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2012 MBD Fed State Returns Pw

2012 MBD Fed State Returns Pw

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Published by: Rachel E. Stassen-Berger on Nov 12, 2013
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, 20(4) if childunder age 17qualifying for childtax credit
(99)IRS Use Only - Do not write or staple in this space.OMB No. 1545-0074For the year Jan. 1-Dec. 31, 2012, or other tax year beginning, 2012, endingYour social security numberSpouse's social security numberMake sure the SSN(s) aboveand on line 6c are correct.Presidential Election CampaignCity, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below.Check here if you, or your spouseif filing jointly, want $3 to go tothis fund. Checking a box belowwill not change your tax or refund.Boxes checked on 6a and 6bNo. of childrenon 6c who:(3) Dependent'srelationship toyou(2) Dependent's socialsecurity numberlived with you did not live withyou due to divorceor separation(see instructions)(1) First name Last nameDependents on 6cnot entered above Add numberson linesaboveCertain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ21000101-11-13Form (2012)
See separate instructions.
123456a b Yourself.Spouse do notcDependents:d778a8abTaxable 8bTax-exemptDo not Attach Form(s) W-2 here. Alsoattach Forms W-2G and1099-R if tax was withheld.9a9ab9b101112131415a16a17181920a21101112131415b16b15a16abb17181920b20abForm 1040-V.212222total income2324252627282930232425262728293031a3233343531a32b33343536373637adjusted gross income1040
 YouSpouseFor Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
        F      o      r      m
Your first name and initialLast nameIf a joint return, spouse's first name and initialLast nameHome address (number and street). If you have a P.O. box, see instructions.Apt. no.Foreign country nameForeign province/state/countyForeign postal codeSingleMarried filing jointly (even if only one had income)Married filing separately. Enter spouse's SSN aboveand full name here.Head of household (with qualifying person). If the qualifyingperson is a child but not your dependent, enter this child'sname here.Check onlyone box.Qualifying widow(er) with dependent childIf someone can claim you as a dependent, check box 6a~~~~~~~~~~~~~~~~•••••••••••••••••••••••••••••••••••••••••••••If more than fourdependents, seeinstructions andcheck hereTotal number of exemptions claimed••••••••••••••••••••••••••••••••••••Wages, salaries, tips, etc. Attach Form(s) W-2~~~~~~~~~~~~~~~~~~~~~~~~~~interest. Attach Schedule B if required~~~~~~~~~~~~~~~~~~~~~~~~~~interest.include on line 8a~~~~~~~~~~~Ordinary dividends. Attach Schedule B if required~~~~~~~~~~~~~~~~~~~~~~~~~Qualified dividends~~~~~~~~~~~~~~~~~~~~~~~Taxable refunds, credits, or offsets of state and local income taxes~~~~~~~~~~~~~~~~~~Alimony receivedBusiness income or (loss). Attach Schedule C or C-EZCapital gain or (loss). Attach Schedule D if required. If not required, check here~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|If you did notget a W-2,see instructions.Other gains or (losses). Attach Form 4797~~~~~~~~~~~~~~~~~~~~~~~~~~~~IRA distributionsPensions and annuities~~~~~~~Taxable amountTaxable amount~~~~~~~~~~~~~~~~Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule EFarm income or (loss). Attach Schedule F~~~~~~~~Enclose, but donot attach, anypayment. Also,please use~~~~~~~~~~~~~~~~~~~~~~~~~~~~Unemployment compensation~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Social security benefits~~~~Taxable amount~~~~~~Other income. List type and amountCombine the amounts in the far right column for lines 7 through 21. This is your •••|~~~~~~~~~~~~~~~~~~~~~~~Educator expenses~~~~~~~~~~~~~~~~~Health savings account deduction. Attach Form 8889~~~~~~~~Moving expenses. Attach Form 3903~~~~~~~~~~~~~~~Deductible part of self-employment tax. Attach Schedule SE~~~~~~Self-employed SEP, SIMPLE, and qualified plans~~~~~~~~~~Self-employed health insurance deduction~~~~~~~~~~~~~Penalty on early withdrawal of savings~~~~~~~~~~~~~~~Alimony paidRecipient's SSN |IRA deductionStudent loan interest deductionTuition and fees. Attach Form 8917~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Domestic production activities deduction. Attach Form 8903~~~~~Add lines 23 through 35~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~••••••••••••••|Subtract line 36 from line 22. This is your
U.S. Individual Income Tax ReturnFiling StatusExemptionsIncome AdjustedGrossIncome
1040 2012
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MARK B.DAYTON***-**-****80 S. 8TH ST., 1800 IDS CENTERMINNEAPOLIS, MN 55402-4523XX11116,125.92,381.86,088.4,437.130,291.0.343,234.343,234.
Form 1040 (2012)PageStandardDeduction for -People whocheck anybox on line39a or 39bwho can beclaimed as adependent. All others:Single orMarried filingseparately,$5,950Married filingjointly orQualifyingwidow(er),$11,900Head ofhousehold,$8,700If you havea qualifyingchild, attachSchedule EIC.Direct deposit?See instructions.namePersonal identificationnumber (PIN)Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.Daytime phone numberYour signatureDateYour occupationJoint return?See instructions.Keep a copyfor yourrecords.Spouse's occupationDateSpouse's signature. If a joint return, must sign.If the IRS sent you an IdentityProtection PIN,enter it hereCheckself-employedifPTINPrint/Type preparer's namePreparer's signatureDateFirm's nameFirm's EINPhone no.21000201-11-13Firm's address
2383839aYouTotal boxeschecked39aSpouse39bb40414243444546Itemized deductions or standard deduction 40or414243444546Exemptions.Taxable income.cTax.ab Alternative minimum tax.47484950515247484950515253bca53545556575859a b6061 total credits54555657ab5859a59b6061total tax 6263646566676869707172626364a65666768697071abEarned income credit (EIC)64babcd total payments727374a73overpaid74 ab refunded to you. cd757677 applied to your 2013 estimated tax75 Amount you owe.7677 Yes.Noboth
Amount from line 37 (adjusted gross income)•••••••••••••••••••••••••••••Checkif: were born before January 2, 1948,Blind. was born before January 2, 1948,Blind.~If your spouse itemizes on a separate return or you were a dual-status alien, check here~~¥(from Schedule A) your (see left margin)~~~~~~~~~~~Subtract line 40 from line 38~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Multiply $3,800 by the number on line 6d~~~~~~~~~~~~~~~~~~~~~~~~~ Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-~~~~~~~~~~~ Check if any from:Form(s) 8814Form 4972962 election~~~~~~~~Attach Form 6251~~~~~~~~~~~~~~~~~~~~~~~~~~~~~¥Add lines 44 and 45••••••••••••••••••••••••••••••••••••••|Foreign tax credit. Attach Form 1116 if required~~~~~~~~~~~~~Credit for child and dependent care expenses. Attach Form 2441~~~~~~Education credits from Form 8863, line 19~~~~~~~~~~~~~~~Retirement savings contributions credit. Attach Form 8880~~~~~~~~Child tax credit. Attach Schedule 8812, if required~~~~~~~~~~~~Residential energy credits. Attach Form 5695~~~~~~~~~~~~~~Other credits from Form:38008801Add lines 47 through 53. These are your~~~~~~~~~~~~~~~~~~~~~~~~~~Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-•••••••••••••••••|Self-employment tax. Attach Schedule SE~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~41378919~~~~~~~~~~~Unreported social security and Medicare tax from Form:Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required~~~~~~~~~~Household employment taxes from Schedule HFirst-time homebuyer credit repayment. Attach Form 5405 if required~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Other taxes. Enter code(s) from instructionsAdd lines 55 through 60. This is your••••••••••••••••••|Federal income tax withheld from Forms W-2 and 1099~~~~~~~~~~2012 estimated tax payments and amount applied from 2011 return~~~~••••••••••••••••••••••Nontaxable combat pay election~~~~~Additional child tax credit. Attach Schedule 8812~~~~~~~~~~~~American opportunity credit from Form 8863, line 8~~~~~~~~~~~Reserved~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Amount paid with request for extension to file~~~~~~~~~~~~~~Excess social security and tier 1 RRTA tax withheldCredit for federal tax on fuels. Attach Form 4136~~~~~~~~~~~~~~~~~~~~~~~~Credits from Form:243988018885~Add lines 62, 63, 64a, and 65 through 71. These are your|If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you~~~~~~~~~|••••••••Amount of line 73 you wantIf Form 8888 is attached, check here|||Amount of line 73 you want Subtract line 72 from line 61. For details on how to pay, see instructions~~~~~~~|Estimated tax penalty (see instructions)••••••••••••••••Do you want to allow another person to discuss this return with the IRS (see instructions)?Complete below.|||
Tax andCreditsOtherTaxesPaymentsRefund Amount You OweThird Party DesigneeSignHerePaidPreparerUse Only 
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MARK B. DAYTON***-**-****343,234.X139,830.303,404.3,800.299,604.49,415.14,742.64,157.64,157.6,260.70,417.24,309.48,295.17,600.90,204.19,787.19,787.XLESLIE KUEHN612-339-715136820LORI HUMELORI HUMEP01263847 WIPFLI, LLP**-*******7601 FRANCE AVENUE S. #400952-548-3400MINNEAPOLIS, MN 55435
OMB No. 1545-0074 AttachmentSequence No.Department of the TreasuryInternal Revenue Service(99)Name(s) shown on Form 1040Your social security number219501 01-11-13
Information about Schedule A and its separate instructions is at . Attach to Form 1040.Caution.12313 2445678 (check only one box):abor567899101213101112131411Note.14151516171819161718must 1920Casualty andTheft Losses20212223Job Expensesand CertainMiscellaneousDeductions2122232424252627 252627OtherMiscellaneousDeductions2828292930For Paperwork Reduction Act Notice, see Form 1040 instructions.Schedule A (Form 1040) 2012
| | Do not include expenses reimbursed or paid by others.Medical and dental expenses (see instructions)~~~~~~~~~~~~~~~~~Enter amount from Form 1040, line 38~~~~~~~~~~Multiply line 2 by 7.5% (.075)~~~~~~~~~~~~~~~~~~~~~~~~~~Subtract line 3 from line 1. If line 3 is more than line 1, enter -0-••••••••••••••••••••State and localIncome taxes, General sales taxes~~~~~~~~~~~~~~~~~~~~~~~~~Real estate taxes (see instructions)~~~~~~~~~~~~~~~~~~~~~~~Personal property taxes~~~~~~~~~~~~~~~~~~~~~~~~~~~~Other taxes. List type and amount| Add lines 5 through 8••••••••••••••••••••••••••••••••••••••••Home mortgage interest and points reported to you on Form 1098~~~~~~~~Home mortgage interest not reported to you on Form 1098. If paid to the personfrom whom you bought the home, see instructions and show that person's name,identifying no., and address| Your mortgageinterestdeduction maybe limited (seeinstructions).Points not reported to you on Form 1098. See instructions for special rulesMortgage insurance premiums (see instructions)~~~~~~~~~~~~~~~~Investment interest. Attach Form 4952 if required. (See instructions.)~~~~~~ Add lines 10 through 14•••••••••••••••••••••••••••••••••••••••Gifts by cash or check. If you made any gift of $250 or more, see instructions~~Other than by cash or check. If any gift of $250 or more, see instructions.If you made agift and got abenefit for it, see instructions. You attach Form 8283 if over $500~~~~~~~~~~~~~~~~~~~~Carryover from prior year~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines 16 through 18••••••••••••••••••••••••••••••••••••••Casualty or theft loss(es). Attach Form 4684. (See instructions.)•••••••••••••••••••Unreimbursed employee expenses - job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. (See instructions.)|Tax preparation feesOther expenses - investment, safe deposit box, etc. List type and amount~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Add lines 21 through 23~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Enter amount from Form 1040, line 38~~~~~~~~~~Multiply line 25 by 2% (.02)~~~~~~~~~~~~~~~~~~~~~~~~~~~Subtract line 26 from line 24. If line 26 is more than line 24, enter -0-•••••••••••••••••Other - from list in instructions. List type and amount| Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040,line 40~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~If you elect to itemize deductions even though they are less than your standard deduction,check here••••••••••••••••••••••••••••••••••••••••LHA 
SCHEDULE A (Form 1040)07MedicalandDentalExpensesTaxes YouPaidInterest  You PaidGifts toCharity TotalItemizedDeductions
Itemized Deductions
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MARK B. DAYTON***-**-****X35,161.35,161.1,000.1,000.INVESTMENT, TAX & ACCOUNTSERVICES10,534.10,534.10,534.343,234.6,865.3,669.39,830.14580730 351960 2100A 2012.04020 DAYTON, MARK B. 2100A__1 4

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