§ 1040 vrs tnciicut income tax Rotum” (2015) ere er is ra coma atta or Wena a a ita Nets une RICHARD LUMENTHAL iTajointreur, spouses Wet name and Tia) [Last ame Spar ml my nano a RIES (Hane and SEB, Mou ave aT br, Sas HEGTONE. FACTO [4 tata nna sanon hy oa ost oi cn and cay i 0S, dao SPO aS DEW ra Foren enna Fain pocaRROORE aaonpeaaTn | atom o _ ct | You_[_] spouse 7 Losi 7 eat of vseho (xh qualiving person). ihe qualifying Filing Status > | sare ing ity (even fon on had income) personis cid but not your dependent ene ths c's Check only 8 [3X] Nard ting separately. Emer spouse's SSN above name here. D> onebon pyr mitigmian PCHNTETA BLUMENTHAL + nuthequsnian amore ‘2 LT Yours. 1 someone ean cam you a dpandat, do ot ehedk Doxéa Same Exemptions "26 owe bee € Dependents: @Orpniets ots ‘peaars Fata ete satya “— Se.) Ht more tan four feats an ‘steed te ‘check here > [_] ‘ag rsnters Craume domme Sina Eats Jreome 7 Wages, stirs, s,s Antach Form(s) STMT LT 17a : ta Toxable mores. tach Sched roqured te 2,269. ‘> Tax-xemptntrst. Be notin one 82 a 217343. W2nere mos 92 Ordinary dvdends. tach Schedule B i equced a 18,388. tach forme >On ents ny 17/871. W26and 10° Taxablreunds, reds, ooo sate andioalincome tes seer Z—stwh | 1 o. decorate, 11 Almony received 1 12 Busines income oF ss). tach Sched C o CZ a tyoudisner 8 CHa gn or oss Ach Sead Direqute. otrequed,cecere > fs =I, 500. wows. 14 Oter gins or Vosses. tach Form 4797 4 Seemstuctons. 164 IRA dstbvtons 158 2 Taxable amount “eh 162 Pansons an annus 16 1 Taxable amount 180 55,761. 17 nial el estat, yas, parterships, S corporations, ust, a. Atach Schedule E 7 =58. 18 Farm incom or (oss. tach Schl F 8 19 Unemployment compensation 19 20a Social seurty Deets 200 1 Taxable amount 28 21 Otharincoms. ist ype and mount 21 22 _Combin th amounts nto aight can Tor fos 7 Wrough27. Tas your tal ncome ble 248, 880. 73 Edo pons 2 Adjusted 24 SEELIGIy angie gg Aerie ees isis [oy Gross 25 Heath savings account eduction. Atach Form 8889 25 Income —— 28 oving expenses. Atach For 3803 26 27 Deductible part of so-amplymant tax. Aah Schedule SE 2 2% Selremployed SEP, SIMPLE, and quali plans 28 29 Soltemployd beatnsurance deduction 20 ‘30 Penayoneariywithdraual of savings 30 318 Alimony paid Recipient's SSW Be aa 22 IRA otztion 22 438 Studuntloan rest deduction = ‘6 _ Tutionand fees. Atach Fm 8917 ea {5 Demet production atte deduction. ach Farm 8903 35 36 Addlines 23 trough 35 26 2 37 _Subiact ne 93 rom ine 2 Tis your suse ross income >» [x [208880 LWA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, se separate instructions. Fo TOAD ca)fom wooo) RICHARD BLUMENTHAL | ag 2 Tax and 8 Amount ron ine 37 (adhsod oss como) = 748,880. Credits s9a check { [XX] Youwers born before January 2, 1951, [_] Blind. | Total boxes Pesan] te [A spouse was bor before Janvary2, 1961, [—] Bind. J checked 300 | _ 1 'b It your spouse itemizes on a separate return or you were @ dua-status alien, check here > sob TXT 40 temized deductions (rom Sched A) er your standard deduction (se et margin) “0 87,507. [At Subiactin 4 tom ino 38 a 61,373. 42 Exemptions. ine 38 is $154,960 or lass, multiply $4,000 by the number on ine 64. Otherwise, see inst. 2 0. 48 TavabloInsme, Subiact e 2 om ne 41. Iino 428 moe tan te 1, nt -0- @ T 373. ‘M4 Tax Check ifany from: al] Forms) 8814 b{_] Form 4972 el] “ 37,801. 45 Alternative minimum tax, Atach Form 6251 6 20,932. leazonen | 46, Excess advance premium xcre opment Ath Fors 6952 ae} pies tes | 47 Addis 4,45, 46 >t 58,733. [5300 | 48. Foreign tx credit. attach Form 1116 traquved a 1,317. Hexesme | 49 Creditor chid and dopendent cae expenses. tach Form 2433 @ [tthe | 50. Education cred rm Form €86, ne 19 0 [Seco | 81. Retirement savings contributions credit. Attach Form 8880 St leict | 82 hl taxeredt. Atach Sehadule 812, required 2 [S253 | 52 esidental enray reds. tach Form 5695 53 4 Oter cre romFom: aL] 3600 »(—] 8801 e[ 3 58. Adaline 4 tough 58 Tes are your ttl rds 5 1,317. 56_Subract ine 5 rom Ine 4. ne 55 is ror than ine 47. enir-0- > [5 BT, 416. 57 Satremployment tox ach Schedule SE 7 Other 58 Uaroprad soci security and Medicare tax rom Form: aC] a7” bE] ta 58 Taxes 58. Additonal taxon Is, ther qualia retroment pln, e. Aah Form 5328 reaued 30 (608 Household payments rom Schedule 0a 1 Fttms homebuyer credtepayment tach Frm S405 required [ooa} ‘61° Heath car: Individual responsibilty (see instructions) __Fulhyear coverage [1] Gl 62 Taxes rom: a[X] Form a959 6[X] Form 8960 ¢ [—] inst; enter codes) STATEMENT 9 ee 570. {8_Adlines 56 trough 62. hiss your wa tx > [es 37,986. Payments 6+ Federal come tx witha rom Forms W-2 and 1000 cH 44/390.| STATEMENT 8 (65. 2015 estimated tax payments and amount aplied trom 2014 return 65 45,071. Taeyer® sa Eamed income credit Ec) co Sretacn [— b Noninable combat pa ecton rs Seat] 67 pagional hid wx ret Attach Schedule 812 7 {8 American opportunity eet rom Focm 886, ine 8 8 68 Natprmum tx cred tach Form 2952 o 70 Amount ald wt request fr edonson tole 70 71 cess sci security and ter 1 ARTA taxwtheld 7m 72. Gre or federal tc on fuels tach Form 4136 7 73 Credits rom Form: a[__}2439 bL_Tneamee | leaes &[ 73 74_ Addins 64, 65,652, 2nd 67 trough 73. These ae your tll payments Bln 89,461. Refund 75 Itline 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid. 75 31,475. 788 Amount ins 75 you wat relunded oyu, IForm 8888s tached heck Toa Fah aA] | Pa Po ‘rmactens_1_ Amount oie Fe youwant applied to your 2016 eefimatetax [77] ‘Amount 78 Amovetyou owe. Subact ne 74 rom nw 6. Fr deals on how to py, 8 asrucons 18 You Owe _79 Estimated tox penaly (see instructions) js] ‘Third Party Do you vantio alow anoter person to assuss is return with te IRS (ee insracions)?” LAK Ves. Complete below: T Tito Designee fk" bSIINO, MICHAEL F. h212-503-8800 __rantarpag "| = Se oe igi ‘ret anes Olan ve CO Fas ae aaeTeN a Dato eas DeSean ay OS Here ‘ursonaue a rece S._SENATOR ins Sey an ey Preston rs Fenawoarare as om 7m Paid satay Preparer STINO, MICHAEL F. 00536611 Use Only “Frvsnse MARKS PANETH LLP Rasen *F=** FEET 685 THIRD AVENUE Phoneme. 212-503-8800 Bic semeasouse NEW YORK, NY 10017