£1040 UiS"individual income Tax Return [2016 | coor ios | na eci-comtmieassh nts en aoe a fevten aed wat — ao inte Sennen cb TO a ia “yankee wa Se000as00 eater ope - ry Filing Status * 2 [Rl ans rot ta nts wean Core ony ane 3 [wang ey res SN ove ne a sO EES Eee aers ase ae ae Examplone Peon a Si arp Sa Sea 2 ere omens pests we ied you 2 {nr han or Se tetera epee thc how E] ered Sere 6 Taal runber o exemptions canes ita woen 4) 7, seo os 7 208,379 Income ta. Tanabe tact Ste iid ra Aan Foro) Tanesempl tbo tr Fs Wore Aso 95 Ory Sir Ath Sei 8 eg aiaek Fame Outed ances is Wenem 10 rented oi i di i 50 vested. 11 Ay ced Traian, 12 Bes Peon & (a ish Sais w 2 Bre 18 oxy en Stent tt nn et Serato. 14 Ofer ote ress Ach Fam ao? {PA distibalons Jb Taxa amoant Pose art ii | ® Thi aman ntl lei, eye tre, SpE FR Sle Ach Sc 2a 1 Fam moe fn). Aah Se 19 Unmponmen eoopreatn 20 Su cut rt is 6 i aca 21° heron i doit 22cm ai isin ih aa in 208,552 2 Eka epowes 2 Adjusted 24 Conan os vii wii i ti Gross fort gona ofa, Mac am 2108 or 210PEZ | 3 Income 25 Hv ang cmc acs ah Form Sta = 2 Mong een ach Fn 278 = 27 poset pot etengoment ai Sia 8 7 28 Soberpoed SEP SMPLE and ued pre Fl 28 Setenpye hah evar din ra 20 Pout on eo icv eens 20 Bia Ay gat” Rests SS Em Parreineny 2 22S bon wil i [a = 34 Tr agen ach om be 38 Demat peso cn ron ish Pi" Ca 36 hades 23 ego, 2% 37S es tome 35 ou add as nem Dar 205,552 Ta 1080 cs iB ino, Prey Re, na Paperwork esucon Act Nae, ee spare Ineo,fensouong TIMOTHY J & GWEN L WALZ 38 Anourfo e (aed ges rear) [3 208,592 tacans 388 Check f [You wonvantosre vam 8” {now won fas i { [pope nrton be sommy 20, Flas } Sas ase oss tones na opal em er wow in nen. eck 3b Sapir La) amis seavcbone um Sctie 8) yor sland daduon (ee nrg) i 29,233 Sst tn 0 tm a 38 at 379,359) xenplon. Hosts in a 8 ian cio Sa a 2 16,200 {male meee arb fens ane = 763,159, Taxon tay Omaaeyton « LTD aL] at 32,670 Aterate minimum tx 5 mcs Ah For ST = fxees stare pe ex cel epaye Alah Fa C82 6 ass 45, [er 32,670 Fon tx ont ch Fo 116 ted Crt el ar pend xe eget, Asch Fo ta” [a Eston ae a Far 86 ne 1 oo Fate sags conto ce Ah Fa 6 a Chis exec St ete 2 53s ene ce. a Fem S35 8 One cea em Fama [] 900 8} i” C] # 8 2as Ines 8 ugh 5, Tees ott rs » 56 _Suttct 55 om ns 7H $58 oan 7 ei 6 32,610 7 Stereo eh Sede SE = Other 58 Unegrod it secny ad Meas ara” CL] 4B Lad A = 58 Aston tx one, or nos alee. eth Fe 20 aed a = 60s atid eprom Shas 02 - 8 Fctine honey oe ramet. Ach Fo 818 Weed b 1 Heath car: invita responsi s60 nrcons) Fullyoar coverage () 6 2 Toes tom [] tnt b [fon © [) hetero a fete 6 gf yl te a [oe 32,870 (4 Fee came x wi om Fors Wan 18 ‘e 32,387 Reymene__65 asin pyr res ann a em 0° eh os [irsmes Bla Ear income d(C) ise Sains, [8 Neate ebay soon” [es SEATS | or pastor ts wx on Atcha 7 68 Ansan eporiny cet Fon Fem 683, fw 8 o 62 tami a ot an Form bs mn 70 pat hot osc i 7 71 Bie ail scar 1 PATA ta wil 7 72 Go ax ni. ta Fo 38 2 73 onan fos [) 208 L]Pemnd eC Jo a CY De TA _ hein 64,5, and 67 trough 78, Thee ae yur teal pape. u |v 32,381 Refund 75 Wire 74 snr arn, vet Go Fon ne 7s ara you oval a 762 Ane of 75 he andes 0 you Fo 86 as cock a) [i ot ont Bg abr ae Te [] chesien L] seinse Sue 8 @ Rei runtar Aco ol i 75 oad your OT etme wx _| 77 ‘imcant 78 aroun you owe Sat 7 fo rw 6. For as onion pay, no Wace | Tk 289 You Owe 70 Esa x poral oe nto) 2 Third Party 5° 7 wala low ater pon dense erehn wh eS io hanes? [Ven Ope i Wo aoe Poo tas rit m4 [12505 Sgn) Skiien reais eaaa eeTcle te oe ue goo 0 a wa ao [oe laa ge 7 7 ene Paid _nicons 3 fosen | en Preparer “fay 7 ae fevene Use Only “five sorb St. Louis Park MN_55416-2611 Fon 1040 5976SCHEDULE A Itemized Deductions OWE Ne 1545-0074 (Form 1080) «maton sou Schedule nd separ auton at mina gowchedien 2016 ee sees ra a Sea O7. TIMOTHY J & GWEN L WALZ ‘auton: Dora clu apace renbued or pall by obs. Medical asl rental xpeen oe stone) 1 and 2 our ana ton Fo 932 268,882 Dent 2 May ne 20710, (10) Bt etry oyu apse wat Expenses Sem bebe Jarry 2, 82 mye 2) 726 OOP) Fle a 20,859 4 Sitar ne mine ies ne than na ne ‘ ‘Tones Vou 6 Sayan wal (chek oly one bos Paid [Rf eave taxes of 8 11,928 © [] ones cose fxs 6: Pelee tes (2 ras) s 2,366 7 Peso! popty ies 7{ ner ae Us yo ara B 8 li ig 9 14,294 Interest 70 Hore oto sex pis msn yo Ferm 8 “o 37639 You Paid 11 Hora rere iret el pore yuo Fam 08. ai to ran fom nny bo ons hans how Pa ote foeats am Koti an sare B tee Sicelon may Be ne 1“ Frain) 2 Beit oped oyu cn Feri, So nan ot Secale 2 13 Norgnge Faunce pontine (ce actos) ra 14 Invests tach Fo 6828 requires. (So Inseons) 1“ 1. is 10 oh 8 9,639 go ce yc oF hy A a Tynan 17 Ofer any eas chek Way git ot 50 are on and ata itso, You ma tc Form 289 oe $500 ” 1,600 Benet! 18 Cayo om pl oar mn see hsiictrs 1 pad im toto 18 8 5,300 Casualty and Theft Losses _20 Consly or thot eer Ati Fam S864 (Se haucton) 0 ‘Job Expenses 21 Ureirtrsed enpzye expensed tavern ds i" [Uedaton, ot! fac Forn £108 o SHOBEZH rure and Certain {Soe fetus) P Hiscolaneous a Deductions aac pepaon ise 2 350 2 One wer il ii Lp 2 26 fe ina 1 voigh 23 2 35 25 Exec ao ae Fam 0 8” [38 308,882 28 Mayne 25 by 2% (002, % 4,172 27st ne 25 tor na 2 iin 2 ar an re 3, ier. zn ° Bee gag 28 Ome tn ns typ a ans Beductions 2» Total BB Fo 10 9 or SSS BEDT temized Ly We, Your ton ook, el th amour Re a ot coda ee fringe «tough 26H oie ts trout on For 00, Ine 0 ao 29,233 (vos, Your deton maybe tnt. Soo tho tized Dedstons ‘Worksheet nth nares Ep fo amour oon 280 Wyo sa to lemizedaditens eon ovah ey te es Pan our tne ott, chock nae » Ff PapawoikTnosion Act Nac, ss Fr 10 nabson ‘Sees R Fan TORO AASCHEDULE E Supplemental Income and Loss co tee (Form 1040) (From rental ea estat, oye, partnerships, & corporation, estates, russ, REMC, fe) atch oFom 040, For a 2016 Sa nn” Jnformation about Schedule E end its separate insructions is at wanes. gowscheduoe See 13 an en Yo a mir TIMOTHY J_& GWEN L WALE a Part! income or Loss From Rental Real Estate and Royalties not: # you aro the bse o ning paronalpopay, ue Sched Cor CZ ss nents yu anne ep are ram ore om Farm 85 one, ne 0 "RD you ake pays i 2016 a woul wai you fo For) 1050 (ose LT ve Ee 8 _ 10 dy ow eal eased ore 108? yes_[] no hyseal eso exch propery si OP ea - th | Tipe ol Popany | __2 For enh vn al eile propery fated ‘eto [Peo w | Ov ee ha pesond te dae Oech he OV bor HE a =] 2 ‘ay Hyeu mete equremens oe es at 366 t oe] 5 ted jr ore. Soo nabcton 8 c c Tipe of Prope 1 Stale Fariy Resnce 8 Vacsfo'Shor-Tem Peril 5 Land 7 Sol eral 2_MubFonty Recenee 4 _Conmerh fovea Ofer seb) toca I Sbomka a z z 3. Reread cn A 7,000) 4_Poyoin recsved 4 - Expenses: 5 poveting 5 6 Auto and Wael ee tution) . 7 Cangas malrance 7 8 canmsstine 2 9 neo 2 10 og anc ter plese eee “a 11 Manageme lees rT 12 Monon res i ors, os es) 2 : 19 Ober ret ra 14 Repos rn 7,036 15 Supls 76 fz 16 Tos 16 17 ies 7 18 Depeccion one dpatan 0 7a] 19 one: aD rn 20 Tau wpe ats S x io 20 T7771 21 Sera ro 20 es no ei) andr & opie). resis os), Stuns a fr you mat fe Form 6198 a 223| 22 Dect etal al se earn, ny, on Form 852 ove hstons) 22 o 288 Tt fal amounts pred on te 3 ra i oper Be 7,000 Toa ff amen repatadon io 4 for al yay propa [| Tea off ameunt ete one 12 1 al properies [ase | (Teal of al amour oes on ra 1 proper 2d Tal Too of a amos oer a ne 2 poeta Ze Taq77 24 foam, fe pone aman shown cn a2. Do not ele ay es 24 223 25 Loses, Al yay ses Fo no 21 ard renal el este oss fo ro 22 Ear lise are 75 2 26 Total rena el esate and royally income or oss), Contin ines 24a 25. Ener he es hee Pas, sc 40 en page 2 mo apo ou ako tr is aan on Fam 04, ra 1, or Farm 040NR, tr 18, Cha, nu eau nl ov 43 on pag 2 a 223 Fx Poverwork Reduction Ae Neto, se he Separate nstustons aR TaDepreciation and Amortization om a ssancr ‘om 4562 (including Information on Listed Property) 2016 ose te any Asch phon SEctimuesews” gn) tormation spout Form 4563 and a. 179 ‘“SHIMOTHY J_& GWEN L WALZ — Part! Election To Expen: in Property Under Section 179 Note: lf you have any lsted property, complete Part V before you complete Part L "Tar amount es nates) i 500,000 2 Total cao ssion 178 propery paced n sens (ee suns) 2 53 Threshol ost of scton 179 prpory bf roduc nan 4 net) 3 2,010, 000 44 Radu i niton. Sub! ne 3 tom ia 2.200 ores, lr 0 HI Dol oi x yo, ub ne fr i elas, ee, lngsparinhs sici 5 (esse open Gyo bee we ot) [Gn 7 Lise propery. Ero arnt Fa tne 25 z {8 Total elec ent of sacton 179 property. At amos clin () es 6 and 7 a 9 Tonto dean. Eno he smal of oe So: re 8 9 10 Caryover f ealowed dean fo ne 19 of you 2015 Fon 82 C0} +1 Buanses ncaa lntton Er the smal of buss income a es than 2) ine Se sons) 1 12 Sealon 178 expene deseo, Ald ras 9 an 10, bu co ele mere tan fro tt 2 12__Canover of dealoned deur to 2017, Add bs 9a 10, es na 2 bet Hote Bort we Pat I or Pa I bbw orld propery. sass ute Pat Part ll Special Depreciation Allowance and Other Depreciation (Don't indude Usted property) (See _insiuctons) 14 Spudal doprecaton atonace fo quslled propery (ater tan ited propery land reece reg the tx year (68 insucions) “ 15 Propoy sec ston 168) sac 15 18 Ohne deprcafon(neing ACR) 16 art lil MARS Depreciation (Don't include listed property) (See instructions.) Seaton A {7 WAGAS doavetone for essa laced a care I lx yeas bagi bolo 2076 = a 18 tuscan ep ny tn de yg ea ae gene me “ ‘Section B-—Asse cad In Serica During 2016 Tex Year Using the Goneral Depreciation Sion momma army | Oimeat | Rmmiames [6m | com | it ie oc 7 = Sr st er ae Cita so i pet a at oie met z x pei TaTOITI TH [ we | | ad pes OB 701716 51485[ gaye [wa [ at 73 tees -_ . | oe oa etn sind Sn Bg He Tox Vnw Ua Alaa epson Som = Gate a tar ma st = te ‘ iat Part iV__Summary (See instructions.) FA Wi pty. wt a a 22 Tonk hans om ate ih, ar 0c ah wi i, fe none pine of yen Pease Sorina 2 14 2 feast sto fads tye eo pio eas i sn Sa 2 Far Papt Redon No, spare en ron ABZ om There are no amounts for Page 2rom 8283 Noneash Charitable Contributions con wes ferme © Aaah 0 your tum you ena ll ection neta i er sot tod pay a ramal Fverwa Senco __Information about Form 8283 and iis separate instructions Is at www.lrs.qov/torrm8283._ _aequnoe No 155, oWecape ewe —— TIMOTHY Je GWEN L WALZ — Hn Fg be anit dpa codon deci Flos cao on So a mm a Section A. Donated Properly of $5000 or Less and Publicly Traded Seculis-Usth Tis eon only Tans or spoups of sir erm) for whieh you damed a Geduchon ot $6000 oes. Also it publey Wadd securities even if the deduction is more than $5,000 (see instructions). Parl Information_on Donated Property-Ii you neod more gpace,allach a slalemont (hare mae co pe a ee es Ceraklansiecd 1 ee Cece et hreto'ta ss ese] Farawain sn fn a oe ge Fr Ee hie ts fm ab ewe es es gy saat tue ‘Minnesota Valley Action Gounod A| 706 victory Deive 0 Jelothing Household Furniture Misc iapieat for umanity 8 | 1951 neeett or o nowseholé ood mato wu_se00n ° o > o € o ieee army cada dan or ano Spay doa a egies 6 aT Nepean | ware Bere mo area aea fone | Seema | Ue San coat ieusaa a| Various | Various | Purchase TH, 400 1 440|mhrizt shop Value s| Various 160| Thrift Shop Value c 3 Part I Partial interests and Resticted Use Property-Completo Ines 2a through 26 ll you gave less than ah entire interest in a property listed in Part |. Complte lines 3a through 3c if conditions were placed on & contribution listed in Part I; also attach the requifed statement (see Instructions), ‘2a Erar olor fom Pat | at eres the rope fr which you pave estan an eto ees » fart apes to mare than one opty, atcha separa salam. Tot sent elses as & ded er te prope td InP (1) Fortis tx your > @) Forery proton yeas Namo and adres ofeach omgniaono which any sch conten was made nar yar compl nlf crak tom te donee ogarizaton bv ‘se ar aoe Syorem min aah «or tingle oper, erie ho pce whore ha ropa cad erkapra {Name of ny oon oer han he dene xganzatn, having seul psesi oe op {8 Ie here restore tompaary er pararan on tha done’ gt to seo dpe fhe donated ves [ No, propery? Did you ah to ajo ar than th done ignian eather Sginenionpacpeing wh he dons ‘maaan cooperate funcasig) he it he come om fe dona propane th poses of the pope, ncn fe rit oe dort saute, acquire Ee prepay by pucbase or ebon orb ‘deck he gereon hain su om possesion, of ib Beau? {sar a sicton nig tn donald propery fra pacar vs? For Paperwork Reduction Act Notes, se separate insructons. fom B2BS pan 2a)rom 1040 Salaries & Wages Report |__ 2016 ‘TIMOTHY J_& GWEN ZL WALZ _ 18 Employer Feder Wagoa ‘Fedora Wied Soe See Wages AT House of Rep-Member Services __ 149,690 25,819 118,500 8 S Indepéndent School District 77 58,629 6,562 65,672 c bo - c= 7 We ot — ee - te on = Ko La M _ Taxpayer 149,690 75,819 — 118,500 Spouse 58,629. 6,562 65,672, Totals = 208,319" 32,381, Tea, 172 Soe Sec Whe Medes Wages Medtare Witold Soc Seo Tips Albelod Tips bop Gx Ban Other, Box A 7,347 __ 160,790 2,331 _ 1,500 8 4.072 —— 65,672 952 c ° = E F s - Hl 1 4 —_ x L " Texpayer 72347. 160, 790 Zsa 7,500 Spouse” 4,072 —— 65,672 952 fous, iL,419) 226, 462 3283 7,500 Sais Se Wipes — Sate WT To Cay Toa Wr oar Wi A MN __ 149,690 9,039 ~ a B MN —— 58,629 2,889 co o _ —-E_ eee = ~ st H ae 1 K Li = Mo Taxpayer 149,690 9,039 as EE Spouse 58,629 2,889 Totals 208,319 “11,9285 M1 MINNESOTA - REVENUE 2016 Individual income Tax tei owe ued os re Dal ell nang you ‘our Fat ee te ‘asthe TIMOTHY J waLZ scent Suse's Ft amma ital Spun’ Last ane fixes GWEN D WALZ vant Crete es eet Asien tr, Roe) a) ‘inte Zip Code MANKATO MN 56001 2016 Federal Fling Stas] 1» Srglo fe Mate tra fy]. Mario ng separate (oace an Xin toed of Ener spe name ac coors Z)tevsenas —[E} 1 ciying widow Sac Say rer how Iymwatsmormrpendn tr sh Poll pay and ode sb: Hecatamantriepey yore Tar Ocmeweamelab” Wt Ono ece, 1s Staufegaget 7 Sirctrononyaratcreicsysretce” sce Hien = 12 From Your Fedral Retr fre eaters seston) et th amount o not send Ws, Enclose Schedule IW to ‘ain Mines eitholans, Wages, snes, tee TAA, Poon, and 208319 Federal txaboIncome (rom tn 4 ode Fam 1040, {ne 27 of Fam {0408 or he 6 of Fm 104062) ‘Stole Income tax or slo ax acon yu td dacs nfo Fam 1040, compote he worse inte ht:fons Cer sions lo reome, nsdn eal Homes deco, sonal exerpon,rendvinesot bad inet, a donee potucton Beles coaisn (eee inehiions: enciose Schecie MA) ‘ad res 1 trough 8 a egate rune, pce an Xin fe ox) Se ncame ah to ne 10 cal Fam 1040 Otter suas, such a et ies or mua fn nde fo US, bon or 112 edu expres 09 iets; enclose Schade MIM) 17 Tol subestons. Ad ines 5 and 6 Minnesota table Income Subract Ine 7 tor Ie 4,260 rls eae lr 9 Tax fom he ai in he teeta 10 Aomsive minimum ix (encose Schl MIT) 41 Aad es Gand 10 12 Paleo eset: Ente he tnt or 11 enna 1, pte 12 ae 1. Prtyear ete and nereeeanie: From Soh WIN, abt om In 27 on In 12, fo ne 28.0 125 en tu ne 24 en ne 1 oc Schel MINA) 18. Tavonlumpaum dbus (encose Scheci MILS) 14 Toxbeloe rei, Ads tes 12 and 12 _ 1015 rules: © Uroreyment 1. on on on " ue “ Fade dunes gs ream 208592 163159, 11928 712 175799 50 50 175749 12000 12000 12000 12000 12[7 2016 mt, page 2 1612 >] 18 Tax bol cra. Aron te na 4 6 12000 16 Mariogo Ged oe eum wen both apases hav ae ered same or tae aime cama once Sched AHA) em 103 17 Coe rine pido enters fantse Scheu) ICR) we 18 ter roneureble cs (ondose Schele MTC). on 49 Teta nanotube coe A nes 16, 47, end 18 ° 103 20 Suan 19 fam tne 15 (resus zr or es, save Bn) 20 11897 21 Nongamo We Fund coven foe itucsons) “Tes wi eon your rounder neesse amount you ome an 22 Adan 20 and 21 2 11897 23 Minnesota income tax withheld Compo an esose Sete NIW fo rope Mionacla wiki fom W.2, 1089, end W'2 Toms (20 ra se). an 11928 24 Minnesota etna tx nd etereln peymaris mado fr 2018 an 25 Indalico, henge Child ard Dependent Caro Cre, Mansota Wong Famty Crd, K-12 Edvaton Cet, ar Creat or Pret of Stor Chiden. You rust compo and endose Schule MIREF, hab obs Cede asm 26 Bienes and hvosirent rats nose Shoaso M8) am Toa payments. Ad Ines 23 rough 25, 2 11928 REFUND. Ine 27 more tan ne 2, strat no 22 om Ino 27 (ooo stuns). ar dct epost, comple fre 29 om 31 123i po of ou tk po ut ean ac ot see i re Ba checra Siege 30 AMOUNT YOU OWE, ine 226 mor han Ine 27, sbvact Ine 27 tom in 22 se nec) om {1 Panay aroun fm Sede MIS (a Intucon) eo sbt tte amount fom Ine 28 sao 3 onciose Sehecto H5) a8 IF YOU PAY ESTIMATED TAX ai er wns cured cn cong Ie on, 282 noun rom he 28 you wa er you ae {28 Aout rom ne 28 you want ape fo your 2017 eatmatad nx an Sti cores rd coo i te yg a net pee: Yum da. seo ana to Psd oer san om am Te To ne He a ia 00057288 inside » apy of your 2016 federal elu and schedules Matt Wrnescs cil Ice Tax ‘3 Paul, MN 85145 0010, ‘Toshckon be dai ol yur ets, Vek wosovenunsttnn.us L 1015 botery mum dese. ayMINNESOTA -REVENUE 1631] ‘Schedule M1W, Minnesota Income Tax Withheld 2016 Complete this schedule to report Minnesota income tax withhold. Include this schedule when you fle your retum. TIMOTHY o WALZ oun wus = yeu rested a W2, 109, W2G, Schsl KP KS or KF fa shone Menesca Ice ox was wel comit hs echesle te coerra in 23 of For Misa th om ht eet Ninna came ex weld, Round or amounts he rarest ls dlr. Yeu mut nau Seco when yo Ro your em, DONT snd in your W'2, 108 or W.2 fom; ee tbr wh your ac rocor Almstuctnsafe node on heehee, 1 Mlonesots wages a ax witht fom W2s, thar han tom WH you have more han fe Wz, compel Ine Son the back Nite We pao Fn ges 2 Met Se wae eon wl symener) horas a a ra te et a 1 x 149690 9039 a 2 x a 58629 2889 ‘Subir atonal W-28 feo neo tho ack) ‘otal innesota tx withheld rom al W.2 forms (ad aunts ns 1, cour E) u 11928 2 Marais ax witha tom 1098 ard W.2G foms. you heve martha or ems, coplt ne 6 on tha back I et orweiske Pant 1.9 Men nn ems ea i on Neve wnt + mous fant rt et pe a baka tt) (rans ene Subir aon! 1099s W.26 ems (rm ne 6 on the back) “ota Minnesota tax withheld tom al 1000 and #26 forme fact ncuron) 1 {Total minnesota tox witeld by partnerships, S corporations and faucires (eo ine 7 ne Bek) at 4 Tota. Ads ine Mines x witht ons 1,2 a al 11928 Err th ol ean on Ine 23 of Far Mt inc his sched wth your Form Wi required, include Schedles KP, KS ae KF. L 1015 =|MINNESOTA -REVENUE Schedule M1M, Income Additions and Subtractions 2016 Complote this schedule to determine tno 3 and tne 6 of Form Mt. Adi 4 mized dedion tson or taxpayers win an sed goss income which TIMOTHY J WALZ ditions to Income conde $184850 (292425 mare fig sopra) 2 Persana exertion phase cul fr aspayes with an agused gross income "hat een ihe apzleabietwesold (ose Intec) ‘eres fom munca bonds of naar sto ots governor ns 4 Feeraly tx oxmpt hides tom mus ends hwesng in bond of arte eae ' Fodor tones depron adn (dtamina fom werkseo! nto ietuctons) 5 Fd scion 179 pendrg don (elemine fom woshet ithe nuetors) fled en tna eral Farm 040 cr 10408 ort governmental uns nclde on ne Bb of aa Form TOA e 140, 7 Stato re ats posed tough to you os a pater ofa perp, a sharchllr olan 8 coparatn ere belay oa bus (60 instr) {8 Dome pcton acts deduction fhm ino 5 of oral Form 1040) 29 Eipensos courted on yer federal rum ati once nol ve 1 Minsk tor han lr rm ned cars om US. bone) 10 Fes, oes and peas eceraly desu a8 rad or buses expense 2 13 “ Sul (s20 rstcts) ‘Suspended fee om 2001 tough 206 o 2008 tough 2015 on our eral tun was gored by torus dopreiaon etna om worstew i he stn) Capa gh poton of lue-sum dtrbulon (ram ne 6 o at Fo 4972 onto Fm 4972). Nl operating oss canyrer adusinenl 60 instucors) he te enol fe ar ‘ed nes 1 ough 14 Er th ti are ad on ine 3 ot Form Mi ibtractions From Income 16 Ntinorest or mul urd ind om US. bond 60 itso) 18 0 Eaton espetes you pil or ou qualing ile lo grades K-12 fe ists) Ener th ame and rade teach ch 8 yu did nt teas cetuctns on your ada eum and yous cartabl conten were more than $500, 68 nets ‘Subtract fo lea bonus depecstn aad back 0 Mesa tal income in 2011 toigh 2035 (determine Kem washes ith nts) Subtodion or feva sicion 179 expensing acid bck fo Mimosa tnx ere in 2011 teugh 2015 (600 heructons) Subiaco or pexans age &5 or air, or prmantily ‘nd oly decid erie Schodie MIF) Boros pal by the Rall Reierrent Boar 6 intuctons) 1015 ull wh all al 1655 n2 m2MINNESOTA -REVENUE 7 Schedule M1MA, Marriage Credit 2016 ea aa ana smuoray J haus : ea a nega GWEN GOO A, - r . Tener sone 1 vege es pt fem 7 Fr 80 ‘or Form 10404 or line # of Form 104062) 1 149690 58629 2 Scop ore bind fie Si SE hr ary nth ho he 8 2 3 Ta pon rome BS fee maton) a @ 4 Tel So Sn ae BO amie om rt Fo 0) ‘ i g ‘5 Add tines + trough 4 for ach cotan 5 —____149680 58629 {5 Aontumines cnn aor oni (en en TOP HERE. Yo doa a) ___ses29 I 7 Joint taxable income from ine 8 of Form Mt. (IF ass than $37,000, STOP HERE. You do nol qualty) 7 175749 FF 6-ineewtecnn 040 atone ont oe oe gs Soo totus air mn a en foi Patino nd nes Crh ° 13 in i008 mar amg ns 8 oh 9 Ee ane ome 8. ° 10 van cto pal sn poet nat ee asin wo 10980 11 shinatine fons “ 42 Ug te cine tr sg para et, § ‘compte the tax forthe amount on Ine 11 2 Bo attr ® E14 promtonne " a: LULUmUmUrt—~—t—‘“—s™—S™S 6 $16 swe mtn ange prone ie rar Se 6 17 Toston nom 1 _ a {8-dttese 10tonin 7 iae s no en oa ,—h———s—— In alfa toy wens ad noe Coe 3 ® Fata Rots aol Romine 10 rw nds ned natn: nen eg fon i 2 Sa HN » 2 thy crn ton pai yn te fm hee oni Fam 1” Include his schedule when you fie Form Keep a copy fr your records, 1015 a aU.S. HOUSE OF REPRESENTATIVES MEMBERS’ SERVICES B235 LONGWORTH HOUSE OFFICE BUILDING WASHINGTON, DC 20515 October 31, 2017 ‘The Honorable Timothy J, Walz, Per your request to forgo any Cost of Living Adjustments for the duration of your tenure at the U S House of Representatives, the amount of any adjustment has been automatically deducted from your pay. To date you have retumed funds to U $ Treasury reducing the national debt by the amount of $81,684.00 If may be of further assistance to you regarding this matter, please do not hesitate to contact me at Bose ate Blizabeth Burnham ‘Members? Services Counselor