Professional Documents
Culture Documents
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on page 16.)
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I. ill CHELLE L. OB~JllA Ii Homo Booress l~umUor ana S1i"~" !.you nave av.u, 001', ~CDpage rs. '1 AIll. ~O. You muS1emer E ..:; h. your SSW.) snove. I, R '-:::.' :::_ . '- -....".-----•. --~. -:---------'-----+--=-=--_:.-=----=Cjl~. L'D~I.riI·...: :J~t
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• rv1 LX.. Married filing Jolntlj' (even If only one hac Incom~) MarriEd'lling ~cpunrtely. Enter spouse's SS~J Dbove and full name hem. I>
0 f1e@cIQfil~lth
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qUilillylnqpilfBon), I[IIle q",.1l1ylng person 1, a GnU!1 but not your d€pandanl, onter Ihls chlld's nama here. r>Qualliylng WI~(\~-~·:-er-~W~llh-' (~J9-pe-o-oe-n~1 C-h'::"II(i~('""$Q-~-p,,-_g-~-1:-:-7)-
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A\ta~1Iform(o) 1foJ-2 hera. 1\I~o Pollucll Forms W-23 and 10B9"fl11l.u was wllhhIJld. It you did not
d TCltal nl.Jrl1o'Jr of ~;t.aml).ticH'l.S! clalm6" .~.~ __~,." . 7 Wages, sOl~I1es,lIQS, etc, Att.ch Form(s) W·2 "" 8a TaKfi~lnintemsl At:a~h Schedule B il rnqui'ad " b Tn)('uxfimpt internst Do llotinclud8 on line B3
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ueta
see p.age22..
w·a,
OlIllnar} IllVldon~ AUllcll SOll~(llIlO B It ruquirarl ,." ,' " .., , b Qualified dividends (se2 page 28) " "." ..•. I 9b I 10 Tm.'atlle refunds, credlm, or aNgOlS QI Slale nnd IQIillJ illtOrM tl~as ....... 1'1 Anmonyeceived .. "" .•. ".""." " r ".". "." ,.. "" ,"" .. "" .. ,, ,.". ,"", , 1~ Busln ass Incnma Or (10ss). Attach Sched ulll C or c·cz I 13 Dapltal gailr. or (lOSS). AtllIch Sc;hedule 0 II requlrsd,J not required, olwcl( hera Orner ~ins or (Iossea), Attach Form 4797 _ 1lia IRA rllslrlbuUons ~ Jea Pcn~lo~s and annUI;I'~"':: :::::::::: 17 Rent~lrsal eSUlte,royailloo, pllriMrship~, S oorpoflHion~,lrImls, 10 Farm Income or (loss). Allaoll SQtledulo F ., '19 UnDmploym~ntcom]lGnSlltlon ., , , ,.,'" "" '." 20a Socllliswurily benolil:; ) :lOB [ 21 Oth~r InGome. LISt1y~e and amount (see page 29i_· 22
:18
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2 , 7511
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14
Enclose, b ~[tdo
I m£_ _ ,
.I> D'3
- 3 , 00 0 ,
" .. ' " l-'1~4 -1J b Tuxoble emoent (soe Pl!!)O::6) 1§b b Taxable amount (Geepo\1!l 25) 11-_':':lG"'b-tr--""_-' _-_----' r.W. Aitlch SChDdul~ E ,, " ,' f-'1,,:-7-Fl __ ~~~
" ,
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AdfUSi:e.d Gross
Income
AIld 11mamounts In the f<!r right column for lines 7 ihwu~h 21. Thi~ is your lotullncrnme .~ .... ~.. ~ducaiore.,pensc~(sea pagB2.91 1>;' '0: ,.. ,. ~Zo.:-3+_~_~ 1-='2::.~+~_~=~~--I
~fr 25 Health savings aocaunt deduGlio~. AltMh Fon'l18BB9 26 MovlTlO oxoon369. Attacll Form 390'3 ..
27 26 29 aa ~10 32 39
:jl.
~ __~~~21~-~~45,OOO, n... 2.2. 1 , 670 , 9'95 , -1 o~~~~:'=rl:;~~::: ~.~~~.~ i~~~~~~ ~~~.~~~~'~~~:.~. .. _.~~I.~.~~~~~ ~ r~~~+~---~---1
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SEE STATEMENT
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One-halfe! fl~lI--Bmploymonlla:l.l\t~Gh Sch~lulo S~ " " .. " Sell·emplav~d SEP, SIMPlE. Rod mJalifled plans "." "" Solf'Bmployed IlealU, insurMM deducljon (see pagE 30)
F27:...+~ __ ·_:"l::..:.5-'-:..:8_:8:.:9:..:.'1 " .. ~20:-+ 1 ".. _;2:.;9'-1-__ ~_ -----1 1~3-:-{) -1---------1 31n -3:-:2"'-1--------l 63 7
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lHA
3S 36
POllalty on early withdrawal of savings ...• .•...•.. Alimony paid b Roclplont's SSN I> IRA dedllGllon (saa I,age 31) ' StudantlD~n interest deduction (see pag9:l-3) TUition a~d iees deductiDn (see page 34}.. Oomoo11cproduetlon actlultiu oeduutioll. Alillch FornI 6903 Add lines 23 through 31a and 32 IIJrou~h35 "
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Gubtr.m line S61rom IIn~ 22. Tills Is your udiuslell grass In~arrm .". ""';c""'''':':''''''''';;;;'''''''_;';''''''''';':;' For DI:solo$lAre. PrivBCY Aot, and PaperworJc Redur;.lon Act Notrce, see pase 18.
37
09121/2006
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YOu Wllr~ tram b~IQreJ.nual}' 2, 18·11. Snouee I'IM burn oElore Jililuary 2, 194 '1.
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.
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as
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40 41 4~
Itemlzod d~duot_lon~(Irom Scllcduj\i AJ arYOUI ulilodard dsdllctlon (see I~!j marDin) "."
4(l
<;u!ltr.!ct line ~O from iina SB " " ,." tf lille ~a i~~'Ief $10S,4ifi, Dr you pravioeli ~ousino 'to a pernon dl~olaMd by HIJrriG3no l(alIin~, sc~ pag~ 37. 0Ihelw;s~ muHlpl1' s:3,200 by 1I1e 101~1number oi BXllmpllonn olaitn~d on Unll ~d 43 T~xable Income. Suulrs[;llina 42 irom lIna 41.11 nne421~mQr~lhan lim; ~ 1, enler ·0·
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41
1,542,6"98.
112,408.
42
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45 4(; 47 q~ ,19 50
tax. Ghecl( Hany1llx 13irom; forr\1(~) 3814 110 Form 4972 ::::::::::::::::::::::::::::::::: 44 Altom~III'B minimum 10..'. Allath form 6~51 ," ', __ , , . 45 Ad(lll~c~ '14 ~nd 45 ... _."............................... I> 40 Forclgn IBY. r~dit. Form 11'16 ifroquirlld _ ~ Arlllr.n "_ ". r4.;.1+ -:r---:~-.o--_I Gredit for cf1l1rl ami depr.nd~nl care oxpense;. AHOlCIlFerm 2441 ." da 1,2 Credill"r lh~ elderl)t or the dlsebleu P,IMCh $,ilsdule R _.,_ " ,. <19 Eouonlion erecits ..~itlGh Fonn ssea _ __._ . , _ ".... l--=ff'::'O +--------\
aD
O. 1,542,6.98,
513,456. 513[456...:.,
aa •
ff'l Retiremenl s8vi~[lS corrtrlbutians cradlL Attar.h Form BaSI) ."..................... ij2 Ghildlax credit (sa. pagB 41). Ati2ch FOflll 8901 if required "................ GS AdopUDn Anach Form 8839 , crerilt, , 54 GrAdim from: a 0 Form 0396 b DForm aSS9 55 Olliar credits. Check ~pplicallIil box(.sj: n Form 3eOO ".. b 56 S7 56 S9 6a
51 r-::-I---~-~-I 52
1-:'55:--1--------1
64 F=--I----~=-_I fiB b;;;;.....L...~
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0 Ff,lml SM1
0 Fom1
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Add lines 47 lhroQyll 55. TMge are YDur toml cr~~IUl __ ""',, li6 SU5h'~cllin~ 56 from Ilfle ~6. If Une 66 fs more tha~ line 46. onlo,-Ot...,. DI Se[l-empIOyme~llD.:t. Atl!lch Sohe(lule SE " " " _ sa Sl,lcial seCUl'lty and MlidiGnm!ax Dil tip Incoms flot l'eJlort~d IQ employ~r. Alraoh ,orm 4137 _ _ 1-'5~9-t-Mdl\lonallll~ On IAAs, ether qmLlllled f9tlmment pt~n5. elJ;. Attn:h Forn153.29 il require~ __ . ,." .__ &0 Bl I\dl{;mceeam~d lncom81:redltp~~mDnts from Form(s) VJ.2 ,_'... . .. _ '".................... '61 02 HousehDld!l!Tlpk;lyI1Wrn1 ..~e,.ArtachSch9,jula H " _ .. __ _ _ 62. ~3 .ll.ddUnes 571lifOUgh 62.. This is your iotilllOIC _ " ~. 53 FOflllr.W-2ond109g _:_ .. G5 2005 e::limJt.d 1Er. paymerrlR and amount ~ppll~ lrom 200~ relllrn
.1,200. 512,256.
:n,7'16,
P<llrm~nt$
~Ba Enrn~tI lncome credit (lim) : ·;: 1· 1.. · ·.. · ·· !--='a6~·a+~~_-t <~.~. ",!-',h • b NQI11aXabieombat pay olact,on .. c ,... ~66:;.:bO-''-_--:-:::-1 , ~<-""''''.ao. 87 Excess soci:;!! Sllcurily and tier 1 RFiTA t~x wlll,i1flld (Me P~IlB 59) _.... r--:a::-T+ ~~~'-l 00 i\d(lItiolial chTldtnn ciedlt Attach Form 8812 ,,, r--::e:::.B+~ 1 69 AmGul1tj!al~wllh requssi for eldJ:nsion to me (sea page 59) •._ ~o:::g+ __ ~ -l 7U Paymem... frum: a DForm 2.4~$ b DForli\ 4136 G DForm eaes 70 t.....:..;'-'-----~-f 11 Add lines 64. 65, G6a,and a7 Ulfougll 70.1hr.sem<ly~\lr total DQymenle ".................... IJ> 71 n Iftlnr. 711" :J10i\; IIWL tiM B3. ,ubtroctlinc B~ jwrr, floe 71. ThlEls thE' amounlYo~ ou~rpaTd " , Refund c·"." 73;1 ,~mOIlIlI arline." vou ""um rMundad to l'0u .. _ ..__ ,,,. .. _............. _ i> 7Ba ",::"",,~ t> b l!~ii:b;r R":lnI!I--~ ')~~ ~:!.,lJ~ ~g l~ t; T7~V: D rNdtlng D ~hllli!!i 1)1- d .1,"''''11 ~1Ir._l-ii1, ;~.':,,~.;~:' 74 .~'"L'lmtoflill~ 7:2 ~ou want eQpli~d Il'lyour 2006 eijtlm31cd l~~ ......... !i". .._-r-:-7-:-4.... ~=------l .
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64 Fi1dai31ncomatlH'/)t.Ilhcld1mm I
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114,747,
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545 614.
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1,582.
114,747.
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09121/2006
9:45AM
00/21/2006
Nam>!(s); fln>t
BJlJUi.CK H.
1.
& HICHEJL~
Numberofq~aliryinuchIWren:
2. EnoorthBamoumirol11
.2 . XS;:ODO.EniBTthareSUIL Form 1040, IInB 38,Dr Form iO"OP.llna~ .... "." ... : 2
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L.
OEAM.A
1, f5 55,106.
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4. Add Hnes 26ndS. Enterliletotal. " .. " ~ 5. E.nter the smoun; shown below loryouf filing atatus, o MilI1Illd jilin g Join fly - $1 11),(loo
o Sin~le, hesd of household,. or qualifying wldoW(er)' $75,000 <l Married filing sflpallljBJy - :1;55,000 6. 11l1he amount en line ~ maro Ulan the amount on line 6? '10. LeDlif nne 6 blank, Enler ·0- on Iino 7.
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Yell.Sublract line e Jrom IIn64. ~"""""""''''''''''''''~'''''''''''''''''' • __ 1"-,:....5::..4..=..::6-'.1-"0..,:0:...0:...:... Iflllil resuli is nota multlple 01 $1,000, Increase it 10 11mnexl lIIul~plB QI $1,000 (rOf e~~H1plo, Increase S425 10 81,000, increa~e $1,02fi TO &:;'000, eIO). ~~.~ 7
7. MulUplylheammmton rme 6b1'5% (.OS). Ent~r lila result. ~~. ~.~ . "' " .. " e. IS·lhe amoun t on Una 1 marE:thsn the .mount on line i? [X] No. STOP] YOU (;lInno lllll<o Ih e ehlw UK oredit 0 n Form 1Q~0, linE B2, or Fmm iMoA, lin a 33. vee, Subtrncllln81trom lI!lQ 1. cnlerlhe result. .. .. "" __~
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11. Enterthil 8mOunl1(om Form 1040, line 46, or FOrr)1104M, line 2a, 10. 1])40 JIIers: EnlBr1helot~1 oj Ihean1Qun!s Irom IIne5 <l7Ihro~gh 51. 104M filter,;: Enter the total olthll amounts irom linus Z~ thr01J~h32.; 11. Are you clalmino any oi Iha jollowln~ cfcdihi?
"
10 _. _
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o Adoption Gredl~ r- 0 rm SSag ., MQrloage interBlit oredlt, FOHn 0396 o OiSlrict of Clllumbi. Hrst-lime homebuy~r cro(,il~FOrM SSag No. Enli'ir the ~mounl from ~n61a~ yo~, Complote ih9 Line i~IWorl!5h~etto figure me amount to entllr nolO.
~ __
12_ SubtraDllina 11 from Ilne~. Enter tile rasou. ~ , '13. Islhe amount on line 6 aimis worksheo[ more lhnn the emouol on tine 12? D No. tnlar the amount from nne B. } Thie 10your
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6
47,950.
PQl'Sonal prapart)! raxes O:har taxes. Un[ type and amount j>'_,- - - --- - --- - - -----
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lCJ Home mIJr.:gage ini<lr!V$ial,d pOint5 report~r:J tol'';uon Fol'il\ 1096 "" 11 Hams' ntortg~gEllr1t~rast not rspertad to you on F0l111 1096. It paid to the person irom whom you bo"~tTt the home, l;l;!a page A·S and ."owtl1at person's name, Id2l1tiiyi"9 rm., and nddres;;;
~--_- __ ----_---~---------------------PolntB not r~p!lrIBd bWe51m6'nt int",rsst. to yo" an Form 1096. "" Attach
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32
418.
47,950 ..
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no! d8duc~bl",
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Gift$'t~ "".Charity
~If! Rnrl g!lt r. bijnei;tJor iJ, QOcpagcA·7.
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you must att~Qh Perm 8.263 if over !BoOO 17 Carryover 1<1 Adcliines
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77,315.
20
Form '1664, (.Se~ page A·6 " Unr;;;;bu ... ed employe!;leXpensl'$ . ,ob tnavel, unkm dv",ljO, Job education:
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19
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2'2 (See
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tees " ", , Other ;a>:'~anse5 ~ 'nve5f:m~~nrsate depOSit box. etc, Llst typFi ~nd Zl.i11ouf'it Till': preparatlcn _ 1-,2_1-:+
0_1.-;;8;..."'1
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.?~~TIill~JTi Y~]l§_ ~_ , _ ~ _
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:<1,500.
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Othu iIlia~~IIM~UOS
27
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27 Tot<ll 28 I~ Form '1040, "n~ :35, over S145.!;JoO (oller $72,97(; I! married liIi~9 ~~Illlrat~~/)? ~ No, Your deduction ia not lintte.d, A<W lha <lI\10Un\S In tM 1m'rlQht column fQr lil,es 4 through E7. Also, enter thk; amount Oil fOIJTl 'IO~(), line 40, Ycurdeduatlen l'Iedut:r:IOl\
Itemized) Dlilductiom;
29
00 y"",.
If you al.ee\ to For Pap5rworl,
may ballmlted. See p"'9a A'9 lorth~ ~mOUl'ltto enter, n~nliID deduebcns oven illough th91'~re loss Il1anynur sia.lltlard d~~U~tlDO,ch~clt hOI'S
Act Notioe,
SGI'!
112.JOB.
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r.>D:;:' "':.'"
A (Form
h"':':'I:i""
: .'
LHA
2005.05030
OBAMA,
5.4
1040) 2000
09/21/2006
BARACK H.
9: 4-5Atvl
40COlli'_J,
~OOfi
Yoof.(!(tcfr,l!;!!r;:mi'qon.l:"llDEf
~ =
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......
'An1~"
propeTiy ru:. a personal ;',,~ldlmQe, sae page 1'1·1 anr;! 11$1: interl;sl this buyer's soda.16ecurlty numpsr fll".d addreas r.:... .
~m. lso, A
show jh~t
11,206.
2 034,
1
145.
-"
-~
sho"m on that
torm,
-----~-.
, •••••••••••.••••••••••• , •••••••••
,_
_.
,---_· ___••• ~ •••••• _ , •• , ••••• , •••• ~ ........... , •••••• u ••••••••••••••••
13,385. 13,385,
Amount
'u" .............
, ..............
______ ..
_0.11i'
8utJtmOl Une a fmmllt'le 2. Enter the fe$Ult here and on Form 1040, line Sa ._ yew mu.st rompl"w PooH:111. )\!olt;!· 11Une 415 0Ile($1,500,
<I5
..
••••
,~
••••
, ••
, ........
3 f,'>
----
..
Peril!
Ordinary !:lIividerids
NORTHERN
TROST BAlof..l{
I>
2,751.L
..
10gg·orVor
substfurte
!;tatemen' from iii I;lrc]~ar..9Gfirm, pay er ;;no <>l'It sr jhe ordInary clillideI1ct~$\10~m on thatterm,
lI~t the firm's narne as the
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--
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.. ...
,
l.'J>
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I)
2,754<
...,_-,Yes ~~I_~-I . __ No __
l~ota, If "ns 6 is aver lIi1,5DO, veu must C~1)1~!~. Part III. You mUG! cornpl~t~ tl'jls p..n if you (6) had over li1,500 cria;,ai;Jl", it'"srestor
account;
Qr .(.::)received a dl"'rlbutloll
frum., er
"""r9
a [Im1lb;lr of, ora transferor 10, a fors.1Y!:!..!s:';.;.' .:;tru""e",t:;.' lI'I or a signature o;lJ'omllr authority ever a financial
~ __
m ulorslgn
country. auol1 as" bank account, securities account, or other finMcial account?
Trusts
$~i5m 1"Z,.V5
~~
-,-_~
DUfil1g 2l106, did you rscelve a di6Uibl,llioh irom, or .,... )'01,1 ..."" It,~ qrarrtor "f, or transferor to. a tor",l~n trusl'l II "Y.. ",' you may have to m", 1'61'rn 8520, See page &2 Reduction [~etIIr;I1'11;;","as f"orm 104fl inst!'uctlol'S, I
""""=,,,,,,,,_.__-,-_i_~
6 (FI/rm 10.-lQ) 20D$
LHA
Fell' Paperwork
09270331
131470
40C01F
2005.05030
OBF~.f
5.5
B~CK R. 09/21/2006
9 : 45A~'1
40CDIF_1
~007
8G~"lEDI..lLEC
(Form 1040)
I) &pi"r;mliI'U ~ftil!) irn~IolJY In l&hJ~1 fl-sI1,oo,tI(j. i3f1l"1rtl;!
I>
J\1tac~ to rormlO'lC
[Sole PropriatOfohlp) jn lnt vp.nlllrns, ele., m IJ ~I ill e f mm 1065 Dr 106S·Il, or 1041. !i,·Sen 1"&lmqlfon~ tor 3~hedul~, C (F~rm 10dO),
A~'B07R~'~~~~~~~~~~==~~ EB,j'5!;;"'~~Gllidl~Q
f
~
~
-=-===~~
~~_~=~~
~~~
Qlhcr (~~~~;iY)
15 1 ~I~~~~~~~~~~1I 0 ony
'mplayo<
reon'''' ",,~':~m
.~
O'7'·1".C- 5 ,H~O'lnII ·
10"umb"I.'Nj.;1
~~
~~~~__l__,__~
_ m __
~ ~ ~-_
City, ";'-"11or I!O~Io~lr;a. sliil~, ~n~ Z:p eodz t,,:~ountillg 'n~tllo~. (1)00 G~~h(2)DAccru~l-
(a)O
...
.," , , ", ,.. "_.,,.,
~ __
~ H
Dill ~OU "ITL(lIorinlly l)arilcl~~'le'11l1he opsraiion of jhl~busl~eSi3 outing 2.005? n '/.0,' sea p:l9.c C-3 lor 11mII on losses Il YQU.iarico or ,~CQuiru~ thi~~u.lne~s during 2005, ~heGkhare .. -,_,_,_" _ _.._,'-_._ -... " ','"'' ,,,
00 y~ 0 " 1>- 0
NQ
- GmM r~~ai~ls 01 ~i!los,. CllutlQn, It UIT91nnome \'la,l-rOOOrl~~ to )'o'U on FDrm W'2 and the ·St,1Iutory employee" hex an fhatj~rm wa9 r.he~r~d.~o~ p3g6 G-~ and check hera ' __-. _.. , -._" .. ,' ,." _, " .. " , " ~~ D Rsll'rn~ and ~IJQl\:an.<)OJs , , ,.. ,""'-" " .- • .,,_ -' ". ,"-._••",,' _ , .-__ '" , ,,__ ."'_." "._-." .. Sut~mct tlne'~ irum lin; i .. ., "'_-'.'__ .. ,." __ ,_ ..", " .._ ', " .. , , _ , _"". .... Cu~i 01 gD~tlS sol~ Ilrom line 42 gO r1ilQe 2) .. "_" ..... __._..... _,, ... _.,_. ...... "."'" .. ,, ...... _......... __
Br~"~prulit. SUblraCllln~ !r~nl IM ~ ~ ) ". _"._._.'.",', __ , ,"", " ,.." Dl~"r inccrn~, incluDingF~llernlandsteta gfl~olin8 or ruellm: credit Of reju~d (soc.pugc G-3)
,i
,'
,',
'''
"
".,
I·p.elit:.!J:1
"" ,'_-.' " .. , " "."., -." ...• ~,~"" [Ont~re xpenses lor business use Qf Y(llir horne only on Iln~ 30.
20a
2ub,
D spre~I~IIQ <no (iP.oim1 179 n I C~M 11 a 00 (klC un 11 (~ot Inci udod in G Panllil (S€~ pnoe c·~)" ... ...,,'.-._.EnlPIOt~9 bBn~jll ~Ioilrilms (uUJOr
1[, 16
24 'ID j·1
16
Ta.en and IIr::msus , " Trauel, meals, nnd 8otertail1m~nt; a Tmvel -. " , .., b De dUOIib Is meals and eni,rtall1mnnl (~fie pa~Q (;.fj) ""
UUliij~3 _ _ _ _
,.. .
2.3
Ulan nn Jin~ '19).-" ...... "', .... ,.."., t~5L1l'l1nGe (11thli] tl1~n ~"illlh) .-' ,
1~I~re'it
. .
"
co ....
~~ ~~':::::;
168 161.i
._.•
26'
MOrlflar.f (paid to nanks, ~ln_) ......... 17 OIh(], ., .... "-. .... ,,.," ...... , L"Q21 "oil prole5sion.n1
•"_.,, .__.... , ,, ,_ 27
,,,
,_
,,
"..17
.,.--------------1
,__ I>-
.. +:_"----.=-::---::-="...-1 -.
na 2.9
I
•
Tr!:~1 MpOI,(;e. ~elui""~lpel1S~510r bClSIMS5' use 01 110 me. Add IIne~ a throuUl1 27 III cOlumnr. _, T~nlllli,," profit i1f)!>S). S"I)tr~t:t lin~.2B rmm li.~e-, ,_ , ' " " __ E~pt'!I~<s lui IIU~w~sL;5e Of i'our nom •• A!I~~h Form B~29 ..... " ...... _-'_", .... __. . I! (;1 I) rom 0 r IIQ ~~), SulllrDJ: t Ii ne 30 tnm line 29, <" II ij profit, enter on Furm11)'oIJ, IIn~ '12,find ulsu on senedure SE, llne 2 (mahrtur) ;mnIQy~e~, ~ee DoueG·(j). ESI6103 ~l1d IrUBIS, Mlil( MI'O(m 'IMl,llns S. o II J los" yuo mu.! gn 10 I:n~3<\I you II;"~ a lo,s. ohsck tile bO)i tllal da50ribOs YOUi'inVD~lmanllii tIli$ a~livity ($oe ~age C·Il). <> II YQu chac,l'~d 2?~, ~nI~r iho IOB8 00 rorm 104Q, lin~ 12, ~nd 21G(l on Schooulo SE, line 2 (siatutcr; omployoBS, SBe pa ge C.·51.Es lulc~ an d \Tusts, emer 0 n Form 1(}4'1, lin e 3. e \I yO ~ G1:~cl:friJ2h, yOIl mlm t a~ach F0 rm 510 e. Yo U i los 5 may be lim~~d. J
6 B r 3 78
so
1,141,495,
32
} }
311,141,495.
32a 52b
D~'~~~~mcD'
0 ii;"~im~~'il."'~"
U9270331
131470 4oeOll
2005.05030
40COIF_1
B:45AM
~008
SCliEDUI..ED
EAR...n.CIi:
a.
& MICH:E:I.JLE
L,
OBAL'1A
t DIJJDr!:i::.~I~
(a) c •• er
£i!JD~f
('1)"",",,10: ... ,
~~j-um i
~~j
02/22/05
10/28/05
;1.0,915,
8,843,
2,072.
:2
Total short-term \11;;1...., priCE!.al1l~llnts. Add nnea 1 ~nd 21n colurnn (eI) , Short-term SOlin irom
1"'~J'Ii'!
'
as , 8,37
_,
I
4 " . ., , , .
loJgt l,orHermg aln or .llo5~)from p~rtn6Jt;hlj!J!1, eorp orallons, esitrt(.!S,. t"" .... s 8 ,"~d shornerm capl till less carryover, O:ntolrih a ameunt, Carryover 7 Worlwh~et in thO' in$lttl~lionS If ;my., from Une B 01you rCOIpibll Lass "" " ,
"
................•..•.•........•
,
, ' " .., , .
..
. :.111, 1~6 .
(e) (ko,«
I::u,!!!f
b:;!:!!ir~
.sUtllrn~t
l1ll'ol"o'II"'''i
s 10
~lar your lonll·!eml tO~B. if any, Iri;lm $Qh~dula 0·1. line 9 Total km .. -term ~:mleHnrice mllQU!\;s.
."
Add IIllss
e ~nd [I lITool\lm,,!d)
,.
_,..."';"',f--_'::""'_-_
"
1.1 Gnln from Form 4797, p(!Jt I; long·t~rm b~lntroJTI Fmms2439 ~.nd 6252; and long-t~rm 9"'" 'or(lo~~l jro'\'Ip(l!TI1~ 41164,G7I:I1,Ii'Inrj81:1.24 .. , ," 1.2 I~at IOI1(j'!erm gain or (los<»from pilrtn~",hips, S eerperancns, estetes, and tnJol~
'13 , ,'
[-'1_I+ [---;'':-2+
1-'1.:;.$+
_ _
_
14
frornSohedw<l('» K-l ." , "" , Ol'pirol !l~I'" <!1I~trlbutlon$ , ,' '." " , , ,. " ,,' long-term c:apitailml5 carryover, iOn I"" th .. amouot, If any" from llne 'lS <;;1 y,,~,r C.,pitill Lo"" C"r:ry~lI""W~rI,th~at.l~ lnstructlone Ihe " " .."
nns~ 8lhrough
,
'14 in coiurm (fj. Then 9.0 to
is
rft-l..-~.-~---)
~_
I~Qt ionfl"lerm
eapfwlgain
PI'
(10$"), CambjM
___ ~p~a~rt~U~lo~n~P~6~9~~~2~..~ ...~ ..~ ..~ ...~ ..~ ~ ..~ ..~ ...~.~~~~.~ ..~ ..~ .. ..~ ..~".~ ..~"~'~.~ ~ ... ..~.~~~~.~ ...~ ..~"'~ .. . ... ..~ ~ LHA For ~pen\lcr!1 Retluc1;lon ,'l,ot Notlca, SM ~orm 1{).10 Instructions.
09270331
131&70
'OeDlF
2005.
050::J 0 OBAl.'"IiA.,
5.7
BA..1'lACJ.{
n,
9: 4·5AI"l
40COlF_1
09/21/2006
Of;
ai
'20Llll
08:.J3
FAX 1 312
:Ii 2 8.!Oi
~:".'"cu,.0 ifc,m
&.
M! CHELI,E L.
O'BAMA
_ '
19
Pop.
~ri:'11I1
16
Summa!""}!
Combln", IIn"'~ 7 and 15 and enter 1M resulL If lin.. '16 io a loss, "Idl) lInGS 17 through 20, and go to IIrrs 21_ If a gain, enter tM g~Ji,"on Porn! 1040. line 1S, and lI'~n go to line 17 below
-13,136.
17
CJ
irstrocuons
"
" secnon
, on , ..
I?~ I'.>
f-:,-!i.::::S+
'.'
~I
Ent$l' U~~ ;!rTIoum, Ii any. rrom line 1£l 01 the Unn:cllptured p;.ge D·e of the lnstruoltona ",., 20 AI'~ li!1!l~ HI a;-d ',!;IllOUl zere or blanll'l ,."
~:,~:} : ~
19
/,
CJ
ancl
pagll36
D No. Complete
21
11' lim; 16 ls "loss, o
(>
Porm lO<!() Ihrougl1l1ne~, lind :h.m ccroprete the Bchedule D i'ax Worksheet on 00 nat campltl"t!! lines 21 ano 2;~ b~lo\'J_
...
• 1'1
;~~
on Form 'I O~O, .UM 9b'!' Ih9 Qullllflccl for Form 1040. 0lvid,.nd9 and
U NQ. c.:",~pl~t\"ltl1"
~t~(i::ii;j!i;;·;,;,;:: .•....
09270331
131470 40C01F
20
as.
05030
OBAMA.
5.8
BJ.l.JU".Cl-tH.
40C01F_1
9: 45AI"I
09/21/2006
09/21/2006
141010
BARACK
n.
&; MICHELL!!:
L.
01'$ȣ:1.1.
Yow$S~1
8118the in~tr1.lc!iClnsfor lln.. 44 on )Jags 37 to ~~.. Ir I'IIU can use thls workuh8"i tc ~gurQyoul'1a:!(.
If' you do nQ~I~"'v~ 10 llt~ Scl1edule D and yoU receivlld caoltal gain dimnbutions. be sura you checked 1h~ bOlllln 1'119is of Form "1040,
1. 2. "',
Ent\!r th~ amount from Foml1040. lins .13 Errtflrthfl amount from F0fTT110'IO,line 9b ··.. Are. yQU fiDn9 $"ha.:Jule D?
0' lin~
···:i:··············,···,,·2","'i£i"4··:· ..
3.
--_.
1. __
.;:1~.5:;,,.:4:.;2;:..<./,.:6..;:9;,..8.::...:...
Cl[] Yes.
50'or "'"
6maller
'5 (I,'
, ••
} "_
D NOr
4.
,,,
, 4.
:2 , 754.
-'0:...;... 6. _--::'--;:=-'i2::-",-:7~5i-.d:i-~ ,,-. 7 -----'~'--'--:.......:....:....-= 1,53.9,944. .
e.
s. I (you II rEI 01~Imlng Investrnent int"re~l Bv.pe.nse on Form 4952, emer 1.h$ ;ll1'1ountfrom [ins '19 of thattonn, Oth~""ise Ohler ·0· .... ", .... "....... 5.. e.. Subtraot lin.. 5 fn;IIY1llna4.11 zero or 1<'.J5~, ·0· ",nh,r ,. SlJl;itr;:;:ct1I11~ from line 1, If zero or lasa, eI'lter ·0· I:'i
Enter th~ srn ..llar at:
The amount on line 1. or $ 29.700 if ~iflgl ... 01' m~I"IQdtiling <lep<lral:$!ly. } ....• ••• •..•.•. .•• $ 59,400 rr I'nlIlTledfiling joimly or quaJl~/h\g wldow{erl. $ 39,800 If hsad of household, 9. Is the ~mouot on Jill" 7 "'''Iuello or mere th~n the ennount en 11M61 00 y~. SI~I" Iln~s !iJlhrougl1 '11, go to ITna12 liJld tlh~cl, th~ 'No' bQ);.
"
' __
........;5::..:9;;..,!:.....:4:.:0:...::0~.
D No. EIlierthe
amDLlnt ircmllne"/
.. ,
"
"...
9.
~_=
~_
~O. Subtract line OJ frQm fins a, " , ". 10, 11. r\01ul~plyline10by5% (.05) " _.._ _ , "., i2. Are the wnounts on lin.... 6 ,.nd , 0 tJ1Q sam B? y"". Silip lin..~ 12 through '15; go to nne 16. !'l\;l.EnMI·ihssmaJI&tofITne1 or[,ne6 " "., , ·I:t. :3 I 1:3. Eni .. rth!il """OUI,t from line 10 (if lill" 10 il; tJl~I'IJ(.I!IFirer OL · , 3. 14. Subtract rrne '13 from lil1'" 12 "......... .....•... 14. 2I '16. Multiply DniO141;l1' 15% (.16) , , , "" " ••......•........ _ ...•.•.•...•.....•..• '16. Fi9"'''' lil~ tal( 01' the amount an Hne 7, Us", thB TID: T~bl" orTEIX Gamplrtatlan Walirnheei, whiClwvsr
11.
00
754. 0• 754 •
" •.• ""
~5. , 16. ".,
413.
513,043.
514,007.
.. ppliEQ "17. 18. Add lings '11,15. GIld 16 " applles , "
"
, ,
17.
513,456.
Flgurell1e tax on the ·amQunt on line 1. US8 the Tax Tabl" or iw: Computation Worl'sh"'~t, \~hkhaver " " ,•.•.••......•.•..... ''',., , •...•............ " ,' , , ,., " ••..• , .. '16. ,.,'.
19. TaJ: all all t~lIabll' inoome. E11'lflrthe smaller of line 17 or line 1B. Alao inolud6 thiB erneurt on Farm lOAD, li,.,,,,44 1111.
~104<11
11·1.·05
09270331
l31470 40C01F
2005.05030
OBAbu~.B~~CK H. 09/21/2006
5.9
9: 45Alvl
WC01'F_1
nfl/~l
2006
@Oll
BAlThC!\ H.
DEAl-fA
!>
No!e. If your ani)' income subject \1;> ~ell·€mpllJ) ....",nt tax 16ohurch (lmplcY9D Income, ::.Iop tines 1 through 4b. Ertt£1r ·D· on line 4c sno go to 1I~f' 59. lncorns from .,.rvlc.'ils YO\I periClTTTled as e mlnist",r or a member Q1a religiou5 order Is not ~i'lulch employM Inr.ome. See page SE·1. A If you S.M a minister, member of a 1'llligioua ol·cil'.lr, or ChrlEUnn Sci~n~e I:l..~[;titioner more of other nat ~arn,ngll from self'employment, oh~el( here a'l(l Cl)ntlnue with
"rut
.. nrj YOu fil~r;l r:'orm 431Sl, but you har;! ~400 or I _ _ ,......
1>0
!~M I!lml proftt or (loss) frQm Schedull1 F, ~nB 36, M~I farm partnersblps, SohiWuI81~'1 (Form 1065). box 1 a. cede A. I~Ot8. Ship this IlnQ i~ u::;~ fhe farm oJ:;llonal m~U1ocl (see page SE·4) you 2 N~I pruiil Of (Ioas) from 6c!1e.dUle G, liM 31; 50heoLlie C·EZ, linl;1;1; 6ch6dlJla 1<·'1(Fonn 1(65),lJox
"
14, COM A
..
'I
1<·'\(Form 10f;6·2), box iii. Mlnlstero; !!]",d marnbers oj religious Ol">:h.r~, see
(seQ pllge 5104)
••.• _. ,._ ••• ·,.
S~·1 for
llflloun'O) to report ,,11111isline. Sea page SI;·2 lor ather lncerne to WPI;1·rt.Not!;. 511ip 'this line
$.#!K..!?r#:T.ID.~
__ •• n _ ••• " •• ,
l2.
_
U&.u
••
_._
~_.'"J1
•••
""
•••.••••••••••
a
4a
41;1 ~4:;:;c;.,.I __
4 ..
If fil1e:3 is mere than ?('rQ. mllmpll' lin~ 3.by 92.35% If yO\) elGct one or oath of the optlonal IT I,,~s than mmhQds, emplo'{BB tram FOlm
(.9235). CthQfVlis",
enteramount
.
.
1,054,171.
1,:1.11,495. 1,1111,4950
emer1he Income,
CombifJ<llin~£· 4a and iJb.1! less tnan $400, lItQP: you do not ewa sel~·employmlilnl ta;;.l:;(ccptj,;rn.
MaO
cnurch inoome
!l a
W·2. SeE>page
rcr lleflnl!lon 0; church cmploy"~ l!'\Com" .. -.. - _ " _ • 1.....:5o.:11:....L_ b Multiply lin,.;;e by 92.35% (,$235). If le~s than $'IOD, 9f1tar'(} " B Nd mln9s from $",rf'!}mploYl"91~t. Add linEls .ole and 51;> _.......... M.",imlJm omoo.JT1; i eornblned w~ge!l and self·amploymant ~ ~amin9S sub]Qct to geoial security hilt 01' i
!h~ 0.2% POrfiOI', ot tne 7.65% W.2) and ri1lll,o~d rotlrernent llnes f)b"hrou~h h
Q
I---------r~'~:·;:
I>
!.:;-; :::~
,
F5:;:;p+_-:r-;:n:"'7"--:r~.--
J-..:G;:._I-_.:::l~,'-0:::..:::S..;4;;.f..,
.
;::1..:7..;1::....:..
rallroar;! rBlIr;;merlt
r
'•.. ' '. \;': .•
90,000.00
J; 1) T0;",1 <,oclal seour't-i \"lagos and tips (!otnl of bcxcs :3 ana 7 on FO:m(5)
(ti~r 11 ,:ompen~~ilon.ltS\lO.OOO iO, and go to linG"
_....................
90,000
•. -l·}·~:.,·:
I>
J~: .: ..,'
So ,0 1'1 '12
Add fine.s B~ end Bb _ Subtrelllllnl'l6cfrum 11M T.lfzep,;> (\)'1886, enter-D' MultiplY the smaller
Q~
~I;l~+--
_
30,571.
30,571.
IIns 6 Of line 9 by 12.4% (:124) , "mpl Ol/ITI apt tax. Multipll' ·!(M·D, line;;;, Add lines 10 and ·'1. !;I'lMrhere Ilnd en Form II"", ·12 loy
"............. _._ _
1"
12
Qf
lll![f·
!'.I
n ",'
't
•• '" •••
', '.'
' ••
Fsrrn OP~OMi
(bj
MEth~d.
only if
/"J
)'000' <]r035
14
15
Ellterih .. smaller of; two-thlrde lnol :8S.~ than _;;E!PJ) or $1,600. AJsc IIlClud,;, this llmount ol1llnB 4b ..i;lO\l~ _ _, "", ";0. i\loni3fm Optlon!!1 M""t>o~. You may usa ·tlli~ method only If (a) your net nonterm prom~3 w .. r~ less than $1 ,733 and t' " also 11iI~ than 72.1 f.l1;"~ "I your 9(lJSS nonfarm il1comB" and (b) 'IOU had nat eamlngs from Eoelf'employmant 01 at :,:,":,', :, : lea6! $400 i., 2 olfur;pllor3 years, r', (' ;-:. Os utl 0 11. You may use this rne thOd no rnors til en five tim~~.
~ '. I ,
"
,21
"
'14
16
SubtrOlctfine1(5fl'llmline14 Enter tha smaller 1i11~1e. Alr,o Include oj; tWQ·1Nrds (213) of eroslll1onlllrm till,; arnount 011111164b abou~ .
f-1:.;:6'-+
~~
"!7
; F;;:rm S~h. F, 'Ine 11, and Sch.I(·1IForm '1065), bar-H, oode B. ~ FrcI1l5c~.~, :Ine 35. alld 5011.1\·1 (FIlTlT1 1065), om: 14, cllde A
17
. -------!i:;:,,~~:!.:,
11.jl'i.aiJ3l
.. -.----.-~---.--I-.
40C01F
09270331
131&70
5.10 09/21/2006.
~;lI.'RAr:Tt E"
9 : L~5Ar"1
40C01F_1
09/21/2006
[iJ1112
~~~~~~~~~~--------~~---~=-----~--~----~~~~~~~se
IflCEBlrLE L. OBAM..~
inoam6 __ ,_... ~.
Nole. 11your (Inl)! lneome aubJ"~t to ~elf·amploym"'l'Jt tID( i"llhUl'ch ernplo~(;!e Income, sl<.ip)ln98 1 thmugh 'lb. enter ·0· on I1ne 40 und go to line Sa. Income rrom se:vice1;: you performed as s mlnlster ora memoar of a r..li9ious order i~ not church employ"", Income. See p~g~ SE·,. A If you Bfe a minister, m~Il'IMr of ~ teUgious altier, or Chl'lsoon Soiern:e pr<l<;ltltloner Ilnd you -mali Farm 4361, but you had ffi~OO or mora Qf other net erunlnga irom selr·amploymenl; eheck hem and oontlnulil with Part I _ --.._ __ , I~",t fmrm pront or Iloss) from Sc:11edul<')F, line 36, and TEIITl1 partnerehlps, 60hedllie K"I (Form 1065), box 14, code A, Note, Skip this line iFYoU use th .. farm opliO;Jriajmethod (see pags SE-4) ". No3tprofit or Qoss) TroI'l1 Schedule C, ITn.. 31: Sch6\iule C'EZ, ~n'" 8; Soh~dule 1~'1 (Fortn '1066), lJO)( 14, cQr;le A ~O'IhSrthan f!!rming)i and $~hadul" .
I--'-t--~~-~=--
K,' (Form 1085'8), b<;ll( 9. Mlni"tsr.s and m!1lmbers of religious orders, see
.. "ge SE·1 for amoun!$ re report on thIs Uml. See PElg" SE·2 lor O'II11Or lnogme to report, l"IIote. Silip !hIs Tlll'il -
:;:
ii~ou useth", no~farm optional method (see page SE·4) ,., " (iJ_~_1:;) ~.?;',~';t'.~W r.-;2~:--=~--;4"'5~ Combin", lines 1 and 2 __ .__.__ . ".. ~ 4<1 If line:3 iii 11':0r;; lh~n zero, mlJl!iply line S by 92.. 5% (.9235). Cllhs'''''se, ental' amount trorn Ime 3 3 ,', , 4" b If you elect on.. or both Qfthe optionall'l'lethods, stoter the iotal 01 line~ i;; and '17 herE .. " "............... 4b
c 5a Combine lines 4" ~d ~b.lfl,,~s then $400. stop; you do not<;lW~ self·employmen1 tox. E~Cfi'p~i"n. emp.ioy",e Incom~, 9I'1ter'0' .. nd (:ontlnue IIIGSS than :!i.:.OO and Y"'" hgd ohurch
JJ
• .,:;O...,O;..:O~.
45 , 000 , 41 , 55 B ,
Enter youI' church employ",,, income frQm for defln~ion QI churdl emploYge InoomE:l. Net earl'lln~6 fr<>ll1 Ge[j-employme,nt.
-I
, ,..
i_ L'-'5.;."~ _
"" ,
"............
1;-
~~,,, __ __ , .
{- ,_
!;b
7
_......................................
7
8~
Maximum amourillJI
Total s(iolaI5e~urity lin"'l; abthrough b c Ul'lrepor-wi;l Adi;llinos
the 6 .. % portion .;lIthe 7,65""(' railroad ralirnment 2 W'2) and railroad r ..II",rr.Bnt
_._
:
.,
", , , ,"
"
",
!I
.-~l
,',
so.eco.oo
~a;;;,_a+~ __ ,.. ,
III'S SUbject to soclsl g~mJrlry lID< (from F'orm 41.;Ji, 1I.~eg) •__ O:aand Db
.'~ ':.,::~::
eo
1'1
1~ ~~~I~::~~:::;~~;~~~~:~~iQ:~:eD~~:~,;;~r(~~~~r~.:.d ..~.~.11.~,~.~~.~~~.~~.~~.~i~:.~.1,,::::::::::::::::::::::::::: ~ I---'.~:..o-l-----~---11 12 13 Ml)lllplyline 6 by 2.9% (.029) " _ .. "t tax. M'lltiply une 12 by V' . ._ " .. _' .. _ . , " . , S!lli.employm~nt 50% (.6). errterth~ t<Ct.Add lines 10 and 1'1. f;rrtsrhere . re<>ult
11816
"
I
1<1
2,205.
1.205,
12
6a 3
0, "... ..
l,p~r;t:18 Optional
FBtm Optional 14 15 Mmlimum enter1he this amount ")QtlwmOpU,;Jne.l MOihod. (b) Your nSI farm prt;lflt!;2 smaller
Method$
You may use this method \'Iereless than $1 ,733. of~ methods _
U5I!)
t\'Jo-thirdc grQ$s
(2/3) of -.. "" .. --
~ ,__:!.i.I-_~
'1;;
:'i'~'f'~
1 ,6_0_0~.O_O
iarm inct;ll11e
Il1Is method onll' if (u) yo:>urnet nonTerm pro-fitG 3 wore tess th;l!n $'1,733 "nd rl,"',:l ,,1$0 less than7:L189% of your gmll5 nontaffi1lnoon'l~ and (!;oj you had not eaming~ Iro,r, ",,,If'employment of al . '., ,",. least t40Cl in :2 of the prior :!I years, Cautioll. You may 1,1$!lt thlll metrod no mor", 1M" five times. M(lttiocJ. You may
11;1 17 Sub\l'~c! Rne 1S from lin" 14 Enlerth~
~tn:lllcr ot tl'lO-lhlrds
" ". __ _. " ,.. _ ,,, .. _ . (2/3) of oroos m;",'<lrm income 4 (not le:w thali zero) or tl'Is amount Qn on line41J aIlove _ _,
3 From
5[]101.mt
"
,.. , L-·I'--'j'-'-
~-_
Sell. ~, una 11,and Sch, 1(-1(Form 1D65), bQ~14, code 6. Frvm Seh. f, lin. 3t', and Sell.il· i (Form 1055), box 14, code A
Sch. C, IIna~1; Suh. G-EZ,IIn~ S; Seh.I<·1 (form '1065), ~~. 1~, code.!J,:, end 8ch. ](-, (Form 10il5·lJ), bell( 9. ~ Fr~m Sch, C .Iine 7; Sch, C·E2, IIn6 'I; Sch.II·1 (Form 1065), oot 14, code C; arnl Bell. 1(-4 (Form 10,.;~·a),bQ~ S.
09270331
131470
40C01F
2005.05030
40CO :i.F_,.l
9: 45AI"1
WSHS.
PC,
CP!\.'
If:~itfi1 .
Persons or Organization:;;
(U)'Q'J ,.,.. ~d
Il'Q~
space,
who
Provided
tne
~_~~
=_
(dJ Amount paid
(b) Add",!;:)
I"
I" ....
~-------------_,
I.1.J
No ~ Ws ___ Did you receive
7,200
- __ ~L....~-~:....=--=--:c",;.,.
...
~,t;;,L..LN~'
2,640.
'>
Compls!,e Complete
d~per.dent
01'1'''' beneilts1
----...;l>
c~1
2
CautlulI_ II'll,e (;3f~ w~s provid~d In Yl;JUrilome, you may owe employYIl6rrt tro:eG, See !h,B irml]l.lctlons for Form 1040, line El2.
C.edit
C"m~E;,(_:;;P:""'::;,'li.:_:s;-:e~s_...",-~
La5~
.,---.-~-:-",,,:,:,,
(b) Qualifying llerS;;;;'a ~ocialsecurtiy nUI,lb~r
Informiltklfl
Ii yaw heve more tl1an t\'IQ qualiiyirl9 person~, see 1he instruction,..
IriCUrmd ~(I ~,IUr.J1:1 20051oC!'" (he flQl"""""" 1;c.1~tJ Ifl cahJli"In ti)
u1'1l~alljl~d e.xpCIIS~SY,,"
Y~IA
A~.
~B1=~~~
BAM./!..
-+_
'--I--~--'.~-""";'"
4,920. 4,920.
-=Oc.;O~O..:...' .=2:._5:_:.6~.
NA'l'ASIL1l" M.
3 Add tile ;l.mQU~[S In oclumn
[e) of line 2, DC! net enter mOrSillElJl $3,Qoo ior one (jualjiylng person or P;;.rt III, Mter the !!mount " oam",d InCome from line ~2 """" , _,_.. , cl' was ",............. _ _" " ,
36,UOO--· ~
_...... '" _..
1-':l=--t-_-_~6::.L!
1--4.:.-+- __ 1,-"",2:;:.• ..:8_0,-,-,
l_s'--t__
4 Erllsr your ~ ~rii!l)d In ~Qme. Sel;! in~tl'ucHol1:; ~ It marrien tiling JQI~UY. enter your Spl;ll,l'S'~ dlsElJIEd, 5 GEnter lh,;, Imrt""c:i~ns):
0~your
;;:PQUSOW~$ ~ student
3_6_2.:.l359 •
6;..",:_, ..::O_O'--'-O..:..,.
Ine5rngllest
oi liplll S. 4, or 5
~6""""+-
7 Emsr the amOl,Jnt lrorn FQlnl1 040, line SS , _.." , ,... Eilts; on. rille a Ihe dedmsl erneunt shown below thllt applies to tile amount an line 7
HUne1 is: aLit not ",O",v::_e1c.· _..:";.:v.=:iM':.._ __ $0· '!i,I'lOO 1$,000' '17,000 '17,000· 19,000 Declm1'l1 --"a:.:,m""'OUl1! Is ,3'1 ,33 If HnElI Is:
II
7 ,27 .26
.25 .24 22 21
.~~,
~~~t;., Ir~
j., : ".:'
Elm not
S 29,000 . 000 31,000 ,33,000
M,COO ·35,000 M,OOO·37,OOO
Deolmal
,···,.'ll
.as
.::Q~v.::c:;,..r_.:c~'~l.=:er:...,__~_.!!:amQunl: is
!;I'.
19,003,21,000
.32 .30
'2;:_.000 2:;,000 .
.3-1
,::;:£1 ,,28
37,000· .;19,000
.22
:'.;:':~: '
,I', "I,
x.2D
20
amount
"q'
,•...••.... ,
'10 iOnterttm a;;ioulil from Forni 1040, Iln<' 46, minus O1nyarnoent on Form ,a'IO,iifllO '11 Creditfot lin,,48 LHA
:515751 1'01'
41 " ", chile! end d",penq~.nt care Ill(pmS<l-$, Efitrerth" smaller al line S Of 11M 10 her", and on Form '1040,
'10
1,200. 5:1.3,456.
;=
,'
·"
l"·
""11nw""''''.''
..
u:J=
n-rs-os
09270331
131470 40C01F
2005,05030
OBAbl\, BAP.ACK H.
09/2'1/2006 9: lr5AlvJ
5.12
40C01F_:1.
li'll 0.15
SCHEDULE H
(Form .! 040)
a:
O";l ::nrn.::nt tno '1"r.lil=:iurj jrur.Ji'..3JflC~li:'Ifllrll;:;c:"'llic
Ii>
(:em
2[Q)(l1)@
number
_
"I~meolemoloY8!
EtnploYOl.r 'dsl1tlfloation
K<UlACK
A
H.
&.
L_-,-
Old ~'ou pay Wly one household emp"wae cash wa.g,,~ of ~;1,'IDO or mars In ~()OS? (If any household employee was your OPQv<!~, 0I.Jrchild Y under a\1'" 21, yovr pan?lnt, or 8l'iyo.1L'l under age , a, s..,e the OneA in~.t[1,lr;:li<;J ~n p ~ge H·3 tl!'lfcra nl; YOU an~I'I"f this ttuestlan.)
[X]
Yes.
1'I1'l.
Go to l[n~6,
Did )'DU ~Jj~'n"ld iQderal income I~ during :l.OO5tor any househr}]d gmploy~a?
=:J
I -I
Q
V",,,, iii".
c.
not ~jlunt cash wages paid in ?O04 or ~005 \9 yo,lr spousa No. Stop. Do nat file tilis schedols.
DYes.
Slrrp Iiniil9 ,·.9 .. nd i;!" 10 tina 1 Q 00 P~>I!. 2. (CaJend!lryp~::!I'taxpayers do net have \0 oornptste thl~ torm rr;>r2005.)
having no household
employees In 2005
~ubiec:t to
social s~~uritytmr.(lS (6~S page lin:; 1 b;' '12.4~'(' (.124)." ...... _..
1-1-41
'1
dO 9 r S .......
"I
;: ,;, :,:
' •
••
e·,)(:I~1 ~~,;ur1ly
=,,~t ultlpl\' M
1,220.
I'
EJ , S4 0 .':
,.. ,
::.?::
205.
~
"f',
() Fad~aJ lncorna
= wllhh~ld.lf
any
_ .._
,' ;-,;5-+_=...--
1,505.
..
1;1
,~\fancEl aarnad In~'omg of~dlt ('"Ie) paym9m~, lt any N",t 'Iaoo<ao:; [sUbll'ti.:t II"".
'j
,,, .." _
"
,, "
, "
,,, ..
[-7:......1- __
--
{,'o'l'lll,,~ 61
:1.,505.
!;I
Di<J Y"I.! P"Y totel ",,5l1 wag":; c: $1.000 or more In any clllendar tlutll'tm' ot 2C04 or 2005 to !1Du$ehold employees?
ltlo
1'10<count
under
L_J
LX:
LHA
,~o.
Sta~. ENOl'lha ~ITlQLlmfrom line 8 above O~ FOlm 'I 040, li~", 6:<, If you are m)t rl.'ql,li,.,ct i;r;l HIli!Form 1040,
the line 9 lnstructinns on [,Ia90 H,q,.
5""
Vas. Gr>10 IhlP.10 on pa!lEl 2. Reductiol' Aot hI<:l!ICiQ, soa separate If'lSlfuctJons. $ohedLlle H (Form 100JQj 2005
=-~~":I;, , • '-r!l-'Of
U9270331
131470
40C01F
:i.l1
40C01F_1
9: 45Ai"I
09/21/2006
09/~1/200B
1'~'"ttr~nr,l Dependent
a.
L.
OBAlY~.J"
.'j
--,----------~~,
'12 Entar the total amolJ"t oitloR"ndcnt C:lI"ebeneTitr:;you reo"ived in 2005. Arno.mls you r.."elved as an .,mployea should 1;1" ~hol/l'l1 in bo~ 10 of your Fr,lTm(s) W·2. Do notincludeamQl,lflts report~1:I as wagasln box 1 of Ferm(s) W·2. If you warG self·employer.! t'Jra partn ..r, Include amo..,ni~ you receiVed under a d5pend"ni 0"''''' a~~isti:ln"e program from your sale prn(ll'lllIlcffihip or partns,,,,hlp .. ' " , 1$ Enter the amount iorleitsd or carried torwerr.l to 2006. if
..
is
Ental' the i"t;JtB1 amount Dr qualiiled expenlOsli Incllrred 1n-:200S fQrthE car~ of the gUlllltylng per9cm(sj .., , , _ ,.., ..
16 EfllGrUlellmall9"0lHne
'1<1
or'5
_
,
"
"
..
..
1:;1 Entgr 1)1" amount shown belOWthst appli5!.\l o you. t o If m,mied filinfj IQinUy. enter your SpOUGo's "~m"'d Income (iFyour -) ~PQua8 wa~ a studtlint or W~S dlsabled, the inotl1JClionl; far line 5).
~"'!l
e Ii mllrlh.dfJli119 I<9parately, ~M tne Inot"uclion~ (mille arnaurrt to ilnt;lr'j " All 01h1;lr.:., enter U1S J!lmlJuntfrom line '17. '
'19 EI,[er!h~ ,.tnalieBt of fine 16,17.!;It 113 .. ,." " "" ,', " .., L-1;,:e-L._~ ~....,_, 20 Entw Ihe amour;! from lirm '12 that yo~, rscalved irom your Boleproprietor;;hlp or Ilfirtnetsl,lp. Jfyeu did not .,'~ ',:, r..Qeiva an.YB~¢i'Iamounts,.",Mor.o , "'.,
ill
'; '''J,
' 1'
21 Sul;!traclline 20 from fjrJe14 " ""..... 2~ Zl: Enter $5.000 ($2,500 if m$yrl!lcl filing EOGparatefy'Ind you were ,'equired to enter YOlJr$pousa's ..",mad I lncorne on ling '16) ' .." " " " , ,', 2S De>;!uctlble b..nefis. Enter the :smol!e~t of line HI, 20, 01'22. AI.e, rr'lclucJ13 amount on Iha appropriate Ihj~
IU1e(s) ofyourretum (saeth9Insl;n.l""~Ol'\sl :" ,' ""
,.........
::·j~!r~,~ I,:'
!'r1r,)::::
2D
i,:t;: ~q
!-"!.L=9+
~
•• -
2:;\
c__.
24 Enterth$z;ma!(crofhne1Sor22
25 ~ter1ho
, ,
..
t±=~41
25
u
.
..
as
(II 'j.~I.~
Cl(o-Iuded b""llfits. SubtrEct line 26 ii1:>m line 24,1(~ro or I.,SY, "ntar -0.
o'lnt6f
:;i;::':
26
'/.,7 Taxable benefits. SLlbtrnt:t line 261rom line 21. 112~ro or lesa, line 7. 0,., the ctottli'c;lU,,1ol next to lIne 7. enter "DOS' '
27
oomplete lil1"'S28-32 balO'.'!. ZEl Ent~r $3.000 ($6,000 If two cr mere qUilliiying pSl50ns) :ZS Add lint'ls Z3 and 26 _ , " you paid 2004 ' r3..;.O-+ __ , , ..
...&!LI-_~
_
_
30 Subtract IineZ.9 from liM 25. It zero or less, step. You cannet take the ornclli.. ~:ceptiol1.lf
e)(peIlS~SIn
200S.
",6" tho
'
3'1 Camplst ...lills:2 0" page 1 (Ii this torrn.Do (1J;)t ln~hJda In cO!lJrnl'l(c) ~r·v b",,,,,ntl; ~ihow" on Jil1e 29 abovs.11·,en, add tM arnounte In cnlumn (..) ~Fjd enter th~ total hen ""
"
1-":3_·1-1-
~-_~
,3
2 ~::~::
::l~~ ~
131470
......132
Fonn 244 i (2:JCJ5)
513152 1,·Ui-Oil
09210331
40C01F
5.13
200'5 • 05030 OEAl1'1..i)",BARACI{ H.
09/21/2006
OU/21.1 2006
141016
,0
Did you PilY unemployment contributions 11;1 only OM ~1:ab;l7 (If you paid ""rrtrlbutlon:;
ohecll"i'lo,") ,., """ ,,
Yes
r~o
10
1'1
'12
ss e p ago; H-4
.'"
. ..
wi w<lges
Next: If you checJ""d !h~ "Vas" box on all me Hnes above, cQmpl~ie S.,<;:tionA. If you checlled the "No" box on any of the linea above, ,Mp Section A and comptsta Section 9.
SectIon
A.'-__;_-----~~---.~~--~.
i~4,.2
j
"""
II.
3 ;) B 5 '!5
ta.~rerum
.9
-15 Contrtbuti-ns
'16 Total cash
""<\9"'..
rrsc •. ".
~
~:~q: :!~~r~
1"'('1"
':;
1__ •
9:......<..1..:6-'4:..°"-'-.
17 I'UTA
~)l.
M":Upl)' iine 1 e
l;Iy .ooe·
77.
(il
(9)
(~J +~lli~Jr
eel.
01
:ilalc
~ryou nee"
(0)
St.i:!'IQ.open]ng nurnllut
taJ
Si~~ II!:I[p~eno:'! r::lo:!
'I")
~~:~~I~;~~l'~~
lii~Utl'l
r;:t\l~
MlJlttp!y ~.
lel
(h)
Sublri!:C;(
pe:l'io~ Ft-onl
I-_T_._+
e};p:!n~
by JJ~
by eel, (O)
Il~~~ r;'iJIl3,
(ClJ.ln1
OJ
COI"1\rtb1JI;:n!:
19 Totsls
QO
..
..............................................
" tax (see the line 16 " " .. " .. , " .."., " "
,
""""
,,,
"......
,,.,"",,
,,
:;:1 Total cash wa~es subject ro R.m; ~ Muldply IIna:21 by 6.2% (.06~) 21 by5.4'ib (.054)
in"lP.i,.nr;'fU'
II '--2_0'-1.
j~'~~~:j~'J
_
..~:l:.; , 'r
-'-
23 Mulilplyllne
"
, 1-7.:23;:...l..-nj
-l~·';j
;',!~~:~; .
24 ~~~;::::;:~:::~::;~~~
:~;t\lu~:
2B FUTA te)(. S\lbtr~at line 24 tram 1~1e 2. Enter tll9 result here ana go ('llill!) 36 2
--~
..
==---
,;;.;0"='
~ . Part IV below.
1.505.
r
sa
..
..
Are you required to ille Form 104D? (X] Yt=1i_ Stop. Enter tho amount rromIlns27
Vh~U
Jlei~lTlenl
ttl:!.IJO t1J;:!IT"Jn!l:d[hi~ Clc.h.t!duh"t."'t;;t\J~I'\Qiacc;).~~Il."Jtlrl.!J .(Il9.1-j""';'-l1!~1n~ " IUM t~,1m~tl (1:;0 I'l DI.atlll l'.I';l!:I. or i=ll.!l1J=:!, Ij.Q;<Iuc.ic:: t;OlC'l Lhc.:: Jl:lI'III::inID!!l
to UdJ DD9t
~m?'ID1iI;!,=,r.:.
rot
m~
l:tlti'.'J!uc!3'a
iI.,(I
balSl,
rv IIUD,
C,{:lTfl::l.
:If'I(]
ClIT'plote.
I~ICI p~.:;t
.::.n1
Sci'~dul~
H (F<:lrl1l10401 2005
2005.05030
5,15 OB.A.!."\lA,I3Ji~CK
H. 9: 1~·5AH
40C01.F_1
09/2'l/2006
IfSflS.
PC,
CPA'S
BJ!RACK
FORM 104,(,)
H.
&;
IHeliELLE
L.
OBM.iI._l'\_
loiISCEJ ..LANEOtTS INCOME
STATEMEiiTT 1l.H01]NT
DESCIUPTIOH
Bh'i
TREEHOlJSE
:j3,QOD. 12,000.
21
45,000.
STATE
AI'IDLOCAL
2002
~r.l'.x PAID
IN
FOLLOWHTG
YEAR
352.
ILLINOlS
352,
'l'A.:li: REFU'rIDS
092'/!l:i31
131470
aocnrr
5.16
STAT~NT(S) 1, 2
40C01P_1
9: L~5AM
09/21/2006
81l0';'
\\'SHS.
PC.
CP_'\.· 5
I4J
018
STATEMENT
AlY10UN'l' SHOWl\1 ON LUTE
(1
NO.
2.
4.
3.
STOP. MULTIPLY $3 r 200 BY THE TOTAL N'''0}'JBER OF EXEMPTIONS CLAn-mn ON FORJ.'Yl1040, LINE 6D r .AND ENTER THE RESULT ON 1IN"'E 42. YES. GO TO LINE 2r MULTIPLY $3,200 BY THE TOTAL NUMBER OF EXE~{f'TIONS CLAINED ON FORM 1040, LINE 6D ••••• , ••.••• 12,800. ENTER THE AMOUNT FROM FORM 1040, LUTE 38 . . 1,655,106 ..
j •••• ,
STATVS?
38,
MORE TR.i!lif
TEE
5.
6, 7.
8.
9.
FILING JO~lT OR W!DDW(ER) $218,950 SUBTRACT LINE 4 FROM L!NE 3 ••• ,.. IF LINE 5 IS !!WRE TRA"J'\1 $122,500 ($61,250 IF MARRIED FILING SEP~~ATE) illYTERZERO ON FO~I 1040, LINE 42, DIVIDE LINE 5 BY $2,500 ($lr250 III MFS) l-IDU.rIPLY LINE 0 BY 2% (,02) 5u~D ENTER 'rEE RESULT , AS A DECI~~ . . . , . . . .
~JU~IED MULTIPLY
HEL]l.D OF HOtrSEEO!,D
SINGLE
FILING
SEP]>_R_7!,_TE
$109
t
I
$145,950
$182 450
475
218,950.
1,436,155,
LINE 2
BY LnqE
...,
TO'.rAL
..
"
...
II
SOBTRACT
LINE
a fROM
1..INE2.
TO FORM 1040
LINE
42,
D.
09270331
131470
40C01~
2005.05030 oa~~,
s . 17
BML~CK E, 09/21/2006
STZ-i.TEMEII/T( S)
40C01F_1 9:45AM
O[!::?l
'211f16 08:-16
FAX 1 H2
372
8407
IaJOIO
&
i6ICHELLE
TAX..~B1E
STll.TE
STATEMEN'l'
;;1004
i\''ET 'l'A.X 1'!.EFIDIDS FROM ,STA.TE ,1I.,.ND LOCAL !NCOME 'J.'A1~ REFUNDS STL<1T.
2003 352.
2002
r.sss
352.
'1'O'.l']:_LITE!HZED
DEDuc'rlON9
BK1'-ORE PIil-,Si1:OUT
DBDiJC'rIONNOT SUBJ TO PHASEOUT NE'l' REPmIDS FROIJi LINE 1 J.. IJ:1E 2 MINUS .LINES 3 AND 4: M1J!_,Il'IPLY LINE 5 ElY B0 % (.80) PRIOR YEAR AGI
ITEI}1., DED. l?F.ASEOtfT .sUBTl<,JI.l.!'r LINE 8 l?ROlYl LINE
THRESHOLD 7
10 11
:2
10 TllROUGH 15, }~ND El,TTER AJr.iOU}TTFR0l1 L niE 1 ON L Il-iE 16) HliL'rIPLY LINE 9 BY 3% ('-03) ALLOl'1AJ3LJll ITEMIZED DEDUCTIONS (LIN:<i: 5 LESS THE LESSER Oli' I,}::rl'E 6 OR LINE 10) !TEM DED. NOT SUBJ TO PHASEOUT ITEtllZED DEDUCTIONS
1,,948. 24,675.
13B PRIOR YR. STD, DED. AVAILABLE 14 PRIOR YR. ALLOWABLE ITEl~. DED.
15
16 L7
OR l,I:NE
BB
~RO:M LINE
TJI...KiUlLE F"EFUlmS
IJESS.t:R OF LINE _;:;_L!,OW~1.BLE PRIOR
1.4
1.5 OR I,nm
'):1\,
ITEM.
1) DED,
352 ..
18 19
20
21 .",r, .. ...
:.,
170,219.
15,328. 352.
Ar([CDN"I' '1'0 INCLUDE ON FORM 1040, LINE 10 w :eli' LIllIE 21 IS -0- OR MORE I USE p.1-iOf;JJ:\TTROM IJ:mE 20 F " IF LIl'ifE 21 IS A NEGATIVE AMOUNT, NET LINES 20 AND 21 STATE AND LOCAL,
353.
PRIOR
'1'0 ;W02
TOT~~ TO FORM
1040, LINE
352.
09270331
131470
40C01F
2005.05030
OBAMA,
5.18
BAJL~CK R. 09/21/2006
ST 1tTEMEHT ( S ) 4
40COIF_1
9:45AM
If!] 020
L.
OBAM..t>..
RECEIVED AND 'rUES WITHHELD STATEMENT 5
FORM 1040
~lAGES
F~DE1Ut.L
T S E:tnPLO'fi;R ' S NAME T UNITED STATES SENATE Wl'.SFInTGTON I D.C. B UNIVERSIT'~ Oli' CHICAGO
AJ."'lO'Ol\lT PAlD
STATE T~ iHTHHELD
TAX ~l1E
CITY SDI
FICA
'I'p.x
MEDIc..~
'l'p...};,
5,580.
:1.,320.
4/743. '7,063.
HoSPITALS
TOTALS
----
5,580.
11160.
FONH 1040
NAME
QEl'
PAYER
lJ1VIDENIlS 2,'754.
9E
2,'754.
:2,754.
SCHEDULE
STATE ~~
S TATEHEN'I'
TQTl'..L TO SCHEDULE A,
LINE
09270331
131470 4QC01F
2005.05030
5.19 OB~m,
BARACK H. 09/21/2006
(19/21 '2006
0(\:
lI'SHS.PC, CPA's
~021
Bl'.B.ACR H.
OBAMA
CASH
COJ.ITTRIBU'TIONS
S TATlilMEJSIT
AMODl'lT
DESCRIE'TJOlli MISCELLAl~OUS
TRINTTY C.~E
50% LH'l!T
30% LIMIT
M~OUNT
RECOGNIZED
CfffiRITIEB
CHURCH OF CHRIST
11,315, 25,000.
SUBTOTALS
'.1'0'1')1.1:., O SCHEDULE T A, r~INlii 15A
77,315.
5,,20
nQ270331
131470
40C01J
2005.05030
OBru1h,
B1L~CR H. 09/2'1/2006
STATEif.IENT ( S )
40C01F_1
9: 45Ai"1
09/21/2006
141022
BAR.4.CK H. SCI-IEDULE A
&.
MICHELLE
L.
OElJiJ>l'A STATEMEN'r 4, 9
1. 2.
9, 14, 18, 19, 26, .t'I..1lD 27 •••• ENTER THE 'l'O,):,AL THE 1'l.MOIDITS OF
13, lSB, AND"19 , PLUS
,A.,
•
l,IJ.I'lES
THEFT LOSSES Il\fCLODED ON LINE :27. • • , . • • • IS TH:E AMOUNT LINE :2 LESS TF.li'-Jlj THE p..1t!OmifT ON LnTE 1? IF NO, YOUR DEDUCTION IS NOT LIl>II'I'ED. ENTER THE Al".l:OOl\lT F1WM LllIL 1 ABOVE ON SCHEDULE A, LINE 28.
FROM SCHEDULE
A, LINES
4,
157,683.
on
o.
157,683.
4.
5.
Q. 7.
MO'LTIPLY LINE 3 BY B 0% (.80). .•.• EN'I'ER THE AMOUNT FROM FOR..1\>I 04 0, LINE 3 a . . 1 ENTEr:.; $H5, ;J50 ($72,975 IF MARRIED FILING SEP]l.R.~TELY) • • • • • • • • • • • • • , • • • IS THE M\>iOmTTON LINE 6 LESS TEAIiT THE m40Ul\JT
OliT LINE S?
.9.
B.
IF NO, YOUR DEDUCTION IS NOT L1MI'I'ED. Kr\1TER 'l'RE p_l1110UNTFROM L D~E 1 ABOVE ON SCHEDULE A, LINE 26. IF YES, SUBTRACT LINE 6 FROM: I.,INE 5 , • • • • MULTIPLY LINE 7 BY 3% (.03) •••••• ENTER THE SH..Zl.LLEROF LINE 4 OR LINE S
1,509,151$.
45,275. 1-
45,275.
112,408,
10.
TOTAL ITEMIZED DEDUCTIONS. SUB'l'RACT LINE 9 FROM LINE ENTER TIiE RESULT HERE .MID ON SCHEDUiJi:!: A, L lIVE 28
SCHEDULE DESCRIPTION
OTHEn
INCOJa
STAT E!-.!ElilT
10
AMOUNT
DYS~EL ~ GODERICH
RAT.l.lDOM HOUSE
335,706.
874,167. L:nm 5 1,2G9,H'73.
TOTAL TO SCHEDULE C,
09270331
131470 40COIF
2005.
05030
5.:21 OElJ.l..M1'~,BA-RACK
n.
STATEMENT(B) 9, 10 40COIF 1
09/21/2006
9:45AM
119. ~l:~nrlll
08:H
BN:,ACK
Hr
OBMrjA
CAPITAL
LOSS
CAPJRYOv~R
STATEMEN1'
11
2. 3. 4.
5. 5.
EN'1'ER THE LOSS FROM SCHEDiT.I..!E D, LINE 21, A,S ,A, POSITIVE AMOUNT. COHEINE LINES 1 J:Il.m 2. IF ZERO OR LESS I ENTER -0E11'1'ER TEE SlviALLER OF LIl.JB 2 OR LINE 3 •.•",•
SCHEDULE D LINE .." AS A POSITIVE ,A.Wi, .FRQl\~SCffEDDLE D, .•-•••.,•
J
"
..
1,542,698 • 3,000.
1,545,698. ~,OOO.
s.
1. 0,
g.
'7.
EN'.rlm. THE LOSS FRON ENTB~ THE G·AIN, IF L INS 15 •..•• ADD LINES .:1 P.1>ID 5 SEfORT- TERM C1.j? I TAL
.il.MOUJ.lTfI'
13,136. 3,000.
.....,...
LO,';:S Cll..RRYOv'"ER TO 200 6.
5,
IF
ZERO OR LESS,
ENTER -0F.MOvNT.
10,136,
12.
:!'J.
ENTER THE 1,088 FROD! SCEEDUT"E D, tINE 15, ENTER THE GAUl" I IF AJ:.TY, FROM SCHEDULE D, LIDTE '7 • • •
< • • • • • • • • II fI
AS A POSITIVE
..
& •
!J
II
ADD LnmSl0 1l.ND11 .•. I,m.Tt"iI-',l'EPJ.li CllJ?ITlili LOSS C]\_RRYOV'ER TO 2006. 8iJBTII.ACT LIl'JE 12 FROM LINE 9. IF ZERO OR J.:ESS,
, • • • • , • •
"
. ..
STA'I'EI".IENT
AMOlJI'iIT
ENTER -0-
SCHEDDldl:
SE
NON-FARM
IlIJ'COME
12
DT!:SCIU.PTIOliJ
1,141,4.95.
SCIIEDm~E BE
NOllT-FARlIj INCOME
STATE1.ffiN'T
13
DEBcnU"rION
BpS VALLE"f FOODS
JI..NODlitT
TREEHotrSE FOODS
TOTAL TO SCHEDULE BE
I
33,000.
12.,000. Lnili\ 2
45,000.
09270331
131470 40C01F
2005.05030
5.,"22
STATEMElilT(S)
11, 12, 13
4.0COIF_1
9:~5AM
09/21/20013
5:107
wsns.
PC, GPA's
@O:'!.j
1015
MICHELLE L, OB~~
BARACK
H.
OB.A1!m
C Rllns~1"lu~
o
'0/'
2.
3
(~G<'J InstnJo~r;Jm;)
--=-----~=-----~~--~~-~-~~---~-~~--~.~-,,of iii prr.>tesslonall>lhletio team o;Iuring 2005 W9,>$ IJie<lmo irom YOIJr U.S. 1[MO, Line 31; U.S. 10AOA, Line 21; or
~~dD~lEd
1,555,106.
an'; dividend income from you, U.S. 1040 or 'IO<lOA, Une Bb:
:2
ather
g g
~ S Step
AddUn~SjmrOUgh,:3.~lli~i~~ls~y~0=u~rt=o=t~~in~oo:m~3~.=-
3 ~4_:====1=r=6:::5:5=r:l::0:6::~
.5 Income F.i!caivedfrom Scciaf $ecurlty benefits and Q6tbAl1"l Qllmment plans ( if Included In Step2, Lins1.Attach federal "'9~1. P 5
6 MU~a'1' pay earned if 11101I.ld,,~In Step ~, l.ine 'I. Atl:!ml, bi1l6, ~O'\BG, ~~vinfls bonds, mlllt~ry W·2.
illinois lncorne Tax oVerJJOlYment Includel;i in U.$. '1040, Uno 10. anc;! U.S. agenc), '1.
6 7 9
352.
yourinoomB. '!,tlach
S~h"dule M.
C1160i( if L.IM 91ncludee erlY amour,! from SohedUla 1299·0. llns$ 5 through 9. Thlals the total ot-your 5ubtraotJons. '1'[ Sub!I·.:let UnB '10 from Une 4. this Is your illinois base lncome,
10 Add
0
...
to
Ii
)( S2.(lOO
1,6;'4/'154.
352.
A 12 a ;"".;,::~."" b
""~~~05
Un. 1i!.
Numb"'f QTe:(QrnptionB from YQl,lrfederal return, If :;;omSorJ9 elsa olaimlild you or your spoua\i' vJrlm here,
<11;1 "
4:
d~j:Jendenl
8,000.
b -
c
.,
~
D SpOUSIl
D Sppua~
)Ii
$2,aOi'l
'"
Q
X $1,000 X ~11.00[)
d----
!
J!I
0)
g.
is 1'lF.!:;;lcient::. only:
.:....:. _:~_:_...::....__:__:_~=o=:...:...::..=:......__,==~~=~ _
p~rt-ye:W reslden-re only;
__
Un." 12 Ircm Llne 'I'. This la your net income, 5l!ip I.ln~ 14.
9 ....,.._~~~=-====:::::::::==:
12
'13
13r 0 [) ,
~14NQtlJ·G'SJd~n.tsand
8t.epB:Trut-=~~~~~~~~--=-~~~~--~----~~========~-15 Residents:
rvlLlitlply Una 1rJ by S% (,O~). Wr;j" the result here. Thls il;; your=. iIIonre5'itlSl1t~ and part-year fGsidents; Writ\! the taR trom SChs.dUle ~IR. Tille> amount mey aot bo less 1h~n zero,
Check 1118box that «pplies to you during ihe year 2005. D Honre:;idsl'lt IIImoi3 .t;ls",. lneom~ from Sche'dul<; NR, Attac:h 5r.h~dlJlcNR" . ~4
o Parl'Y,,6f
f;;:;idenl
~
16
r~UUJIlfD
..:4:.:9'-'--,..::4:..;O:..;3~.
IL~
~:~-P~l
TIlle. 'orJTJb :iillJl,tlri:tuI lIS llUlnno rI D;I lIi" 1~1no\!:ltI~i';il'J j;t£f, A..:-1. OI~cllJ:lmo 01 till!:! inh::"rm=lllnn liJ Ai:QIJIA-5:[;J. provfd"CI in:lCitI\t!_1I0" c-owld ft.'3Jn t=, IJi ptlnwl;'.11l18 r\l~mlI.as tlGQII'i i)pp~a'l1i:;d b)' lliil fo.."m!] Menn~Jru::nt t:~'ltcr.
IL·Q'02-DDtiS ~
09/21/2006
O~I ~l·~UO!:i
llS:.JS
FA.\: 1
ai a
,TrZ 8407
1I'SHS, PC,
CPll'
Ig)025
B;'ill.....l1CK E!.
& MI CHELLE L. OBfu'\ffi. is Taxamo\Jl'lH'.:.mP"gB1,$tepe,Ur!e1~ Step /: Payments end C~'edi1:s i 7 Ullnoi3 lncorna T"J< wKhheld, Attac.h W,2
1S Estimated pavrncms ovsrpayrnent
:::'~:":=~:':::"~.:._------------------:_:_:::..===~:=~==
and 1 D[1g fQrI'Tl~, lneJudir'ig
1$
4.9,403.
'17 __
~1_3""",_95._,_O_. ....
i8
19
_
~3~4~rO~O~O~.
_
1!j
InCOIilB tall paJd ID anolh(>! l!;ttlte whll .. an liIillois SCMdul" CR WI.. Qth<:!r ~\;;\te£l' rannns, IIJjmJi~ Prop.rr\, Tax ere:llt. CamlJlate PT WQr1';:.hest Line 3 amount L;n~ i;I .. nl~unl 206
20
PT WQrka~eelin in:;truGlio05.
rT W."I,r,i1egl
21 K12
orSohmluln
ttl
---20b
or $cl]edyle ED. 21 a
F.1C Worl,;;l1eet
~--~--_
_
2'1 b
In InS1:rLlctlotiS.
ED Workshea! or S~h~~\Jkl ED I.lne '10 amount Eamed Income Credit You must complete
una
1 ",m~\I[lt
22a
~ __
~_
Ele ~r'?Oi( amount rrom the EIG Work5l~l!!et :22b Cheoll fi you hava a qualifying child (living woh IOU) bom aftsr121'3i187. 23 lneorne I~~ ureal!
-,.--r-------
amount
$<;h"duie
i 29'8·0
23 --:-_-:-_....,..
__
--;~
24 ,\dd UMS 1;', 1<I, 1 P., 20.~I;1,~2~1~b~, El:n~d~2_3_._Th_IS_I_S ~2:2~b~, _th_a~t=o~t~~I_O~f \~'o_u~r~p~a:}'~m~ent~, ~S~!IfI::._:d_c_r_9d_'_lSStep 8: Ol!o;ll'f,lsym<ilm 01" Tax Due _
25 Ifline 24 is greater
i6
2:.:4..:====4:7::':' ~9:5=O:::::.
25 ;;- ..... "".."
than Una
ie, SU~n'!ot
Llrie 1G from
gre~l.e_:..rt1l::a~n.:.u=·n.::e~2=-4.:.,_:S...:U...:bO ...:a.:..I;:_t_L_ln_ .._2_4.:_fr.:.om_L:..in..:e:_1:..6~.~li_'ll:,.iS..:I_S.:Y.:.OU:..I_' i_::tl:.:lt_:tI.... '1_9_, 2.7 I.Bte-p-aymem pel'l~[Y for Unclp.rpp.yment ot e~lirnated tax, Z7
Ch<1Clllf you annu3112Gd YOUI'lnlJom~ E5 or older "nd permanently on Form 1!.·221 D, step 6, 01' II you a", nome. living In "nur"in~
=.:.2:.:Ei..:=====1~~1:4:5:::3:.:
_
Am.c"
FOI7TIIL-2210.
Siep
'10: D.msticli1$
Any o;;iJ;lnertignwill redllG6 Yllur roiulicl cr Ih!1r..."~ "the amount you OWol) _=~~= .
fU!1ds
==_~
_ _
~
2-8.
MAKE GIVING
EASY
Amount you \".IISI,10 don .. l e to one or more of lhe [ollowlng VOlunt"ry Wlldlflo a MllilaryFamlly 9 Child Abuaa b Lou G~hrIO'G h AlZhnlmor's c IL Veler~m;' Home Homeles~ d Epi.lep5y J
8t,usIC"ncer
<'
.__
23
_ _
DiEltl~I~3
CQlon Gano~r
k______
.'t.\jI~pIB SoIeroSi5 r .. •
StL'!jJ
29
Add U,,<'~s thr\lugll ll. Tni;;;.\1 yow' !Jonations ~t;t":. AdLi Une 27 arid L1na 2B. Thl~ is ynurtetal pe~8!tv ana donations.
--=
==== __ __.
29
__ .
--_==
~al:.
on
U"a 25
SO
Direcl Deposit
J'/ Ame'lIlt trem t.lne SOthat YOLI w,mt "'!mlied to mUG "gtlmatod $2 Subtro~tUnl'~11 irom 1-ine 30, lilis Is ycur refund. 38 GomplB[B to dlrsct deposit ~o'ir ll<iCI'1d.
3'------------~ 32 _
111'0\1 have an :lverpayrnant 011 Ulle 25 ~Ind this amount Is 1113$:11"", Line 29, El.lb!reot Une 2S irom Un" 29. Tl~la~ t."e amount you owe.
I state that l hava e:~amlnM th'5 J'l;rum
$<,'1-
~~
_;:1::....:,_;:4:..::5~3-'-.
___
~.,d.o the t
[1I~miJcr •
best 01 my ImowledS6,
';"'Orr;ij,-;~I"'!:1l"'"'"lu;;;;ro:-----------On..Hl<or---
UIJllilriD p~r.1!!
)I no
p~ymenlls
enoli)uell. mall to: ILLlflOIS IJ~PAFlTM.IIT OF AEVENHE SPRINGFIELD II. 6?7'!.I-OOO~ ___ Pf _ CA
or
M~
r./S
PR
RR
IW
WA
WV
ZZ
1o
09/21/2006
9 : 45Fl~1
WSHS,
PC, CPA'!;
mL 22 ~ [ffi ComputaftUon
ffilr®it ..
Seqll~llCG No,EO
2(OjmJ~
Read
'j
1!:llilis ijlf~fiiJI[J"maitio[f1 FOI mlglnal mwrr.~ only, Do nQtvse thl5iorm Ilyou are fillno FG,m IL-'IO<lO-X, Armmdfld IndMduallncomc T~~Roturn, .nsr lim El;d~ndcd due dliE oi Ilia return, We eorourage you to 101s 119Yr~our pen~Ii<~" und ,end yuu a bill insmad 01 compl~tlng and mlng lhl~ 10rm yourself. u ,
r
and endlflg
~=-_--',=::-,--- __
MQluh '(11..,(
2
3
2 BAAACK
;3
fL
Write your Social Security number as It ;;.ppoo~" on thi" year's Form 11.·10<10. Ii you, prior year FormlL·1 040 wa~ 111M usin~
(l
4 This yeaf 5
A
Lasi: yea.
e
1 8
49,40:3.
49,403, 13,950. 35,453. 44,lJ63. 5,783. 1,446.
QlJari:el'S
Sepi.embl;!r 15, 2000
5,980. 5,783.
197.
9
10 "1
12
Quartet' 'l
'ij S Writ<;! the r"":r,lired inst~lIm!lnt,
Sea 1i,${nJctlOM_
April 16,2005
JUltlllto, 2Il05
Quarter :2
Qualtel'4
Jen>.J';o'Y '17, 2006
'l4 15
'16
1,446, 3,488.
1,446,
3,498.
1, 446 ,
__
J..445
::1,466.
Writ>? any credl! ~fliod telJ'IlJard trom tha prior year :;Ind the erncunr Sam Imm-ucrlons_ Sul;ltl«qtUne14iromLine13,lftile arnourrt Is negauve, us .. brackets, Itthe amount on Line '17 Df II1Il withheld.
3,488.
<2,042.>
.... 2,042.>
<2,041.>
17
i9 Add your etedlt caniad forward from fua prior year, your total $5f:rm..te,1 Pilymenls made thIs yeW', and your withl10lding <16' shown on your W-2 forms. Compare that total to either the arnourn \'ll1usn 01'1 U'l;l! i 1, or, jf you
annnallaed, the tDtaI of Line 13, QUart"fE 1 IhrllUSh a, and writa the gTlml1J!l' urnount h~re. made on or before Apn117, 20013,
20
19
47,950.
Write olhsrpsymentB
a WritB1I11l amount ~nrJ IhE! d~t8 01your r-arm IL_.!;;05-1. b Write the amount and the dare oi any othar pnYftlel'1t
Add Un .... iDa ",1'Io:! 201;0. rilljf Eh~ l1mo..,nt here, W
zOGl
20b
20
21~
1,453.
21
22
Add lines 19 AAd 20. Wrltl'l th~ 10lal am1!lUi'I! hete. S!,!btr;lol Une 21 from tlne 'I S, If the amount Is
c POSllill"', Wl'it", lila! amount here. Continue to step 4, and write this amount 11\ aliifllty WorIOl;h~ '1, lIns 24, Column C. P ..1 o zero or n~gatJv~, \\Irl~ In.. t ... o;,Ul'Itl",r';;l,if neg<itlve .IBe bro.ckirt5, Cominus to step 4, skip P~n;:;,ltyWor~"M?t 1, m I mi;l 91;> P~natty Worl"'heet~. You may apply this amount to any underpayrneni when 'ijgwing your Penalty to 5~glal Work$h~ ..t 2. e lm.tructions. 22 -,-
s...
0::....:....
t2-El-CS
09270331
131470 4oCOIF
2005,05030
OBAM..J:>., BARACK
13:. 9: 45Al l
y
40COl.F_1
09121/2005
IgJ 02'1
me p~nalry
I"I,,,,,ally ra\~
,02 :10
I-~~~~~~~~heei
I~I. 2:3
oil - Late"payment
. --=.=======-=_=-=-""-::=.~=',,,,'-J:o='
·=l·1 .
Amol<nt
Date paid __
all
I I 124
A
;;
0 ----~
PCIIO~
Due ~.I~
SeD
amnunt
iJnpald __
Pilymeflt .pp~ed
Pa~lI\Ilnt
dDta
PanBlty rata
tI
(Seeab~ve)
PenalPI
25~~~~
i Nut",
'26
fQf underpal/msm:
of estimated
ta}(
:==J
_
Oate. paid
from Line 17 by the payment due dare fpi eech quarter, do n()~completethis VlorllSheel
Virile [he amount am! the dme of each esttrnated income till; peyrnentyou made. S"" ih.slromlon5,
Amount a
2.7
osteiPaid
b----~-
c d------
e~
f
Amount
from Step 2, Una 17, Quarters 1 I/1rouoh 4, onlhe first nne "ltr.~ approprlale
quarters
in Column C balow.
A
1
i P ~r'otl
n~le
i)1'G
~mount
Un ~~H1
. __
D
Pa~rn9/1t
applied
PCIl;]
II Oh'
':'::~~~I
Jan , '17,,WM
128
.<\ctd Columfll,
()uarl!)~"
penalty
for und0i'paYn1Mt
o1~;,i:im;'l,~r:l"".;(.
"'nd On yeur
2=8=· ======;;;
IL~~2'lo(.A-12105)
f.1:~'~~
i ::,,~:j,,[i~
P~~n~Of ~ :;;
09270331
131470
4QC01p
2005,0503·0
.9
9:45AM
0[)/21/20(16
\\,,'JHS, PC,
CPA'S
~028
L. OBAl~~
anl!1 If
o you at!! ftl.1n9 yo u r Form IL-1040 R Her O~IObo(16, 2005; and o your \ax l'/Il ~ not pa id by All rll i7, 2005.
;;;1
=========
e..
sa Wrll~ your 1111 basg Income now (or &!Icll pBrlod. see Inslruciions.
AnnuJIiz3tion metar:;. 38 MuI~p,y Line 36 by Line 37, Til I, Is your &11nuilIl1.~d IncomQ. 39 ExempiiDrlS. S~e InstilJoiions. 40 SublractLinf, 39 from LIne 38. This is yaur !lIino~ nci lncorne. 4'1 MulllPIV line 40 by:3'/o (.03). 42 For en~h PBrlod, wmB Ihe amo unt you VI(Ot~ in Slap Z, Golum n A, Lln~ (i_ 43 SubtractLlnB "Umm Lim 41. -14 Appll~able percenmga, 45 Multiply Uno 43 by Line 44. This Is YQ\lr annlll!lIlEld Imrta~m~nt oW Add tlIc amounls on Line 52 of eacn of the preceding Golumns anti wrilll tlm
37
45
totaJIl$r~
47 Sultu-.JctLinn «5 from line 4l'i, It tssa jh~n ze 10, wrilG"O....8 Write the arnonnt Imm Slop 2, Line 12. in eath rDiumn. 49 Write !~e arnauni lrom Une 51 01 the precsding colui'Il~, so Add Lines ~aano 49_ 51 If Line 50 m gre;;terthan Une 47, 5ubtr~¢t Li~~ .17 ((0111 Llno 6Q. Dtherwise, wrlle ''0,'. 52 Wrile me i5Sssr or Lilla 47 or line 5D nere and on Step 2, Line 13. This is your required instRllmenl.
n.·~~11'Jt;l·'~lDu) IC::lO~ 1 BdS1o-tJ 12-2:H)5
4$
Ship
,Itl.n ••
rer (lotu"",,-.
41 <!.S_~
49
e:l':lp li1tc lint!
[Of
_ _
Cdb..", A.
6t:l
5'1
52 __
09270331
131170
40COIF
2005.05030
.0 OBAYL~,
BARl~CK R.
09/2'1/2006
\l.QC01F_1 9; 45AIVI
;W.Q.~.
Cnlcago,
Prepared by
~~
uuol~
P.C.
Lawrence A. Horwich & Associates, 125 S. Wacker Drive - suite 2800 Chicago, IL 60606-4475
Amount
of tall
TDtal tax Less: payments and credrts PIus: int;;, rest and penal tie"
,.."
$
.'j;
Overpayment
Credited Refunded
to
your
you
estimated
tsx
_,
9
0
;0
Mai(e check payable to !Vlail tax return and check (if applicable) to Return must be mailed on or before Special Instructions
Not
applicable
..---.--.- ..---.
The
return
should will
be
signed
and
be deposited
directly
';(InOral
0.5.-01-011