File by Mail Instructions for your Federal Amended Tax Return

Important: Your taxes are not finished until all required steps are completed.

Joshua D Roberts
4816 Beech Dr
Louisville, KY 40216
|

Balance
| Your federal amended tax return shows you are due a refund of $213.00
Due/
| The IRS estimates it will take up to 16 weeks to process your amended
Refund
| tax return. Your refund will be mailed to you
______________________________________________________________________________________
|
|
| Your amended tax return - Form 1040X. Remember to sign and date
| the return.
|
| Be sure to attach all forms or schedules that changed to your amended
| return.
|
| Mail your return and attachments to:
| Department of the Treasury
| Internal Revenue Service Center
| Kansas City, MO 64999
|
| Note: Your state return may be due on a different date. Please
| review your state filing instructions.
|
| Don't forget correct postage on the envelope.
______________________________________________________________________________________
|
|
What You
| Keep these instructions and a copy of your return for your records.
Need to
| If you did not print one before closing TurboTax, go back to the
Keep
| program and select File tab, then select the Print for Your Records
| category.
______________________________________________________________________________________
|
|
| Adjusted Gross Income Correct Amount
$
27,631.00
Federal
| Taxable Income Correct Amount
$
21,431.00
Tax
| Total Tax Correct Amount
$
2,760.00
Return
| Total Payments/Credits Correct Amount
$
3,171.00
Summary
| Amount to be Refunded
$
213.00
______________________________________________________________________________________
|

What You
Need to
Mail

Page 1 of 1

Hi Joshua,
We just want to thank you for using TurboTax this year!
your taxes easy and accurate, year after year.

It's our goal to make

With TurboTax Freedom Edition:
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- You received a printed copy of your return with supporting documents for your
records
Many happy returns from TurboTax.

Form

1040X

(Rev. December 2014)

Department of the Treasury—Internal Revenue Service

Amended U.S. Individual Income Tax Return
a

OMB No. 1545-0074

Information about Form 1040X and its separate instructions is at www.irs.gov/form1040x.

This return is for calendar year
2014
Other year. Enter one: calendar year

2013

2012

2011

or fiscal year (month and year ended):

Your first name and initial

Your social security number

Last name

Joshua D

Roberts

If a joint return, spouse’s first name and initial

402-45-8464
Spouse’s social security number

Last name

Current home address (number and street). If you have a P.O. box, see instructions.

Apt. no.

Your phone number

4816 Beech Dr

(502)418-5421

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Louisville KY 40216
Foreign country name

Foreign postal code

Foreign province/state/county

Amended return filing status. You must check one box even if you are not changing Full-year coverage.
your filing status. Caution. In general, you cannot change your filing status from joint to If all members of your household have fullseparate returns after the due date.
year minimal essential health care coverage,
check "Yes." Otherwise, check "No."
Single
Married filing separately
(See instructions.)
Qualifying widow(er)
Head of household (If the qualifying person is a child but not
your dependent, see instructions.)

Married filing jointly

Yes

Use Part III on the back to explain any changes
Income and Deductions
1
2
3
4
5

No

A. Original amount B. Net change—
or as previously
amount of increase
adjusted
or (decrease)—
(see instructions)
explain in Part III

Adjusted gross income. If net operating loss (NOL) carryback is
included, check here . . . . . . . . . . . . . . . a
Itemized deductions or standard deduction
. . . . . . . . .
Subtract line 2 from line 1 . . . . . . . . . . . . . . .
Exemptions. If changing, complete Part I on page 2 and enter the
amount from line 29 . . . . . . . . . . . . . . . . .
Taxable income. Subtract line 4 from line 3 . . . . . . . . . .

C. Correct
amount

1
2
3

27,430.
6,200.
21,230.

201.
0.
201.

27,631.
6,200.
21,431.

4
5

0.
21,230.

0.
201.

0.
21,431.

6

2,730.

30.

2,760.

7
8
9
10
11

0.
2,730.
0.
416.
3,146.

0.
30.
0.
-243.
-213.

0.
2,760.
0.
173.
2,933.

12

3,171.

0.

3,171.

13
14

0.
0.

0.
0.

0.
0.

0.

0.

16
17

0.
3,171.

18
19
20
21
22

25.
3,146.

Tax Liability
6

Tax. Enter method(s) used to figure tax (see instructions):

7

Credits. If general business credit carryback is included, check
here . . . . . . . . . . . . . . . . . . . . . a
Subtract line 7 from line 6. If the result is zero or less, enter -0- . . .
Health care: individual responsibility (see instructions) . . . . . .
Other taxes . . . . . . . . . . . . . . . . . . . .
Total tax. Add lines 8, 9, and 10 . . . . . . . . . . . . .

Table

8
9
10
11

Payments
12
13
14
15

Federal income tax withheld and excess social security and tier 1 RRTA
tax withheld (if changing, see instructions) . . . . . . . . . .
Estimated tax payments, including amount applied from prior year’s
return . . . . . . . . . . . . . . . . . . . . . .
Earned income credit (EIC) . . . . . . . . . . . . . . .
Refundable credits from:
Schedule 8812 Form(s)
4136
2439
5405
8962 or

8801
8812 (2011)
other (specify):

8839

8863

8885

15
0.
Total amount paid with request for extension of time to file, tax paid with original return, and additional
tax paid after return was filed . . . . . . . . . . . . . . . . . . . . . . . .
17
Total payments. Add lines 12 through 16 . . . . . . . . . . . . . . . . . . . .
Refund or Amount You Owe (Note. Allow up to 16 weeks for Form 1040X to be processed.)
18
Overpayment, if any, as shown on original return or as previously adjusted by the IRS . . . . . .
19
Subtract line 18 from line 17 (If less than zero, see instructions) . . . . . . . . . . . . .
20
Amount you owe. If line 11, column C, is more than line 19, enter the difference
. . . . . . . .
21
If line 11, column C, is less than line 19, enter the difference. This is the amount overpaid on this return
22
Amount of line 21 you want refunded to you . . . . . . . . . . . . . . . . . . .
23
Amount of line 21 you want applied to your (enter year):
estimated tax . 23
16

213.
213.

Complete and sign this form on Page 2.
For Paperwork Reduction Act Notice, see instructions.

BAA

REV 01/27/15 TTO

Form 1040X (Rev. 12-2014)

Page 2

Form 1040X (Rev. 12-2014)

Part I

Exemptions

Complete this part only if you are increasing or decreasing the number of exemptions (personal and dependents) claimed on line 6d of
the return you are amending.
A. Original number
of exemptions or
amount reported or
as previously
adjusted

See Form 1040 or Form 1040A instructions and Form 1040X instructions.
24
25
26
27
28
29

30

Yourself and spouse. Caution. If someone can claim you as a
dependent, you cannot claim an exemption for yourself . . . . . .
Your dependent children who lived with you . . . . . . . . .
Your dependent children who did not live with you due to divorce or separation
Other dependents . . . . . . . . . . . . . . . . . .
Total number of exemptions. Add lines 24 through 27 . . . . . .

24
25
26
27
28

C. Correct
number
or amount

B. Net change

0
0
0
0
0

0
0
0
0
0

0
0
0
0
0

Multiply the number of exemptions claimed on line 28 by the exemption
amount shown in the instructions for line 29 for the year you are
0.
0.
amending. Enter the result here and on line 4 on page 1 of this form . .
29
List ALL dependents (children and others) claimed on this amended return. If more than 4 dependents, see instructions.
(a) First name

Part II

(b) Dependent’s social
security number

Last name

(c) Dependent’s

relationship to you

0.

(d) Check box if qualifying
child for child tax credit (see
instructions)

Presidential Election Campaign Fund

Checking below will not increase your tax or reduce your refund.
Check here if you did not previously want $3 to go to the fund, but now do.
Check here if this is a joint return and your spouse did not previously want $3 to go to the fund, but now does.
Part III
Explanation of changes. In the space provided below, tell us why you are filing Form 1040X.
a Attach any supporting documents and new or changed forms and schedules.

The money I received on a 1099 Misc was reported incorrectly. I didn't earn the
money. I won a trip from the radio.

Sign Here
Remember to keep a copy of this form for your records.
Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying
schedules and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer
(other than taxpayer) is based on all information about which the preparer has any knowledge.
F

F

Your signature

Date

Spouse’s signature. If a joint return, both must sign.

Date

Firm’s name (or yours if self-employed)

Date

Paid Preparer Use Only
F

Preparer’s signature

Print/type preparer's name

Self-prepared

Firm's address and ZIP code
Check if self-employed

PTIN

For forms and publications, visit IRS.gov.

Phone number
REV 01/27/15 TTO

EIN
Form 1040X (Rev. 12-2014)

Form

1040

2014

(99)

Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2014, or other tax year beginning
Your first name and initial

OMB No. 1545-0074

, 2014, ending

IRS Use Only—Do not write or staple in this space.

See separate instructions.

, 20

Last name

Joshua D

Your social security number

Roberts

402-45-8464

Last name

If a joint return, spouse’s first name and initial

Spouse’s social security number

Apt. no.

Home address (number and street). If you have a P.O. box, see instructions.

c

4816 Beech Dr
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Presidential Election Campaign
Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign postal code
a box below will not change your tax or
refund.
You
Spouse

Louisville KY 40216
Foreign country name

Filing Status
Check only one
box.

Exemptions

Foreign province/state/county

1
2
3

Single
Married filing jointly (even if only one had income)

4

c

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. a

Married filing separately. Enter spouse’s SSN above
and full name here. a

6a
b

5

Qualifying widow(er) with dependent child

Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse
.
Dependents:

(1) First name

.

.

.

.

.

.

.

.

.

.

.

(2) Dependent’s
social security number

Last name

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

(4)  if child under age 17
qualifying for child tax credit
(see instructions)

(3) Dependent’s
relationship to you

}

Dependents on 6c
not entered above

d

Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.

If you did not
get a W-2,
see instructions.

Adjusted
Gross
Income

Boxes checked
on 6a and 6b
No. of children
on 6c who:
• lived with you
• did not live with
you due to divorce
or separation
(see instructions)

If more than four
dependents, see
instructions and
check here a

Income

Make sure the SSN(s) above
and on line 6c are correct.

Total number of exemptions claimed

.

.

.

.

.

.

.
.

.

.

.

.

.

.

.

7

.
8b
. .

.

.

.

.

.

.

.

8a

.

.

.

.

.

.

.

9a

10
11

Qualified dividends . . . . . . . . . . .
9b
Taxable refunds, credits, or offsets of state and local income taxes
Alimony received . . . . . . . . . . . . . . .

.
.

.
.

.
.

.
.

.
.

.
.

10
11

0.

12
13
14

Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . .
Capital gain or (loss). Attach Schedule D if required. If not required, check here a
Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . .

.

12
13
14

1,222.

15a
16a
17

IRA distributions .
15a
b Taxable amount
. . .
Pensions and annuities 16a
b Taxable amount
. . .
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

15b
16b
17

18
19
20a

Farm income or (loss). Attach Schedule F .
Unemployment compensation . . . .
Social security benefits 20a

18
19
20b

21
22

Gambling Winnings
Other income. List type and amount
Combine the amounts in the far right column for lines 7 through 21. This is your total income

23

Educator expenses

24

Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ

25

Health savings account deduction. Attach Form 8889

.

24
25

26
27
28

Moving expenses. Attach Form 3903 . . . . . .
Deductible part of self-employment tax. Attach Schedule SE .
Self-employed SEP, SIMPLE, and qualified plans
. .

26
27
28

29
30
31a

Self-employed health insurance deduction
Penalty on early withdrawal of savings . .

.
.

.
.

.
.

.
.

32
33
34

Alimony paid b Recipient’s SSN a
IRA deduction . . . . . . .
Student loan interest deduction . .
Tuition and fees. Attach Form 8917 .

29
30
31a

.
.
.

.
.
.

.
.
.

.
.
.

32
33
34

35
36
37

Domestic production activities deduction. Attach Form 8903
35
Add lines 23 through 35 . . . . . . . . . . . . .
Subtract line 36 from line 22. This is your adjusted gross income

7

Wages, salaries, tips, etc. Attach Form(s) W-2

.

.

.

.

8a
b
9a

Taxable interest. Attach Schedule B if required .
Tax-exempt interest. Do not include on line 8a .
Ordinary dividends. Attach Schedule B if required

.
.
.

.
.
.

.

b

.

.

.

.

.

.

.
.
.

.

.
.
.

.
.

.

.
.

.

.
.

.

.
.

.

.

.

.

.

. . . . . .
. . . . . .
b Taxable amount

.

.
.
.

.

.
.
.

.

.

.
.
.
a

.

.

Add numbers on
lines above a

.

24,696.

21
22

1,800.
27,718.

36
37

87.
27,631.
1040 (2014)

23

87.

.
.

.
.

.
.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA

.
.

.
.

.
a

REV 05/19/15 TTO

Form

Page 2
27,631.

Form 1040 (2014)

38

Amount from line 37 (adjusted gross income)

Tax and
Credits

39a

Check
if:

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,
$6,200
Married filing
jointly or
Qualifying
widow(er),
$12,400
Head of
household,
$9,100

If you have a
qualifying
child, attach
Schedule EIC.

Blind.
Blind.

.

}

.

.

.

.

.

.

38

Total boxes
checked a 39a

Exemptions. If line 38 is $152,525 or less, multiply $3,950 by the number on line 6d. Otherwise, see instructions
Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . .
Form 4972 c
Tax (see instructions). Check if any from: a
Form(s) 8814 b

44
45
46

Alternative minimum tax (see instructions). Attach Form 6251 .
Excess advance premium tax credit repayment. Attach Form 8962

47
48

Add lines 44, 45, and 46
. . . . . . .
Foreign tax credit. Attach Form 1116 if required .

49
50
51

.
.

.
.

.
.

.
.

.
.

.
.

.
48

.

.

.

.

.

.

52
Residential energy credits. Attach Form 5695 . . . .
53
3800 b
8801 c
Other credits from Form: a
54
Add lines 48 through 54. These are your total credits . . . . .
Subtract line 55 from line 47. If line 55 is more than line 47, enter -0-

.
.

.
.

.
.

.
.

.
.

.
.

.

Self-employment tax. Attach Schedule SE

.

.

.

.

.

.

.

8919

.

.

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required

.

.

.
.

.
.

.
.

.
.

.
.

.

.

.

.

58
59
60a

Unreported social security and Medicare tax from Form:

a

b
61

First-time homebuyer credit repayment. Attach Form 5405 if required

67
68
69
70
71
72

.

.

.

Household employment taxes from Schedule H

.

.

.

.

.

.

.

.

4137
.

.

.
.

.

.

.

67

American opportunity credit from Form 8863, line 8 .
Net premium tax credit. Attach Form 8962 . . . .
Amount paid with request for extension to file . . .

.
.
.

.
.
.

68
69
70

.
.

.
.

b
.
.

.
.

.
.

71
72
Credits from Form: a
2439 b
Reserved c
Reserved d
73
Add lines 64, 65, 66a, and 67 through 73. These are your total payments .
Excess social security and tier 1 RRTA tax withheld

Credit for federal tax on fuels. Attach Form 4136

75
76a

.
.

.
.

6,200.
21,431.

43

21,431.
2,760.

44
45
46
47

.
.
a

2,760.

.
.

.
.

55
56
57

a

.

.

.

.

2,760.
173.

58
59
60a
60b

Health care: individual responsibility (see instructions) Full-year coverage
. . . . .
Form 8960 c
Taxes from: a
Form 8959 b
Instructions; enter code(s)
a
Add lines 56 through 62. This is your total tax . . . . . . . . . . . . .
3,171.
64
Federal income tax withheld from Forms W-2 and 1099 . .
2014 estimated tax payments and amount applied from 2013 return
65
Earned income credit (EIC) . . . . . . . . . . 66a

Nontaxable combat pay election
66b
Additional child tax credit. Attach Schedule 8812 .

40
41
42

49
50
51

Credit for child and dependent care expenses. Attach Form 2441

64
65
66a
b

.
.

.
.

Education credits from Form 8863, line 19 . . . . .
Retirement savings contributions credit. Attach Form 8880
Child tax credit. Attach Schedule 8812, if required . . .

52
53
54
55

a

If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid

61
62
63

2,933.

74

3,171.
238.
238.

75

. a
76a
Routing number
Checking
Savings
0 8 3 9 0 0 6 8 0 a c Type:
0 0 0 5 1 8 5 2 2 3 0 4 5
Account number
Amount of line 75 you want applied to your 2015 estimated tax a 77
77
78
Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions a 78
79
Estimated tax penalty (see instructions) . . . . . . .
79
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete below.
Amount of line 75 you want refunded to you. If Form 8888 is attached, check here

b
d

No

Personal identification
a
number (PIN)

Phone
no. a

Designee’s
name a

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.

F

Paid
Preparer
Use Only

.

42
43

Sign
Here
Joint return? See
instructions.
Keep a copy for
your records.

You were born before January 2, 1950,
Spouse was born before January 2, 1950,

.

39b

a

Third Party
Designee

.

.
.

Direct deposit?
See
a
instructions.

Amount
You Owe

.

Itemized deductions (from Schedule A) or your standard deduction (see left margin)
Subtract line 40 from line 38
. . . . . . . . . . . . . . . . .

73
74

Refund

.

40
41

62
63

Payments

.

If your spouse itemizes on a separate return or you were a dual-status alien, check here a

b

56
57

Other
Taxes

{

.

Your signature

Date

Your occupation

Daytime phone number

Spouse’s signature. If a joint return, both must sign.

Date

Spouse’s occupation

Student

Print/Type preparer’s name

Firm’s name

a

Firm’s address a
www.irs.gov/form1040

Preparer’s signature

Self-Prepared

(502)418-5421

Date

If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)
PTIN
Check
if
self-employed
Firm's EIN

a

Phone no.
REV 05/19/15 TTO

Form 1040 (2014)

Net Profit From Business

SCHEDULE C-EZ
(Form 1040)

OMB No. 1545-0074

Department of the Treasury
Internal Revenue Service (99)
Name of proprietor

Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B.
a Attach to Form 1040, 1040NR, or 1041. a See instructions on page 2.

Attachment
Sequence No. 09A
Social security number (SSN)

Joshua D Roberts
Part I

402-45-8464

General Information
a

You May Use
Schedule C-EZ
Instead of
Schedule C
Only If You:

a

• Had business expenses of $5,000 or
less.

• Had no employees during the year.
• Are not required to file Form 4562,
Depreciation and Amortization, for
this business. See the instructions for
Schedule C, line 13, to find out if you
must file.
• Do not deduct expenses for business
use of your home.

• Use the cash method of accounting.
• Did not have an inventory at any time
during the year.

And You:

• Did not have a net loss from your
business.
• Had only one business as either a sole
proprietor, qualified joint venture, or
statutory employee.

A

2014

(Sole Proprietorship)
a

• Do not have prior year unallowed
passive activity losses from this
business.

B Enter business code (see page 2)

Principal business or profession, including product or service

a 9 9 9 9 9 9

Auto Body Repair Laborer

D Enter your EIN (see page 2)

C Business name. If no separate business name, leave blank.
E

Business address (including suite or room no.). Address not required if same as on page 1 of your tax return.

4816 Beech Dr
City, town or post office, state, and ZIP code

Louisville, KY 40216
Did you make any payments in 2014 that would require you to file Form(s) 1099? (see the Schedule C
instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F

G If “Yes,” did you or will you file required Forms 1099? .

Part II

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Yes
Yes

.

No
No

Figure Your Net Profit

Gross receipts. Caution. If this income was reported to you on Form W-2 and the “Statutory
employee” box on that form was checked, see Statutory employees in the instructions for
Schedule C, line 1, and check here . . . . . . . . . . . . . . . . . . a

1

2,763.

2

Total expenses (see page 2). If more than $5,000, you must use Schedule C

.

2

1,541.

3

Net profit. Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on both
Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 and Schedule SE,
line 2 (see instructions). (Statutory employees do not report this amount on Schedule SE, line 2.)
Estates and trusts, enter on Form 1041, line 3 . . . . . . . . . . . . . . . . .

3

1,222.

1

Part III

.

.

.

.

.

.

Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 2.

4

When did you place your vehicle in service for business purposes? (month, day, year)

5

Of the total number of miles you drove your vehicle during 2014, enter the number of miles you used your vehicle for:
a

Business

a

b Commuting (see page 2)

c

Other

6

Was your vehicle available for personal use during off-duty hours? .

.

.

.

.

.

.

.

.

.

.

.

Yes

No

7

Do you (or your spouse) have another vehicle available for personal use? .

.

.

.

.

.

.

.

.

.

.

Yes

No

8a

Do you have evidence to support your deduction?

.

.

.

.

.

.

.

Yes

No

.

.

.

.

.

.

.

Yes

No

b If “Yes,” is the evidence written? .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

For Paperwork Reduction Act Notice, see the separate instructions for Schedule C (Form 1040). BAA

REV 11/26/14 TTO

Schedule C-EZ (Form 1040) 2014

SCHEDULE SE
(Form 1040)

Self-Employment Tax
a

Department of the Treasury
Internal Revenue Service (99)

OMB No. 1545-0074

2014

Information about Schedule SE and its separate instructions is at www.irs.gov/schedulese.
a Attach

Attachment
Sequence No. 17

to Form 1040 or Form 1040NR.

Name of person with self-employment income (as shown on Form 1040 or Form 1040NR)

Joshua D Roberts

Social security number of person
with self-employment income a

402-45-8464

Before you begin: To determine if you must file Schedule SE, see the instructions.

May I Use Short Schedule SE or Must I Use Long Schedule SE?
Note. Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions.
Did you receive wages or tips in 2014?
No
d

Yes
d

d

Are you a minister, member of a religious order, or Christian
Science practitioner who received IRS approval not to be taxed
on earnings from these sources, but you owe self-employment
tax on other earnings?

Yes

Was the total of your wages and tips subject to social security
or railroad retirement (tier 1) tax plus your net earnings from
self-employment more than $117,000?

a

No

Yes

Did you receive tips subject to social security or Medicare tax
that you did not report to your employer?

a

Yes

a

No
d

No
d
Did you receive church employee income (see instructions)
reported on Form W-2 of $108.28 or more?

a

No
d

d
Are you using one of the optional methods to figure your net
earnings (see instructions)?

Yes

Yes

a

`

No

Did you report any wages on Form 8919, Uncollected Social
Security and Medicare Tax on Wages?

Yes

a

No
d
You may use Short Schedule SE below

d
a

You must use Long Schedule SE on page 2

Section A—Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE.
1a

Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form
1065), box 14, code A . . . . . . . . . . . . . . . . . . . . . . . .
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z

2

3
4

5

6

Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),
box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1.
Ministers and members of religious orders, see instructions for types of income to report on
this line. See instructions for other income to report . . . . . . . . . . . . . .
Combine lines 1a, 1b, and 2
. . . . . . . . . . . . . . . . . . . . .
Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do
not file this schedule unless you have an amount on line 1b . . . . . . . . . . . a
Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b,
see instructions.
Self-employment tax. If the amount on line 4 is:
• $117,000 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 57,
or Form 1040NR, line 55
• More than $117,000, multiply line 4 by 2.9% (.029). Then, add $14,508 to the result.
Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55 . . . . . . .
Deduction for one-half of self-employment tax.
Multiply line 5 by 50% (.50). Enter the result here and on Form
1040, line 27, or Form 1040NR, line 27 . . . . . . . .
87.
6

For Paperwork Reduction Act Notice, see your tax return instructions. BAA

REV 10/29/14 TTO

1a
1b (

)

2
3

1,222.
1,222.

4

1,129.

5

173.

Schedule SE (Form 1040) 2014

ELECTRONIC POSTMARK - CERTIFICATION OF ELECTRONIC FILING
Taxpayer:
Primary SSN:

Joshua D Roberts
402-45-8464

Federal Return Submitted:
Federal Return Acceptance Date:

August 25, 2015
08/25/2015

11:15 AM PDT

The Intuit Electronic Postmark shows the date and time Intuit received your federal tax return. The Intuit
Electronic Postmark documents the filing date of your income tax return, and the electronic postmark
information should be kept on file with your tax return and other tax-related documentation.
There are two important aspects of the Intuit Electronic Postmark:
1. THE INTUIT ELECTRONIC POSTMARK.
The electronic postmark shows the date and time Intuit received the federal return, and is deemed the
filing date if the date of the electronic postmark is on or before the date prescribed for filing of the
federal individual income tax return.
TIMELY FILING:
For your federal return to be considered filed on time, your return must be postmarked on or before
midnight April 15, 2015. Intuit’s electronic postmark is issued in the Pacific Time (PT) zone. If you are
not filing in the PT zone, you will need to add or subtract hours from the Intuit Electronic Postmark time
to determine your local postmark time. For example, if you are filing in the Eastern Time (ET) zone and
you electronically file your return at 9 AM on April 15, 2015, your Intuit electronic postmark will indicate
April 15, 2015, 6 AM. If your federal tax return is rejected, the IRS still considers it filed on time if the
electronic postmark is on or before April 15, 2015, and a corrected return is submitted and accepted
before April 20, 2015. If your return is submitted after April 20, 2015, a new time stamp is issued to
reflect that your return was submitted after the IRS deadline and, consequently, is no longer considered
to have been filed on time.
If you request an automatic six-month extension, your return must be electronically postmarked by
midnight October 15, 2015 If your federal tax return is rejected, the IRS will still consider it filed on time
if the electronic postmark is on or before October 15, 2015, and the corrected return is submitted and
accepted by October 20, 2015.
2. THE ACCEPTANCE DATE.
Once the IRS accepts the electronically filed return, the acceptance date will be provided by the Intuit
Electronic Filing Center. This date is proof that the IRS accepted the electronically filed return.

File by Mail Instructions for your Kentucky Amended Tax Return
Important: Your taxes are not finished until all required steps are completed.

Joshua D Roberts
4816 Beech Dr
Louisville, KY 40216
|
| Your Kentucky state amended tax return shows you owe a balance due of
| $11.00.
|
| You are paying by check.
|
| You can also pay your balance due by MasterCard, VISA, Discover
| credit card or by ACH Debit through April 15, 2015. Access the
| Department of Revenue's secure Web site (www.revenue.ky.gov) to make
| electronic payments over the Internet. Click on the KY E-Tax logo and
| select E-Payments-Credit Cards and ACH Debits link. If you do not
| have access to the Internet, you may call the Department of Revenue
| at (502) 564-4581 for assistance with payments. For more information,
| go to http://www.revenue.ky.gov.
______________________________________________________________________________________
|
|
What You
| Your amended tax return - Form 740X. Remember to sign and date
Need to
| the return.
Mail
|
| Your payment - Mail a check or money order for $11.00, payable to
| "Kentucky State Treasurer". Write your Social Security number and "
| Form 740X" on the check. Mail the return and check together.
|
| Be sure to attach wage and tax statements (Forms W-2, 1099, W2-G and
| PTE-WH if applicable)to the front of your return if they include any
| Kentucky withholding.
|
| Mail your return, attachments and payment to:
| Kentucky Department of Revenue
| Frankfort, KY 40619-0008
|
| Don't forget correct postage on the envelope.
______________________________________________________________________________________
|
|
What You
| Keep these instructions and a copy of your return for your records.
Need to
| If you did not print one before closing TurboTax, go back to the
Keep
| program and select File tab, then select the Print for Your Records
| category.
______________________________________________________________________________________
|
|
| Adjusted Gross Income As Originally Filed
$
27,430.00
Kentucky
| Adjusted Gross Income Correct Amount
$
27,631.00
Tax
| Taxable Income As Originally Filed
$
25,030.00
Return
| Taxable Income Correct Amount
$
25,231.00
Summary
| Total Tax As Originally Filed
$
1,258.00
| Total Tax Correct Amount
$
1,269.00
| Total Payments/Credits As Originally Filed
$
109.00
| Total Payments/Credits Correct Amount
$
1,149.00
| Payment Due
$
11.00
______________________________________________________________________________________
|

Balance
Due/
Refund

Page 1 of 2

File by Mail Instructions for your Kentucky Amended Tax Return
Important: Your taxes are not finished until all required steps are completed.

Joshua D Roberts
4816 Beech Dr
Louisville, KY 40216
|
| Your printed state tax forms may have special formatting on them,
| such as bar codes or other symbols. This is to enable fast
| processing. Don't worry, these forms have been approved by your
| taxing authority and are acceptable for printing and mailing.
______________________________________________________________________________________
|

Special
Formatting

Page 2 of 2

740-X

42A740-X (11-14)
Department of Revenue

For calendar year or
For fiscal year beginning __________ , ______ , and ending __________ , ______
Filing Status: Check only one block.

AMENDED
KENTUCKY INDIVIDUAL
INCOME TAX RETURN

Spouse’s Social Security No.

14
20___ 

Your Social Security No.

Original Amended

1.

Single

2.


3.

Married, filing separately
on this combined return

Married, filing joint return

4.






Married, filing separate
returns. Enter spouse’s
name and Social Security
number as it appears on
separate return.

INCOME AND DEDUCTIONS

402-45-8464

Last Name

First Name (Joint or combined return, give both names and initials.)

Roberts, Joshua D
Mailing Address

Number and Street including Apartment Number or P.O. Box

4816 Beech Dr
City, Town or Post Office

State

Louisville

KY

I—As Originally
Reported or Adjusted

II—Net Change Increase
or Decrease (see p. 2)

 1. KENTUCKY ADJUSTED GROSS INCOME (Form 740 or 740-EZ)

Column A, Spouse...............................

Column B, Yourself (or Joint)..............
27,430.
201.
 2. ITEMIZED DEDUCTIONS / STANDARD DEDUCTION

Column A, Spouse...............................

Column B, Yourself (or Joint)..............
2,400.
0.
 3. TAXABLE INCOME

Column A, Spouse...............................

Column B, Yourself (or Joint)..............
25,030.
201.
TAX LIABILITY
 4. Enter tax from Form 740, line 14 or Form 740-EZ, line 4.

Column A, Spouse...............................
1,268.
11.

Column B, Yourself (or Joint)..............
 5. Business Incentive Credits. Column A, Spouse...............................

Column B, Yourself (or Joint)..............
 6. Personal Tax Credits.
Column A, Spouse...............................

Column B, Yourself (or Joint)..............
10.
0.
 7. Subtract lines 5 and 6
Column A, Spouse...............................
0.

from line 4.
Column B, Yourself (or Joint)..............
1,258.
11.
  8. Add line 7, Columns A and B and enter here......................................
1,258.
11.
  9. Family Size Tax Credit...........................................................................
0.
0.
10. Education Tuition Tax Credit..................................................................
11. Child and Dependent Care Credit........................................................
12. New Home Tax Credit (2009 and 2010 Only).......................................
1,258.
11.
13. Income Tax Liability. Subtract lines 9, 10, 11 and 12 from line 8........
14. Kentucky Use Tax...................................................................................
0.
0.
15. Total Tax Liability...................................................................................
1,258.
11.
PAYMENTS AND CREDITS
16. Kentucky Income Tax Withheld.............................................................
1,149.
0.
17. Kentucky Estimated Tax Payments.......................................................
18. Refundable Kentucky Corporation Tax Credit (KRS 141.420(3)(c)).....
19. Refundable certified rehabilitation credit (KRS 141.382(1)(b))...........
20. Film industry tax credit (KRS 141.383).................................................
21. Amount paid with original return, plus additional payments made after it was filed...........................................
22. Total of lines 16 through 21, Column III.....................................................................................................................
REFUND OR AMOUNT DUE
23. Overpayment, if any, shown on original return, Form 740 or Form 740-EZ............................................................
24. Subtract line 23 from line 22 and enter the result.....................................................................................................
25. If line 15, Column III, is more than line 24, enter amount due.................................................................................
26. Compute interest on the amount due from the due date until paid. Use Interest Rate

Chart on Page 2, Part IV when calculating interest..................................................................................................
27. Add lines 25 and 26. Pay in full with this return........................................................................................................
28. If line 15, Column III, is less than line 24, enter refund to be received....................................................................
1555

REV 12/18/14 TTO

ZIP Code

40216
III
Correct Amount

27,631.

2,400.

25,231.

1,279.

10.
0.
1,269.
1,269.
0.

1,269.
0.
1,269.
1,149.

109.
1,258.

1,258.
11.

11.

N

F

Form 740-X (11-14)

Page 2

PART I – TAX CREDITS

(This section must be completed for any increase or decrease in the number of personal tax credits claimed
on original return)
  1. Number of personal tax credits claimed on original return (Form 740, Section B, lines 3A and 3B)..................................
1
  2. Number of personal tax credits claimed on this return...........................................................................................................
1
0
 3. Difference.....................................................................................................................................................................................
  Explain any difference in detail below. Include name and Social Security number.

PART II – FAMILY SIZE TAX CREDIT

(This section must be completed for any increase or decrease to T
  otal Family Size claimed on
original return.)

  4. Total Family Size claimed on original return

1

2

3

4 or more

  5. Total Family Size claimed on this return

1

2

3

4 or more

  Explain any difference in detail below. Include name and Social Security number.

PART III – CHANGES Explain changes to income, deductions and tax from page 1, Column II in detail below. Attach additional or
corrected Kentucky and/or federal forms, schedules or W-2s.

If you do not attach the required information, processing of your Form 740-X may be delayed.

The money from a 1099 Misc was reported incorrectly.

PART IV – INTEREST RATE CHART - Use the following rates when computing interest for amount on Page 1, Line 25.




Jan. 1, 2015–Dec. 31, 2015
Jan. 1, 2014–Dec. 31, 2014
Jan. 1, 2013–Dec. 31, 2013
Jan. 1, 2012–Dec. 31, 2012
Jan. 1, 2011–Dec. 31, 2011





6%
6%
6%
6%
5%

I, the undersigned, declare under penalties of perjury that I have examined this return, including all accompanying schedules and statements, and, to
the best of my knowledge and belief, it is true, correct and complete. I also understand and agree that our election to file a combined return under the
provisions of appropriate income tax regulations will result in refunds being made payable to us jointly and in each of us being jointly and severally liable
for all taxes accruing under this return.

(502)418-5421
Your Signature (If a joint or combined return, both must sign.)

Spouse’s Signature

Telephone Number (daytime)

Date Signed

Self-Prepared
Typed or Printed Name of Preparer Other than Taxpayer

Make check payable to:
Kentucky State Treasurer. 
1555

I.D. Number of Preparer

REFUNDS

Date

Mail to: Kentucky Department of Revenue, Frankfort, KY 40618-0006.

PAYMENTS Mail to: Kentucky Department of Revenue, Frankfort, KY 40619-0008.
REV 12/18/14 TTO

INSTRUCTIONS FOR FORM 740-V
ELECTRONIC FILING PAYMENT VOUCHER
Do I need to use a payment voucher?

2014

l If you owe tax on your 2014 electronic Kentucky return, send only the payment voucher with your payment. You
must pay the amount you owe by April 15, 2015, to avoid interest and penalties.
l If your 2014 electronic Kentucky return shows a refund or no tax due, do not use the payment voucher.

Why use a payment voucher?

l The Department of Revenue does not issue statements of liability prior to the April 15 deadline for payment.
l For balance due returns, taxpayers should complete Form 740-V and submit it along with payment. To avoid
penalties and interest, payments should be postmarked on or before April 15, 2015.
l The use of Form 740-V Kentucky Electronic Payment Voucher, will help process your payment more accurately
and efficiently. Do not send a copy of your electronically filed return with payment of tax due.

How do I prepare my payment?

l Make your check or money order payable to the Kentucky State Treasurer. Do not send cash.
l Be sure to write your name and address on the check or money order if it is not already written on the check or
money order.
l Write your Social Security number and "2014 Form 740" on the check or money order.

How do I prepare my payment voucher?

l Enter your Social Security number in the boxes above "Your Social Security Number". If married filing jointly or on
a combined return, enter spouse's Social Security number in the boxes above "Spouse's Social Security Number".
l Enter your name(s) in boxes identified as "Last Name/First Name/Spouse's Name".
l Enter mailing address on the appropriate lines.
l Enter the amount of additional tax due from Form 740, Line 41 (Form 740-NP, Line 41) in the boxes identified as
"Additional Tax Due".
l Enter the amount of interest and penalty calculated from Form 740, Line 43 (Form 740-NP, Line 43) in the boxes
identified as "Interest, File Late and Pay Late Penalties".

How do I send in my payment and the payment voucher?

l Detach the payment voucher at the dotted line below.
l Do not attach the payment voucher to the check.
l Mail your payment and payment voucher to: Kentucky Department of Revenue, Frankfort, KY 40620-0011.

FORM 740V(9-14)

Ú

DETACH HERE AND MAIL VOUCHER WITH YOUR PAYMENT

Kentucky Electronic Payment Voucher

402-45-8464
YOUR SOCIAL SECURITY NUMBER
FIRST NAME

SPOUSE'S NAME

Additional Tax Due
Interest, File Late and
Pay Late Penalties

4816 BEECH DR
Number and street or P.O. Box
State

Zip Code

Make check payable to: Kentucky State Treasurer
Mail to: Kentucky Department of Revenue
Frankfort, KY 40620-0011
1555

2014

SPOUSE'S SOCIAL SECURITY NUMBER

ROBERTS, JOSHUA D
LAST NAME

LOUISVILLE KY 40216
City, Town or post office

Ú

Total Payment

DO NOT ATTACH CHECK TO VOUCHER
42A740-S23

120. 00
0. 00
11. 00

42A740V0002

REV 01/15/15 TTO

740

42A740

Department of Revenue
For calendar year or other taxable year beginning _________ , 2014, and ending ________ , 20____ .

A. Spouse’s Social Security Number

KENTUCKY
INDIVIDUAL INCOME TAX RETURN
Full-Year Residents Only

2014

B. Your Social Security Number

402-45-8464
Name—Last, First, Middle Initial (Joint or combined return, give both names and initials.)

Roberts

Joshua D

Mailing Address (Number and Street including Apartment Number or P.O. Box)

4816 Beech Dr
City, Town or Post Office

Louisville

  1
  2
  3
  4

State

KY

ZIP Code

40216

FILING STATUS (see instructions)
Single
Married, filing separately on this combined return. (If both had income.)
Married, filing joint return.
Married, filing separate returns. Enter spouse’s Social Security number above
and full name here.

POLITICAL PARTY FUND
Designating $2 will not change your refund or tax due.

A. Spouse
Democratic
Republican
No Designation

Attach Form W-2(s), Other Supporting Statement(s) and Payment Here—Staple to Top Page Only

INCOME/TAX
A.  Spouse (Use if
 Filing Status 2 is checked.)
  5 Enter amount from federal Form 1040, line 37; 1040A, line 21 or

1040EZ, line 4. (If total of Columns A and B is $31,721 or less, you

00

may qualify for the Family Size Tax Credit. See instructions.) ....................... • 5

(1)
(2)
(3)

B.

B. Yourself
(4)
(5)
(6)
Yourself
(or Joint)

27,631. 00
• 5

00
00
• 6
  6 Additions from Schedule M, line 8..................................................................... • 6

00
27,631. 00
  7 Add lines 5 and 6................................................................................................. 7 7

00 • 8
0. 00
  8 Subtractions from Schedule M, line 20.............................................................. • 8

00
27,631. 00
  9 Subtract line 8 from line 7. This is your Kentucky Adjusted Gross Income...... 9 9

10 Itemizers: Enter itemized deductions from Kentucky Schedule A.
00 • 10
2,400. 00

Nonitemizers: Enter $2,400 in Columns A and/or B.......................................... • 10
00 • 11
25,231. 00
11 Subtract line 10 from line 9. This is your Taxable Income ............................... • 11

12 Enter tax from Tax Table, Computation or Schedule J.

00 12
1,279. 00

Check if from Schedule J
........................................................................... 12
00 • 13
00
13 Enter tax from Form 4972-K
; Schedule RC-R
..................................... • 13

00 14
1,279. 00
14 Add lines 12 and 13 and enter total here .......................................................... 14

00 15
00
15 Enter amounts from page 3, Section A, lines 23A and 23B.............................. 15

00
1,279. 00
16 Subtract line 15 from line 14. If line 15 is larger than line 14, enter zero........ 16 16
00 • 17
10. 00
17   Enter personal tax credit amounts from page 3, Section B, lines 4A and 4B • 17

00 18
1,269. 00
18 Subtract line 17 from line 16. If line 17 is larger than line 16, enter zero........ 18
19
1,269. 00
19 Add tax amount(s) in Columns A and B, line 18 and enter here................................................................................

4
20 Check the box that represents your total family size (see instructions before completing lines 20 and 21)......... • 20   1   2   3

00
0.
0 and enter here ......................... • 21
 __ __ (__ __ __%)
21 Multiply line 19 by Family Size Tax Credit decimal amount __ 0.00
22
1,269. 00
22 Subtract line 21 from line 19.........................................................................................................................................
• 23
00
23 Enter the Education Tuition Tax Credit from Form 8863-K..........................................................................................
1,269.

00
24 Subtract line 23 from line 22......................................................................................................................................... 24

25 Enter Child and Dependent Care Credit
• 25
00

from federal Form 2441, line 9 ➤
x 20% (.20)..............................................
1,269. 00

26 Income Tax Liability. Subtract line 25 from line 24. If line 25 is larger than line 24, enter
zero............................... 26

(see instructions) • 27
27  Enter KENTUCKY USE TAX due on Internet, mail order, or other out-of-state purchases
0. 00
1,269. 00
28
28 Add lines 26 and 27.  Enter here and on page 2, line 29 .............................................................................................
1555

REV 12/06/14 TTO

FORM 740 (2014)

Page 2 of 3

REFUND/TAX PAYMENT SUMMARY

• 29
29 Enter amount from page 1, line 28. This is your Total Tax Liability . .........................................................................

1,269. 00

30 (a) Enter Kentucky income tax withheld as shown on attached
2014 Form W-2(s) and other supporting statements.........................................

(b) Enter 2014 Kentucky estimated tax payments...................................................

(c) Enter 2014 refundable certified rehabilitation credit (KRS 141.382(1)(b)).......

(d) Enter 2014 film industry tax credit (KRS 141.383).............................................
31
32

1,149. 00
•  30(a)
•  30(b)
00
•  30(c)
00
00
•  30(d)

•  31
Add lines 30(a) through 30(d).......................................................................................................................................

If line 31 is larger than line 29, enter AMOUNT OVERPAID (see instructions).........................................................
32

Fund Contributions; See instructions.

➤  (Enter amount(s) checked)

33 Nature and Wildlife Fund..............................................  

$10  $25  $50  Other

34 Child Victims’ Trust Fund..............................................  

$10  $25  $50  Other

35
36
37
38
39
40
41

1,149. 00
00

• 33
• 34
• 35
• 36
• 37

00
00
Veterans’ Program Trust Fund......................................
 $10  $25  $50  Other

00
Breast Cancer Research/Education Trust Fund .........
 $10  $25  $50  Other

00
Farms to Food Banks Trust Fund . ...............................
 $10  $25  $50  Other

00
Add lines 33 through 37................................................................................................................................................
38

Amount of line 32 to be CREDITED TO YOUR 2015 ESTIMATED TAX . ......................................................................
• 39

REFUND
Subtract lines 38 and 39 from line 32. Amount to be REFUNDED TO YOU ...................................

• 40

If line 29 is larger than line 31, enter ADDITIONAL TAX DUE . ..................................................................................
• 41

00
00
00
120. 00

42(a)
00
42(b)

00
(c) Late payment penalty.......................................................................................... 42(c)
00
(d) Late filing penalty................................................................................................. 42(d)
00

Add lines 42(a) through 42(d). Enter here....................................................................................................................
• 43
OWE
Add lines 41 and 43 and enter here. This is the AMOUNT YOU OWE ..................................................
44

00
120. 00

42 (a) Estimated tax penalty and/or interest. Check if Form 2210-K attached....
(b) Interest..................................................................................................................

43
44
l

Visit www.revenue.ky.gov for electronic payment options; or

l

Make check payable to Kentucky State Treasurer, include your Social Security number and “KY Income Tax—2014.”

OFFICIAL USE ONLY

A.

SECTION A—BUSINESS INCENTIVE AND OTHER TAX CREDITS
  1 Enter nonrefundable limited liability entity credit (KRS 141.0401(2)) ...................

1

  2 Enter Kentucky small business investment credit...................................................

2

  3 Enter skills training investment credit (attach copy(ies) of certification)..............

3

  4 Enter nonrefundable certified rehabilitation credit (KRS 171.397(1)(a))................

4

  5 Enter credit for tax paid to another state (attach copy of other state’s return(s))

5

  6 Enter unemployment credit (attach Schedule UTC)................................................

6

  7 Enter recycling and/or composting equipment credit (attach Schedule RC)........

7

  8 Enter Kentucky investment fund credit (attach copy(ies) of certification).............

8

  9 Enter coal incentive credit.........................................................................................

9

10 Enter qualified research facility credit (attach Schedule QR)..................................

10

11 Enter GED incentive credit (attach Form DAEL-31)..................................................

11

12 Enter voluntary environmental remediation credit (attach Schedule VERB).........

12

13 Enter biodiesel and renewable diesel credit............................................................

13

14 Enter environmental stewardship credit..................................................................

14

15 Enter clean coal incentive credit...............................................................................

15

16 Enter ethanol credit (attach Schedule ETH).............................................................

16

17 Enter cellulosic ethanol credit (attach Schedule CELL)...........................................

17

18 Enter energy efficiency products credit (attach Form 5695-K)...............................

18

1555

REV 12/06/14 TTO

PWR

Spouse

B.
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Yourself

00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00

Continue to page 3 to complete Section A

FORM 740 (2014)

A.

SECTION A—BUSINESS INCENTIVE AND OTHER TAX CREDITS (continued)
19 Enter railroad maintenance and improvement credit (attach Schedule RR-I).......

Spouse

B.
00
00
00
00
00

19

20 Enter Endow Kentucky credit (attach Schedule ENDOW).......................................

20

21 Enter New Markets Development Program credit..................................................

21

22 Enter food donation credit (attach Schedule FD).....................................................

22

23 Add lines 1 through 22, Columns A and B. Enter here and on page 1, line 15 ...

23

Page 3 of 3

Yourself

00
00
00
00
00

19
20
21
22
23

SECTION B—PERSONAL TAX CREDITS

Check
Regular

Check all four
if 65 or over

Check all four
if blind

Check both for Kentucky
National Guard
1 Enter number of
boxes checked
on line 1.........................

  1 (a) Credits for yourself:

(b) Credits for spouse:

  2 Dependents:

1

2 Enter number of
dependents who:

Dependent’s

First name
Last name
Social Security number

Dependent’s
relationship
to you

Check if qualifying
child for family
size tax credit

• lived with you.............

• did not live with you
(see instructions)........

  3


• other dependents.......

Add total number of credits claimed on lines 1 and 2.
3 Enter total credits..........
If married filing separately on a combined return (Filing Status 2), each taxpayer must claim his or her
Spouse
Yourself
own credits from line 1, divide the credits on line 2, and enter the totals in Boxes 3A and 3B. All other
• 3B
filers enter the amount from line 3 in Box 3B .........................................................................................................➤ • 3A

  4 Multiply credits on line 3A by $10 and enter on line 4A. Multiply credits on line 3B by $10 and

enter on line 4B. Enter here and on page 1, line 17, Columns A and B . ...................................................................

x $10
4A

1

1

x $10
4B

10.

SECTION C—FAMILY SIZE TAX CREDIT (List the name and Social Security number of qualifying children that are not claimed as dependents in
Section B.)
First name

Last name

Social Security number

First name

Last name

Social Security number

Attach a complete copy of federal Form 1040 if you received farm, business, or rental income or loss. If not required, check here.
I, the undersigned, declare under penalties of perjury that I have examined this return, including all accompanying schedules and statements, and
to the best of my knowledge and belief, it is true, correct and complete. I also understand and agree that our election to file a combined return under
the provisions of Regulation 103 KAR 17:020 will result in refunds being made payable to us jointly and in each of us being jointly and severally liable
for all taxes accruing under this return.

   
(502)418-5421
Your Signature (If joint or combined return, both must sign.)

Spouse’s Signature

Date Signed

Telephone Number (daytime)

Self-Prepared
Typed or Printed Name of Preparer Other than Taxpayer

I.D. Number of Preparer

Date

Firm Name

EIN

Date

1555

Mail to:

  REFUNDS

Kentucky Department of Revenue, Frankfort, KY 40618-0006.

  PAYMENTS

Kentucky Department of Revenue, Frankfort, KY 40619-0008.
REV 12/06/14 TTO

Form

1040X

(Rev. December 2014)

Department of the Treasury—Internal Revenue Service

Amended U.S. Individual Income Tax Return
a

OMB No. 1545-0074

Information about Form 1040X and its separate instructions is at www.irs.gov/form1040x.

This return is for calendar year
2014
Other year. Enter one: calendar year

2013

2012

2011

or fiscal year (month and year ended):

Your first name and initial

Your social security number

Last name

Joshua D

Roberts

If a joint return, spouse’s first name and initial

402-45-8464
Spouse’s social security number

Last name

Current home address (number and street). If you have a P.O. box, see instructions.

Apt. no.

Your phone number

4816 Beech Dr

(502)418-5421

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Louisville KY 40216
Foreign country name

Foreign postal code

Foreign province/state/county

Amended return filing status. You must check one box even if you are not changing Full-year coverage.
your filing status. Caution. In general, you cannot change your filing status from joint to If all members of your household have fullseparate returns after the due date.
year minimal essential health care coverage,
check "Yes." Otherwise, check "No."
Single
Married filing separately
(See instructions.)
Qualifying widow(er)
Head of household (If the qualifying person is a child but not
your dependent, see instructions.)

Married filing jointly

Yes

Use Part III on the back to explain any changes
Income and Deductions
1
2
3
4
5

No

A. Original amount B. Net change—
or as previously
amount of increase
adjusted
or (decrease)—
(see instructions)
explain in Part III

Adjusted gross income. If net operating loss (NOL) carryback is
included, check here . . . . . . . . . . . . . . . a
Itemized deductions or standard deduction
. . . . . . . . .
Subtract line 2 from line 1 . . . . . . . . . . . . . . .
Exemptions. If changing, complete Part I on page 2 and enter the
amount from line 29 . . . . . . . . . . . . . . . . .
Taxable income. Subtract line 4 from line 3 . . . . . . . . . .

C. Correct
amount

1
2
3

27,430.
6,200.
21,230.

201.
0.
201.

27,631.
6,200.
21,431.

4
5

0.
21,230.

0.
201.

0.
21,431.

6

2,730.

30.

2,760.

7
8
9
10
11

0.
2,730.
0.
416.
3,146.

0.
30.
0.
-243.
-213.

0.
2,760.
0.
173.
2,933.

12

3,171.

0.

3,171.

13
14

0.
0.

0.
0.

0.
0.

0.

0.

16
17

0.
3,171.

18
19
20
21
22

25.
3,146.

Tax Liability
6

Tax. Enter method(s) used to figure tax (see instructions):

7

Credits. If general business credit carryback is included, check
here . . . . . . . . . . . . . . . . . . . . . a
Subtract line 7 from line 6. If the result is zero or less, enter -0- . . .
Health care: individual responsibility (see instructions) . . . . . .
Other taxes . . . . . . . . . . . . . . . . . . . .
Total tax. Add lines 8, 9, and 10 . . . . . . . . . . . . .

Table

8
9
10
11

Payments
12
13
14
15

Federal income tax withheld and excess social security and tier 1 RRTA
tax withheld (if changing, see instructions) . . . . . . . . . .
Estimated tax payments, including amount applied from prior year’s
return . . . . . . . . . . . . . . . . . . . . . .
Earned income credit (EIC) . . . . . . . . . . . . . . .
Refundable credits from:
Schedule 8812 Form(s)
4136
2439
5405
8962 or

8801
8812 (2011)
other (specify):

8839

8863

8885

15
0.
Total amount paid with request for extension of time to file, tax paid with original return, and additional
tax paid after return was filed . . . . . . . . . . . . . . . . . . . . . . . .
17
Total payments. Add lines 12 through 16 . . . . . . . . . . . . . . . . . . . .
Refund or Amount You Owe (Note. Allow up to 16 weeks for Form 1040X to be processed.)
18
Overpayment, if any, as shown on original return or as previously adjusted by the IRS . . . . . .
19
Subtract line 18 from line 17 (If less than zero, see instructions) . . . . . . . . . . . . .
20
Amount you owe. If line 11, column C, is more than line 19, enter the difference
. . . . . . . .
21
If line 11, column C, is less than line 19, enter the difference. This is the amount overpaid on this return
22
Amount of line 21 you want refunded to you . . . . . . . . . . . . . . . . . . .
23
Amount of line 21 you want applied to your (enter year):
estimated tax . 23
16

213.
213.

Complete and sign this form on Page 2.
For Paperwork Reduction Act Notice, see instructions.

BAA

REV 01/27/15 TTO

Form 1040X (Rev. 12-2014)

Page 2

Form 1040X (Rev. 12-2014)

Part I

Exemptions

Complete this part only if you are increasing or decreasing the number of exemptions (personal and dependents) claimed on line 6d of
the return you are amending.
A. Original number
of exemptions or
amount reported or
as previously
adjusted

See Form 1040 or Form 1040A instructions and Form 1040X instructions.
24
25
26
27
28
29

30

Yourself and spouse. Caution. If someone can claim you as a
dependent, you cannot claim an exemption for yourself . . . . . .
Your dependent children who lived with you . . . . . . . . .
Your dependent children who did not live with you due to divorce or separation
Other dependents . . . . . . . . . . . . . . . . . .
Total number of exemptions. Add lines 24 through 27 . . . . . .

24
25
26
27
28

C. Correct
number
or amount

B. Net change

0
0
0
0
0

0
0
0
0
0

0
0
0
0
0

Multiply the number of exemptions claimed on line 28 by the exemption
amount shown in the instructions for line 29 for the year you are
0.
0.
amending. Enter the result here and on line 4 on page 1 of this form . .
29
List ALL dependents (children and others) claimed on this amended return. If more than 4 dependents, see instructions.
(a) First name

Part II

(b) Dependent’s social
security number

Last name

(c) Dependent’s

relationship to you

0.

(d) Check box if qualifying
child for child tax credit (see
instructions)

Presidential Election Campaign Fund

Checking below will not increase your tax or reduce your refund.
Check here if you did not previously want $3 to go to the fund, but now do.
Check here if this is a joint return and your spouse did not previously want $3 to go to the fund, but now does.
Part III
Explanation of changes. In the space provided below, tell us why you are filing Form 1040X.
a Attach any supporting documents and new or changed forms and schedules.

The money I received on a 1099 Misc was reported incorrectly. I didn't earn the
money. I won a trip from the radio.

Sign Here
Remember to keep a copy of this form for your records.
Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying
schedules and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer
(other than taxpayer) is based on all information about which the preparer has any knowledge.
F

F

Your signature

Date

Spouse’s signature. If a joint return, both must sign.

Date

Firm’s name (or yours if self-employed)

Date

Paid Preparer Use Only
F

Preparer’s signature

Print/type preparer's name

Self-prepared

Firm's address and ZIP code
Check if self-employed

PTIN

For forms and publications, visit IRS.gov.

Phone number
REV 01/27/15 TTO

EIN
Form 1040X (Rev. 12-2014)

Form

1040

2014

(99)

Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2014, or other tax year beginning
Your first name and initial

OMB No. 1545-0074

, 2014, ending

IRS Use Only—Do not write or staple in this space.

See separate instructions.

, 20

Last name

Joshua D

Your social security number

Roberts

402-45-8464

Last name

If a joint return, spouse’s first name and initial

Spouse’s social security number

Apt. no.

Home address (number and street). If you have a P.O. box, see instructions.

c

4816 Beech Dr
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Presidential Election Campaign
Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign postal code
a box below will not change your tax or
refund.
You
Spouse

Louisville KY 40216
Foreign country name

Filing Status
Check only one
box.

Exemptions

Foreign province/state/county

1
2
3

Single
Married filing jointly (even if only one had income)

4

c

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. a

Married filing separately. Enter spouse’s SSN above
and full name here. a

6a
b

5

Qualifying widow(er) with dependent child

Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse
.
Dependents:

(1) First name

.

.

.

.

.

.

.

.

.

.

.

(2) Dependent’s
social security number

Last name

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

(4)  if child under age 17
qualifying for child tax credit
(see instructions)

(3) Dependent’s
relationship to you

}

Dependents on 6c
not entered above

d

Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.

If you did not
get a W-2,
see instructions.

Adjusted
Gross
Income

Boxes checked
on 6a and 6b
No. of children
on 6c who:
• lived with you
• did not live with
you due to divorce
or separation
(see instructions)

If more than four
dependents, see
instructions and
check here a

Income

Make sure the SSN(s) above
and on line 6c are correct.

Total number of exemptions claimed

.

.

.

.

.

.

.
.

.

.

.

.

.

.

.

7

.
8b
. .

.

.

.

.

.

.

.

8a

.

.

.

.

.

.

.

9a

10
11

Qualified dividends . . . . . . . . . . .
9b
Taxable refunds, credits, or offsets of state and local income taxes
Alimony received . . . . . . . . . . . . . . .

.
.

.
.

.
.

.
.

.
.

.
.

10
11

0.

12
13
14

Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . .
Capital gain or (loss). Attach Schedule D if required. If not required, check here a
Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . .

.

12
13
14

1,222.

15a
16a
17

IRA distributions .
15a
b Taxable amount
. . .
Pensions and annuities 16a
b Taxable amount
. . .
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

15b
16b
17

18
19
20a

Farm income or (loss). Attach Schedule F .
Unemployment compensation . . . .
Social security benefits 20a

18
19
20b

21
22

Gambling Winnings
Other income. List type and amount
Combine the amounts in the far right column for lines 7 through 21. This is your total income

23

Educator expenses

24

Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ

25

Health savings account deduction. Attach Form 8889

.

24
25

26
27
28

Moving expenses. Attach Form 3903 . . . . . .
Deductible part of self-employment tax. Attach Schedule SE .
Self-employed SEP, SIMPLE, and qualified plans
. .

26
27
28

29
30
31a

Self-employed health insurance deduction
Penalty on early withdrawal of savings . .

.
.

.
.

.
.

.
.

32
33
34

Alimony paid b Recipient’s SSN a
IRA deduction . . . . . . .
Student loan interest deduction . .
Tuition and fees. Attach Form 8917 .

29
30
31a

.
.
.

.
.
.

.
.
.

.
.
.

32
33
34

35
36
37

Domestic production activities deduction. Attach Form 8903
35
Add lines 23 through 35 . . . . . . . . . . . . .
Subtract line 36 from line 22. This is your adjusted gross income

7

Wages, salaries, tips, etc. Attach Form(s) W-2

.

.

.

.

8a
b
9a

Taxable interest. Attach Schedule B if required .
Tax-exempt interest. Do not include on line 8a .
Ordinary dividends. Attach Schedule B if required

.
.
.

.
.
.

.

b

.

.

.

.

.

.

.
.
.

.

.
.
.

.
.

.

.
.

.

.
.

.

.
.

.

.

.

.

.

. . . . . .
. . . . . .
b Taxable amount

.

.
.
.

.

.
.
.

.

.

.
.
.
a

.

.

Add numbers on
lines above a

.

24,696.

21
22

1,800.
27,718.

36
37

87.
27,631.
1040 (2014)

23

87.

.
.

.
.

.
.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA

.
.

.
.

.
a

REV 05/19/15 TTO

Form

Page 2
27,631.

Form 1040 (2014)

38

Amount from line 37 (adjusted gross income)

Tax and
Credits

39a

Check
if:

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,
$6,200
Married filing
jointly or
Qualifying
widow(er),
$12,400
Head of
household,
$9,100

If you have a
qualifying
child, attach
Schedule EIC.

Blind.
Blind.

.

}

.

.

.

.

.

.

38

Total boxes
checked a 39a

Exemptions. If line 38 is $152,525 or less, multiply $3,950 by the number on line 6d. Otherwise, see instructions
Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . .
Form 4972 c
Tax (see instructions). Check if any from: a
Form(s) 8814 b

44
45
46

Alternative minimum tax (see instructions). Attach Form 6251 .
Excess advance premium tax credit repayment. Attach Form 8962

47
48

Add lines 44, 45, and 46
. . . . . . .
Foreign tax credit. Attach Form 1116 if required .

49
50
51

.
.

.
.

.
.

.
.

.
.

.
.

.
48

.

.

.

.

.

.

52
Residential energy credits. Attach Form 5695 . . . .
53
3800 b
8801 c
Other credits from Form: a
54
Add lines 48 through 54. These are your total credits . . . . .
Subtract line 55 from line 47. If line 55 is more than line 47, enter -0-

.
.

.
.

.
.

.
.

.
.

.
.

.

Self-employment tax. Attach Schedule SE

.

.

.

.

.

.

.

8919

.

.

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required

.

.

.
.

.
.

.
.

.
.

.
.

.

.

.

.

58
59
60a

Unreported social security and Medicare tax from Form:

a

b
61

First-time homebuyer credit repayment. Attach Form 5405 if required

67
68
69
70
71
72

.

.

.

Household employment taxes from Schedule H

.

.

.

.

.

.

.

.

4137
.

.

.
.

.

.

.

67

American opportunity credit from Form 8863, line 8 .
Net premium tax credit. Attach Form 8962 . . . .
Amount paid with request for extension to file . . .

.
.
.

.
.
.

68
69
70

.
.

.
.

b
.
.

.
.

.
.

71
72
Credits from Form: a
2439 b
Reserved c
Reserved d
73
Add lines 64, 65, 66a, and 67 through 73. These are your total payments .
Excess social security and tier 1 RRTA tax withheld

Credit for federal tax on fuels. Attach Form 4136

75
76a

.
.

.
.

6,200.
21,431.

43

21,431.
2,760.

44
45
46
47

.
.
a

2,760.

.
.

.
.

55
56
57

a

.

.

.

.

2,760.
173.

58
59
60a
60b

Health care: individual responsibility (see instructions) Full-year coverage
. . . . .
Form 8960 c
Taxes from: a
Form 8959 b
Instructions; enter code(s)
a
Add lines 56 through 62. This is your total tax . . . . . . . . . . . . .
3,171.
64
Federal income tax withheld from Forms W-2 and 1099 . .
2014 estimated tax payments and amount applied from 2013 return
65
Earned income credit (EIC) . . . . . . . . . . 66a

Nontaxable combat pay election
66b
Additional child tax credit. Attach Schedule 8812 .

40
41
42

49
50
51

Credit for child and dependent care expenses. Attach Form 2441

64
65
66a
b

.
.

.
.

Education credits from Form 8863, line 19 . . . . .
Retirement savings contributions credit. Attach Form 8880
Child tax credit. Attach Schedule 8812, if required . . .

52
53
54
55

a

If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid

61
62
63

2,933.

74

3,171.
238.
238.

75

. a
76a
Routing number
Checking
Savings
0 8 3 9 0 0 6 8 0 a c Type:
0 0 0 5 1 8 5 2 2 3 0 4 5
Account number
Amount of line 75 you want applied to your 2015 estimated tax a 77
77
78
Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions a 78
79
Estimated tax penalty (see instructions) . . . . . . .
79
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete below.
Amount of line 75 you want refunded to you. If Form 8888 is attached, check here

b
d

No

Personal identification
a
number (PIN)

Phone
no. a

Designee’s
name a

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.

F

Paid
Preparer
Use Only

.

42
43

Sign
Here
Joint return? See
instructions.
Keep a copy for
your records.

You were born before January 2, 1950,
Spouse was born before January 2, 1950,

.

39b

a

Third Party
Designee

.

.
.

Direct deposit?
See
a
instructions.

Amount
You Owe

.

Itemized deductions (from Schedule A) or your standard deduction (see left margin)
Subtract line 40 from line 38
. . . . . . . . . . . . . . . . .

73
74

Refund

.

40
41

62
63

Payments

.

If your spouse itemizes on a separate return or you were a dual-status alien, check here a

b

56
57

Other
Taxes

{

.

Your signature

Date

Your occupation

Daytime phone number

Spouse’s signature. If a joint return, both must sign.

Date

Spouse’s occupation

Student

Print/Type preparer’s name

Firm’s name

a

Firm’s address a
www.irs.gov/form1040

Preparer’s signature

Self-Prepared

(502)418-5421

Date

If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)
PTIN
Check
if
self-employed
Firm's EIN

a

Phone no.
REV 05/19/15 TTO

Form 1040 (2014)

Net Profit From Business

SCHEDULE C-EZ
(Form 1040)

OMB No. 1545-0074

Department of the Treasury
Internal Revenue Service (99)
Name of proprietor

Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B.
a Attach to Form 1040, 1040NR, or 1041. a See instructions on page 2.

Attachment
Sequence No. 09A
Social security number (SSN)

Joshua D Roberts
Part I

402-45-8464

General Information
a

You May Use
Schedule C-EZ
Instead of
Schedule C
Only If You:

a

• Had business expenses of $5,000 or
less.

• Had no employees during the year.
• Are not required to file Form 4562,
Depreciation and Amortization, for
this business. See the instructions for
Schedule C, line 13, to find out if you
must file.
• Do not deduct expenses for business
use of your home.

• Use the cash method of accounting.
• Did not have an inventory at any time
during the year.

And You:

• Did not have a net loss from your
business.
• Had only one business as either a sole
proprietor, qualified joint venture, or
statutory employee.

A

2014

(Sole Proprietorship)
a

• Do not have prior year unallowed
passive activity losses from this
business.

B Enter business code (see page 2)

Principal business or profession, including product or service

a 9 9 9 9 9 9

Auto Body Repair Laborer

D Enter your EIN (see page 2)

C Business name. If no separate business name, leave blank.
E

Business address (including suite or room no.). Address not required if same as on page 1 of your tax return.

4816 Beech Dr
City, town or post office, state, and ZIP code

Louisville, KY 40216
Did you make any payments in 2014 that would require you to file Form(s) 1099? (see the Schedule C
instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F

G If “Yes,” did you or will you file required Forms 1099? .

Part II

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Yes
Yes

.

No
No

Figure Your Net Profit

Gross receipts. Caution. If this income was reported to you on Form W-2 and the “Statutory
employee” box on that form was checked, see Statutory employees in the instructions for
Schedule C, line 1, and check here . . . . . . . . . . . . . . . . . . a

1

2,763.

2

Total expenses (see page 2). If more than $5,000, you must use Schedule C

.

2

1,541.

3

Net profit. Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on both
Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 and Schedule SE,
line 2 (see instructions). (Statutory employees do not report this amount on Schedule SE, line 2.)
Estates and trusts, enter on Form 1041, line 3 . . . . . . . . . . . . . . . . .

3

1,222.

1

Part III

.

.

.

.

.

.

Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 2.

4

When did you place your vehicle in service for business purposes? (month, day, year)

5

Of the total number of miles you drove your vehicle during 2014, enter the number of miles you used your vehicle for:
a

Business

a

b Commuting (see page 2)

c

Other

6

Was your vehicle available for personal use during off-duty hours? .

.

.

.

.

.

.

.

.

.

.

.

Yes

No

7

Do you (or your spouse) have another vehicle available for personal use? .

.

.

.

.

.

.

.

.

.

.

Yes

No

8a

Do you have evidence to support your deduction?

.

.

.

.

.

.

.

Yes

No

.

.

.

.

.

.

.

Yes

No

b If “Yes,” is the evidence written? .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

For Paperwork Reduction Act Notice, see the separate instructions for Schedule C (Form 1040). BAA

REV 11/26/14 TTO

Schedule C-EZ (Form 1040) 2014

SCHEDULE SE
(Form 1040)

Self-Employment Tax
a

Department of the Treasury
Internal Revenue Service (99)

OMB No. 1545-0074

2014

Information about Schedule SE and its separate instructions is at www.irs.gov/schedulese.
a Attach

Attachment
Sequence No. 17

to Form 1040 or Form 1040NR.

Name of person with self-employment income (as shown on Form 1040 or Form 1040NR)

Joshua D Roberts

Social security number of person
with self-employment income a

402-45-8464

Before you begin: To determine if you must file Schedule SE, see the instructions.

May I Use Short Schedule SE or Must I Use Long Schedule SE?
Note. Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions.
Did you receive wages or tips in 2014?
No
d

Yes
d

d

Are you a minister, member of a religious order, or Christian
Science practitioner who received IRS approval not to be taxed
on earnings from these sources, but you owe self-employment
tax on other earnings?

Yes

Was the total of your wages and tips subject to social security
or railroad retirement (tier 1) tax plus your net earnings from
self-employment more than $117,000?

a

No

Yes

Did you receive tips subject to social security or Medicare tax
that you did not report to your employer?

a

Yes

a

No
d

No
d
Did you receive church employee income (see instructions)
reported on Form W-2 of $108.28 or more?

a

No
d

d
Are you using one of the optional methods to figure your net
earnings (see instructions)?

Yes

Yes

a

`

No

Did you report any wages on Form 8919, Uncollected Social
Security and Medicare Tax on Wages?

Yes

a

No
d
You may use Short Schedule SE below

d
a

You must use Long Schedule SE on page 2

Section A—Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE.
1a

Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form
1065), box 14, code A . . . . . . . . . . . . . . . . . . . . . . . .
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z

2

3
4

5

6

Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),
box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1.
Ministers and members of religious orders, see instructions for types of income to report on
this line. See instructions for other income to report . . . . . . . . . . . . . .
Combine lines 1a, 1b, and 2
. . . . . . . . . . . . . . . . . . . . .
Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do
not file this schedule unless you have an amount on line 1b . . . . . . . . . . . a
Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b,
see instructions.
Self-employment tax. If the amount on line 4 is:
• $117,000 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 57,
or Form 1040NR, line 55
• More than $117,000, multiply line 4 by 2.9% (.029). Then, add $14,508 to the result.
Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55 . . . . . . .
Deduction for one-half of self-employment tax.
Multiply line 5 by 50% (.50). Enter the result here and on Form
1040, line 27, or Form 1040NR, line 27 . . . . . . . .
87.
6

For Paperwork Reduction Act Notice, see your tax return instructions. BAA

REV 10/29/14 TTO

1a
1b (

)

2
3

1,222.
1,222.

4

1,129.

5

173.

Schedule SE (Form 1040) 2014