payments from Form 1099-R, box 1. Also, enter this amount on Form 1040, line 16a................................... 1. 17585 2. Enter your cost in the plan at the annuity starting date............. 2. 34250 Note. If you completed this worksheet last year, skip line 3 and enter the amount from line 4 10/01/1986 of last year s worksheet on line 4 below (even if the amount of your pension or annuity has changed). Otherwise, go to line 3. 3. Enter the appropriate number from Table 1 below. But if your annuity starting date was after 1997 and the payments are for your life and that of your beneficiary, enter the appropriate number from Table 2 below..................... 3. 300 4. Divide line 2 by the number on line 3.................. 4. 114.17 5. Multiply line 4 by the number of months for which this year s payments were made. If your annuity starting date was before 1987, skip lines 6 and 7 and enter this amount on line 8. Otherwise, go to line 6....................... 5. 1370 6. Enter the amount, if any, recovered tax free in years after 1986. If you completed this worksheet last year, enter the amount from line 10 of last year s worksheet...... 6. 7. Subtract line 6 from line 2...................... 7. 34250 8. Enter the smaller of line 5 or line 7........................... 8. 1370 9. Taxable amount. Subtract line 8 from line 1. Enter the result, but not less than zero. Also, enter this amount on Form 1040, line 16b. If your Form 1099-R shows a larger amount, use the amount on this line instead of the amount from Form 1099-R. If you are a retired public safety officer, see Insurance Premiums for Retired Public Safety Officers before entering an amount on line 16b.......................... 9. 16215 10. Was your annuity starting date before 1987? x Yes. STOP Do not complete the rest of this worksheet. 11. No. Add lines 6 and 8. This is the amount you have recovered tax free through 2017. You will need this number if you need to fill out this worksheet next year................. 10. Balance of cost to be recovered. Subtract line 10 from line 2. If zero, you won t have to complete this worksheet next year. The payments you receive next year will generally be fully taxable........ 11. IF the age at annuity starting date was... 55 or under 56 60 61 65 66 70 71 or older Table 1 for Line 3 Above AND your annuity starting date was before November 19, 1996, after November 18, 1996, enter on line 3... enter on line 3... 300 360 260 310 240 260 170 210 120 160 Table 2 for Line 3 Above IF the combined ages at annuity starting date were... THEN enter on line 3... 110 or under 410 111 120 360 121 130 310 131 140 260 141 or older 210 QNA

MARIE EXTENDED QUINCY & THOMAS MORRISON 047-00-4500 12477 STOP X 47595 6239 41056 300 47595 STOP 32000 X 15595 QNA TIP 12000 3595 12000 6000 6000 3056 9056 10605 9056

MARIE EXTENDED QUINCY & THOMAS MORRISON 047-00-4500 Worksheet A 2017 EIC Lines 66a and 66b Keep for Your Records Before you begin: Be sure you are using the correct worksheet. Use this worksheet only if you answered No to Step 5, question 2. Otherwise, use Worksheet B. Part 1 1. Enter your earned income from Step 5. 1 12241 All Filers Using Worksheet A 2. Look up the amount on line 1 above in the EIC Table (right after Worksheet B) to find the credit. Be sure you use the correct column for your filing status and the number of children you have. Enter the credit here. STOP If line 2 is zero, You can t take the credit. Enter No on the dotted line next to line 66a. 2 4890 3. Enter the amount from Form 1040, line 38. 3 50112 4. Are the amounts on lines 3 and 1 the same? x Yes. Skip line 5; enter the amount from line 2 on line 6. No. Go to line 5. Part 2 Filers Who Answered No on Line 4 5. If you have: No qualifying children, is the amount on line 3 less than $8,350 ($13,950 if married filing jointly)? 1 or more qualifying children, is the amount on line 3 less than $18,350 ($23,950 if married filing jointly)? x Yes. Leave line 5 blank; enter the amount from line 2 on line 6. No. Look up the amount on line 3 in the EIC Table to find the credit. Be sure you use the correct column for your filing status and the number of children you have. Enter the credit here. Look at the amounts on lines 5 and 2. Then, enter the smaller amount on line 6. 5 99 Part 3 Your Earned Income Credit 6. This is your earned income credit. Reminder If you have a qualifying child, complete and attach Schedule EIC. 1040 EIC 6 Enter this amount on Form 1040, line 66a. 1040 99 CAUTION If your EIC for a year after 1996 was reduced or disallowed, see Form 8862, who must file, earlier, to find out if you must file Form 8862 to take the credit for 2017.

MARIE EXTENDED QUINCY & THOMAS MORRISON Worksheet B 2017 EIC Lines 66a and 66b Keep for Your Records Use this worksheet if you answered Yes to Step 5, question 2. Complete the parts below (Parts 1 through 3) that apply to you. Then, continue to Part 4. If you are married filing a joint return, include your spouse s amounts, if any, with yours to figure the amounts to enter in Parts 1 through 3. Part 1 Self-Employed, Members of the Clergy, and People With Church Employee Income Filing Schedule SE 1a. b. e. Enter the amount from Schedule SE, Section A, line 3, or Section B, line 3, whichever applies. Enter any amount from Schedule SE, Section B, line 4b, and line 5a. c. Combine lines 1a and 1b. d. Enter the amount from Schedule SE, Section A, line 6, or Section B, line 13, whichever applies. Subtract line 1d from 1c. + = = 1a 1b 1c 1d 1e Part 2 Self-Employed NOT Required To File Schedule SE For example, your net earnings from self-employment were less than $400. 2. a. b. Don t include on these lines any statutory employee income, any net profit from services performed as a notary public, any amount exempt from self-employment tax as the result of the filing and approval of Form 4029 or Form 4361, or any other amounts exempt from self-employment tax. Enter any net farm profit or (loss) from Schedule F, line 34, and from farm partnerships, Schedule K-1 (Form 1065), box 14, code A*. Enter any net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1*. c. Combine lines 2a and 2b. = 2c *If you have any Schedule K-1 amounts, complete the appropriate line(s) of Schedule SE, Section A. Reduce the Schedule K-1 amounts as described in the Partner s Instructions for Schedule K-1. Enter your name and social security number on Schedule SE and attach it to your return. + 2a 2b Part 3 Statutory Employees Filing Schedule C or C-EZ 3. Enter the amount from Schedule C, line 1, or Schedule C-EZ, line 1, that you are filing as a statutory employee. 3 Part 4 All Filers Using Worksheet B Note. If line 4b includes income on which you should have paid selfemployment tax but didn t, we may reduce your credit by the amount of self-employment tax not paid. 4a. Enter your earned income from Step 5. b. Combine lines 1e, 2c, 3, and 4a. This is your total earned income. If line 4b is zero or less, You can t take the credit. Enter No on the dotted line next to line 66a. 5. If you have: 3 or more qualifying children, is line 4b less than $48,340 ($53,930 if married filing jointly)? 2 qualifying children, is line 4b less than $45,007 ($50,597 if married filing jointly)? 1 qualifying child, is line 4b less than $39,617 ($45,207 if married filing jointly)? No qualifying children, is line 4b less than $15,010 ($20,600 if married filing jointly)? x Yes. If you want the IRS to figure your credit, see Credit figured by the IRS, earlier. If you want to figure the credit yourself, enter the amount from line 4b on line 6 of this worksheet. STOP STOP No. You can t take the credit. Enter No on the dotted line next to line 66a. 4a 4b 12241 12241

Worksheet B 2017 EIC Lines 66a and 66b Continued Keep for Your Records Part 5 All Filers Using Worksheet B 6. 7. Enter your total earned income from Part 4, line 4b. Look up the amount on line 6 above in the EIC Table to find the credit. Be sure you use the correct column for your filing status and the number of children you have. Enter the credit here. 6 12241 7 4890 STOP If line 7 is zero, You can t take the credit. Enter No on the dotted line next to line 66a. 8. Enter the amount from Form 1040, line 38. 8 50112 9. Are the amounts on lines 8 and 6 the same? x Yes. No. Skip line 10; enter the amount from line 7 on line 11. Go to line 10. Part 6 Filers Who Answered No on Line 9 10. If you have: No qualifying children, is the amount on line 8 less than $8,350 ($13,950 if married filing jointly)? 1 or more qualifying children, is the amount on line 8 less than $18,350 ($23,950 if married filing jointly)? x Yes. Leave line 10 blank; enter the amount from line 7 on line 11. No. Look up the amount on line 8 in the EIC Table to find the credit. Be sure you use the correct column for your filing status and the number of children you have. Enter the credit here. Look at the amounts on lines 10 and 7. Then, enter the smaller amount on line 11. 10 99 Part 7 11. This is your earned income credit. 11 99 Your Earned Income Credit Reminder If you have a qualifying child, complete and attach Schedule EIC. 1040 EIC Enter this amount on Form 1040, line 66a. 1040 CAUTION If your EIC for a year after 1996 was reduced or disallowed, see Form 8862, who must file, earlier, to find out if you must file Form 8862 to take the credit for 2017.

2017 Form OR-40 Page 1 of 4, 150-101-040 (Rev. 12-17) Oregon Department of Revenue Office use only Oregon Individual Income Tax Return for Full-year Residents Fiscal year ending: Submit original form do not submit photocopy Space for 2-D barcode do not write in box below Amended return. If amending for an NOL, tax year the NOL was generated: Calculated using as if federal return. Short year tax election. Extension filed. Form OR-24. First name and initial Spouse s first name and initial Current mailing address Filing status (check only one box) 1. Single. Last name Spouse s last name Deceased Deceased City State ZIP code Country Social Security no. (SSN) MARIE EXTENDED QUINCY 047-00-4500 Spouse s SSN THOMAS MORRISON 048-00-4907 3300 BOWIE DR Date of birth (mm/dd/yyyy) 01/21/1950 First time using this SSN (see instructions) First time using this SSN (see instructions) Spouse s date of birth 03/15/1955 Phone Exemptions 6a. Credits for yourself: Regular Severely disabled... 6a. Applied for ITIN Applied for ITIN EUGENE OR 97401 (541) 954-6666 Total X 1 X 2. Married filing jointly. 3. Married filing separately (enter spouse s information above). Check box if someone else can claim you as a dependent. X 1 6b. Credits for spouse: Regular Severely disabled...6b. 4. Head of household (with qualifying dependent). Check box if someone else can claim your spouse as a dependent. 5. Qualifying widow(er) with dependent child. Dependents. List your dependents in order from youngest to oldest. If more than four, check this box with your return. First name Last name Code* Dependent s SSN and include Schedule OR-ADD-DEP Dependent s date Check if child with of birth (mm/dd/yyyy) qualifying disability DANNY MORRISON SD 049-00-4907 11/03/2000 X BART MORRISON SD 060-00-4906 05/28/1996 *Dependent relationship code Please see instructions to determine the appropriate code. 6c. Total number of dependents... 6c. 6d. Total number of dependent children with a qualifying disability (see instructions)... 6d. 6e. Total exemptions. Add 6a through 6d...Total 6e. 1038 2 1 5

2017 Form OR-40 Page 2 of 4, 150-101-040 (Rev. 12-17) Oregon Department of Revenue Name MARIE EXTENDED A QUINCY 047-00-4500 Note: Remember to reprint page 1 if any changes are made on this page. SSN Taxable income 7. Federal adjusted gross income. Federal Form 1040, line 37; 1040A, line 21; 1040EZ, line 4; 1040NR, line 36; 1040NR-EZ, line 10; or 1040X, line 1C. See instructions... 7. 8. Total additions from Schedule OR-ASC, section 1... 8. 9. Income after additions. Add lines 7 and 8... 9. Subtractions 10. 2017 federal tax liability. See instructions for the correct amount: $0-$6,550... 10. 11. Social Security included on federal Form 1040, line 20b; or Form 1040A, line 14b... 11. 12. Oregon income tax refund included in federal income... 12. 13. Total subtractions from Schedule OR-ASC, section 2... 13. 14. Total subtractions. Add lines 10 through 13... 14. 15. Income after subtractions. Line 9 minus line 14... 15. Deductions 16. Itemized deductions from federal Schedule A, line 29. If you are not itemizing your deductions, skip lines 16 through 18... 16. 17. State income tax claimed as an itemized deduction... 17. 18. Net Oregon itemized deductions. Line 16 minus line 17... 18. 19. Standard deduction. See instructions... 19. 50,112.00 700.00 50,812.00 9,056.00 20,250.00 29,306.00 21,506.00 10,729.00 1,335.00 9,394.00 X You were: 19a. 65 or older 19b. Blind Your spouse was: 19c. 65 or older 19d. Blind 20. Enter the larger of line 18 or line 19. If you skipped line 18, enter the amount from line 19... 20. 21. Oregon taxable income. Line 15 minus line 20. If line 20 is more than line 15, enter -0-... 21. Oregon tax 22. Tax. See instructions. Enter tax on line 22. Check box if tax is calculated using an alternative method... 22. 9,394.00 12,112.00 715.00 22a. Form OR-FIA-40 22b. Worksheet OR-FCG 22c. Schedule OR-PTE-FY 23. Interest on certain installment sales... 23. 24. Total tax before credits. Add lines 22 and 23... 24. Standard and carryforward credits 25. Exemption credit. If the amount on line 7 is less than $100,000, multiply your total exemptions on line 6e by $197. Otherwise, see instructions... 25. 26. Political contribution credit. See limits... 26. 27. Total standard credits from Schedule OR-ASC, section 3... 27. 28. Total standard credits. Add lines 25 through 27... 28. 29. Tax minus standard credits. Line 24 minus line 28. If line 28 is more than line 24, enter -0-... 29. 30. Total carryforward credits claimed this year from Schedule OR-ASC, section 4. Line 30 can t be more than line 29 (see Schedule OR-ASC instructions)... 30. 31. Tax after standard and carryforward credits. Line 29 minus line 30... 31. 715.00 985.00 100.00 1,000.00 2,085.00

2017 Form OR-40 Page 3 of 4, 150-101-040 (Rev. 12-17) Oregon Department of Revenue Name MARIE EXTENDED A QUINCY 047-00-4500 Note: Remember to reprint page 1 if any changes are made on this page. SSN Payments and refundable credits 32. Oregon income tax withheld. Include a copy of Form(s) W-2 and 1099... 32. 33. Amount applied from your prior year s tax refund... 33. 34. Estimated tax payments for 2017. Include all payments made prior to the filing date of this return. Do not include the amount already reported on line 33... 34. 35. Earned income credit. See instructions... 35. 36. Oregon surplus credit (kicker). Enter your kicker amount. See instructions. If you elect to donate your kicker to the State School Fund, enter -0- and see line 53... 36. 37. Total refundable credits from Schedule OR-ASC, section 5... 37. 38. Total payments and refundable credits. Add lines 32 through 37... 38. Tax to pay or refund 39. Overpayment of tax. If line 31 is less than line 38, you overpaid. Line 38 minus line 31... 39. 40. Net tax. If line 31 is more than line 38, you have tax to pay. Line 31 minus line 38... 40. 41. Penalty and interest for filing or paying late. See instructions... 41. 42. Interest on underpayment of estimated tax. Include Form OR-10... 42. 935.00 400.00 8.00 21.00 1,364.00 1,364.00 Exception number from Form OR-10, line 1: 42a. Check box if you annualized: 42b. 43. Total penalty and interest due. Add lines 41 and 42... 43. 44. Net tax including penalty and interest. Line 40 plus line 43... This is the amount you owe 44. 45. Overpayment less penalty and interest. Line 39 minus line 43... This is your refund 45. 46. Estimated tax. Fill in the part of line 45 you want applied to your estimated tax account.... 46. 47. Charitable checkoff donations from Schedule OR-DONATE, line 30... 47. 1,364.00 48. Political party $3 checkoff. Party code: 48a. You. 48b. Spouse... 48. 49. Total Oregon 529 College Savings Plan deposits from Schedule OR-529. See instructions... 49. 50. Total. Add lines 46 through 49; total can t be more than your refund on line 45... 50. 51. Line 45 minus line 50. This is your net refund...net refund 51. 1,364.00 Direct deposit 52. For direct deposit of your refund, see instructions. Check the box if this refund will go to an account outside the United States: Type of account: Checking or Savings Routing number: Account number: Surplus credit donation 53. Oregon surplus credit (kicker) donation. If you elect to donate your kicker to the State School Fund, check the box: 53a. Write the amount from line 7 of the surplus credit worksheet here. This election is irrevocable...53b.

2017 Form OR-40 Page 4 of 4, 150-101-040 (Rev. 12-17) Oregon Department of Revenue Name MARIE EXTENDED A QUINCY 047-00-4500 Note: Remember to reprint page 1 if any changes are made on this page. Sign here. Under penalty of false swearing, I declare that the information in this return is true, correct, and complete. Your signature Date X 12/24/2017 Spouse s signature (if filing jointly, both must sign) X Signature of preparer other than taxpayer Preparer address City State ZIP code Date Preparer phone X (202) 202-2022 Important: Include a copy of your federal Form 1040, 1040A, 1040EZ, 1040X, 1040NR, or 1040NR-EZ. Without this information, we may adjust your return. SSN 12/24/2017 Preparer license number, if professionally prepared 15 PRACTICE LAB WAY WASHINGTON DC 20005 Make your payment (if you have an amount due on line 44) Online payments: You may make payments online at www.oregon.gov/dor. Mailing your payment: Make your check or money order payable to the Oregon Department of Revenue. Write 2017 Oregon Form OR-40 and the last four digits of your SSN or ITIN on your check or money order. Include your payment, along with the Form OR-40-V payment voucher, with this return. Send in your return Non-2-D barcode. If the 2-D barcode area on the front of this return is blank: Mail tax-due returns to: Oregon Department of Revenue, PO Box 14555, Salem OR 97309-0940. Mail refund and no-tax-due returns to: Oregon Department of Revenue, PO Box 14700, Salem OR 97309-0930. 2-D barcode. If the 2-D barcode area on the front of this return is filled in: Mail tax-due returns to: Oregon Department of Revenue, PO Box 14720, Salem OR 97309-0463. Mail refund and no-tax-due returns to: Oregon Department of Revenue, PO Box 14710, Salem OR 97309-0460. Amended statement. Only complete this section if submitting an amended return or filing with a new SSN. If filing an amended return, complete this statement with an explanation of what you are amending. Indicate the return line numbers and the reason for each change. If your filing status has changed, explain why. If filing with a new SSN, enter your former identification number.

2017 Schedule OR-ASC Page 1 of 1, 150-101-063 (Rev. 12-17) Oregon Department of Revenue Office use only Oregon Adjustments for Form OR-40 Filers First name and initial Spouse s first name and initial Submit original form do not submit photocopy. Last name Spouse s last name Social Security number (SSN) MARIE EXTEND A QUINCY 047-00-4500 Spouse s SSN THOMAS MORRISON 048-00-4907 Use Schedule OR-ASC to claim any of the following that aren t included on Form OR-40: Additions. Carryforward credits. Subtractions. Refundable credits. Standard credits. Identify the code you re claiming and enter the information requested in the corresponding section. For more information, refer to the instructions beginning on page 2. Section 1: Additions (codes 102 164) Code Amount 1a. 1b. 1c. 1d. 1e. 1f. 1g. 1h. 1i. 1j. 158 300.00 134 400.00 Enter total on Form OR-40, line 8 700.00 Section 2: Subtractions (codes 300 360) Code Amount 2a. 2b. 2c. 2d. 2e. 2f. 2g. 2h. 2i. 2j. 307 16,215.00 315 75.00 351 1,400.00 311 60.00 322 500.00 20,250.00 Enter total on Form OR-40, line 13 Section 3: Standard credits (codes 802 815) Code Amount 3a. 3b. 3d. 3e. 3g. 3h. 3j. 3k. 3m. 3n. 807 1,000.00 Enter total on Form OR-40, line 27 1,000.00 State abbreviation (if claiming code 802 or 815) 3c. 3f. 3i. 3l. 3o. Section 4: Carryforward credits (codes 835 868) Code Amount from prior year Amount awarded this year Total used this year 4a. 4e. 4i. 4m. 4q. 4b. 4f. 4j. 4n. 4r. 4c. 4g. 4k. 4o. 4s. 4d. 4h. 4l. 4p. 4t. Enter total on Form OR-40, line 30 Section 5: Refundable credits (codes 890 895) Code Amount 5a. 5c. 5e. 5b. 5d. 5f. Enter total on Form OR-40, line 37 You must include this schedule with your Oregon income tax return

2017 Schedule OR-ASC Page 1 of 1, 150-101-063 (Rev. 12-17) Oregon Department of Revenue Office use only Oregon Adjustments for Form OR-40 Filers First name and initial Spouse s first name and initial Submit original form do not submit photocopy. Last name Spouse s last name Social Security number (SSN) MARIE EXTEND A QUINCY 047-00-4500 Spouse s SSN THOMAS MORRISON 048-00-4907 Use Schedule OR-ASC to claim any of the following that aren t included on Form OR-40: Additions. Carryforward credits. Subtractions. Refundable credits. Standard credits. Identify the code you re claiming and enter the information requested in the corresponding section. For more information, refer to the instructions beginning on page 2. Section 1: Additions (codes 102 164) Code Amount 1a. 1b. 1c. 1d. 1e. 1f. 1g. 1h. 1i. 1j. Enter total on Form OR-40, line 8 Section 2: Subtractions (codes 300 360) Code Amount 2a. 2b. 2c. 2d. 2e. 2f. 2g. 2h. 2i. 2j. 324 2,000.00 Enter total on Form OR-40, line 13 Section 3: Standard credits (codes 802 815) Code Amount 3a. 3b. 3d. 3e. 3g. 3h. 3j. 3k. 3m. 3n. Enter total on Form OR-40, line 27 State abbreviation (if claiming code 802 or 815) 3c. 3f. 3i. 3l. 3o. Section 4: Carryforward credits (codes 835 868) Code Amount from prior year Amount awarded this year Total used this year 4a. 4e. 4i. 4m. 4q. 4b. 4f. 4j. 4n. 4r. 4c. 4g. 4k. 4o. 4s. 4d. 4h. 4l. 4p. 4t. Enter total on Form OR-40, line 30 Section 5: Refundable credits (codes 890 895) Code Amount 5a. 5c. 5e. 5b. 5d. 5f. Enter total on Form OR-40, line 37 You must include this schedule with your Oregon income tax return