Apr181206:59p
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~1040
SusanBysiewiczforCT(860)3431591p,2
Dep.>rtmcl1t~r1h.
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Rev.nueService(99)
U.S_IndividualIncomeTaxReturn
2011
OMBN<>,l~S.D074
IRS
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or!hByaa~Jan.l...c~~,31,2011,orolhorluyoarbegi'lnlng
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11
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14
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19
pleaseuse
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20a
21
22
23
Adjusted
24
Gross
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25
26
27
21!
29
30
31a
32
33
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W-2•.'.,,.,,,.,,,,,.,•,
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ScheduleS
ifreQuireo,.."..,"",'
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aa,..."..
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diVidends.
Al1acl'l
Schedule
B
if
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B\Jsjne~i,ncomeor(loss),Attach
SChedule
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n
rY.l1required,
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here'",'••,.,..,,'
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(IDSSes),Attach
FOIm4797
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Renlal
real
estate,royanles,partnerships,Scorporations,trusts,etc,
Attach
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r2D~'I',,....,.'.'.'.',..".,',.
r
b.
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and
amount
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businessexpensesofraservlsts,performinpartists.and
fee-basis
govemment
offic'lats.AUach
Form2106
or
2100·EZ
Health
savings
accountdeduclion.Attach'FormB8S9
Movingexpenses,AttachForm3903Deductiblepartofself-employmenttax.AtlachScheduleSESelf-employedSEP,SIMPLE.andqualifiedplans'",..
Self-employedheaUh
insurance
deduction
Penaltyon
enrlyWithdrawal
ofsavings,..",::::::::::::::,:::::::::Alimonypaidb
Recipient's
SSN~
IRAdeduction
Stu<lenlloaninteresloeduetlon
......................................
TuitiDrtandfees,Attach
form
6917
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Taxand
38
Cre.dits
39a
b
StandardDedLJction
40
for-
41
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42
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43
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49
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50
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51
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52
wl~DW{er).
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54
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$(1,$00
Other
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39a
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2
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I-.:..:.....J----------
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child
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Child
laxcredit(seeinstructions}
j...-:::..!..4-----------
Residentialenergycredits.A"achForm5695OthercreditslromForm:a
0
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0
6a01".~·
0:
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Addlines47through53.Theseareyourtotalcredlts..••.•..,,:,..Subtract54fromline46.If54enterSelf-employman'
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t~
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o··~
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8'919'::::::::::::
Addi!ionallaxonIRAs,olherQualifiedretiremenlplans.etc,A!lachForm5329ifrequired.........
~9
Householdemploymenttaxes(romScheduleH'First-timeJ10mebuyercreditrepaymentAUacl1
F~~~'5405
if
~~q~i'r~d':::::::::::::::::::.•:::::::
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.lines
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.
~
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ayments
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[EIC1..•........................
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L...::.64..:.;b::....L~~:"r:>:~'~:1
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<-
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from
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0
2439b
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6B39
e
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62,6S,64a.and6511.These
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73
743
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IrfineT2ismoremanline61,subtraclllne61fromline72.ThisisIheamountyouoverpaid,.Amountoffine73youwanl
refunded
to
you.lf
Form
8888isattached•.chec~here......
0
ROllUngnumber
I
I·~
cType:
0
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0
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I
2012
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5
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10
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~~~~~_2~~~~~~~~~~~~~~~----------------------------~~~~
Use
Only
DM
S'd
ManchesterCTQ6040
~6St£vS(09B)
SCHEDULEA(Form:1040)
Medica]
and
Dental
Expenses
ItemizedDeductions
~AttachtoForm1040.~CautiQn.Donotinclude
expensesreimbursed
orpeldbyothers.
1Medicaland
denialexpenses
(seeinstructions),',.,
2EnleramountlromForm1040,111193B
3Mulfiplyline2by7,5%(.075),..
4~
$ubtraclline
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from
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line
1
enter
·0·
TaxesYou
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5Slaleand
local
(check
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:~~::~It::~:.
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6Realestatetaxes(seeinstructions},,,•'.,.',,.,".,,.'.'7Personar
property
taxes,,",..,:,..
BOthertaxes.
Usttypeandamount'",.,,,,,,,:.,,,
9
'Addiiries'5'8'..,.,,','.,,,,,',.,..,..,.
Inta)"9st
YouPaid
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inleresf
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belimited(seginstructions).
1
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10HomemortgagBinleresland
poiflls
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you
anFarm
1093•.,.,.
11Homemortgag9imerest
not
reported10youonForm1098.
;r
paid10
the
pelSOllfrornwhom
Y01l
boughllhehome.seeInstructionsandshow
IMt
pe~on'snan!e,Jdenllfyingno.,and
address~,........".,....,....'.'.'
•••••••<••••••••••••••
>>•••••••••••••••••
+•••••••••••••,••••
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12
Points
not
reported
III
youonform
1098.
See
instructions
for
specialrules,•..",.""".,,.",.,.,.,..',..'.'.,.,.,13MortgageInsurance
premiums(see
tnstructlons),,,.,.....,
14~Investment
interest.
Attach
Form
4952if
required.(See
lnstructions.),.......,"....,'..,,",.,."
15Addlir.es1014
Gifts
to
Charity
see
instructions
Ifyoumadea.
gift
and
gOI
a
bEneli1for
it
seeInstfuctio!ls.
Mjsc~ltaneous
Deductions
Total
Itemized
DeductIons
16.
Gifts
by
cashorcheck.
If
youmadeanygiftof$250ormore,17Otherthanbycashorcheck.Ifanyginof$250ormore,see
Instructions.Youmust
attach
"'orm8283.ifover$500
fa
Carryover{rom
prior
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19AcId
lines
1618
'156
Unreimblmt;td
employee
e)(:penses-jobtravel.
uniondues,
jobeducation,etc.Attach
Fonn2106or21QS·EZ
ir
required.
(Seeinstructions.)'".................."..
22Taxpreparationfees..,'....."',.,.,...,.'•.........,..'...,,.,..23Otherexpenses-e-investment,safedepos~bex,
etc.
Listtype
andamount,.,
.......',~.t;~~~:):~~~s.~~l1;~
::~~~:n:~:~:::::::::
24Addlines21lhrO!.lgh23
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MD.line38
26'Multiplyline25
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farrightcolumnforlines
4
fhrough
2B.
Also,enterthis
amount
..onForm1040,line40".',',,,",,,..3l)Ifyouelect10itemizededflctionseventhoughtheyarelessthanyoursiandard
DM
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10
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