2016 TAX RETURN Government Copy Client: JUSTANS1 Prepared for: Bill and Joyce Schnappauf 27 Northup Street Wakefield, RI 02879 Prepared by: Roger J Yule R. J. Yule & Company, Ltd. 10179 Lincoln Highway Frankfort, IL 60423-1274 (815) 806-1040 Date: October 8, 2017 Comments: Route to: FDIL2001L 09/01/16
Mail to: P.O. Box 37007 Hartford, CT 06176-7007 I Detach Here and Mail With Your Payment I Calendar Year ' Due 4/18/2017 2017 Form 1040-ES Payment Voucher 1 File only if you are making a payment of estimated tax by check or money order. Mail this voucher with your check or money order payable to the 'United States Treasury.' Write your social security number and '2017 Form 1040-ES' on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher. 371-42-5207 BILL SCHNAPPAUF JOYCE SCHNAPPAUF 27 NORTHUP STREET WAKEFIELD, RI 02879 Amount of estimated tax you are paying by check or money order.......... G 1030 FDIA1901L 08/11/16 81 INTERNAL REVENUE SERVICE PO BOX 37007 HARTFORD CT 06176-7007 150520546 RH SCHN 30 0 201712 430
Mail to: P.O. Box 37007 Hartford, CT 06176-7007 I Detach Here and Mail With Your Payment I Calendar Year ' Due 6/15/2017 2017 Form 1040-ES Payment Voucher 2 File only if you are making a payment of estimated tax by check or money order. Mail this voucher with your check or money order payable to the 'United States Treasury.' Write your social security number and '2017 Form 1040-ES' on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher. 371-42-5207 BILL SCHNAPPAUF JOYCE SCHNAPPAUF 27 NORTHUP STREET WAKEFIELD, RI 02879 Amount of estimated tax you are paying by check or money order.......... G 1030 FDIA1902L 08/11/16 81 INTERNAL REVENUE SERVICE PO BOX 37007 HARTFORD CT 06176-7007 150520546 RH SCHN 30 0 201712 430
Mail to: P.O. Box 37007 Hartford, CT 06176-7007 I Detach Here and Mail With Your Payment I Calendar Year ' Due 9/15/2017 2017 Form 1040-ES Payment Voucher 3 File only if you are making a payment of estimated tax by check or money order. Mail this voucher with your check or money order payable to the 'United States Treasury.' Write your social security number and '2017 Form 1040-ES' on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher. 371-42-5207 BILL SCHNAPPAUF JOYCE SCHNAPPAUF 27 NORTHUP STREET WAKEFIELD, RI 02879 Amount of estimated tax you are paying by check or money order.......... G 1030 FDIA1904L 08/11/16 81 INTERNAL REVENUE SERVICE PO BOX 37007 HARTFORD CT 06176-7007 150520546 RH SCHN 30 0 201712 430
Mail to: P.O. Box 37007 Hartford, CT 06176-7007 I Detach Here and Mail With Your Payment I Calendar Year ' Due 1/16/2018 2017 Form 1040-ES Payment Voucher 4 File only if you are making a payment of estimated tax by check or money order. Mail this voucher with your check or money order payable to the 'United States Treasury.' Write your social security number and '2017 Form 1040-ES' on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher. 371-42-5207 BILL SCHNAPPAUF JOYCE SCHNAPPAUF 27 NORTHUP STREET WAKEFIELD, RI 02879 Amount of estimated tax you are paying by check or money order.......... G 1030 FDIA1905L 02/01/17 81 INTERNAL REVENUE SERVICE PO BOX 37007 HARTFORD CT 06176-7007 150520546 RH SCHN 30 0 201712 430
File only if you are making a payment with Form 104 Return this voucher with check or money order payable to the "United States Treasury." Please write your social security number, daytime phone number, and " 2016 Form 1040" on your check or money order. Please do not send cash. Enclose, but do not staple or attach, your payment with this voucher. ----------------------------------------------------------------------------------------Make your check payable to the "United States Treasury" and mail Form 1040-V payments with your return to: P.O. Box 37008 Hartford, CT 06176-7008 I Detach Here and Mail With Your Payment and Return I 2016 (99) G Use this voucher when making a payment with Form 104 G Do not staple this voucher or your payment to Form 104 G Make your check or money order payable to the 'United States Treasury.' G Write your social security number (SSN) on your check or money order. BILL & JOYCE SCHNAPPAUF 27 NORTHUP STREET WAKEFIELD RI 02879 Form 1040-V (2016) Form 1040-V Payment Voucher Enter the amount of your payment......... G 1030 FDIA8601L 08/11/16 INTERNAL REVENUE SERVICE P.O. BOX 37008 HARTFORD CT 06176-7008 150520546 RH SCHN 30 0 201612 610 633.
Form 1040 ' (99) U.S. Individual Income Tax Return For the year Jan. 1 - Dec. 31, 2016, or other tax year beginning 2016, 2016, ending Your first name and initial OMB No. 1545-0074 IRS Use Only, 20 See separate instructions. Last name Your social security number Bill Schnappauf If a joint return, spouse's first name and initial Last name Spouse's social security number Joyce Schnappauf 371-42-5207 Home address (number and street). If you have a P.O. box, see instructions. Apt. no. 27 Northup Street City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Wakefield, RI 02879 Foreign country name Filing Status Check only one box. Exemptions Foreign province/state/county 1 2 3 Single 4 X Married filing jointly (even if only one had income) Married filing separately. Enter spouse's SSN above & full name here.. G 5 Foreign postal code J Make sure the SSN(s) above and on line 6c are correct. Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund. You Spouse Head of household (with qualifying person). (See instructions.) If the qualifying person is a child but not your dependent, enter this child's name here.. G Qualifying widow(er) with dependent child 6a X Yourself. If someone can claim you as a dependent, do not check box 6a........... b X Spouse......................................................................... c Dependents: (1) First name If more than four dependents, see instructions and check here... G ' Do not write or staple in this space. Will Schnappauf Dan Schnappauf Tom Schnappauf Boxes checked on 6a and 6b... No. of children on 6c who: 2 (4) b if child under? lived with you...... age 17 qualifying for child tax credit? did not Last name (see instructions) live with you due to divorce or separation (see instructions).. Dependents on 6c not entered above.. Add numbers on lines claimed........................................................ above...... G (2) Dependent's social security number (3) Dependent's relationship to you 372-46-2611 Son 377-42-3411 Son 375-49-6511 Son 3 X d Total number of exemptions 7 Wages, salaries, tips, etc. Attach Form(s) W-2......................................... 7 Income 8 a Taxable interest. Attach Schedule B if required........................................ 8a b Tax-exempt interest. Do not include on line 8a.............. 8b 1,665. 9 a Ordinary dividends. Attach Schedule B if required...................................... 9a Attach Form(s) b Qualified dividends........................................ 9b 2,149. W-2 here. Also attach Forms 10 Taxable refunds, credits, or offsets of state and local income taxes..................... 10 W-2G and 1099-R 11 Alimony received.................................................................... 11 if tax was withheld. 12 Business income or (loss). Attach Schedule C or C-EZ................................. 12 If you did not 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here.......... G X 13 get a W-2, 14 Other gains or (losses). Attach Form 4797............................................. 14 see instructions. 15 a IRA distributions............ 15 a b Taxable amount............. 15 b 16 a Pensions and annuities..... 16 a b Taxable amount............. 16 b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. 17 18 Farm income or (loss). Attach Schedule F............................................. 18 19 Unemployment compensation........................................................ 19 20 a Social security benefits.......... 20 a b Taxable amount............. 20 b 21 Other income. List type and amountsee Statement 2 21 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income............. G 22 23 Educator expenses....................................... 23 Adjusted 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ.................... 24 Gross 25 Health savings account deduction. Attach Form 8889........ 25 Income 26 Moving expenses. Attach Form 3903....................... 26 27 Deductible part of self-employment tax. Attach Schedule SE.............. 27 28 Self-employed SEP, SIMPLE, and qualified plans........... 28 29 Self-employed health insurance deduction.................. 29 30 Penalty on early withdrawal of savings..................... 30 31 a Alimony paid b Recipient's SSN.... G 31 a 32 IRA deduction............................................ 32 33 Student loan interest deduction............................ 33 34 Tuition and fees. Attach Form 8917........................ 34 35 Domestic production activities deduction. Attach Form 8903.............. 35 36 Add lines 23 through 35................................................................... 36 37 Subtract line 36 from line 22. This is your adjusted gross income..................... G 37 BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. FDIA0112L 12/05/16 5 152,272. 2,129. 2,149. 818. 105. 6,505. 7,345. 171,323. 171,323. Form 1040 (2016)
Form 1040 (2016) Tax and Credits Standard Deduction for '? People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions.? All others: Single or Married filing separately, $6,300 Married filing jointly or Qualifying widow(er), $12,600 Head of household, $9,300 Other Taxes Payments If you have a qualifying child, attach Schedule EIC. Refund Direct deposit? See instructions. Amount You Owe Third Party Designee Sign Here Joint return? See instructions. Keep a copy for your records. Bill and Joyce Schnappauf 38 Amount from line 37 (adjusted gross income).......................................... 39 a Check You were born before January 2, 1952, Blind. Total boxes Spouse was born before January 2, 1952, if: Blind. checked G 39 a b If your spouse itemizes on a separate return or you were a dual-status alien, check here......... G 39 b Itemized deductions (from Schedule A) or your standard deduction (see left margin).................... Subtract line 40 from line 38.......................................................... Exemptions. If line 38 is $155,650 or less, multiply $4,050 by the number on line 6d. Otherwise, see instrs...... Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-....................................................... 44 Tax (see instructions). Check if any from: a c Form(s) 8814 b Form 4972........................... 45 Alternative minimum tax (see instructions). Attach Form 6251.......................... 46 Excess advance premium tax credit repayment. Attach Form 8962...................... 47 Add lines 44, 45, and 46........................................................... G 48 Foreign tax credit. Attach Form 1116 if required............. 48 49 Credit for child and dependent care expenses. Attach Form 2441.......... 49 50 Education credits from Form 8863, line 19.................. 50 51 Retirement savings contributions credit. Attach Form 888.. 51 52 Child tax credit. Attach Schedule 8812, if required.......... 52 53 Residential energy credits. Attach Form 5695............... 53 40 41 42 43 54 Other crs from Form: a 54 3800 b 8801 c 55 Add lines 48 through 54. These are your total credits.................................. 56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0-.................. G 57 Self-employment tax. Attach Schedule SE...................................................... 58 Unreported social security and Medicare tax from Form: a 8919....................... 4137 b 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required................... 60 a Household employment taxes from Schedule H........................................ b First-time homebuyer credit repayment. Attach Form 5405 if required................... X... 61 Health care: individual responsibility (see instructions) Full-year coverage 62 Taxes from: a Form 8959 b Form 8960 c Instrs; enter code(s) 63 Add lines 56 through 62. This is your total tax................................................ G 64 Federal income tax withheld from Forms W-2 and 1099..... 64 25,302. 65 2016 estimated tax payments and amount applied from 2015 return........ 65 66 a Earned income credit (EIC)............................... 66 a b Nontaxable combat pay election..... G 66 b 67 Additional child tax credit. Attach Schedule 8812............ 67 68 American opportunity credit from Form 8863, line 8......... 68 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 73 2439 b Reserved c 8885 d 74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments............................. G 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid............... 76 a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here.. G G b Routing number........ G c Type: Checking Savings G d Account number........ 77 Amount of line 75 you want applied to your 2017 estimated tax........ G 77 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions............... G 79 Estimated tax penalty (see instructions).................... 79 Do you want to allow another person to discuss this return with the IRS (see instructions)?........... Designee's name G Roger FDIA0112L 12/05/16 Phone no. J Yule G (815) 40 41 42 12,60 158,723. 20,25 43 138,473. 44 45 46 47 25,935. 25,935. 55 56 57 58 59 60 a 60 b 61 62 63 25,935. 25,935. 25,302. 74 75 76 a 633. 78 X Yes. Complete below. 806-1040 Personal identification number (PIN) No G 20060 Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date Your occupation Daytime phone number A Spouse's signature. If a joint return, both must sign. Sales Manager Date If the IRS sent you an Identity Protection PIN, enter it here (see inst.) Spouse's occupation Author Print/Type preparer's name Paid Preparer Use Only Page 2 38 171,323. Preparer's signature Roger J Yule Roger J Yule Firm's name G R. J. Yule & Company, Ltd. Firm's address G 10179 Lincoln Highway Frankfort, IL 60423-1274 Date 10/08/17 Check PTIN if P00449921 self-employed 36-4087407 (815) 806-1040 Firm's EIN G Phone no. Form 1040 (2016)
SCHEDULE B OMB No. 1545-0074 Interest and Ordinary Dividends (Form 1040A or 1040) (Rev. January 2017) (99) 2016 G Attach to Form 1040A or 104 G Information about Schedule B and its instructions is at www.irs.gov/scheduleb. Name(s) shown on return Attachment Sequence No. 08 Your social security number Bill and Joyce Schnappauf Amount 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used Part I the property as a personal residence, see instructions on back and list this interest first. Also, show that buyer's social security number and address G Interest Hawthorne Savings Bank Pebble Beach Investors as Nominee United Insurance Corporation Wakefield Bank (See instructions for Form 1040A, or Form 1040, line 8a.) Note: If you received a Form 1099-INT, Form 1099-OID, or substitute statement from a brokerage firm, list the firm's name as the payer and enter the total interest shown on that form. 1 2 3 Add the amounts on line 1............................................................. Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815............................................................................ 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a.................. G Note: If line 4 is over $1,500, you must complete Part III. Part II 417. 717. 38 615. 5 2,129. 2 3 4 2,129. Amount List name of payer G Coca-Cola Corporation Collingwood Capital Fund Pebble Beach Investors as Nominee Ordinary Dividends 1,372. 176. 601. (See instructions on back and the instructions for Form 1040A, or Form 1040, line 9a.) Note: If you received a Form 1099-DIV or substitute statement from a brokerage firm, list the firm's name as the payer and enter the ordinary dividends shown on that form. 5 6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a................... G Note: If line 6 is over $1,500, you must complete Part III. 6 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. Part III Foreign Accounts and Trusts (See instructions on back.) 7a At any time during 2016, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign country? See instructions........................................................................................ If 'Yes,' are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those requirements...................................................... b If you are required to file FinCEN Form 114, enter the name of the foreign country where the financial 2,149. Yes No X account is located G 8 During 2016, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If 'Yes,' you may have to file Form 352 See instructions on back.......................................... X BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA0401L 01/13/17 Schedule B (Form 1040A or 1040) 2016
Schedule E (Form 1040) 2016 Attachment Sequence No. 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 Bill and Joyce Schnappauf 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 Note: 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 'Yes,' see instructions before completing this section........................ 28 A B C D (b) Enter P for partnership; S for S corporation (a) Name B&F Antique Restoration S Passive Income and Loss (f) Passive loss allowed (attach Form 8582 if required) (c) Check if foreign partnership (g) Passive income from Schedule K-1 Yes (d) Employer identification number Nonpassive Income and Loss (i) Section 179 (j) Nonpassive (h) Nonpassive loss expense deduction income from from Schedule K-1 from Form 4562 Schedule K-1 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 (e) Check if any amount is not at risk 05-7652473 A 62 B C D 29 a Totals................ b Totals................ 62 30 Add columns (g) and (j) of line 29a...................................................................... 30 31 Add columns (f), (h), and (i) of line 29b................................................................. 31 32 X No 7,125. 7,125. 7,125. -62 6,505. 32 Income or Loss From Estates and Trusts 33 (a) Name (b) Employer ID no. A B Passive Income and Loss Nonpassive Income and Loss (c) Passive deduction or loss allowed (attach Form 8582 if required) (d) Passive income from Schedule K-1 (e) Deduction or loss from Schedule K-1 A B 34 a Totals..................................... b Totals..................................... 35 Add columns (d) and (f) of line 34a..................................................................... 36 Add columns (c) and (e) of line 34b..................................................................... 35 36 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 37 Part IV 38 Income or Loss From Real Estate Mortgage Investment Conduits (REMICs) ' Residual Holder (a) Name (b) Employer identification number (c) Excess inclusion from Schedules Q, line 2c (see instructions) (d) Taxable income (net loss) from Schedules Q, line 1b 39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below........... Part V Net farm rental income or (loss) from Form 4835. Also, complete line 42 below............................ 41 Total income or (loss). Combine lines 26, 32, 37, 39, and 4 Enter the result here and on Form 1040, line 17, or Form 1040NR, line 18.......................................................... 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 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 43 BAA (e) Income from Schedules Q, line 3b 39 Summary 40 42 (f) Other income from Schedule K-1 FDIZ2302L 08/23/16 40 G 41 6,505. Schedule E (Form 1040) 2016
Form 4562 OMB No. 1545-0172 Depreciation and Amortization (Including Information on Listed Property) (99) 2016 G Attach to your tax return. G Information about Form 4562 and its separate instructions is at www.irs.gov/form4562. Attachment Sequence No. 179 Name(s) shown on return Identifying number Bill and Joyce Schnappauf Business or activity to which this form relates Part I - Summary Election To Expense Certain Property Under Section 179 Part I Note: If you have any listed property, complete Part V before you complete Part I. 1 2 3 4 5 6 Maximum amount (see instructions)..................................................................... Total cost of section 179 property placed in service (see instructions)..................................... Threshold cost of section 179 property before reduction in limitation (see instructions)...................... Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0-................................ Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing separately, see instructions............................................................................. (a) Description of property (b) Cost (business use only) (c) Elected cost From Schedule K-1 2,010,00 5 500,00 62 7 Listed property. Enter the amount from line 29...................................... 7 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7....................... 9 Tentative deduction. Enter the smaller of line 5 or line 8................................................. 10 Carryover of disallowed deduction from line 13 of your 2015 Form 4562.................................... 11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instrs).. 12 Section 179 expense deduction. Add lines 9 and 10, but don't enter more than line 11...................... 13 Carryover of disallowed deduction to 2017. Add lines 9 and 10, less line 12........ G 13 Note: Don't use Part II or Part III below for listed property. Instead, use Part V. Part II 500,00 1 2 3 4 8 9 10 11 12 62 62 159,397. 62 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............................................................. 16 Other depreciation (including ACRS).................................................................... 14 Part III 14 15 16 MACRS Depreciation (Don't include listed property.) (See instructions.) Section A 17 MACRS deductions for assets placed in service in tax years beginning before 2016......................... 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...................................................................... (a) 17 G Section B ' Assets Placed in Service During 2016 Tax Year Using the General Depreciation System (c) Basis for depreciation (b) Month and (d) (e) (f) Classification of property year placed in service 19 a 3-year property.......... b 5-year property.......... c 7-year property.......... d 10-year property......... e 15-year property......... f 20-year property......... g 25-year property......... h Residential rental (business/investment use only ' see instructions) Recovery period 25 yrs 27.5 yrs 27.5 yrs 39 yrs Convention Method MM MM MM MM MM (g) Depreciation deduction property................. i Nonresidential real property................. Section C ' Assets Placed in Service During 2016 Tax Year Using the Alternative Depreciation System 20 a Class life................ b 12-year.................. c 40-year.................. Part IV 21 22 12 yrs 40 yrs Summary (See instructions.) Listed property. Enter amount from line 28............................................................. 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..................................... 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 Notice, see separate instructions. FDIZ0812L 01/24/17 21 22 Form 4562 (2016)
2016 Federal Statements Page 1 Bill and Joyce Schnappauf 10/08/17 12:20AM Statement 1 Form 1040 Wage Schedule Taxpayer - Employer USC Equipment Corp Grand Total Wages 152,272. 152,272. Federal W/H 23,871. 23,871. FICA Medicare 7,347. 7,347. 2,208. 2,208. State W/H 5,577. 5,577. Local W/H Statement 2 Form 1040, Line 21 Other Income Gambling Winnings............................................................................... $ PTO Service Award............................................................................... Radio Station Prize - Cash.................................................................. Radio Station Prize - Tablet............................................................... Total $ 6,20 25 30 595. 7,345.