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Department of the Treasury ' Internal Revenue Service (99) Form 1040 U.S. Individual Income Tax Return 2017 OMB. 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 Homer J. Sampson 999-99-9999 If a joint return, spouse's first name and initial Last name Spouse's social security number Marge A. Sampson 888-88-8888 Home address (number and street). If you have a P.O. box, see instructions. 1234 Springfield Ave City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Buckeye, AZ 85999 Apt. no. Foreign country name Foreign province/state/county 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 $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 Filing Status instructions.) If the qualifying person is a child 2 X Married filing jointly (even if only one had income) but not your dependent, enter this child's 3 Married filing separately. Enter spouse's SSN above & full name here.. G Check only one box. name here.. G 5 Qualifying widow(er) (see instructions) Boxes checked Exemptions 6a X Yourself. If someone can claim you as a dependent, do not check box 6a........... on 6a and 6b... 2 b X Spouse.......................................................................... of children on 6c who: c Dependents: (2) Dependent's (3) Dependent's (4) b if child under? lived social security relationship age 17 with you...... 3 number to you qualifying for child tax credit? did not (1) First name Last name (see instructions) live with you due to divorce Bart A. Sampson 111-11-1111 Son or separation If more than four (see instructions).. dependents, see Lisa J. Sampson 222-22-2222 Daughter Dependents on 6c not instructions and Maggie J. Sampson 333-33-3333 Daughter X entered above.. check here... G Add numbers on lines d Total number of exemptions claimed........................................................ above...... G 5 Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2......................................... 7 80,000. 8a Taxable interest. Attach Schedule B if required........................................ 8a 2,300. b Tax-exempt interest. Do not include on line 8a.............. 8 b 500. 9a Ordinary dividends. Attach Schedule B if required...................................... Attach Form(s) 9a 5,000. W-2 here. Also b Qualified dividends........................................ 9 b 5,000. attach Forms 10 Taxable refunds, credits, or offsets of state and local income taxes..................... 10 W-2G and 1099-R if tax was withheld. 11 Alimony received.................................................................... 11 12 Business income or (loss). Attach Schedule C or C-EZ................................. 12 80,911. If you did not 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here.......... G 13 650. get a W-2, see instructions. 14 Other gains or (losses). Attach Form 4797............................................. 14 5,000. 15a IRA distributions............ 15 a b Taxable amount............. 15b 16a Pensions and annuities..... 16 a b Taxable amount............. 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. 17 2,350. 18 Farm income or (loss). Attach Schedule F............................................. 18 19 Unemployment compensation........................................................ 19 20a Social security benefits.......... 20 a b Taxable amount............. 20b 21 Other income. List type and amountgambling Winnings 21 2,500. 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income............. G 22 178,711. Adjusted 23 Educator expenses....................................... 23 24 Certain business expenses of reservists, performing artists, and fee-basis Gross government officials. Attach Form 2106 or 2106-EZ.................... 24 Income 25 Health savings account deduction. Attach Form 8889........ 25 6,750. 26 Moving expenses. Attach Form 3903....................... 26 27 Deductible part of self-employment tax. Attach Schedule SE.............. 27 5,716. 28 Self-employed SEP, SIMPLE, and qualified plans........... 28 15,039. 29 Self-employed health insurance deduction.................. 29 4,800. 30 Penalty on early withdrawal of savings..................... 30 200. 31a Alimony paid b Recipient's SSN.... G 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 32,505. 37 Subtract line 36 from line 22. This is your adjusted gross income..................... G 37 146,206. BAA For Disclosure, Privacy Act, and Paperwork Reduction Act tice, see separate instructions. FDIA0112L 10/19/17 Form 1040 (2017)

Form 1040 (2017) Homer J. and Marge A. Sampson 999-99-9999 Page 2 38 Amount from line 37 (adjusted gross income).......................................... 38 146,206. Tax and 39 a Check You were born before January 2, 1953, Blind. Total boxes Credits if: Spouse was born before January 2, 1953, Blind. checked G 39a Standard b If your spouse itemizes on a separate return or you were a dual-status alien, check here......... G 39b Deduction 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin).................... 40 for ' 41 Subtract line 40 from line 38.......................................................... 41 40,419. 105,787.? People who 42 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instrs...... 42 20,250. check any box 43 Taxable income. Subtract line 42 from line 41. on line 39a or If line 42 is more than line 41, enter -0-....................................................... 43 85,537. 39b or who can 44 Tax (see instructions). Check if any from: a Form(s) 8814 c be claimed as a dependent, see b Form 4972........................... 44 12,359. instructions. 45 Alternative minimum tax (see instructions). Attach Form 6251.......................... 45 0.? All others: 46 Excess advance premium tax credit repayment. Attach Form 8962...................... 46 Single or 47 Add lines 44, 45, and 46........................................................... G 47 12,359. Married filing 48 Foreign tax credit. Attach Form 1116 if required............. separately, 48 $6,350 49 Credit for child and dependent care expenses. Attach Form 2441.......... 49 Married filing 50 Education credits from Form 8863, line 19.................. 50 3,000. jointly or 51 Retirement savings contributions credit. Attach Form 8880... 51 Qualifying widow(er), 52 Child tax credit. Attach Schedule 8812, if required.......... 52 $12,700 53 Residential energy credit. Attach Form 5695................ 53 Head of 54 Other crs from Form: a 3800 b 8801 c 54 household, $9,350 55 Add lines 48 through 54. These are your total credits.................................. 55 3,000. 56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0-.................. G 56 9,359. Other 57 Self-employment tax. Attach Schedule SE...................................................... 57 11,432. Taxes 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 60a 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 Instrs; enter code(s) 62 63 Add lines 56 through 62. This is your total tax................................................ G 63 20,791. Payments 64 Federal income tax withheld from Forms W-2 and 1099..... 64 15,000. If you have a 65 2017 estimated tax payments and amount applied from 2016 return........ 65 12,000. qualifying 66a Earned income credit (EIC)............................... 66a child, attach b ntaxable combat pay election..... G Schedule EIC. 66b 67 Additional child tax credit. Attach Schedule 8812............ 67 68 American opportunity credit from Form 8863, line 8......... 68 2,000. 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............................. G 74 29,000. Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid............... 75 8,209. 76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here.. G 76a 0. G b Routing number........ G c Type: Checking Savings Direct deposit? G d Account number........ See instructions. 77 Amount of line 75 you want applied to your 2018 estimated tax........ G 77 8,209. Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions............... G 78 You Owe 79 Estimated tax penalty (see instructions).................... 79 Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)?............ Complete below. X Designee Designee's Phone Personal identification G G G 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. Your signature Date Your occupation Daytime phone number Sign Here Joint return? See instructions. Advertising (602) 555-5555 A Keep a copy 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 for your records. Consultant here (see inst.) Paid Preparer Use Only FDIA0112L 10/19/17 Print/Type preparer's name Preparer's signature Date Check if PTIN Firm's name Firm's address G G Self-Prepared self-employed Firm's EIN Phone no. G Form 1040 (2017)

SCHEDULE A (Form 1040) Itemized Deductions G Go to www.irs.gov/schedulea for instructions and the latest information. G Attach to Form 1040. OMB. 1545-0074 2017 Department of the Treasury Attachment Internal Revenue Service (99) Sequence. 07 Name(s) shown on Form 1040 Your social security number Homer J. and Marge A. Sampson 999-99-9999 Medical Caution: Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see instructions).......................... 1 Dental Expenses 2 Enter amount from Form 1040, line 38...... 2 3 Multiply line 2 by 10% (0.10).................................. 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0-........................... 4 Taxes You 5 State and local (check only one box): Paid a X Income taxes, or 5 7,500............................... b General sales taxes 6 Real estate taxes (see instructions)........................... 6 2,700. 7 Personal property taxes...................................... 7 119. 8 Other taxes. List type and amount G 8 9 Add lines 5 through 8.................................................................... 9 Interest 10 Home mortgage interest and points reported to you on Form 1098............ You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person 10 22,000. from whom you bought the home, see instructions and show that person's name, 0. 10,319. te: Your mortgage interest deduction may be limited (see instructions). identifying no., and address G 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 Gifts to 16 Gifts by cash or check. If you made any gift of $250 or Charity more, see instructions.......................................... 16 If you made a 17 Other than by cash or check. If any gift of $250 or gift and got a more, see instructions. You must attach Form 8283 if benefit for it, over $500................................................... 17 see instructions. 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 21 Unreimbursed employee expenses'job travel, union dues, and Certain job education, etc. Attach Form 2106 or 2106-EZ if Miscellaneous Deductions required. See instructions. G 21 Other Miscellaneous Deductions 22 Tax preparation fees........................................ 22 23 Other expenses'investment, safe deposit box, etc. List type and amount G 23 24 Add lines 21 through 23...................................... 24 750. 25 Enter amount from Form 1040, line 38..... 25 146,206. 26 Multiply line 25 by 2% (0.02)................................. 26 2,924. 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 G Gambling Losses to Extent of Winnings 2,500. 28 Total 29 Is Form 1040, line 38, over $156,900? Itemized. Your deduction is not limited. Add the amounts in the far right column Deductions X for lines 4 through 28. Also, enter this amount on Form 1040, line 40.. Your deduction may be limited. See the Itemized Deductions Worksheet in the instructions to figure the amount to enter. 30 If you elect to itemize deductions even though they are less than your standard deduction, check here................................................................... G 11 5,300. 300. 750........................ 29 22,000. 5,600. 0. 0. 2,500. 40,419. BAA For Paperwork Reduction Act tice, see the instructions for Form 1040. FDIA0301L 10/20/17 Schedule A (Form 1040) 2017

SCHEDULE B Interest and Ordinary Dividends (Form 1040A or 1040) 2017 Department of the Treasury G Attach to Form 1040A or 1040. Attachment (99) G Go to www.irs.gov/scheduleb for instructions and the latest information. OMB. 1545-0074 Internal Revenue Service Sequence. 08 Name(s) shown on return Your social security number Homer J. and Marge A. Sampson 999-99-9999 Part I 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used Amount the property as a personal residence, see the instructions and list this interest first. Also, Interest (See instructions and the instructions for Form 1040A, or Form 1040, line 8a.) show that buyer's social security number and address G Buckeye Bank 2,300. te: 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. 1 Part II Ordinary Dividends 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.................. G 4 te: If line 4 is over $1,500, you must complete Part III. 5 2,300. 2,300. Amount List name of payer G Macrohard 5,000. (See instructions and the instructions for Form 1040A, or Form 1040, line 9a.) te: If you received 5 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 6 6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a................... G te: 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. Foreign 7a At any time during 2017, did you have a financial interest in or signature authority over a financial Accounts account (such as a bank account, securities account, or brokerage account) located in a foreign country? and Trusts See instructions........................................................................................ If ',' 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 (See instructions.) 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 G 5,000. 8 During 2017, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If ',' you may have to file Form 3520. See instructions.................................................. X BAA For Paperwork Reduction Act tice, see your tax return instructions. FDIA0401L 10/25/17 Schedule B (Form 1040A or 1040) 2017 X

SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) G Go to www.irs.gov/schedulec for instructions and the latest information. G Attach to Form 1040, 1040NR, or 1041; partnerships generally must file Form 1065. OMB. 1545-0074 2017 Department of the Treasury Attachment Internal Revenue Service (99) Sequence. 09 Name of proprietor Social security number (SSN) Marge A. Sampson 888-88-8888 A Principal business or profession, including product or service (see instructions) B Consultant G541990 C Business name. If no separate business name, leave blank. D Enter code from instructions Employer ID number (EIN), (see instr.) E Business address (including suite or room no.) G F G H I J Part I City, town or post office, state, and ZIP code Accounting method: (1) X Cash (2) Accrual (3) Other (specify) G Did you 'materially participate' in the operation of this business during 2017? If ',' see instructions for limit on losses. If you started or acquired this business during 2017, check here.................................................... Did you make any payments in 2017 that would require you to file Form(s) 1099? (see instructions)..................... If ',' did you or will you file required Forms 1099?................................................................. Income 1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on Form W-2 and the 'Statutory employee' box on that form was checked............................ G 1 130,000. 2 Returns and allowances................................................................................ 2 3 Subtract line 2 from line 1.............................................................................. 3 130,000. 4 Cost of goods sold (from line 42)........................................................................ 4 5 Gross profit. Subtract line 4 from line 3................................................................. 5 130,000. 6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions)...................................................................................... 6 7 Gross income. Add lines 5 and 6...................................................................... G 7 130,000. Part II Expenses. Enter expenses for business use of your home only on line 30. 8 Advertising.................... 8 1,350. 18 Office expense (see instructions)........ 18 650. 9 Car and truck expenses 19 Pension and profit-sharing plans........ 19 (see instructions).............. 9 5,626. 20 Rent or lease (see instructions): 10 Commissions and fees......... 10 a Vehicles, machinery, and equipment..... 20a 2,100. 11 Contract labor (see instructions).............. 11 b Other business property................ 20b 12 Depletion...................... 12 21 Repairs and maintenance............... 21 13 Depreciation and section 22 Supplies (not included in Part III)........ 22 125. 179 expense deduction 23 Taxes and licenses..................... 23 318. (not included in Part III) (see instructions).............. 13 25,000. 24 Travel, meals, and entertainment: 14 Employee benefit programs a Travel................................. 24a 2,500. (other than on line 19)......... 14 b Deductible meals and entertainment 15 Insurance (other than health)... 15 1,500. (see instructions)....................... 24b 2,000. 16 Interest: 25 Utilities................................ 25 a Mortgage (paid to banks, etc.)........ 16 a 26 Wages (less employment credits)........ 26 b Other......................... 16b 27 a Other expenses (from line 48)........... 27a 2,820. 17 Legal and professional services.. 17 1,200. b Reserved for future use................ 27b 28 Total expenses before expenses for business use of home. Add lines 8 through 27a...................... G 28 29 Tentative profit or (loss). Subtract line 28 from line 7..................................................... 29 30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829 unless using the simplified method (see instructions). Simplified method filers only: enter the total square footage of: (a) your home: and (b) the part of your home used for business:. Use the Simplified Method Worksheet in the instructions to figure the amount to enter on line 30.............................. 30 31 32 Net profit or (loss). Subtract line 30 from line 29.? If a profit, enter on both Form 1040, line 12 (or Form 1040NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3.? If a loss, you must go to line 32. If you have a loss, check the box that describes your investment in this activity (see instructions).? If you checked 32a, enter the loss on both Form 1040, line 12, (or Form 1040NR, line 13) and on 32a All investment is Schedule SE, line 2. (If you checked the box on line 1, see the line 31 instructions). Estates and at risk. trusts, enter on Form 1041, line 3. 32b Some investment? If you checked 32b, you must attach Form 6198. Your loss may be limited. is not at risk. BAA For Paperwork Reduction Act tice, see the separate instructions. FDIZ0112L 10/19/17 Schedule C (Form 1040) 2017 31 G X X X 45,189. 84,811. 3,900. 80,911.

Schedule C (Form 1040) 2017 Marge A. Sampson 888-88-8888 Page 2 Part III Cost of Goods Sold (see instructions) 33 34 35 Method(s) used to value closing inventory: a Cost b Lower of cost or market c Other (attach explanation) Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If ',' attach explanation......................................................................................... Inventory at beginning of year. If different from last year's closing inventory, attach explanation..................................................................................... 35 36 Purchases less cost of items withdrawn for personal use................................................. 36 37 Cost of labor. Do not include any amounts paid to yourself................................................ 37 38 Materials and supplies.................................................................................. 38 39 Other costs............................................................................................ 39 40 Add lines 35 through 39................................................................................ 40 41 Inventory at end of year................................................................................ 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4...................... 42 Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) G 44 Of the total number of miles you drove your vehicle during 2017, enter the number of miles you used your vehicle for: a Business b Commuting (see instructions) c Other 45 Was your vehicle available for personal use during off-duty hours?................................................... 46 Do you (or your spouse) have another vehicle available for personal use?............................................ 47a Do you have evidence to support your deduction?................................................................... b If ',' is the evidence written?................................................................................... Part V Other Expenses. List below business expenses not included on lines 8-26 or line 30. Bank Charges 120. Dues and Subscriptions 800. Parking and Tolls 200. Postage 325. Printing 175. Telephone 1,200. 48 Total other expenses. Enter here and on line 27a........................................................ 48 2,820. Schedule C (Form 1040) 2017 FDIZ0112L 10/19/17

SCHEDULE D (Form 1040) Department of the Treasury (99) OMB. 1545-0074 Capital Gains and Losses G Attach to Form 1040 or Form 1040NR. 2017 G Go to www.irs.gov/scheduled for instructions and the latest information. Attachment Sequence. Internal Revenue Service G Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10. 12 Name(s) shown on return Part I Short-Term Capital Gains and Losses ' Assets Held One Year or Less Your social security number Homer J. and Marge A. Sampson 999-99-9999 See instructions for how to figure the amounts to (g) (h) Gain or (loss) enter on the lines below. (d) (e) Adjustments Subtract column (e) Proceeds Cost to gain or loss from from column (d) and This form may be easier to complete if you round (sales price) (or other basis) Form(s) 8949, Part I, combine the result with off cents to whole dollars. line 2, column (g) column (g) 1a Totals for all short-term transactions reported on Form 1099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 1b..................... Totals for all transactions reported on 1b Form(s) 8949 with Box A checked........... Totals for all transactions reported on 2 Form(s) 8949 with Box B checked........... Totals for all transactions reported on 3 Form(s) 8949 with Box C checked........... 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 in the instructions........................................................................... 6 7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any long-term capital gains or losses, go to Part II below. Otherwise, go to Part III on the back............................ Part II Long-Term Capital Gains and Losses ' Assets Held More Than One Year See instructions for how to figure the amounts to (g) (h) Gain or (loss) enter on the lines below. (d) (e) Adjustments Subtract column (e) Proceeds Cost to gain or loss from from column (d) and This form may be easier to complete if you round (sales price) (or other basis) Form(s) 8949, Part II, combine the result with off cents to whole dollars. line 2, column (g) column (g) 8a Totals for all long-term transactions reported on Form 1099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 8b.................................. Totals for all transactions reported on 8b Form(s) 8949 with Box D checked........... 100,000. 125,000. -25,000. 7 Totals for all transactions reported on 9 Form(s) 8949 with Box E checked........... Totals for all transactions reported on 10 Form(s) 8949 with Box F checked........... 11 358,000. 125,000. -233,000. 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............................................................................ 11 25,650. 12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1.... 12 13 Capital gain distributions. See the instrs......................................................................... 13 14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover Worksheet in the instructions........................................................................... 14 15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on the back............................................................................................... 15 650. BAA For Paperwork Reduction Act tice, see your tax return instructions. Schedule D (Form 1040) 2017 FDIA0612L 08/16/17

Schedule D (Form 1040) 2017 Homer J. and Marge A. Sampson 999-99-9999 Page 2 Part III Summary 16 Combine lines 7 and 15 and enter the result............................................................. 16? If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line 14. Then go to line 17 below.? If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22.? If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form 1040NR, line 14. Then go to line 22. 650. 17 Are lines 15 and 16 both gains? X. Go to line 18.. Skip lines 18 through 21, and go to line 22. 18 If you are required to complete the 28% Rate Gain Worksheet (see instructions), enter the amount, if any, from line 7 of that worksheet............................................................ G 18 0. 19 If you are required to complete the Unrecaptured Section 1250 Gain Worksheet (see instructions), enter the amount, if any, from line 18 of that worksheet.................................... G 19 19,150. 20 Are lines 18 and 19 both zero or blank? X. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44 (or in the instructions for Form 1040NR, line 42). Don't complete lines 21 and 22 below.. Complete the Schedule D Tax Worksheet in the instructions. Don't complete lines 21 and 22 below. 21 If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:? The loss on line 16 or? ($3,000), or if married filing separately, ($1,500)................................................ 21 te: When figuring which amount is smaller, treat both amounts as positive numbers. 22 Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b?. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44 (or in the instructions for Form 1040NR, line 42).. Complete the rest of Form 1040 or Form 1040NR. Schedule D (Form 1040) 2017 FDIA0612L 08/16/17

Form 8949 (2016) Attachment Sequence. 12A Page 2 Name(s) shown on return. Name and SSN or taxpayer identification no. not required if shown on other side SSN or taxpayer identification number Homer J. and Marge A. Sampson *******9999 Before you check Box D, E, or F below, see whether you received any Form(s) 1099-B or substitute statement(s) from your broker. A substitute statement will have the same information as Form 1099-B. Either will show whether your basis (usually your cost) was reported to the IRS by your broker and may even tell you which box to check. Part II Long-Term. Transactions involving capital assets you held more than 1 year are long term. For short-term transactions, see page 1. te: You may aggregate all long-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS and for which no adjustments or codes are required. Enter the totals directly on Schedule D, line 8a; you aren't required to report these transactions on Form 8949 (see instructions). You must check Box D, E, or F below. Check only one box. If more than one box applies for your long-term transactions, complete a separate Form 8949, page 2, for each applicable box. If you have more long-term transactions than will fit on this page for one or more of the boxes, complete as many forms with the same box checked as you need. (D) Long-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see te above) (E) Long-term transactions reported on Form(s) 1099-B showing basis wasn't reported to the IRS X (F) Long-term transactions not reported to you on Form 1099-B 1 (a) Description of property (Example: 100 shares XYZ Co.) (b) Date acquired (Mo., day, yr.) Sale of principal residence 2/14/94 (c) Date sold or disposed of (Mo., day, yr.) 7/01/16 (d) Proceeds (sales price) (see instructions) 358,000. (e) Cost or other basis. See the te below and see Column (e) in the separate instructions 125,000. Adjustment, if any, to gain or loss. If you enter an amount in column (g), enter a code in column (f). See the separate instructions. (f) Code(s) from instructions H (g) Amount of adjustment -233,000. (h) Gain or (loss). Subtract column (e) from column (d) and combine the result with column (g) 0. 2 Totals. Add the amounts in columns (d), (e), (g), and (h) (subtract negative amounts). Enter each total here and include on your Schedule D, line 8b (if Box D above is checked), line 9 (if Box E above is checked), or line 10 (if Box F above is checked).............................. G 358,000. 125,000. -233,000. 0. te: If you checked Box D above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment. FDIA9212L 12/22/16 Form 8949 (2016) CS - 11

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SCHEDULE E (Form 1040) Department of the Treasury Internal Revenue Service Name(s) shown on return Supplemental Income and Loss (From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.) OMB. 1545-0074 2017 G Attach to Form 1040, 1040NR, or Form 1041. (99) G Go to www.irs.gov/schedulee for instructions and the latest information. Attachment Sequence. 13 Your social security number Homer J. and Marge A. Sampson 999-99-9999 Part I Income or Loss From Rental Real Estate and Royalties te: If you are in the business of renting personal property, use Schedule C or C-EZ (see instructions). If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40. A Did you make any payments in 2017 that would require you to file Form(s) 1099? (see instructions)................... X B If "," did you or will you file required Forms 1099?.............................................................. 1 a A Physical address of each property (street, city, state, ZIP code) 1 Woody Hayes Blvd,, Columbus, OH 43229 B C 1 b Type of Property 2 For each rental real estate property listed (from list below) Fair Rental Days Personal Use Days QJV above, report the number of fair rental and A 1 personal use days. Check the QJV box only A 358 if you meet the requirements to file as a B qualified joint venture. See instructions. B C C Type of Property: 1 Single Family Residence 3 Vacation/Short-Term Rental 5 Land 7 Self-Rental 2 Multi-Family Residence 4 Commercial 6 Royalties 8 Other (describe) Income: Properties: A B C 3 Rents received.............................................. 3 15,000. 4 Royalties received.......................................... 4 Expenses: 5 Advertising................................................. 5 6 Auto and travel (see instructions)............................ 6 7 Cleaning and maintenance.................................. 7 8 Commissions............................................... 8 9 Insurance.................................................. 9 10 Legal and other professional fees............................ 10 11 Management fees........................................... 11 12 Mortgage interest paid to banks, etc. (see instructions)................... 12 13 Other interest............................................... 13 14 Repairs..................................................... 14 15 Supplies.................................................... 15 16 Taxes...................................................... 16 17 Utilities..................................................... 17 18 Depreciation expense or depletion........................... 18 19 Other (list) G See Stm 2 19 20 Total expenses. Add lines 5 through 19....................... 20 800. 300. 1,500. 4,900. 1,800. 1,000. 5,175. 1,200. 16,675. 21 Subtract line 20 from line 3 (rents) and/ or 4 (royalties). If result is a (loss), see instructions to find out if you must file Form 6198.................................................. 21-1,675. 22 Deductible rental real estate loss after limitation, if any, on Form 8582 (see instructions)................................ 22-13,675. 23 a Total of all amounts reported on line 3 for all rental properties....................... 23a 15,000. b Total of all amounts reported on line 4 for all royalty properties...................... 23b c Total of all amounts reported on line 12 for all properties............................ 23c 4,900. d Total of all amounts reported on line 18 for all properties............................ 23d 5,175. e Total of all amounts reported on line 20 for all properties............................ 23e 16,675. 24 Income. Add positive amounts shown on line 21. Do not include any losses............................... 24 25 Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here... 25-13,675. 26 Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter this amount on Form 1040, line 17, or Form 1040NR, line 18. Otherwise, include this amount in the total on line 41 on page 2............................................................................... 26-13,675. BAA For Paperwork Reduction Act tice, see the separate instructions. FDIZ2301L 10/23/17 Schedule E (Form 1040) 2017

Schedule E (Form 1040) 2017 Attachment Sequence. 13 Page 2 Name(s) shown on return. Do not enter name and social security number if shown on Page 1. Your social security number Homer J. and Marge A. Sampson 999-99-9999 Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1. Part II Income or Loss From Partnerships and S Corporations te: If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See instructions. 27 Are you reporting any loss not allowed in a prior year due to the at-risk, excess farm loss, or basis limitations, a prior year unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? If you answered "," see instructions before completing this section....................... 28 (a) Name (b) Enter P for (c) Check if partnership; S (d) Employer (e) Check if foreign identification any amount for S corporation partnership number is not at risk ARosco Real Estate, LP BPYA: Passive Carryover CBuckeye Publishing, Inc D Passive Income and Loss P P S 55-5555555 55-5555555 66-6666666 npassive Income and Loss (f) Passive loss allowed (g) Passive income (h) npassive loss (i) Section 179 (j) npassive expense deduction income from (attach Form 8582 if required) from Schedule K-1 from Schedule K-1 from Form 4562 Schedule K-1 A B C D 29 a Totals................ b Totals................ 13,975. 30 Add columns (g) and (j) of line 29a...................................................................... 30 31 Add columns (f), (h), and (i) of line 29b.. See...... Statement............... 4............. See...... Statement............... 3........ 31 32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the result here and include in the total on line 41 below..................................................................... Part III Income or Loss From Estates and Trusts 33 (a) Name A B A B 5,000. 8,975. Passive Income and Loss 32 X (b) Employer ID no. npassive Income and Loss (c) Passive deduction or loss allowed (d) Passive income (e) Deduction or loss (f) Other income (attach Form 8582 if required) from Schedule K-1 from Schedule K-1 from Schedule K-1 34 a Totals..................................... b Totals..................................... 35 Add columns (d) and (f) of line 34a..................................................................... 35 36 Add columns (c) and (e) of line 34b..................................................................... 36 37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and include in the total on line 41 below...................................................... 37 Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs) ' Residual Holder (b) Employer (c) Excess inclusion from (d) Taxable income 38 (a) Name (e) Income from identification number Schedules Q, line 2c (net loss) from (see instructions) Schedules Q, line 3b Schedules Q, line 1b 39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below........... 39 Part V Summary 40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below............................ 40 30,000. 30,000. 30,000. -13,975. 16,025. 41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Form 1040, line 17, or Form 1040NR, line 18.......................................................... G 41 2,350. 42 Reconciliation of farming and fishing income. Enter your gross farming and fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065), box 14, code B; Schedule K-1 (Form 1120S), box 17, code V; and Schedule K-1 (Form 1041), box 14, code F (see instructions)................................ 42 43 Reconciliation for real estate professionals. If you were a real estate professional (see instructions), enter the net income or (loss) you reported anywhere on Form 1040 or Form 1040NR from all rental real estate activities in which you materially participated under the passive activity loss rules........ 43 BAA FDIZ2302L 10/23/17 Schedule E (Form 1040) 2017

SCHEDULE SE OMB. 1545-0074 (Form 1040) Self-Employment Tax 2017 G Go to www.irs.gov/schedulese for instructions and the latest information. Department of the Treasury Attachment Internal Revenue Service (99) G Attach to Form 1040 or Form 1040NR. Sequence. 17 Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) Social security number of person Marge A. Sampson with self-employment income G 888-88-8888 Before you begin: To determine if you must file Schedule SE, see the instructions. May I Use Short Schedule SE or Must I Use Long Schedule SE? te: Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions. Did you receive wages or tips in 2017? I I I Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval Was the total of your wages and tips subject to social G not to be taxed on earnings from these sources, but you security or railroad retirement (tier 1) tax plus your net owe self-employment tax on other earnings? earnings from self-employment more than $127,200? I Are you using one of the optional methods to figure your net earnings (see instructions)? I G I Did you receive tips subject to social security or Medicare tax that you didn't report to your employer? Did you receive church employee income (see instruc- Did you report any wages on Form 8919, Uncollected tions) reported on Form W-2 of $108.28 or more? Social Security and Medicare Tax on Wages? G I G H You may use Short Schedule SE below You must use Long Schedule SE on page 2 G I G G I Section A ' Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE. 1 a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A........................................................................................ If you received social security retirement or disability benefits, enter the amount of Conservation Reserve b Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z................................................................................................ 2 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. Ministers and members of religious orders, see instructions for types of income to report on this line. See instructions for other income to report............................................................................................... 1 a 1 b 2 80,911. 3 Combine lines 1a, 1b, and 2............................................................................ 3 80,911. 4 Multiply line 3 by 92.35% (0.9235). If less than $400, you don't owe self-employment tax; don't file this schedule unless you have an amount on line 1b........................................................ G te: If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions. 4 74,721. 5 Self-employment tax. If the amount on line 4 is:?$127,200 or less, multiply line 4 by 15.3% (0.153). Enter the result here and on Form 1040, line 57, or Form 1040NR, line 55?More than $127,200, multiply line 4 by 2.9% (0.029). Then, add $15,772.80 to the result. Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55.................................. 5 6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (0.50). Enter the result here and on Form 1040, line 27, or Form 1040NR, line 27.................................. 6 5,716. BAA For Paperwork Reduction Act tice, see your tax return instructions. Schedule SE (Form 1040) 2017 FDIA1101L 08/21/17 11,432.

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Form 2441 Child and Dependent Care Expenses OMB. 1545-0074 G Attach to Form 1040, Form 1040A, or Form 1040NR. 2017 Department of the Treasury Internal Revenue Service Name(s) shown on return Attachment Sequence. (99) G Go to www.irs.gov/form2441 for instructions and the latest information. 21 Your social security number Homer J. and Marge A. Sampson 999-99-9999 Part I Persons or Organizations Who Provided the Care ' You must complete this part. (If you have more than two care providers, see the instructions.) 1 (a) Care provider's (b) Address (c) Identifying number (d) Amount paid name (number, street, apt. no., city, state, and ZIP code) (SSN or EIN) (see instructions) 2422 Ramblewood Dr Suzy Nanny Goodyear, AZ 85395 101-01-0101 12,000. Did you receive dependent care benefits? VVVVVV VVVVVV VVVG VVVG Complete only Part II below. Complete Part III on the back next. Caution: If the care was provided in your home, you may owe employment taxes. If you do, you can't file Form 1040A. For details, see the instructions for Form 1040, line 60a, or Form 1040NR, line 59a. Part II Credit for Child and Dependent Care Expenses 2 Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions. (a) Qualifying person's name (b) Qualifying person's social (c) Qualified expenses security number you incurred and paid in 2017 for the person listed in column (a) First Last Maggie J. Sampson 333-33-3333 12,000. 3 Add the amounts in column (c) of line 2. Don't enter more than $3,000 for one qualifying person or $6,000 4 for two or more persons. If you completed Part III, enter the amount from line 31.......................... Enter your earned income. See instructions............................................................. 3 4 5 If married filing jointly, enter your spouse's earned income (if you or your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4............................. 5 6 Enter the smallest of line 3, 4, or 5..................................................................... 6 7 Enter the amount from Form 1040, line 38; Form 1040A, line 22; or Form 1040NR, line 37............................................................. 7 8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7 If line 7 is: If line 7 is: But not Decimal But not Decimal Over over amount is Over over amount is $0 ' 15,000.35 $29,000 ' 31,000.27 15,000 ' 17,000.34 31,000 ' 33,000.26 17,000 ' 19,000.33 33,000 ' 35,000.25 19,000 ' 21,000.32 35,000 ' 37,000.24 21,000 ' 23,000.31 37,000 ' 39,000.23 23,000 ' 25,000.30 39,000 ' 41,000.22 25,000 ' 27,000.29 41,000 ' 43,000.21 27,000 ' 29,000.28 43,000 ' limit.20 8 X 9 Multiply line 6 by the decimal amount on line 8. If you paid 2016 expenses in 2017, see the instructions..... 9 10 Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions........................................................... 11 Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 49; Form 1040A, line 31; or Form 1040NR, line 47............................ BAA For Paperwork Reduction Act tice, see your tax return instructions. 10 11 Form 2441 (2017) FDIA3212L 09/07/17

Form 2441 (2017) Homer J. and Marge A. Sampson 999-99-9999 Page 2 Part III Dependent Care Benefits 12 Enter the total amount of dependent care benefits you received in 2017. Amounts you received as an employee should be shown in box 10 of your Form(s) W-2. Don't include amounts reported as wages in box 1 of Form(s) W-2. If you were self-employed or a partner, include amounts you received under a dependent care assistance program from your sole proprietorship or partnership........................... 12 5,000. 13 Enter the amount, if any, you carried over from 2016 and used in 2017 during the grace period. See instructions....................................................................................... 13 14 Enter the amount, if any, you forfeited or carried forward to 2018. See instructions......................... 14 15 Combine lines 12 through 14. See instructions........................................................... 15 16 Enter the total amount of qualified expenses incurred in 2017 for the care of the qualifying person(s)..................................................... 16 17 Enter the smaller of line 15 or 16............................................ 17 18 Enter your earned income. See instructions.................................. 18 19 Enter the amount shown below that applies to you.?if married filing jointly, enter your spouse's earned income (if you or your spouse was a student or was disabled, see the instructions for line 5).?If married filing separately, see instructions........... 19?All others, enter the amount from line 18. 20 Enter the smallest of line 17, 18, or 19....................................... 20 21 Enter $5,000 ($2,500 if married filing separately and you were required to enter your spouse's earned income on line 19)..................................... 21 5,000. 22 Is any amount on line 12 from your sole proprietorship or partnership? (Form 1040A filers go to line 25). X. Enter -0-.. Enter the amount here......................................................................... 22 23 Subtract line 22 from line 15................................................. 23 5,000. 24 12,000. 5,000. 80,000. 75,195. 5,000. Deductible benefits. Enter the smallest of line 20, 21, or 22. Also, include this amount on the appropriate line(s) of your return. See instructions................................................................... 25 Excluded benefits. Form 1040 and 1040NR filers: If you checked '' on line 22, enter the smaller of line 20 or 21. Otherwise, subtract line 24 from the smaller of line 20 or line 21. If zero or less, enter -0-. Form 1040A filers: Enter the smaller of line 20 or line 21............................................................. 25 26 Taxable benefits. Form 1040 and 1040NR filers: Subtract line 25 from line 23. If zero or less, enter -0-. Also, include this amount on Form 1040, line 7, or Form 1040NR, line 8. On the dotted line next to Form 1040, line 7, or Form 1040NR, line 8, enter 'DCB.' Form 1040A filers: Subtract line 25 from line 15. Also, include this amount on Form 1040A, line 7. In the space to the left of line 7, enter 'DCB'............................... 26 24 5,000. 0. 0. 5,000. 0. To claim the child and dependent care credit, complete lines 27 through 31 below. 27 Enter $3,000 ($6,000 if two or more qualifying persons).................................................. 27 28 Form 1040 and 1040NR filers: Add lines 24 and 25. Form 1040A filers: Enter the amount from line 25....... 28 29 Subtract line 28 from line 27. If zero or less, stop. You can't take the credit. Exception. If you paid 2016 expenses in 2017, see the instructions for line 9......................................................... 30 Complete line 2 on the front of this form. Don't include in column (c) any benefits shown on line 28 above. Then, add the amounts in column (c) and enter the total here............................................. 31 Enter the smaller of line 29 or 30. Also, enter this amount on line 3 on the front of this form and complete lines 4 through 11............................................................................ 29 30 31 3,000. 5,000. -2,000. Form 2441 (2017) FDIA3212L 09/07/17

OMB. 1545-0184 Form 4797 Sales of Business Property (Also Involuntary Conversions and Recapture Amounts Under Sections 179 and 280F(b)(2)) 2017 Department of the Treasury G Attach to your tax return. Attachment Internal Revenue Service G Go to www.irs.gov/form4797 for instructions and the latest information. Sequence. 27 Name(s) shown on return Identifying number Homer J. and Marge A. Sampson 999-99-9999 1 Enter the gross proceeds from sales or exchanges reported to you for 2017 on Form(s) 1099-B or 1099-S (or substitute statement) that you are including on line 2, 10, or 20. See instructions....................... 1 155,000. Part I Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From Other Than Casualty or Theft ' Most Property Held More Than 1 Year (see instructions) 2 (e) Depreciation (f) Cost or other (a) Description (b) Date acquired (c) Date sold (d) Gross (g) Gain or (loss) allowed or basis, plus of property (mo., day, yr.) (mo., day, yr.) sales price allowable since improvements and acquisition expense of sale Subtract (f) from the sum of (d) and (e) 3 Gain, if any, from Form 4684, line 39.......................................................................... 3 4 Section 1231 gain from installment sales from Form 6252, line 26 or 37......................................... 4 5 Section 1231 gain or (loss) from like-kind exchanges from Form 8824........................................... 5 6 Gain, if any, from line 32, from other than casualty or theft..................................................... 6 7 Combine lines 2 through 6. Enter the gain or (loss) here and on the appropriate line as follows:................... 7 Partnerships (except electing large partnerships) and S corporations. Report the gain or (loss) following the instructions for Form 1065, Schedule K, line 10, or Form 1120S, Schedule K, line 9. Skip lines 8, 9, 11, and 12 below. Individuals, partners, S corporation shareholders, and all others. If line 7 is zero or a loss, enter the amount from line 7 on line 11 below and skip lines 8 and 9. If line 7 is a gain and you didn't have any prior year section 1231 losses, or they were recaptured in an earlier year, enter the gain from line 7 as a long-term capital gain on the Schedule D filed with your return and skip lines 8, 9, 11, and 12 below. 8 nrecaptured net section 1231 losses from prior years. See instructions........................................ 8 9 Subtract line 8 from line 7. If zero or less, enter -0-. If line 9 is zero, enter the gain from line 7 on line 12 below. If line 9 is more than zero, enter the amount from line 8 on line 12 below and enter the gain from line 9 as a long-term capital gain on the Schedule D filed with your return. See instructions................................. 9 Part II Ordinary Gains and Losses (see instructions) 10 Ordinary gains and losses not included on lines 11 through 16 (include property held 1 year or less): 27,650. 27,650. 2,000. 25,650. 11 Loss, if any, from line 7...................................................................................... 11 12 Gain, if any, from line 7 or amount from line 8, if applicable.................................................... 12 13 Gain, if any, from line 31..................................................................................... 13 14 Net gain or (loss) from Form 4684, lines 31 and 38a........................................................... 14 15 Ordinary gain from installment sales from Form 6252, line 25 or 36............................................. 15 16 Ordinary gain or (loss) from like-kind exchanges from Form 8824............................................... 16 17 Combine lines 10 through 16................................................................................. 17 18 For all except individual returns, enter the amount from line 17 on the appropriate line of your return and skip lines a and b below. For individual returns, complete lines a and b below: a If the loss on line 11 includes a loss from Form 4684, line 35, column (b)(ii), enter that part of the loss here. Enter the part of the loss from income-producing property on Schedule A (Form 1040), line 28, and the part of the loss from property used as an employee on Schedule A (Form 1040), line 23. Identify as from 'Form 4797, line 18a.' See instructions............................................................................................. b Redetermine the gain or (loss) on line 17 excluding the loss, if any, on line 18a. Enter here and on Form 1040, line 14...................................................................................................... 18 b 5,000. BAA For Paperwork Reduction Act tice, see separate instructions. Form 4797 (2017) 18 a 2,000. 3,000. 5,000. FDIZ1001L 08/23/17

Form 4797 (2017) Homer J. and Marge A. Sampson 999-99-9999 Page 2 Part III Gain From Disposition of Property Under Sections 1245, 1250, 1252, 1254, and 1255 (see instructions) 19 (a) Description of section 1245, 1250, 1252, 1254, or 1255 property: (b) Date acquired (c) Date sold (mo., day, yr.) (mo., day, yr.) A Office furniture B EDPA Residential rental house C 6/03/15 1/01/14 1/15/17 12/25/17 D These columns relate to the properties on lines 19A through 19D.............................. G 20 Gross sales price (te: See line 1 before completing.)................... 20 21 Cost or other basis plus expense of sale........ 21 22 Depreciation (or depletion) allowed or allowable.. 22 23 Adjusted basis. Subtract line 22 from line 21.... 23 24 Total gain. Subtract line 23 from line 20........ 24 25 If section 1245 property: a Depreciation allowed or allowable from line 22.... 25a b Enter the smaller of line 24 or 25a..... 25b 26 If section 1250 property: If straight line depreciation was used, enter -0- on line 26g, except for a corporation subject to section 291. a Additional depreciation after 1975 (see instrs)... b Applicable percentage multiplied by the smaller of line 24 or line 26a. See instructions 26a 26b c Subtract line 26a from line 24. If residential rental property or line 24 isn't more than line 26a, skip lines 26d and 26e........................ 26c d Additional depreciation after 1969 and before 1976. 26d e Enter the smaller of line 26c or 26d.... f Section 291 amount (corporations only)........ g Add lines 26b, 26e, and 26f........... 26e 26f 26g 27 If section 1252 property: Skip this section if you didn't dispose of farmland or if this form is being completed for a partnership (other than an electing large partnership). a Soil, water, and land clearing expenses........ 27a b Line 27a multiplied by applicable percentage. See instructions........... 27b c Enter the smaller of line 24 or 27b..... 27c 28 If section 1254 property: a Intangible drilling and development costs, expenditures for development of mines and other natural deposits, mining exploration costs, and depletion. See instructions.................. 28a b Enter the smaller of line 24 or 28a..... 28b 29 If section 1255 property: Property A Property B Property C Property D a Applicable percentage of payments excluded from income under section 126. See instructions.......... 29a b Enter the smaller of line 24 or 29a. See instrs.... 29b Summary of Part III Gains. Complete property columns A through D through line 29b before going to line 30. 30 Total gains for all properties. Add property columns A through D, line 24................................. 30 30,650. 31 Add property columns A through D, lines 25b, 26g, 27c, 28b, and 29b. Enter here and on line 13................................ 31 3,000. 32 Subtract line 31 from line 30. Enter the portion from casualty or theft on Form 4684, line 33. Enter the portion from other than casualty or theft on Form 4797, line 6......................................................... 32 27,650. Part IV Recapture Amounts Under Sections 179 and 280F(b)(2) When Business Use Drops to 50% or Less (see instructions) 33 Section 179 expense deduction or depreciation allowable in prior years............... 33 34 Recomputed depreciation. See instructions......................................... 34 35 Recapture amount. Subtract line 34 from line 33. See the instructions for where to report................ 35 BAA 3,000. 155,000. 9,800. 148,500. 9,800. 21,150. 127,350. 3,000. 27,650. 9,800. 3,000. 0. (a) Section 179 (b) Section 280F(b)(2) FDIZ1002L 08/23/17 Form 4797 (2017)

Form 6251 Alternative Minimum Tax ' Individuals G Go to www.irs.gov/form6251 for instructions and the latest information G Attach to Form 1040 or Form 1040NR. OMB. 1545-0074 2017 Department of the Treasury Attachment Internal Revenue Service (99) Sequence. 32 Name(s) shown on Form 1040 or Form 1040NR Your social security number Homer J. and Marge A. Sampson 999-99-9999 Part I Alternative Minimum Taxable Income (See instructions for how to complete each line.) 1 If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41, and go to line 2. Otherwise, enter the amount from Form 1040, line 38, and go to line 7. (If less than zero, enter as a negative amount.). 1 2 Reserved for future use................................................................................ 2 3 Taxes from Schedule A (Form 1040), line 9.............................................................. 3 4 Enter the home mortgage interest adjustment, if any, from line 6 of the worksheet in the instructions for this line.................... 4 5 Miscellaneous deductions from Schedule A (Form 1040), line 27.......................................... 5 6 If Form 1040, line 38, is $156,900 or less, enter -0-. Otherwise, see instructions........................... 6 7 Tax refund from Form 1040, line 10 or line 21............................................................ 7 8 Investment interest expense (difference between regular tax and AMT).................................... 8 9 Depletion (difference between regular tax and AMT)...................................................... 9 10 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount......................... 10 11 Alternative tax net operating loss deduction.............................................................. 11 12 Interest from specified private activity bonds exempt from the regular tax.................................. 12 13 Qualified small business stock, see instructions.......................................................... 13 14 Exercise of incentive stock options (excess of AMT income over regular tax income)....................... 14 15 Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A).............................. 15 16 Electing large partnerships (amount from Schedule K-1 (Form 1065-B), box 6)............................. 16 17 Disposition of property (difference between AMT and regular tax gain or loss).............................. 17 18 Depreciation on assets placed in service after 1986 (difference between regular tax and AMT).............. 18 19 Passive activities (difference between AMT and regular tax income or loss)................................ 19 20 Loss limitations (difference between AMT and regular tax income or loss)................................. 20 21 Circulation costs (difference between regular tax and AMT)............................................... 21 22 Long-term contracts (difference between AMT and regular tax income).................................... 22 23 Mining costs (difference between regular tax and AMT)................................................... 23 24 Research and experimental costs (difference between regular tax and AMT)............................... 24 25 Income from certain installment sales before January 1, 1987............................................. 25 26 Intangible drilling costs preference...................................................................... 26 27 Other adjustments, including income-based related adjustments.......................................... 27 28 Alternative minimum taxable income. Combine lines 1 through 27. (If married filing separately and line 28 is more than $249,450, see instructions.).......................................... 28 Part II Alternative Minimum Tax (AMT) 29 Exemption. (If you were under age 24 at the end of 2017, see instructions.) IF your filing status is.... AND line 28 is not over... THEN enter on line 29.... Single or head of household............... $120,700................ $54,300 Married filing jointly or qualifying widow(er) 160,900................ 84,500...... Married filing separately................... 80,450................ 42,250 29 If line 28 is over the amount shown above for your filing status, see instructions. 30 Subtract line 29 from line 28. If more than zero, go to line 31. If zero or less, enter -0- here and on lines 31, 33, and 35, and go to line 34.............................................. 30 31?If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter.?if you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends on Form 1040, line 9b; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (as refigured for the AMT, if necessary), complete Part III on the back and enter the amount from line 64 here........ 31?All others: If line 30 is $187,800 or less ($93,900 or less if married filing separately), multiply line 30 by 26% (0.26). Otherwise, multiply line 30 by 28% (0.28) and subtract $3,756 ($1,878 if married filing separately) from the result. 32 Alternative minimum tax foreign tax credit (see instructions).............................................. 32 105,787. 10,319. 4,000. 120,106. 84,500. 35,606. 8,702. 33 Tentative minimum tax. Subtract line 32 from line 31..................................................... 33 Add Form 1040, line 44 (minus any tax from Form 4972), and Form 1040, line 46. Subtract from the result 34 any foreign tax credit from Form 1040, line 48. If you used Schedule J to figure your tax on Form 1040, line 44, refigure that tax without using Schedule J before completing this line (see instructions)............. 34 8,702. 12,359. 35 AMT. Subtract line 34 from line 33. If zero or less, enter -0-. Enter here and on Form 1040, line 45......... 35 BAA For Paperwork Reduction Act tice, see your tax return instructions. FDIA5312L 08/31/17 Form 6251 (2017) 0.

Form 6251 (2017) Homer J. and Marge A. Sampson 999-99-9999 Page 2 Part III Tax Computation Using Maximum Capital Gains Rates Complete Part III only if you are required to do so by line 31 or by the Foreign Earned Income Tax Worksheet in the instructions. 36 Enter the amount from Form 6251, line 30. If you are filing Form 2555 or 2555-EZ, enter the amount from line 3 of the worksheet in the instructions for line 31..................................................... 36 37 Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44, or the amount from line 13 of the Schedule D Tax Worksheet in the instructions for Schedule D (Form 1040), whichever applies (as refigured for the AMT, if necessary) (see instructions). If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter.............................. 38 Enter the amount from Schedule D (Form 1040), line 19 (as refigured for the AMT, if necessary) (see instructions). If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter............... 39 If you did not complete a Schedule D Tax Worksheet for the regular tax or the AMT, enter the amount from line 37. Otherwise, add lines 37 and 38, and enter the smaller of that result or the amount from line 10 of the Schedule D Tax Worksheet (as refigured for the AMT, if necessary). If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter........................................................ 40 Enter the smaller of line 36 or line 39................................................................... 40 41 Subtract line 40 from line 36............................................................................ 41 42 If line 41 is $187,800 or less ($93,900 or less if married filing separately), multiply line 41 by 26% (0.26). Otherwise, multiply line 41 by 28% (0.28) and subtract $3,756 ($1,878 if married filing separately) from the result............................................................................................ G 42 43 Enter:? $75,900 if married filing jointly or qualifying widow(er),? $37,950 if single or married filing separately, or......................................... 43? $50,800 if head of household. Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions 44 for Form 1040, line 44, or the amount from line 14 of the Schedule D Tax Worksheet in the instructions for Schedule D (Form 1040), whichever applies (as figured for the regular tax). If you did not complete either worksheet for the regular tax, enter the amount from Form 1040, line 43; if zero or less, enter -0-. If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter.................................. 44 45 Subtract line 44 from line 43. If zero or less, enter -0-.................................................... 45 46 Enter the smaller of line 36 or line 37................................................................... 46 47 Enter the smaller of line 45 or line 46. This amount is taxed at 0%........................................ 47 48 Subtract line 47 from line 46............................................................................ 48 49 Enter:? $418,400 if single? $235,350 if married filing separately? $470,700 if married filing jointly or qualifying widow(er)? $444,550 if head of household......................................... 49 50 Enter the amount from line 45.......................................................................... 50 51 Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44, or the amount from line 19 of the Schedule D Tax Worksheet, whichever applies (as figured for the regular tax). If you did not complete either worksheet for the regular tax, enter the amount from Form 1040, line 43; if zero or less, enter -0-. If you are filing Form 2555 or Form 2555-EZ, see instructions for the amount to enter................................................................. 51 52 Add line 50 and line 51................................................................................. 52 53 Subtract line 52 from line 49. If zero or less, enter -0-.................................................... 53 Enter the smaller of line 48 or line 53................................................................... 54 54 55 Multiply line 54 by 15% (0.15)........................................................................... G 55 56 Add lines 47 and 54.................................................................................... 56 If lines 56 and 36 are the same, skip lines 57 through 61 and go to line 62. Otherwise, go to line 57. 57 Subtract line 56 from line 46............................................................................ 57 58 Multiply line 57 by 20% (0.20)........................................................................... G 58 If line 38 is zero or blank, skip lines 59 through 61 and go to line 62. Otherwise, go to line 59. 59 Add lines 41, 56, and 57................................................................................ 59 60 Subtract line 59 from line 36............................................................................ 60 61 Multiply line 60 by 25% (0.25)......................................................................... G 61 62 Add lines 42, 55, 58, and 61............................................................................ 62 37 38 39 35,606. 5,000. 19,150. 5,650. 5,650. 29,956. 7,789. 75,900. 80,537. 0. 5,000. 5,000. 470,700. 79,887. 79,887. 390,813. 5,000. 750. 5,000. 34,956. 650. 163. 8,702. 63 If line 36 is $187,800 or less ($93,900 or less if married filing separately), multiply line 36 by 26% (0.26). Otherwise, multiply line 36 by 28% (0.28) and subtract $3,756 ($1,878 if married filing separately) from the result.............................................................................................. 63 64 Enter the smaller of line 62 or line 63 here and on line 31. If you are filing Form 2555 or 2555-EZ, do not enter this amount on line 31. Instead, enter it on line 4 of the worksheet in the instructions for line 31....... 64 9,258. 8,702. FDIA5312L 08/31/17 Form 6251 (2017)

Education Credits OMB. 1545-0074 Form 8863 (American Opportunity and Lifetime Learning Credits) 2016 Department of the Treasury G Attach to Form 1040 or Form 1040A. Attachment Internal Revenue Service (99) G Information about Form 8863 and its separate instructions is at www.irs.gov/form8863. Sequence. 50 Name(s) shown on return Your social security number Homer J. and Marge A. Sampson *******9999 CAUTION! 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 5,000. 2 Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er)...................................................... 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................................... 4 5 6 Subtract line 3 from line 2. If zero or less, stop; you can't take any education credit............................................................. Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er)...................................................... 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)..................................................................... 7 Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet the credit; skip line 8, enter the amount from line 7 on line 9, and check this box......................... G 7 conditions described in the instructions, you can't take the refundable American opportunity 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 nrefundable Education Credits 9 Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions)........ 9 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................................... 11 Enter the smaller of line 10 or $10,000.................................................................. 11 12 Multiply line 11 by 20% (0.20)........................................................................... 12 13 Enter: $131,000 if married filing jointly; $65,000 if single, head of household, or qualifying widow(er)...................................................... 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................................... 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................................................. 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)....................................................................................... 18 Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions)........ G 19 nrefundable 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...................................... BAA For Paperwork Reduction Act tice, see your tax return instructions. 2 3 4 5 13 14 15 180,000. 146,206. 33,794. 20,000. 6 10 17 18 19 1.000 5,000. 2,000. 3,000. 3,000. FDIA3601L 12/10/16 Form 8863 (2016) CS - 23

Page 2 Form 8863 (2016) Name(s) shown on return Your social security number Homer J. and Marge A. Sampson *******9999 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) Student social security number (as shown on page 1 of your tax return) 21 Bart A. Sampson 22 a 111-11-1111 Educational institution information (see instructions) Name of first educational institution b Name of second educational institution (if any) ARIZONA STATE UNIVERSITY (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. NEVER NUMBER 1 AVE TEMPE, AZ 85004 (2) Did the student receive Form 1098-T from this institution for 2016? X (2) Did the student receive Form 1098-T from this institution for 2016? (3) Did the student receive Form 1098-T from this institution for 2015 with box 2 filled in and box 7 checked? X (3) Did the student receive Form 1098-T from this institution for 2015 with box 2 filled in and box 7 checked? If you checked '' in both (2) and (3), skip (4). (4) If you checked '' in (2) or (3), enter the institution's federal identification number (from Form 1098-T). If you checked '' in both (2) and (3), skip (4). (4) If you checked '' in (2) or (3), enter the institution's federal identification number (from Form 1098-T). 98-7654321 23 Has the Hope Scholarship Credit or American opportunity credit been claimed for this student for any 4 tax years before 2016? 24 Was the student enrolled at least half-time for at least one academic period that began or is treated as having begun in 2016 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 2016? See instructions. 26 Was the student convicted, before the end of 2016, of a felony for possession or distribution of a controlled substance? CAUTION! ' Stop! Go to line 31 for this student. X ' Go to line 24. X ' Go to line 25. ' Stop! Go to line 31 for this student. ' Stop! Go to line 31 for this student. ' Stop! Go to line 31 for this student. X ' Go to line 26. X ' 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 28 Adjusted qualified education expenses (see instructions). Don't enter more than $4,000...................... 27 Subtract $2,000 from line 27. If zero or less, enter -0-..................................................... 28 29 Multiply line 28 by 25% (0.25)............................................................................ 29 4,000. 2,000. 500. 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 2,500. Lifetime Learning Credit 31 BAA Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts III, line 31, on Part II, line 10................................................................................ FDIA3602L 12/10/16 CS - 24 31 Form 8863 (2016)

Page 2 Form 8863 (2016) Name(s) shown on return Your social security number Homer J. and Marge A. Sampson *******9999 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) Student social security number (as shown on page 1 of your tax return) 21 Lisa J. Sampson 22 a 222-22-2222 Educational institution information (see instructions) Name of first educational institution b Name of second educational institution (if any) THE OHIO STATE UNIVERSITY (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. 1 TOP DOG AVE COLUMBUS, OH 44060 (2) Did the student receive Form 1098-T from this institution for 2016? X (2) Did the student receive Form 1098-T from this institution for 2016? (3) Did the student receive Form 1098-T from this institution for 2015 with box 2 filled in and box 7 checked? X (3) Did the student receive Form 1098-T from this institution for 2015 with box 2 filled in and box 7 checked? If you checked '' in both (2) and (3), skip (4). (4) If you checked '' in (2) or (3), enter the institution's federal identification number (from Form 1098-T). If you checked '' in both (2) and (3), skip (4). (4) If you checked '' in (2) or (3), enter the institution's federal identification number (from Form 1098-T). 87-6543210 23 Has the Hope Scholarship Credit or American opportunity credit been claimed for this student for any 4 tax years before 2016? 24 Was the student enrolled at least half-time for at least one academic period that began or is treated as having begun in 2016 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 2016? See instructions. 26 Was the student convicted, before the end of 2016, of a felony for possession or distribution of a controlled substance? CAUTION! ' Stop! Go to line 31 for this student. X ' Go to line 24. X ' Go to line 25. ' Stop! Go to line 31 for this student. ' Stop! Go to line 31 for this student. ' Stop! Go to line 31 for this student. X ' Go to line 26. X ' 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 28 Adjusted qualified education expenses (see instructions). Don't enter more than $4,000...................... 27 Subtract $2,000 from line 27. If zero or less, enter -0-..................................................... 28 29 Multiply line 28 by 25% (0.25)............................................................................ 29 4,000. 2,000. 500. 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 2,500. Lifetime Learning Credit 31 BAA Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts III, line 31, on Part II, line 10................................................................................ FDIA3602L 12/10/16 CS - 25 31 Form 8863 (2016)

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Form8889 Health Savings Accounts (HSAs) G Attach to Form 1040 or Form 1040NR. G Go to www.irs.gov/form8889 for instructions and the latest information. OMB. 1545-0074 2017 Department of the Treasury Attachment Internal Revenue Service Sequence. 52 Name(s) shown on Form 1040 or Form 1040NR Social security number of HSA beneficiary. If both spouses have HSAs, see instructions Homer J. Sampson G 999-99-9999 Before you begin: Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required. Part I HSA Contributions and Deduction. See the instructions before completing this part. If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part I for each spouse. 1 Check the box to indicate your coverage under a high-deductible health plan (HDHP) during 2017 (see instructions).................................................................................... G Self-only X Family 2 HSA contributions you made for 2017 (or those made on your behalf), including those made from January 1, 2018, through April 17, 2018, that were for 2017. Do not include employer contributions, contributions through a cafeteria plan, or rollovers (see instructions)........................................................... 2 6,750. 3 If you were under age 55 at the end of 2017, and on the first day of every month during 2017, you were, or were considered, an eligible individual with the same coverage, enter $3,400 ($6,750 for family coverage). All others, see the instructions for the amount to enter................................................... 3 6,750. 4 Enter the amount you and your employer contributed to your Archer MSAs for 2017 from Form 8853, lines 1 and 2. If you or your spouse had family coverage under an HDHP at any time during 2017, also include any amount contributed to your spouse's Archer MSAs....................................................... 4 5 Subtract line 4 from line 3. If zero or less, enter -0-...................................................... 5 6 Enter the amount from line 5. But if you and your spouse each have separate HSAs and had family coverage under an HDHP at any time during 2017, see the instructions for the amount to enter...................... 7 If you were age 55 or older at the end of 2017, married, and you or your spouse had family coverage under an HDHP at any time during 2017, enter your additional contribution amount (see instructions).............. 8 Add lines 6 and 7...................................................................................... 8 9 Employer contributions made to your HSAs for 2017.......................... 9 10 Qualified HSA funding distributions........................................... 10 11 Add lines 9 and 10..................................................................................... 11 12 Subtract line 11 from line 8. If zero or less, enter -0-..................................................... 12 13 HSA deduction. Enter the smaller of line 2 or line 12 here and on Form 1040, line 25, or Form 1040NR, line 25................................................................................................ 13 6,750. Caution: If line 2 is more than line 13, you may have to pay an additional tax (see instructions). Part II HSA Distributions. If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part II for each spouse. 14 a Total distributions you received in 2017 from all HSAs (see instructions)................................... 14 a b Distributions included on line 14a that you rolled over to another HSA. Also include any excess contributions (and the earnings on those excess contributions) included on line 14a that were withdrawn by the due date of your return (see instructions)........................................................................... c Subtract line 14b from line 14a......................................................................... 14 c 15 Qualified medical expenses paid using HSA distributions (see instructions)................................ 15 16 Taxable HSA distributions. Subtract line 15 from line 14c. If zero or less, enter -0-. Also, include this amount in the total on Form 1040, line 21, or Form 1040NR, line 21. On the dotted line next to line 21, enter 'HSA' and the amount........................................................................................ 16 17 a If any of the distributions included on line 16 meet any of the Exceptions to the Additional 20% Tax (see instructions), check here.......................................................................... G b Additional 20% tax (see instructions). Enter 20% (0.20) of the distributions included on line 16 that are subject to the additional 20% tax. Also include this amount in the total on Form 1040, line 62, or Form 1040NR, line 60. Check box c on Form 1040, line 62, or box b on Form 1040NR, line 60. Enter 'HSA' and the amount on the line next to the box...................................................................... 17 b BAA For Paperwork Reduction Act tice, see your tax return instructions. Form 8889 (2017) 6 7 14 b 6,750. 6,750. 6,750. 6,750. FDIA2512L 08/03/17

Form 8889 (2017) Homer J. Sampson 999-99-9999 Page 2 Part III Income and Additional Tax for Failure To Maintain HDHP Coverage. See the instructions before completing this part. If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part III for each spouse. 18 Last-month rule........................................................................................ 18 19 Qualified HSA funding distribution....................................................................... 19 20 Total income. Add lines 18 and 19. Include this amount on Form 1040, line 21, or Form 1040NR, line 21. On the dotted line next to Form 1040, line 21, or Form 1040NR, line 21, enter 'HSA' and the amount........ 21 Additional tax. Multiply line 20 by 10% (0.10). Include this amount in the total on Form 1040, line 62, or Form 1040NR, line 60. Check box c on Form 1040, line 62, or box b on Form 1040NR, line 60. Enter 'HDHP' and the amount on the line next to the box...................................................................... 21 20 Form 8889 (2017) FDIA2512L 08/03/17

Form 8867 Department of the Treasury Internal Revenue Service Taxpayer name(s) shown on return Enter preparer's name and PTIN Paid Preparer's Due Diligence Checklist Earned Income Credit (EIC), American Opportunity Tax Credit (AOTC), Child Tax Credit (CTC), and Additional Child Tax Credit (ACTC) To be completed by preparer and filed with Form 1040, 1040A, 1040EZ, 1040NR, 1040SS, or 1040PR. G G Go to www.irs.gov/form8867 for instructions and the latest information. OMB. 1545-1629 2017 Attachment Sequence. Taxpayer identification number Homer J. and Marge A. Sampson 999-99-9999 70 Part I Due Diligence Requirements 1 Please check the appropriate box for the credit(s) claimed on this return and complete the related Parts I-IV for the credit(s) claimed (check all that apply). Did you complete the return based on information for tax year 2017 provided by the taxpayer or reasonably obtained by you?............................ EIC CTC/ACTC AOTC X X 2 Did you complete the applicable EIC and/or CTC/ACTC worksheets found in the Form 1040, 1040A, 1040EZ, 1040SS, 1040PR, or 1040NR instructions, and/or the AOTC worksheet found in the Form 8863 instructions, or your own worksheet(s) that provides the same information, and all related forms and schedules for each credit claimed?................................................................... X 3?? Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both of the following: Interview the taxpayer, ask questions, and document the taxpayer's responses to determine that the taxpayer is eligible to claim the credit(s) Review information to determine that the taxpayer is eligible to claim the credit(s) and for what amount................................................ X 4 Did any information provided by the taxpayer, a third party, or reasonably known to you, in connection with preparing the return, appear to be incorrect, incomplete, or inconsistent? (If "," answer questions 4a and 4b. If "," go to question 5.).................................................................... a Did you make reasonable inquiries to determine the correct, complete, and consistent information?.......................................................... X b Did you document your inquiries? (Documentation should include the questions you asked, whom you asked, when you asked, the information that was provided,and the impact the information had on your preparation of the return.)................................................................... 5 Did you satisfy the record retention requirement? To meet the record retention requirement, you must keep a copy of your documentation referenced in 4b, a copy of this Form 8867, a copy of applicable worksheets, a record of how, when, and from whom the information used to prepare Form 8867 and worksheet(s) was obtained, and a copy of any document(s) provided by the taxpayer that you relied on to determine eligibility or to compute the amount for the credit(s)................................. X List those documents, if any, that you relied on. 6 7 Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for and the amount of the credit(s) claimed on the return if his/her return is selected for audit?............................................... X Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year?.................................................................... (If credits were disallowed or reduced, go to question 7a; if not, go to question 8.).... X a Did you complete the required recertification Form 8862?.......................... N/A 8 If the taxpayer is reporting self-employment income, did you ask questions to prepare a complete and correct Form 1040, Schedule C?................ X N/A BAA For Paperwork Reduction Act tice, see separate instructions. Form 8867 (2017) FDIA4312L 09/25/17

Form 8867 (2017) Homer J. and Marge A. Sampson Page 2 Part II Due Diligence Questions for Returns Claiming EIC (If the return does not claim EIC, go to Part III.) EIC CTC/ACTC AOTC 9a Have you determined that this taxpayer is, in fact, eligible to claim the EIC for the number of children for whom the EIC is claimed, or to claim EIC if the taxpayer has no qualifying child? (Skip 9b and 9c if the taxpayer is claiming EIC and does not have a qualifying child.) b Did you explain to the taxpayer that he/she may not claim the EIC if the taxpayer has not lived with the child for over half the year, even if the taxpayer has supported the child?.......................................................... c Did you explain to the taxpayer the rules about claiming the EIC when a child is the qualifying child of more than one person (tie-breaker rules)? N/A Part III Due Diligence Questions for Returns Claiming CTC and/or ACTC (If the return does not claim CTC or ACTC, go to Part IV.) 10a Did all children for whom the taxpayer is claiming the CTC/ACTC reside with the taxpayer? (If "," go to question 10c; if "," go to question 10b.)............. b Did you ask if there is an active Form 8332, Release/Revocation of Claim to Exemption for Child by Custodial Parent, or a similar statement in place and, if applicable, did you attach it to the return?......................................... c Part IV Have you determined that the taxpayer has not released the claim to another person?.................................................................. Due Diligence Questions for Returns Claiming AOTC (If the return does not claim AOTC, go to Part V.) N/A N/A 11 Did the taxpayer provide substantiation such as a Form 1098-T and/or receipts for the qualified tuition and related expenses for the claimed AOTC?......................... Part V Credit Eligibility Certification X G You have complied with all due diligence requirements with respect to the credits claimed on the return of the taxpayer identified above if you: A. Interview the taxpayer, ask adequate questions, document the taxpayer's responses on the return or in your notes, review adequate information to determine if the taxpayer is eligible to claim the credit(s) and in what amount(s); B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for all credits claimed; C. Submit Form 8867 in the manner required; and D. Keep all five of the following records for 3 years from the latest of the dates specified in the Form 8867 instructions under Document Retention. 1. A copy of Form 8867, 2. The applicable worksheet(s) or your own worksheet(s) for any credits claimed, 3. Copies of any taxpayer documents you may have relied upon to determine eligibility for and the amount of the credit(s), 4. A record of how, when, and from whom the information used to prepare this form and worksheet(s) was obtained, and 5. A record of any additional questions you may have asked to determine eligibility for and amount of the credits, and the taxpayer's answers. G If you have not complied with all due diligence requirements for all credits claimed, you may have to pay a $510 penalty for each credit for which you have failed to comply. 12 Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and complete?............................................. X Form 8867 (2017) FDIA4312L 09/25/17

Form 8582 Passive Activity Loss Limitations OMB. 1545-1008 2017 G See separate instructions. Department of the Treasury (99) G Attach to Form 1040 or Form 1041. Internal Revenue Service Attachment G Go to www.irs.gov/form8582 for instructions and the latest information. Sequence. 88 Name(s) shown on return Identifying number Homer J. and Marge A. Sampson 999-99-9999 Part I 2017 Passive Activity Loss Caution: Complete Worksheets 1, 2, and 3 before completing Part I. Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities in the instructions.) 1 a Activities with net income (enter the amount from Worksheet 1, column (a)).... 1 a 27,650. b Activities with net loss (enter the amount from Worksheet 1, column (b))....... 1 b -1,675. c d Prior years' unallowed losses (enter the amount from Worksheet 1, column (c)). Combine lines 1a, 1b, and 1c........................................................................... Commercial Revitalization Deductions From Rental Real Estate Activities Commercial revitalization deductions from Worksheet 2, column (a)............ 2 a 2 a b Prior year unallowed commercial revitalization deductions from Worksheet 2, column (b).................................................................. c Add lines 2a and 2b.................................................................................... All Other Passive Activities Activities with net income (enter the amount from Worksheet 3, column (a)).... 3 a 3 a 1 c 2 b -12,000. 1 d 2 c 13,975. b Activities with net loss (enter the amount from Worksheet 3, column (b))....... 3 b -5,000. c d Prior years' unallowed losses (enter the amount from Worksheet 3, column (c)). 3 c -17,000. Combine lines 3a, 3b, and 3c........................................................................... 3 d -22,000. 4 Combine lines 1d, 2c, and 3d. If this line is zero or more, stop here and include this form with your return; all losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Report the losses on the forms and schedules normally used.............................................................. 4 If line 4 is a loss and:? Line 1d is a loss, go to Part II.? Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III.? Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III and go to line 15. Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part II or Part III. Instead, go to line 15. Part II Special Allowance for Rental Real Estate Activities With Active Participation te: Enter all numbers in Part II as positive amounts. See instructions for an example. 5 Enter the smaller of the loss on line 1d or the loss on line 4.............................................. 5 6 Enter $150,000. If married filing separately, see instructions................... 6 7 Enter modified adjusted gross income, but not less than zero (see instrs)....... 7 151,922. te: If line 7 is greater than or equal to line 6, skip lines 8 and 9, enter -0- on line 10. Otherwise, go to line 8. 8 Subtract line 7 from line 6................................................... 8 9 Multiply line 8 by 50% (0.50). Do not enter more than $25,000. If married filing separately, see instructions.. 9 10 Enter the smaller of line 5 or line 9..................................................................... 10 If line 2c is a loss, go to Part III. Otherwise, go to line 15. Part III Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities 11 te: Enter all numbers in Part III as positive amounts. See the example for Part II in the instructions. Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions....... 11 12 Enter the loss from line 4............................................................................... 12 13 Reduce line 12 by the amount on line 10................................................................ 13 14 Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13............................. 14 Part IV Total Losses Allowed 15 Add the income, if any, on lines 1a and 3a and enter the total............................................ 15 16 Total losses allowed from all passive activities for 2017. Add lines 10, 14, and 15. See instructions to find out how to report the losses on your tax return...................................................... 16 BAA For Paperwork Reduction Act tice, see instructions. FDIZ1901L 10/16/17-8,025. 0. 27,650. 27,650. Form 8582 (2017)

Form 8582 (2017) Homer J. and Marge A. Sampson 999-99-9999 Page 2 Caution: The worksheets must be filed with your tax return. Keep a copy for your records. Worksheet 1 ' For Form 8582, Lines 1a, 1b, and 1c (See instructions.) Current year Prior years Overall gain or loss Name of activity (a) Net income (b) Net loss (c) Unallowed (line 1a) (line 1b) loss (line 1c) (d) Gain (e) Loss Residential rental 27,650. 1,675. 12,000. 13,975. Total. Enter on Form 8582, lines 1a, 1b, and 1c..................................... G 27,650. 1,675. 12,000. Worksheet 2 ' For Form 8582, Lines 2a and 2b (See instructions.) Name of activity (a) Current year deductions (line 2a) (b) Prior year unallowed deductions (line 2b) (c) Overall loss Total. Enter on Form 8582, lines 2a and 2b........................... G Worksheet 3 ' For Form 8582, Lines 3a, 3b, and 3c (See instructions.) Current year Prior years Overall gain or loss Name of activity (a) Net income (b) Net loss (c) Unallowed (line 3a) (line 3b) loss (line 3c) (d) Gain (e) Loss Rosco Real Estate, LP 5,000. 17,000. 22,000. Total. Enter on Form 8582, lines 3a, 3b, and 3c..................................... G 5,000. 17,000. Worksheet 4 ' Use this worksheet if an amount is shown on Form 8582, line 10 or 14 (See instructions.) Form or schedule (c) Special (d) Subtract Name of activity and line number (a) Loss (b) Ratio allowance column (c) from to be reported on column (a) (see instructions) Total........................................................ G 1.00 Worksheet 5 ' Allocation of Unallowed Losses (See instructions.) Form or schedule Name of activity and line number to be reported on (a) Loss (b) Ratio (c) Unallowed loss (see instructions) Rosco Real Estate, LP Sch E Ln 28 22,000. 1.000000 8,025. Total............................................................... G 22,000. 1.00 8,025. BAA FDIZ1902L 08/02/17 Form 8582 (2017)

Form 8582 (2017) Homer J. and Marge A. Sampson 999-99-9999 Page 3 Worksheet 6 ' Allowed Losses (See instructions.) Form or schedule Name of activity and line number to be reported on (a) Loss (b) Unallowed loss (c) Allowed loss (see instructions) Rosco Real Estate, LP Sch E Ln 28 22,000. 8,025. 13,975. Total............................................................... G 22,000. 8,025. 13,975. Worksheet 7 ' Activities With Losses Reported on Two or More Forms or Schedules (See instructions.) (a) (b) (c) Ratio (d) Unallowed loss (e) Allowed loss Name of activity.... Form or schedule and line number to be reported on (see instructions): 1 a Net loss plus prior year unallowed loss from form or schedule................. G b Net income from form or schedule..... G c Subtract line 1b from line 1a. If zero or less, enter -0-..... G Form or schedule and line number to be reported on (see instructions): 1 a Net loss plus prior year unallowed loss from form or schedule................. G b Net income from form or schedule..... G c Subtract line 1b from line 1a. If zero or less, enter -0-..... G Form or schedule and line number to be reported on (see instructions): 1 a Net loss plus prior year unallowed loss from form or schedule................. G b Net income from form or schedule..... G c Subtract line 1b from line 1a. If zero or less, enter -0-..... G Form or schedule and line number to be reported on (see instructions): 1 a Net loss plus prior year unallowed loss from form or schedule................. G b Net income from form or schedule..... G c Subtract line 1b from line 1a. If zero or less, enter -0-..... G Total........................................................ G 0. 1.00 Name of activity... Form or schedule and line number to be reported on (see instructions): 1 a Net loss plus prior year unallowed loss from form or schedule................. G b Net income from form or schedule..... G c Subtract line 1b from line 1a. If zero or less, enter -0-..... G Form or schedule and line number to be reported on (see instructions): 1 a Net loss plus prior year unallowed loss from form or schedule................. G b Net income from form or schedule..... G c Subtract line 1b from line 1a. If zero or less, enter -0-..... G Form or schedule and line number to be reported on (see instructions): 1 a Net loss plus prior year unallowed loss from form or schedule................. G b Net income from form or schedule..... G c Subtract line 1b from line 1a. If zero or less, enter -0-..... G Form or schedule and line number to be reported on (see instructions): 1 a Net loss plus prior year unallowed loss from form or schedule................. G b Net income from form or schedule..... G c Subtract line 1b from line 1a. If zero or less, enter -0-..... G Total........................................................ G 0. 1.00 BAA FDIZ1903L 08/02/17 Form 8582 (2017) 0. 0. 0. 0.

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Form 8829 Expenses for Business Use of Your Home G File only with Schedule C (Form 1040). Use a separate Form 8829 for each home you used for business during the year. GGo to www.irs.gov/form8829 for instructions and the latest information. OMB. 1545-0074 2017 Department of the Treasury Attachment Internal Revenue Service (99) Sequence. 176 Name(s) of proprietor(s) Your social security number Marge A. Sampson 888-88-8888 Part I Part of Your Home Used for Business 1 Area used regularly and exclusively for business, regularly for daycare, or for storage of inventory or product samples (see instructions)...................................................................... 1 300 2 Total area of home..................................................................................... 2 3,000 3 Divide line 1 by line 2. Enter the result as a percentage.................................................. 3 10.00 % For daycare facilities not used exclusively for business, go to line 4. All others, go to line 7. 4 Multiply days used for daycare during year by hours used per day.............. 4 hr 5 Total hours available for use during the year (365 days x 24 hours) (see instructions)............. 5 hr 6 Divide line 4 by line 5. Enter the result as a decimal amount................... 6 7 Business percentage. For daycare facilities not used exclusively for business, multiply line 6 by line 3 (enter the result as a percentage). All others, enter the amount from line 3........................................................................ G 7 10.00 % Part II Figure Your Allowable Deduction 8 Enter the amount from Schedule C, line 29, plus any gain derived from the business use of your home, minus any loss from the trade or business not derived from the business use of your home (see instructions). 8 See instructions for columns (a) and (b) before completing lines 9-21. 9 Casualty losses (see instructions)................. 9 10 Deductible mortgage interest (see instructions).... 10 (a) Direct expenses 11 Real estate taxes (see instructions)............... 11 12 Add lines 9, 10, and 11........................... 12 13 Multiply line 12, column (b) by line 7.............. 13 (b) Indirect expenses 2,300. 14 Add line 12, column (a) and line 13............... 14 15 Subtract line 14 from line 8. If zero or less, enter -0-.......... 15 16 Excess mortgage interest (see instructions)........ 16 17 Insurance....................................... 17 1,200. 18 Rent............................................ 18 19 Repairs and maintenance......................... 19 20 Utilities.......................................... 20 4,800. 21 Other expenses (see instructions)................. 21 22 Add lines 16 through 21.......................... 22 6,000. 23 Multiply line 22, column (b), by line 7......................................... 23 600. 24 Carryover of prior year operating expenses (see instructions).................. 24 25 Add line 22, column (a), line 23, and line 24............................................................. 25 26 Allowable operating expenses. Enter the smaller of line 15 or line 25.................................................... 26 27 Limit on excess casualty losses and depreciation. Subtract line 26 from line 15............................ 27 28 Excess casualty losses (see instructions)..................................... 28 29 Depreciation of your home from line 41 below................................. 29 30 Carryover of prior year excess casualty losses and depreciation (see instructions)................ 30 20,000. 3,000. 23,000. 1,000. 31 Add lines 28 through 30................................................................................ 31 32 Allowable excess casualty losses and depreciation. Enter the smaller of line 27 or line 31..................................... 32 33 Add lines 14, 26, and 32................................................................................ 33 34 Casualty loss portion, if any, from lines 14 and 32. Carry amount to Form 4684 (see instructions)........... 34 84,811. 2,300. 82,511. 600. 600. 81,911. 1,000. 1,000. 3,900. 35 Allowable expenses for business use of your home. Subtract line 34 from line 33. Enter here and on Schedule C, line 30. If your home was used for more than one business, see instructions.................. G 35 3,900. Part III Depreciation of Your Home 36 Enter the smaller of your home's adjusted basis or its fair market value (see instructions).................................... 36 430,000. 37 Value of land included on line 36........................................................................ 37 40,000. 38 Basis of building. Subtract line 37 from line 36........................................................... 38 390,000. 39 Business basis of building. Multiply line 38 by line 7...................................................... 39 39,000. 40 Depreciation percentage (see instructions)............................................................... 40 2.564 % 41 Depreciation allowable (see instructions). Multiply line 39 by line 40. Enter here and on line 29 above............................ 41 1,000. Part IV Carryover of Unallowed Expenses to 2018 42 Operating expenses. Subtract line 26 from line 25. If less than zero, enter -0-............................. 42 0. 43 Excess casualty losses and depreciation. Subtract line 32 from line 31. If less than zero, enter -0-.......... 43 0. BAA For Paperwork Reduction Act tice, see your tax return instructions. FDIA6902L 10/23/17 Form 8829 (2017)

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Depreciation and Amortization OMB. 1545-0172 Form 4562 (Including Information on Listed Property) 2017 G Attach to your tax return. Department of the Treasury Internal Revenue Service (99) G Go to www.irs.gov/form4562 for instructions and the latest information. Attachment 179 Name(s) shown on return Homer J. and Marge A. Sampson Business or activity to which this form relates Schedule C - Marge A. Sampson Part I Election To Expense Certain Property Under Section 179 te: If you have any listed property, complete Part V before you complete Part I. 1 Maximum amount (see instructions)..................................................................... 1 2 Total cost of section 179 property placed in service (see instructions)..................................... 2 3 Threshold cost of section 179 property before reduction in limitation (see instructions)...................... 3 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0-................................ 4 5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing separately, see instructions............................................................................. 5 6 (a) Description of property (b) Cost (business use only) (c) Elected cost See Statement 5 25,000. 7 Listed property. Enter the amount from line 29...................................... 7 0. 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7....................... 8 9 Tentative deduction. Enter the smaller of line 5 or line 8................................................. 9 10 Carryover of disallowed deduction from line 13 of your 2016 Form 4562.................................... 10 11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instrs).. 11 12 Section 179 expense deduction. Add lines 9 and 10, but don't enter more than line 11...................... 12 13 Carryover of disallowed deduction to 2018. Add lines 9 and 10, less line 12........ G 13 0. te: Don't use Part II or Part III below for listed property. Instead, use Part V. Part II 14 Sequence. Identifying number Special Depreciation Allowance and Other Depreciation (Don't include listed property.) (See instructions.) Special depreciation allowance for qualified property (other than listed property) placed in service during the tax year (see instructions).............................................................................. 15 Property subject to section 168(f)(1) election............................................................. 15 16 Other depreciation (including ACRS).................................................................... 16 Part III MACRS Depreciation (Don't include listed property.) (See instructions.) Section A 17 MACRS deductions for assets placed in service in tax years beginning before 2017......................... 17 18 If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here...................................................................... G Section B ' Assets Placed in Service During 2017 Tax Year Using the General Depreciation System (a) (b) Month and (c) Basis for depreciation (d) (e) (f) (g) Depreciation Classification of property year placed (business/investment use Recovery period Convention Method deduction in service only ' see instructions) 19 a 3-year property.......... b 5-year property.......... c 7-year property.......... d 10-year property......... e 15-year property......... 999-99-9999 f 20-year property......... g 25-year property......... 25 yrs S/L h Residential rental 27.5 yrs MM S/L property................. 27.5 yrs MM S/L i nresidential real 39 yrs MM S/L property................. MM S/L Section C ' Assets Placed in Service During 2017 Tax Year Using the Alternative Depreciation System 20a Class life................ S/L b 12-year.................. 12 yrs S/L c 40-year.................. 40 yrs MM S/L Part IV Summary (See instructions.) 21 Listed property. Enter amount from line 28............................................................. 21 22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations ' see instructions..................................... 22 25,000. 23 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs........................ 23 BAA For Paperwork Reduction Act tice, see separate instructions. FDIZ0812L 08/15/17 Form 4562 (2017) 14 510,000. 25,000. 2,030,000. 0. 510,000. 25,000. 25,000. 0. 235,963. 25,000.

Form 4562 (2017) Homer J. and Marge A. Sampson 999-99-9999 Page 2 Part V Listed Property (Include automobiles, certain other vehicles, certain aircraft, certain computers, and property used for entertainment, recreation, or amusement.) te: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable. Section A ' Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.) 24 a Do you have evidence to support the business/investment use claimed?.......... X 24b If ',' is the evidence written?...... X (a) (b) (c) (d) (e) (f) (g) (h) Type of property Business/ Cost or Basis for depreciation Recovery Method/ Depreciation Elected Date placed (list vehicles first) in service investment other basis (business/investment period Convention deduction section 179 use percentage use only) cost 25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 50% in a qualified business use (see instructions)............................... 26 Property used more than 50% in a qualified business use: Automobile 1/01/10 72.75 25 (i) 27 Property used 50% or less in a qualified business use: 28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1............... 28 0. 29 Add amounts in column (i), line 26. Enter here and on line 7, page 1.............................................. 29 Section B ' Information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner,' or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. 0. (a) (b) (c) (d) (e) (f) 30 Total business/investment miles driven Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6 during the year (don't include commuting miles)......................... 10,516 31 Total commuting miles driven during the year........ 32 33 Total other personal (noncommuting) miles driven.............................. Total miles driven during the year. Add lines 30 through 32........................ Was the vehicle available for personal use 34 during off-duty hours?..................... Was the vehicle used primarily by a more 35 than 5% owner or related person?......... Is another vehicle available for 36 personal use?............................ 14,455 X X X 3,939 Section C ' Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who aren't more than 5% owners or related persons (see instructions). Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, 37 by your employees?............................................................................................... Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your 38 employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners.............. 39 Do you treat all use of vehicles by employees as personal use?...................................................... 40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received?....................................................................... 41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.)................. te: If your answer to 37, 38, 39, 40, or 41 is ',' don't complete Section B for the covered vehicles. Part VI Amortization (a) (b) (c) (d) (e) (f) Description of costs 42 Amortization of costs that begins during your 2017 tax year (see instructions): Date amortization Amortizable Code Amortization Amortization begins amount section period or for this year percentage 43 Amortization of costs that began before your 2017 tax year.............................................. 43 44 Total. Add amounts in column (f). See the instructions for where to report............................... 44 FDIZ0812L 08/15/17 Form 4562 (2017)

2017 Federal Statements Page 1 Homer J. and Marge A. Sampson 999-99-9999 Statement 1 Form 1040 Wage Schedule Federal Medi- State Local Taxpayer - Employer Wages W/H FICA care W/H W/H Buckeye Publsishing, Inc 80,000. 15,000. 5,282. 1,235. 3,000. Grand Total 80,000. 15,000. 5,282. 1,235. 3,000. 0. Statement 2 Schedule E, Line 19-1 Woody Hayes Blvd, Other Rental and Royalty Expenses Association Dues................................................................................. $ 1,200. Total $ 1,200.

2017 Federal Statements Page 2 Homer J. and Marge A. Sampson 999-99-9999 Statement 3 Schedule E, Line 31 Basis Limitation Activity Name: Rosco Real Estate, LP Adjusted basis at beginning of year 30,000. Additional amounts invested in current year Current year distributions of money Current year distribution of property Change in partner's share of liabilities -2,000. Current year income from partnership 0. Adjusted basis used for basis limitation 28,000. Loss allowed by basis limitation 5,000. Adjusted basis at end of year 23,000. Income or Loss (C) (A) (B) Loss Current Year Prior Year Allowable (D) loss or Unallowed by Basis Basis deduction Basis Loss Limitation Carryover RRE Income (Loss) 5,000. 5,000. Regular Tax 5,000. 0. 5,000. 0. Deductions Regular Tax 0. 0. 0. 0. Alternative Minimum Tax Alt min tax beginning basis 30,000. Alt min tax income Current year adjustments to basis -2,000. Alt min tax basis used for limitation 28,000. Loss allowed by Alt min tax basis 5,000. Alt min tax final basis 23,000. Alt Min Tax Ordinary Income (Loss) 5,000. 0. Total $ 5,000. $ 0.

2017 Federal Statements Page 3 Homer J. and Marge A. Sampson 999-99-9999 Statement 3 Schedule E, Line 31 Basis Limitation Activity Name: Buckeye Publishing, Inc Stock basis at beginning of year 25,000. Additional amounts invested in current year Current year distributions -40,000. Current year income from S Corporation 30,000. Less income used to restore debt basis Stock basis used for basis limitation 15,000. Loss allowed by basis limitation 1,000. Stock basis at end of year 14,000. Principal amount of debt S Corp owes to shareholder at beginning of year Debt basis 0. Income used to restore debt basis Loans made to S Corp during the year Loan repayments Debt basis used for basis limitation 0. Loss allowed by basis limitation 0. Debt basis at end of year 0. Principal amount of debt S Corp owes to shareholder at end of year Income or Loss (C) (A) (B) Loss Current Year Prior Year Allowable (D) loss or Unallowed by Basis Basis deduction Basis Loss Limitation Carryover Regular Tax 0. 0. 0. 0. Deductions ndeductible Expenses 1,000. 1,000. Regular Tax 1,000. 0. 1,000. 0. Alternative Minimum Tax Alt min tax beginning basis 25,000. Alt min tax income 30,000. Current year adjustments to basis -40,000. Alt min tax basis used for limitation 15,000. Loss allowed by Alt min tax basis 1,000. Alt min tax final basis 14,000. Alt Min Tax ndeductible Expenses 1,000. 0. Total $ 1,000. $ 0.

2017 Federal Statements Page 4 Homer J. and Marge A. Sampson 999-99-9999 (C) (E) (G) (A) (B) Disallowed (D) Disallowed (F) Disallowed Current Prior Year due to Prior Year due to Prior Year due to Year unallowed Basis unallowed at-risk unallowed Passive loss (H) Amount Basis loss Limitation At-risk loss Limitation Passive loss Limitations Tax return RRE Income (Loss) -5,000. Net Income (Loss) -5,000. 0. 0. 0. 0. -17,000. 8,025. -13,975. Total Schedule E page 2-5,000. 0. 0. 0. 0. -17,000. 8,025. -13,975. (C) (E) (G) (A) (B) Disallowed (D) Disallowed (F) Disallowed Current Prior Year due to Prior Year due to Prior Year due to Year unallowed Basis unallowed at-risk unallowed Passive loss (H) Amount Basis loss Limitation At-risk loss Limitation Passive loss Limitations Tax return Ordinary Income (Loss) 30,000. Net Income (Loss) 30,000. 0. 0. 0. 0. 30,000. Total Schedule E page 2 30,000. 0. 0. 0. 0. 0. 0. 30,000. ndeductible expenses 1,000. 1,000. Statement 4 Schedule E, Line 31 Schedule of Loss Limitations Activity Name: Rosco Real Estate, LP Statement 4 Schedule E, Line 31 Schedule of Loss Limitations Activity Name: Buckeye Publishing, Inc

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