F IO4fl

Name, Address, and SSN

u.s. lndividual lncome Tax

Return 20 10

'

ffa jornt retur0, sp0use's fst

nme and inrlial

See

Mak6 sur6 rh SSN(S) bovo

separale

rnslructions.

Chclinoa box below willnol

chango your

Pesdental Electon Carnagn

ld

or relund

>
Sn0lc

want S3 to
Mared fling joinlly (ven
if only one had ncome) SSN above

to this fund
Head of household (with qualitying person). lf the qualifying

Filing
Check

Status

person is a child but not your dependent, enter this child's

name here.

only

f]

[arfled filing separalely. Enter sp0use's

and fullnam hee.

on 6 d 6b

Yoursll. lfsome0ne can claim you

Dependents:

as a dependent, do not check box 6a

Eoxeschcled

.>

ln,,o

trvoa wrttr

rou

you doto divorce

(s@ nEtulihs)

not tqed abov6

lncome
Attach torm(6) W-21ere. Also

I
8 b

Wages, salaries, tips, elc. Atlach Form(s)W-2

Taxable interest. Attach Schedule Tax-exempl inteest.

0ualified dvidends

B f required

Do not include on line 8a B f required

attch orms W-2G and 1099-R f tax

was wthheld.

ga
b 10

ordinary dividends. Attach Schedul

Taxable refunds, credits, 0r offsets ofstate and localincome laxes Alimony recived

l1 lfyou
dd

not

12 13 14

tsusnessncomeor(loss).Attachschedule other
IRA
d

Co;C, ..... ...

get a W-2, see paoe 20, Enclose, but do not atlach, any payment. Also, please use

Capill gain or (loss). Allach Schedule D f reqked. lf nol required, check here
Oains 0r (losses). Atlach Form 4797

15a 168
17 18 19

istrburio

Pensions and

ns annuities

ll6aI ll"------l
F

b Taxable amounl b Taxabte amount

E

Rental real estate, royalties, partnershps, S corporations, trusts, elc. Attch Schedule Farm income or (loss). Attach Schedule

Fom 1040-V,

Unemploymenlcompensation
Social securily beneflts

.....

..

20
21

b Taxable amounl

other income. Lisltype nd amount

23

Adjustd Gross
lncome

24

Educator expenses cdlain businss xpos;;i l;;iii; ofrcils. Altach Form 210d 21oa EZ

oii;i;; iiii

....

d ?;b

;'iii

25

Health savnosaccountdeduction.Attach l\rovn0 expenses. Anach Form 3903

Form8889

. ..

..

28 29 30

one-half ol self'employment taK Anach Schedule Selr-employed SEP, SIMPLE, and qualilied plans
Sell-employed heallh nsurance deducli0n Penalty on early withdrawalof savings IRA deduction Student loan inleresl

SE

.. .

3la Alimony pad b Fecioienfs SSN >

32
33

deducton
8917

.
..

. . .. S.iMC...,
8903

34 35 36

Tulon and lees. Allach Form

Domestc production actvties deduction. Attach Form

...

..

Add lines 23 throu0h 31a and 32lhrou0h 35

LHA For Disclosure, Prvacy Act, and Paporwork Reducton Act Notico, see separate structons.

sm

1040 torol

.--or ftfll&Ell J Tviw, al,{\,,

,',

'

ot67tl

,,' rrt 8(,,1 .zstrs ctrc 'o,

Tt'; ,,, Pu c* c,, ^tt to* t' c ig'ot

o_9'll'J

Y
Fi. ca!dr yor
2OlO.

611.,

DEIACH HERE

,_

4868
R.

Application for Automatic Extension of Tme To File U,S. lndividual lncome Tax Return
.r othf t yo{

Hrrno

.Zoto.drdho

!T{ES

1010 coLoRDO usTrN, Tx 7870L

PERRY

& }.{. NITA

PERRY

4 5 6

Eslmato of lolal taxlhbilty for

2010 ...

Tol12010 paymsnts

Balanco duo. Subtract

from lno 4

lne 5

22,000.
counbf and
1o:lotlR.Z

I
I

Chocft hers lf you aro 'out of the

cit0n or
Cfpa<

rosld8nl
tf yor

a U.S.

tc
.e

o orm to4oNR

...............,... rld dd no{ ro..lw

>n
f-l

t/06

rr srlPl. {'b.d

lo U,s, k.ome

r wlhhddho .,....

PT PERR 30

o tt,ot,e b?o

Tax and

Credts

38
39a

Am0!nt from lne 37 (adjusted gross income)

I Totat boxes -f checked 39a I b lfyourspouseilemizesonaseparatereturnoyouwereadual'statusalien,checkhere > 39b

Check
You were born before Jnuary 2,

ir,

f E \ E

1946,

f l

alino.
arino.

spou$e was born belore January 2, 1946,

[__l

40 ltemized deductons (kom Schedufe A) or your standard deduction (see instruclrons) 41 Subtract line 40 kom line 38 42 xempliors. l\ultiply $3,650 by the number on ljne 6d 43 Taxable ncome. Subtract line 42 from lne 41. lf line 42 is more thn line 41, enler -044 Tax. Check ifafly lax is rom: f] Form(s)8814 bf]Form4972 45 mnimm tax. Attach Form 6251 Add lines 44 46 ^lternative and 45 47 Foreign tax cred1, Attach Form l116ifrequked .........
.

,18

Credil for child a0d dependent care expenses. Attach Form 2441

49 Education credits lrom Form 8863, lne 23 50 Retrement savings c0nlribulions credit. Attach F0rm 8880 51 Child lax credrt(see inslrucri0ns) 52 esidential energy credils. Atlach Form 5695 sg other credits trom For*, ,fl 3s00 bT__l 8801 cf_l 54 Add lines 47 through 53. These are your total credt6
.

46. lf ine 54 s more than linc

Other
Taxes

56 57 58 59

Selfemploymenl tax. Atlach Schedule SE lJnreporled socialsecurity and Medicare taxfrom Form: s

af]

4137 bf_-] 8919

Additional tax on lRAs, other qualified relrement plans, etc. Attach Form 5329 f required

Form(s)w-2. box

I b f] Srhrdulrtt

cE

Form 5405. tioe 16

Payments 61 62 63
I a qulryno I

tederalincome raxwithheld from FormsW,2 and

Making work ay credrt. Allach Schedule M Esrned rcome credir

1099.. ....

2010 estimaled tax payments and amount applied from 2009 return

I::,1". !
I

Olr

(Ltc) ..

ach

... ... ...

torm 88l2

I ch,rd. auch schodure Erc

I l 6s

b Nontaxable combt pay electron

Addrtiona child lax credit.

66 American 0pportunly creditlrom torm 8863,ltne 14 .. . 67 Frrst-time homebuyer credl rom Form 5405, lne 10 . . . 68 Amountpad wlh requestfor exlension t0 file ............ .. 69 Excess social security and tier 1 RRIA tax wthheld 70 Credit for lederal tax on fuels. Attach torm 4136 7r credils from Form: , flzg f_-]ss39 . e1 Eess
.

Rfund 73 lf line 72 is more than li0e 60, subtract line 60 from lne 72. This is the amount you overpaid
oirrdposir?>
71a Amounl of line 73 vou want telnded to vou. lf lorm 8888
is aflached- che

fjii?l----_l,

,,*,

cnecrrnq

s,*0,

>

fl',"00'1,

Amount 76 Amountyouowe.SubtractlineT2fromline60.Fordetals0nhowt0pay,seenstructions You Owe 72 F.iii,l.v n, L,

I

nvlyp r r's

Paid

Preparer
Use

Only

ri'-'"

"*"

;:f,1""

F,n.saddr66s

2414 EXPOSTTTON BI,VD, SUITE BC-230 >AUSTIN, TX ?8703

SCHEDULE A

(Form 1040)

Itemized Deductions
>
Attach to Form

oMB No. 1545-0074

1040. >

See lnskuctions for Schedule A (Form 1o4O).

Medical and Dental Expenses

Taxes Paid

1 2 3

Cauton. Do not include expenses reimbursod or paid by others Medical and dental expenses (see instructions) Enter amount from Form 1040, . Multiply line 2 by 7.5% (.075)

lne38.

Stale and local(check only one box):

n b
6
7

Il

rn"o.e ta,ur,
Genorat sales

El

o,- L
,l

..

..

. S.EE . S.TATEMEI{T

..7

taxos

Real state taxes (soo instructions)

New motor vehiclo taxes from lne 11 of tho workshoot on page 2 (for crtain vehcles purchasd in 2009). Skp ths line f you checked box 5b Other taxes. List type and

amount

>

lnterost You Paid

Hom mortgage nterest and points roported to you on Form 1098.. __. _ ........ Home modgage interest not reportod lo you on Form 1098. ll paid lo the prson rom whom you bought tho home, see instructions and show that porson's name, identifyinq no., and addrss

>

Note.
Your mortgage nterst dgductron may be limted (s6o nstructions).

't2
13 14

Points not reportod to you on Form 1098. Soo instructions for spcial ruls Modgage nsurance promums (seo instructions) ..... .. lnvostment intorest. Attach Form 4952 if roqured. (See instructions.)
Gfts by cash or check. lf you made any gift of $250 or more, see instructions Other than by cash or check. lf any gift of $250 or more, see instructions. You must attach Form 8283 if over $500 Carryovor from prior year ....................

Gifts to Charty
ll you made a gift and got a
beneft lor it, see instructions

16
17

STMT

Casualty and Theft Losses

Job Expenses and Certan Mscellaneous Deductons

21

Unrembursod employeo expnses , job travel, union duos, job ducaton, etc Atlach Form 2106 or 2106-EZ if requred. (Se ntructions.)

22 23

Tax proparaton

foes

.................... _s_

Other exponss . invostment, safe deposit box, etc. List typo and amount

>_ gEE_ _S_T!rEU_EN!

24 25

6
Other
Mscellaneous

Add lins 21 through23.. Enter amount from Form 1040, line 38 Multipty li 25 by 2o/o (.O21
ft

28

Othor from list in nstructions. Ljst typo and amount

Deductions

TOtal 29 Add the amounts in tho far rght column for lines 4 through 28. Also, onter this amount on Form 1040, Itemized tine 40 Deductions go tt y,o, io t".ir" ir"i"" i^"rsh ;hr .," ;;; ;;;;il;; ;"ir| ,"". "reci """"
'"" LHA
o1o5o1

12-21-lo For Papt work Reducton Act Notce, se Form lO4O nsuctions.

Schedule A (Forr 104O)2010

14400916 786859 630

2O1O. O3060 PERRY, JMES R.

530

Schdule A (Fo.m 1040) 2010

Pge 2
You cannot take this deduction if the amount on Form 1040, line 38, is equal to or greater than $135,000 ($260,000 f madod riling jointly).
See the instructions for lin 7 on pago

Worksheet Before you begin: /

for Lne 7 New motor
vehcle

4.6

taxes

Enter the state or local sales or excise taxes you pard in 2010 for the purchs of any now motor vohiclo(s)after February 16, 2009, and bfore January 1, 2010 (see instructions)

workshoet
to figure the
mount to entr

Use this

2 Enter the purchse price (befofe Iaxes)of the new motor vohcle(s) 3 ls the amount on lin 2 moro than M9,500? No. Enterrhe amount from line 1

on

lne 7.

X fJ

Yes.

(Attach to Form 1040.)

Frguro the portion of th tax from lno 1 tht is altrbutablo to th lkst $49,500

of the purchase prc of each new motor vohicle and enter it here (soe nstructos).

4
5

Enterthe amount from Form 1040,line

Enlor the totalof any-

38

...... ..

Amouts rom Form 2555, lines 45 and

Form 2555.E2, line 18;and Form 4563, Iine

and
.
6 7 I
Excluson of ncome from Puerto

5Oi I ;5, I
I

Rico

Add lins 4 and 5

Entr $125,000 ($250,000 if married filing

jointly)

....

...........

ls th amount on lne 6 more than th amount on line 7?

ff n I

No.

Entor the amount from line 3 abovo on Schodulo A, line 7. Do not compote tho rest

ofthis worksheet,

Yes, Subtract

lne 7 from lne 6

Divdo th amount on lng B by $10,000. Entor the result as a decimal (rounded to at loast thres places). lf tho rosult s L000

or more, entor 1.000

fO Multiply

lino 3 by jne 9

It

Deducton lor new motor vehlole taxes. Subtract lino i0 from lns 3. Entor tho rosult here
7

Schedule A (Form l04O) 2010

01s502

12.21

1n^o't

?o a Eo 2^

a^l

1^rll

ttrEW

I.ETQ

?n

SCHEDULE B
(Form 10404 or 1040)

lnterest and Ordinary Dividends

>
Attch to Form
1O4OA

or 1040,

>

See instructons.

Ali'll9ll," oe

Part I lnterest

List name of payer. lf ny intorost is from a seller'financed mortgago and the byr used tho proporty as a personl residonc, soe page 8.1 and list this interest first. Also, show that buyer's social security numbor and addross >

PLAINSCAPITL BNK
Note. lf you roceivod a Form 1099.tNT, Form 1099-OlD, or substituto
statement from
a brokorage firm, lst the frrm's

name as the payer and onter the total interest

shown on that
form.

Add tho mounts on lino 1 Excludablo intersst on series EE and I U.S. savings bonds issuod after 1989. Attach Form 8815 4 Sublract line 3 from line 2, Enter the rsult here and on Form 10404, or Form 1040, line 8a Note, lf line 4 is ovor $1.500.

2 3

Part ll Ordinary Divdends

Lst name

ofpayer

>

Notei lf you
recevod a Form 1099.D|V or

substtute statement from a brokerago firm, list the frm's

nam as ths payr and enter

the ordinary dvldends shown on that form.

Part lll Foregn Accounts and Trusts

You must complote ths pad f you (a) had over $1,500 of taxable nterest or ordinary dvdsnds; (b) had a loroign
At any trme durino 2010, did y0u have an nterest in or a country, such as a bank account, securities account, or ( requremenls for Form TD F 90-22,1 ........... ....... lf Yes,' entr the name of the foregn country authorty over a tnancal accou nt n a f0re0n See paoe B-2 for exceptio0s and filin0

b A Durng 2010, did you receive

>

a distrbution from, or wore you the

gnlor of, or transfrol to, a foroign trust? Schedule B (Forrn IO+OA or lO4O) 2OlO

"Yes." vou mv hve t fle Form 3520.

LHA

For Paperwork Reducton Act Notice, seo separate insuctons.

1nnql 7Aq qo ?n

tnl n n?nn DDv

TMEIC P

?n

SCHEDULE D

(Form 1040)

Capital Gains and Losses

>
Attach to Form

Opnmnl ol th lreasuy lldd nvnu Sc

>

or Form 104oNR. > Se lnstructons for Schedule D (Form Use Schedule D- l to lst dditonal transactons for les i and 8.
1O4O

YoursocrLsulynumb4

(a) Dosdplion oipro6rry

(Exampl: 1oo sh. XYz co.)

(l|

oain or oss

2 3 4 5

Entor your short.term totals, fany, from Schedule

D.1,lino2 .............

Totalshort-term sales prce amounts.

Add linos 1 and 2 in column (d)
Short.term gain from Form 6252 and short.torm gan or (loss) from Forms 4684, 6781. and 8824 . Net short'term gain or (loss) from partnorships, S corporations, estates, and trusts from Schedule(s) K-l SEE,STTEMENT,...9,,, Short{erm capital loss carryover. Entr the amount, if any, from ln '10 of your Captal Loss

..

Carryover Worksheet in the instructions

()

ossqplion orropery

(l)cain d

(ross)

{Exrmlo: 100 sh. XYZ C.

I
't0
11

Enter your long.term totals, f any, from Schedule D.1, lno Total long-term saes prce amounts. Add linos 8 and I n column (d)...

I
i..r.tl

Gan from Form 4797, Part l; long'term gan from Forms 2439 and 6252; and

12 13 14 15

Iong-torm gain or (loss) from Forms 4684, 6781, and 8824 Net long.trm gan or (loss) from partnerships, S corporatons, states, and trusts

from Schodul6(s)K.1

. SEE STATEMENT.. 10

Capitalgan distributons .. Long.term capitl loss carryovor. Entor the amount, f any, from lno 15 of your Captal Loss Carryover Worksheet in the instructions Net long-term captal gan or (loss). Combne lins B through 14 i column (0. Then go to For Papowork Reduction Act Notice, see ygur lax return lnstructions Schedule D (Form 1O) tO

LHA

o2a51l 12-27-10

lt^^o1 tAe qA ?n

,r1n n2nn D!'v

.-[MFS I?.

61n

16

Combine lines 7 and 15 and ente the rsult

.lllno16isgn,enterthoamountfromlinol6onForml040,

lin 13, or Form 1040NR, fine 14.

. o 17

Then go to ino 17 below. lf line 16 is a loss, skp lines 17 through 20 below. Thn go to lin 21. Also be sureto complete line 22. lf lne 16 is zero, skip linos 17 through 21 below and ontor-0.on Form 1040, line 13, or Form 1040NR, lino 14. Then go to line 22.

Ar lnes 15 and 16 both gans?

f] n 18 19 20

Yes. Go to line 18. No. Skip lines 1B through 21, and go to ln 22.

Enter the amount, f any, from ine 7 of the 28% Rate Gan Worksheet on pago D-8 of the nstruclions.............. Enter the amount, if any, hom lino 18 of tho Unrecaptured Secton 1250 Gai Worksheet on page D 9 of the instructions .... .....

..

Are lines f8 and 19 both zero or blank?

f] E

Yes. Completo Form 1O4O through ine 43, or Form 1040NR through lino 41. Then complete the

Oualled ovdonds and Captal Gan Tax worksheet in tho Instructions for Form 1040, line 44 (or in tho lnstructions for Form 1040NR, lne 42). Do not complete lines 21 and 22 below. No. Complt Form 1040 through lino 43, or Form 1O40NR through lne 41. Then comploto the Schedule D Tax Worksheet on pag D.'f 0 of the nstructions. Do not complet lines 21 and 22 blow.

21

lf line 16

a loss, onter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:

o .

The loss on ln 16
($3,OOO),

or
($t,5OO)

or if marriod tiling separately,

I l

E.E,,ST.AEEJ, ENT...1 1

Note. When figuring whch amount s smallor, troat both amounts as positivo numbrs.

22

Do you havo qualfed dvidends on Form 1040, line 9b, or Form 1040NR, line 10b?

E E

Yes. Comploto form 1O4O through line 43, or Form 1O40NR through lne 41. Thon complete the Oualifed Dvdends and Capital Gan Tax worksheet n th lnstructons for Form 1040, line 44 (or n the lnstructons lor Form'1040NR, lne 42).
No, Complete th rst of Form 1O4O or Form 1040NR.

Schedule D (Form 104O) 2010

020512 12-2f- \A

14400916 7868s9 630

2010.03060

PERRY,

'JUES R.

630 _-_..2

Qualified Dividends and Capital Gain Tax Worksheet - Line

Namo(s) shown on return

14

Keep lor Your Recotds

YoUTSSNI
See the instruclions for line 44 on page 35 to see if you can uso this worksheet to figure your tax
tf you do not have to fil Schedule D and you received capital gain dstributions, be sure you checkd the box on line 13 of Form 1040.

IAMES R. & M. NTT PERRY

Befoe you

begin: / ,/

1.

Enter the amount f rom Form 1040, line 43. However, if you are filng Form 2555 or 2555-EZ (relating to loreign earned ncomo), enter the amount from lie 3 of tho workshet on page 36

2. 3.

Enterthe amount from Form 1040, line

Are you flng Schedule D?'

9o- . z.
^ o-w'

4,103.

1.

191,860.

E Y.".
LJ No.

.n,*,""

or r,.e 15 o. 10 Schodu,e "rnaller hn 15 or rno O.lfilhd blsk or a loss, enld

-o-

13,s I
13
J

or

cnro, th amoLr tom Form 1oo h1

4. 5. 6. 7. 8.

Add lines 2 and .. .'...... lf liling Form 4952 (used to figure investment ntorest expense deducton), enter any amounl from fns 49 of that form. Otherwiso, enter-o. ... Subtract line 5 from line 4. lf zero or less, entor Subtract line 6 from line 1 . lf zero or less, nter
Entri

4.

,703

5. -0.0'

0.
.

6.
7-

4,103.
18'7 ,'.757 .

....._.....

$ 34,000 f snge or marriod fiing separatly, $ 68,000 f marred filng jointly or qiralifyng wdow(or),
$ 45.550 if head of housohold.

8. 9.
10.

68,000.

I 10. Enter the smallor of lne 7 or line I

9.
Enter the smaller of loe 1 or lino ln

68,000.

11. Subtract

l0 from lino L

This amount s taxed at 0%

f1.
12.
13.

12- Enter the smallr of lino 1 or lin6 6 13. Enter the amount from lin 11 14. Subtract lne 13 from lino 12 15. Mutply lino 14 by 15% (.15) 16. Figuro the tax on the amount on line

4,103.

14.

4,L03,

0.

15.
16.

615.

7. lf the amount on lne 7 s less than $100,000, use the Tax Table to figure this tax. lfthe amount on Iino 7 rs $100,000 or mor, use tho Tax Computaton Worksht 17. Add lnos 15 and 16 ...... .. . f8, Fgure the tax on th6 amount on lno 1. lf tho amount on line 1 is loss than $100,000, use the Tax Tablo to

_ 17.

40,815. 4L,430. 4L.964

41,430.

19. Tax on all taxable ncome,

Enter the smaller of lin 1 7 or line 18. Also include ths amount on Form 1040, line 44. lf you aro fling Form 2555 or 2555-EZ, do not onter this amount on Form 1040, line 44.

lnstead, onter it on ln 4 of the worksheet on pag

36 . ... .

...... 19.

' ll you are llng Fom 2555 or 2555-EZ, see the lootnote n the wosheet on page 36 belorc completing ths lne.

o104st
12-29-10

1rlrtno1<

?QoEo

(?n

tnln

n?nn

ol DErpv

.T,f!q

10

SCHEDULE (Form 1040)

Supplemental lncome and Loss

l00l

0[B No.

6pall ol lhe frouy

lnldnlqv6h!Sic

>

(From rental real estate, royalties, partnershps, S corporatons, esttes, trusts, REMlCs, etc,) Attach lo Form 1040, l040NR, or orm 1041. > See l0stflclio0s lor Schedule

(torm

rool

2010
ii'il"Ji,"

rs

Name(s) slown on relurn

Your social security number

or Loss
Schdule C or C-tZ (see aoe E-3)

Note. llyou are

r0

the busness ol renlng

are a0 individual, reDorl farm renlal income 0r loss from Form 4835 on

RESIDENTTAIJ RENTL PROPERTY

For each rental realeslate pr0perty listed

on lre 1, did you or your family use it during lhe taxyear for personalpurposes for more than the greater 01:

o .
lncome:

14 days or 10% ofthe totaldays rented at renta,value?

fai

Bents rece,ved

I Expenss:

5 6 7
B

Adverlising Aulo and travel(see page

Cleanrng and

E-5) .

mainleonce

Commssions lnsuraoce Legaland olher

p

I
10

rofess i0nal fees

l1
l3
14
15 16

l\.lana0emenl fees interest paid t0 banks, etc

'12 Mortgage

(see page E-5)

other nterest
Repairs Spplies Taxes
r..'tliries

17
1B

other

(lisl)

>

SEE STTEMENT 12

19 20

Add lines S lhrou0h

18 .. ........

Deprecialon expens or depfetion (see page -S) Total expenses. Add lifles 19 and

2l
22

20

ncome or (loss) from r nlal real estale or r0yafly propeties. Subtract llne 21 from line 3 (rents)or line 4 (royaltjes). lf the resull is a (loss), see page -6 to lind out rl you must file Form ..

6190

23

oeduclible renta, real estate loss. Cston rentalrealestale loss on line 22 may be limited. See paoe 8"6 to find out fyou must file F0rm 8582. Realestate professionals
YoJr

muslcomplete

lne 43 on paoe 2
.

24 lncome. Add positve amounls shown on lin 22. Do not include any losses . . 25 Losses. Add royalty lossBs rom line 22 and rentalrealestate lOsses fom lin 23.
26 Toll rental real eststo and royalty i0come or (los6). Combne
lf Parts ll,

Enter totaltosses here

lines 24 and 25. Enler the resutt here.

lll, lV, and lin 40 on page 2 do not apply to you, also enter this am0nt on Form 'l040,

021401

o3-21.11

LHA

Fof Psperwork Reduction Act flotice, see insttuclion

Schedule

(Form '1040) 2010

14400976 786859 630

2010,03060 PERRY, arr{Es R.

10

630

Ca!tion. The

IRS compares amounts reporled on your tax return wilh am0nts shown on Schedule(s) K-1.

amount rs not at rsk.

check column f on lne 28 and attach Form 6198. See Daoe E-2

27

Are you rporling ary l0ss nol allowed in a pri0r year due t0 lhe al-risk or basis limitalions, a prior year unallowed loss passive activity (if lhat loss was not reporled on Fofm B5B2), or unrelmbursed parlnrship expenses? lhs seclon.

f0m

vu"

E
{e)

r'o
check

(a)Name

lncome and Loss

(f) Passve loss allowd (attach Form 8582 if required)

()Nonpassive ncome from Schedule K-1

1"4.1

29a

Totals

b 30 31 32

fotals
Add c0lumns (g) and (j) of line 29a Add columns (f), (h), nd (i) of line 29b

otal parte16hip and S corporaton income of (lo6s), Combine lines 30 and 31. Enter the

or Loss

and Trusts
{a)Name

Passve lncome and Loss

(c) Passive deducton or loss allowed (attach torm 8582 if required)

Nonpassive lncome and Loss (l) other ncome from Schedle K-f

3{a

Totals Totals
Add columns (d)and (f) ol line 34a

b
36 37

601.
n the

Add columns (c)and (e)ofline 34b Totelestt and

totalon line 41 below (o) lncome from Schedules 0, line 3b

(a) Name

40
4l

Net farm rentalincome 0r (loss) from Form 4835. Also, complete line 42 below

TotalnCome

Or (l0SS). Combno tin 26,3e,3z. so,

42 43

dd

40. Enrtrrhordsutr

h*ad

on

Fo.

1040, tin6

Reconcillallon of farmng snd fish09 ncom. Enler your 0toss farmino and fishing income
reported on Form 4835, lne 7;Schodule K1

(Form 1065), box 14, code B; Schedule K-1

(orm 1120S), b0x 17, code U; and Schedute K-1 (Form 1041), ine 14, code F (see page E-B) RconcilistOn lor feal estate prolessOnalS. Iyou
woro rotsrgto prorosstoat(6 ps E-2),

nl lho net ncho d (loss) you rpodd s/h{6 on Fdd ro{o

dfdm

1o0NR lYon all rntrl rl 6stsl

021501

fi-2r.11

/nno1

?44

o 4?r

tnl n 2trn !iw

tL

MFq

?n

INCOME FROM PASSTHROUGH STATEMENT, PAGE

2010

Passthrough ,1.
PRTNERSHlP

R.

pERRy co.

SSN/EIN
TXPYER

Ordinary business ncome (loss).-__ Rental real state income (oss) .-..-_
.

Other net renta income (loss) __ ....... . Intangible drillng costvdry hole costs

Seltcharged passive nterst expense Guaranteed payments ..........._......_.. Section 179 and canyover _.........._... Disallowed section 179 xpense ... Excess farm loss
Net income (loss) First passive

other

..

... .

Second passive other Cost deplton Percentage depletion

Depletign canyover Disallowed due to 65% lmitatio

...

Unreimbursed expenses (nonpassive) Nonpssive other _..._

Section 1231 qain (loss)

1

Net short.tem cap. gain (loss) Net long.term cap. gan (loss)

lnvestment nterest expense. Sch. A

Chadtable contrib!tions.._..__-.... ...._... Oeductions related to portfolio ncome

Other .....

_.

..............

021551 03-03-11

T2

SCHEDULE E Name

INCOME FROM PASSTHROUGH STATEMENT, PAGE 2

2010

Passthrough
PRTNERSHIP

lo

'15-a642655

ssN/ErN

III]_

lnterest income
Ordinary

_ ._.._..-_..

lnterest from U.S. bonds

dividends,......

Qulified dividends

Depreciation adjustment afte. 12/31 /86 Adjusted gan or oss

Benefciary's AMT adjustmenl ._....... Depletion {otherthan oif) ... .. .. ........

Setf-employment eamings (loss)^Vages Gross farming & fishing

nc ......._.......
__. _ __ .._

Foyattis -......... .. ... Foyafty expensevdepletion

Undistributed capitalgains Backup withholding .

credit

..

Credit f or estmated lax ..... ............... Cancellation of debt Medical insurance . 1040 . Dependent care benefrts Retirement plans

.. .

...

..

oualfied production activities income .. ..

Passthrough adjustmeft to Form 1040 Penalty on eary withdrawal of savngs

NOL

......... .....

Othr taxes/recapture of credits _.....

Crdits ... -. ...... . . Casualty and theft loss .._..._..._.._.......

13
421552

05-ol-10

SCHEDULE E Nme Passthrough REvc_LE

ESTTE OR TRUS

INCOME FBOM PASSTHROUGH STATMENT, PAGE

"alr'

TRUsr cRrNT Bo NTT

pER.Ry

lD

03

ssN/EtN
60927 80

l-

Ordinary business income (loss) .. ... Rental realestate income (oss) ....-

Other nt rentalncome (loss) ... .. _.. lntangible drillng costs/dry hole costs Selfharged passive nterest expense Guaranteed Sec'lion 179 and

payments ...__............-_. carryover ...._..._.....

Disalfowed section 179 Excess frm loss Net ncome (loss) First passive other

expense

.....

Second passive other Cost deplelion Percentage depletion

Depletion crryover Dsallowed due to 65% lmitation . .. Unreimbursed expenses (nonpassive) Nonoassive other

Section 1231 gain (oss)

Net short-term cap. gain (loss)

Net long'term cap. gain (loss)

lnvestment interest expense - Sch. A

Charitable contributio ns

-.

_.

-..

_ . _. _

_.....

_ .

Dcluctons related to portfolio income

Other -.. .. .......-..-...

L4
021551

03-03.11

INCOME FROM PASSTHROUGH STATEMENT, PAGE 2

2010

lD

03

ssNrN
6092?80
SPOUSE

Interest ncome .__..__.... lnterest from U.S. bonds

Ordinarydividends ...
Qualifred dvidends

..

Depreciation adrstment after 12/31 /86 Adjusted gain or loss Beneficiary's AMT adjustment .. ...-.
Depletion (other than

oif)

. .. , .........-.

Selfmployment eamings (loss)^Vags

Gross farmng Royalty

&fshing inc . _..-. _......

.

Royafties ...... . .,.....

expensevdepletion

-. ..

..

Undistributed capital gans credit ..... Backup withholdng ,. Crdit for estimted tax ................ _.... Cancellation of debt Medical nsurance-1040 Dependent cre benefts
Retrement plans
oualified production activities

.. .... . ..... ....._.... ._.

incorne .. . Passthrough adjustment to Form 1040

Penatty on early withdrawal of savings

NOL ..................
Otherlaxesfecapture of credits -. Credits ................ Casuahy and theft loss

..

..

021552 o5-01-10

15

SCHDULE E Name

INCOME FROM PASSTHROUGH STATEMENT, PAGE

P""*rounn
ESTTE OR TRUST

lD

?4,646?s84

ssrrer.I

Ordnary busness income (loss) Rental real estate income

__. ... _._

(loss)

Other net rental income (loss) ... ..__.._ lntangible diling costvdry hote costs

Self{hrged passive interest expense

Guaranteed payment Section 179 and carryover
Excess
...._.._.._

Dsllowed section 179 expense

fam loss

Net income (loss)

Frst passive other Secod passive other Cost depleton

Percentage depetion
Depleto carryover Disallowed due to 65%

limitation ...

Unrembursed expenses (nonpassve)

Nonpassive other._..

Section 1231 gan (loss)

Net short.term cap. gain (loss) Net long.lerm cap. gain (loss)

lnvestment nterest expense. Sch. A

Charitable contribLtons.... _._....._..__.... Deductions related to portfolo ncome

Other

021551

!6

SCHEDULE E Name .JEs

INCOME FROM PASSTHROUGH STATEMENT, PAGE 2

R.

PERRY

PAsSlhTOUgh REVOCTILE

BLIND 'IIRUSI STE GFE4ENT FBO RrCK PERRY

ESTE OR RUST

DlD

IO

SSNIN

74-5461584

TI{PAYER

nteresl income ...._........ lnterest from U.S. bonds

Ordinarydividends .....
Qualifed dividends

Depreciation adjustment after 1 231186 Adjusted gain or loss

Beneficiary's AMT adjustment Deoletion (other than oif)
. .

Selfmployment eamings (loss)^Vages Gross farming & fshing inc ...... ........ Royaties ...-. -..-.....
.

Royattyexpenses/dopletion ... .... ...

Undistributed capital gains credit ...-.. Backup withholding .. Credil for estimated tax ..................... Cancellation of debt Medical insuranc- 1040 . . __. ._. _.._ Dependent care benefrts ..._......_..__.._ Retirement plans
ouallfied production activtes

ncome

..

Passthrough adjustment to Form 1@10 Penalty on early withdrawal of savngs

NOL

...

...............

Othertaxes/recapture of

credits..

...

Credits ...

..

Casuatty and theft

loss

.._.._......_.._....

L7
021552

SCHEDULE E

INCOME FROM PASSIHROUGH STATEMENT. PAGE

pERRy

Name .l'lEs RESTTE OR TRUS

Passthrough Rp 2O1O uNcEMxNT TRUST _ TERRY VCDNIEL. fRusTEE

lo

SSN/EIN
2'7

I}

-6832469

Ordinary business income (loss) .. __ Bental realestate income (toss) . ._ . . Other net rental income (lgss) .._.. _... Intangible drillng costs/dry hole cosls

Setf{harged passve interest expense

Guafanteed payments .,..._..__ .... .... Section 179 and carryover .........,..._
Disallowed seqtion 179 Excess farm loss Net income (loss) First passive other Second passive other

expnse

...

Cost depletion Percentage depleiion

Depletion carryover Disallowed due to 65% Nonpassve other

limitation .....

Unrembursed expenses (nonpassve)

Section 1231 gain (loss)

1

Net short-term cap. gain (loss)

Net long term cap. gan (loss)

lnvestment interest exense' Sch. A

Charitable contributions.__.._......._.._.._. Deduclions related to portfolo income

Other _. _

_. _

. .. ...,..

18
021551

SCHEDULE E Name Passth.ough Rp 2010 MNG{ENT ESTTE OR RUST

INCOME FROM PASSTHROUGH STATEMENT, PAGE 2

2010

TRus

TERRY

HCDNIEL

TRUSTEE

lD

21 5832469

SsN/ElN

llr
TXPYER

lnterest income _..._..-_. ... lnterest from U.S. bonds

Ordinarydividends ..... .. Qualified divdends ..-. ...

Dprecaton adjustment after 12l31 /86 Adjusted gain or loss Beneficary's AMT

adjustment

...

Degletion (o'ther than oil)

Sellmployment emings (loss),,^Wages

Gross farming & fshing

inc

._
.
..

.__

Boyalties.
Royatty

expensevdepleton

Undistributed captal gans credit Backup withholding .Credit tor estmated tax Cancellaton of debt

_ ..

Medical nsurance - 1O40

_ ..

..

..._

Dependent care benefrts .._.._.... Retirement plans

.._

0ualifed producton activities income .. Passthrough adjustmet to Form 1040 Penalty on early withdrawal of savings

NOL
Other txes/fecapture of credts _....

Credits ._...... ...-..-... Casuahy and theft loss ..__.,_.._...........

421552 05-01-10

19

SCHEDULE E Narne
PASSthTOUgh

INCOME FROM PASSTHROUGH STATEMENT, PAGE

TI'B P 2O1O MNGE{{ TRUST TERY UCDNIEI, TRUSEE

EST18 OR RUST

ID

ssN/tN
21,693249'.1 sPousE

-t
(toss)... .... Rental rea'estate ncome (loss) , .. __.
Ordinary business income Other net rental income (oss)

.......

lntangible drilling costvdry hote costs Self-charged passive nterst expense Guaranleed payments ._..._._.._......._.. Secton 179 and carryover ._ ._......_...
Disallowed section 179 Excess farm loss Net income (loss) First passe other

expense

......

Second passive other

C,ost depletion

Percentage depletion
Depletion carryover

limilation . . . Unrembursed expenses (nonpassive)

Disallowed due to 65%

Nonpassive other ..

Secton 1231 gai (loss)

Net short-term cap. gain (loss) Net long{erm cp. gain (loss)

lnvestment interesl expense .Sch. A

Charitable contributons...._........._.._... Deductions rltd to portfolio icome

Other . _. ___._. . __ ...

20
021551

03-03-11

SCHEDULE E Nme Passthrough

INCOME FROM PASSTHROUGH STATEMENT. PAGE 2

H! p 2010

MtU{cEutT

TRtrsl

lo

SSN/EIN
2't-6832491

I
SPOUSE

ESTTE OR TRUS

lnterest ncome _..._.._.... lnterest from U-S. bonds

Ordinary dividends ... .. Qualified dividends

Deprecia{ion adjustmer.l aftet 12/31 /86 Adjusted gain or loss Beneficary's AMT

adjustment .........

DeDleton (other thn ol)

Selfmployment eamngs (loss)/Vvages

Gross farmng &fshing

inc

..........
.
_. __
__. _.

Royalties ..-...
Royatty

expenseldepletion

Undstrjbuted capitalgains credil Backup withholding ..

Credit for estimated tax ............ Cancellaton ot debt

..

_.._... _.

- 1040 ... ....... . .. Dependent care benefits .... ......_.... . Betirement plans

Medical insurance

0ualified production activities income ..

Passthrough adjustment to Form 1040 Penahy on early withdrawal of savings

NOL ...

...........

. .

Other taxes/recapture of credits . .. ..

Credits

_.__.-..-_.._.

Casualty and theft loss .._.._...............

021552 05-01-10

2!

SCHEDULE SE

(Form

1010)

Self-Employment Tax
{ee)l

Oedtent ol ihe lreasuy rrqnar F6vouo

s(o

2010

>

Attach to Form

.t

O4O

or Form lO4ONR.

>

See lnstrrJctons for Schedule SE (Form 1040), Socaf securty number of

Name of person wjth sell-employment incomo (as shown on Form 1040)

porson with self-employment Before you begn: To determino if you must file Schedule SE, see the instructons on page SE

May I Use Short Schedule SE or Must I Use Long Schedule SE?

Note. Use this flowhart only if you must file Schodule SE. lf unsure, soe Who Must Fle Sc,edule SE on page SE
Dd vo ceve waoes of tios in 2010?

Ae you a minisler, member ola reliOious order, or Chrislian Science praclilioner who recejved IRS aproval not lo be taxed on ean;ngs from lhese sources, butyou owe self-employmenl tx on olhr earninos?

Was the lotal of your wages a0d lrps subject t0 social security p lu8 y0ur arnngs or railroad ietirement (tier 1) tax D lus Vour net arnings from retirement self"em0lovmenl more than $'106,800?

Are you usinq 0ne of the optional methods to fgure your net earnings {see pa0e SE-5)?

Dd you receive tips subiect to socialsecurly or Medicare tax that y0u did not report to your employer?

Did you receive church employee income {see page SE'1) reported 0n Forrn W-2 of$108.28 or more?

Did you reporl any wages on Form 8919, Uncollecled Social Security and lvedicare Tax on Wages?

Yo may use Short Schedle SE below

Secton A-Short Schedule SE. Cauton.

Rad above to see if you can use Short Schedule SE

K-1

la
b

Net farm proft or (foss) from Schedulo F, lino 36, and farm partnershps, Schedule (Forrn 1065), box 14, code

.... ....

..

lf you rocived socal securty rgtiremnt or disablity bonefts, entor th amount of Conseryaton Reservg Program payments included on Schodule F, lino 6b, or listod on Schedul K.1 (Form 1065), box 20, code Y Net profit or(loss) from Sohedulo C, line 31; Schodule C.Ez, line 3; Schodule K-t (Form 1065), box 14, code A (other than farming); and Schdule K-f (Form 1065 8), box 9, code J1 . M inistrs and members ot rlgious ordrs,

2 3 4 5

l for types of income to report on this lino. Se page SE.3 for other icome to roport S.T.MI ..l4. Combnolrnesla, 1b, and 2. Subtract from that total the amount on Form 1040, lino 29, or Form 104oNR, lne
see page sE 29, and enter tho result (seo pag SE.8)

Multiply line 3 by 92.35% (,9235). lf less than $400, you do not owe self.omploymont tax;do not file ths

scheduleUnlessyouhaveanamounlonline1b'''...'...'..,,,,''.'..'.'.'-,,,'.'>
Note. lf line 4 s loss than $400 due to Consorvation Reserve Program payments on lne 1b, see page SE 3.

Self-employment tax. lf th amount on line 4 s: . $106,800 or less, multply lne 4 by 15.3% (.153). Enter the result hero and on Form 1040, lne 56, or Form !o4ONR, line 54 . Mor than $106,800, multiply lno 4 by 2.9/o (.029), Then, dd $13,243.20 to tho rsult. Enter the totalhere and on Form lO4Or line 56, or Form 1O4ONR, lne S . .. Deduclion for one-half ot self-employment tax. Multipfy lne 5 by 50% (.50),
For Paporwork Reduction Act Notice, see your tax return nstructons. Schdule SE (Form 1O4O)2010

LHA

024501 12-2-10

22

2^

s.hoduresElFm

1040)2010

Arlachmonl S6auce No

17

Namo of porson with selt-employment rncom (as shown on Form 1040)

for th dofintion ofchurch omployee income.

AX Note. lf your only ncome subject to self-mployment tax

church employee ncome, see page

nstluctrons

A
1a

lf yoo are a minister, membr of a rolgious order, or Christian Science pacttioner and you fled Form 431, but you had morg of other net amings from seliemployment, check here and continue with Parl I

M00 or

box14,codeA. Note, Skip lines 1and lbif you use the farm optional mthod

Net farm protit or (loss) rom Schodulo F, line 36, and farm partnerships, Schedule K'1 (Form 1065), (soe page S-5)

. .

b 2

C, lne 31 ; Schedule (othor than farming); and Schedul K.1 (Form 1065.8), box I, code J1. NIinsters and membrs of roligious orders, see pg SE.1 for types of ncome to roport on this line. Se6 pg SE-4 for other income to rport.

lf you received social security retiremnt or disabilty benefits, onter the amount of Conseruation Reservo Program payments included on Schedule F, line 6b, or lsted on Schedulo K.1 (Form 1065), box 20, cod Y Net profit or (loss) from Schedulo C-EZ, lino 3; Schodul K-1 (Form '1065), box 14, code

3 4 b c
5

Note. Skip this line if you use tho nonfarm optional method (see pago SE . SE.. S.TT.EMENT...1.5. Combn lins 1a, 1b, and 2. Subtract from tht tolal the amount on Form 1040, lino 29, or Form 1040NR,

5)

ontorthe result (see pago SE 3) lf lne3 is morethan zero, multiply lne 3 by 92.35% (.9235). Othorwse, enter amount from lin 3
lno 29, and

Note. lf lino 4a rs less thn M00 due to Conservation Reserye Program payments on lne 1b, soo page S-3. lf you elect one or both ol the optional mthods, entor the total of lies 15 and 1 7 here
Combine linos 4a and 4b. lf less than $400, stop; you do not owe self omployment tx. Excepton. lf less than $400 and you had churoh employee income, enter-0 and continue Enter your church employee income from Form W-2. Soe page SE for defnton of church employee ncome Multiply line 5a by 92,35% (.9235). lflessthan$100, entor-0.
1

a b

6
7

Add lines 4c and 5b

Maxmum amount of combined wages and self.employment earnings subiect to socal securty tax or th 7,65yo .ailroad retiement (tier 1 ) tax f or 201 ....... Totaf socal securty wags and tips (totalof boxes 3 and 7 on Form(s) tho 6.2% portion of

106,800.00

Ba

W.2) and raikoad retirement (tier 1) compensaton. lf $106,800 or more, skip lnos 8b through 10, and go to line 11

b Unroported tps subict to socialsecurty tax (from Form 4137, linel0) c Wages subject to socalsecurity tax (from Form 8919, lin10) d Add lines Ba, 8b, nd 8c
I l0 1f '12 13

..

Subtrct lne 8d f rom line 7, lf zoro or loss, ontor -0. horo and on lin 10 and go to line Multipy tho smaller of lne 6 or lne 9 by 12.4% (.124) Multiply lino 6 by 2.9/o \.O29)

1 1

Self-employment tax. Add lines '10 and 11. Entr hre nd on Form 1040, lne 56, or Form O4ONR, lne Deducton for one-half of self-employment tax. Multply lino 12 by 50plo (.50).

ff

Farm Optonal Method. You may use this method only (b) your net farm profits2 wre lss than 94,851.

(a) your gross farm incomel was not moro than $6,720, or

14 15

lvlaximum ncome for optonal methods Enter th smaller of: two-thrds (2/3) of gross farm incomo
1

(not loss than zero) or $4,480. Also include

Nofrm Optional Method. You may use this method only if (a) your net nonfrm profits3 wore less than $4.851 and also less than 72.189P/o of your gross nonlarm ncomel and (b) you had net earnings from sellemployment of at lest $400 in 2 ol the prior 3 yoars. Caution. You may use thls method no moro than fivo times.

16 17
1

Subtract line 15 from ln 14 .. .. Entgr the smaller of; lwo.thrds (2/3) of gross nonfarm ncome lrno 16. Also include ths amount on lno 4b abovo
3

(not less than zoro) or the amount on

trom Sch.

F, lne 11, and Sch. K-1 (torm 1065), box f4, codo B. From Sch. F, line 36, a0d Sch. K-1 (torm 1065), box 14, code A - minus the amount you would have ented on line 1b had you not used the ootionalmethod.
lO

From Sch. C, line 31;Sch. C-Ez,line 3;Sch. K-1 (Form 1065), box 14, code A; and Sch. K-1 (Form 1065'8), b0x I, code J1. 4 From Sch. C , line 7; Sch. C-Fz, line 1; Sch. K-1 (Form 1065), box 14, code C; and Sch. K-1 (Form 1065-B), box 9, code J2. Schedule SE (torm 1040)2010

a24502 12-20-

23

..,.

1116
>
PERRY

Foreign Tax Credit

(lndvidual, Estate, or Trust)

2010
Ai'iliL" rs
ldentifyng nUmber
as

frnmnl f lh. los!rv lntqal Revne Sqvice '{Og)

Attach to Form 1040, 104ONR, 1o41, or 99O-l

shown o psqo I ol vor

td

rerurn

Use a separale Form 1116 for each category 0f income fisted below. See Cale0ores ol lrcome in the inslruclions

only one box 0n each Form 1116. Beporl all

amounts in U.S. d0llars except where specified n Part ll below.

aE b f-l
I

Passive category

Generalcale0ory

income cI ncome d E

Sectio0 901(j) iflcome Certain

Lump-sum distributions

incore re-souced by trealy

Rcdnt f

/nrmp

l^rntv !

TTNTrlFn qtP'FRS

Nole'. ll you paid taxes to onty one lorcgn country or IJ.S. possession, use colun A n Pad I and le A in Parf ll. lf you paid taxs t(more than one loreign country ot U-5. possesslon, use a separate column and lne for each country or possesson.

Taxable lncom or Loss From souces Outsd the United States

Checked Above)

g
1

possesson

Enter the nme ol the foreign country or U.S.

..

Gross income lrom sourcs within c0untry shown above and of the lype checked above:

Check if line 1a is compensation for personal services as n mployee, your tolalcompensation from allsources is

$250,000 0r more, and Vou used an alternative basis t0 determine ls source (see inslr

Deductons and losses (Cat0n: see ,instn/ction9:

2 3
a

Expenses defntely relaled lo lhe income on line 1a

(ttach stalement) Pro rata share 0f other deductons n0t detintely related: Cerlain itemized deducti0ns or standard deducti0n

b 0lher deductions (attach stalemert) c i\dd lnes 3a and 3b d Gross foreign source ncome .. .
Gross income from allsources
.

Divde lioe 3d by lne

[rultiply line 3c by line

3e 3l .
.

..

..

Pro rata share of interest expens:

a Home mortoage interest (us worksheet 0n paoe ol lhe instructions) b 0ther interesl expense

14

5 6

Losses lrom foreign sources

or accrued
ln U.S. dollars (slTotaltoreign
Taxes withheld at source on: Taxes withheld at source on: taxes paid or accrued (add cols.

(o)through (r))

LHA For Paperwork Reduction Act

Notlce, see lnstfuctions.

ro,. 1116

tzorol

24

Fnter the amount from line B. These ar your tolal forer0n laxes pad or accrued for the calegory 0fincome checkd above Part
I

1O Caflyback or cayover (anach delailed c0mputali0n)

11

Add llnes 9 and

10

..

12

Beduction in foreign txes

't3 Subtracllinel2lromlinell.Thisislhelolalamountolforei0nlaxesavailableforcredit... 14 nler the amount from line 7. This is your taxablc inc0m or (loss) fom sources outside the
U0iled Slales (belore adjustments) for the category of income checked above Parl
I

15

Adjustmenls to line

14

... .. . ..

..

16

Combine the amounls on lines 14 and 15. This is your net foreign source laxabe i0c0me.

(lf the result is zero or less, you have n0 foreon tax credil for the cate00ry 0f income

youchsckedab0vPartl.SkiplineslTthrouOh2l,Howevr,ifyouarefilingmorethan
0ne

torm 1116, you must complcle line 19.)

f7

lndviduals: Enter lhe amounl from Form 1040, line 41, or orm 1040NR, lne 39.
Estates and lrusts: Enler your taxabfe income without the deduclion for y0ur exemDlion

Caulion: lf you fgurcd

you

tax using the lower rctes on quallied dvldnds or capital gains, see nstructions
16 is more than lrne 17,

1g 19

Divide line 16 by

lne 17. lf line

enter'1' la, or the total of Form 990-T,

lndvdual6: Enler the amounl from torm 1040,|ne 44. lf you are a nonresidnt alien, enler th amount from torm 1040NR,
line 42. Eslate6 and tru$ts: Enler the amount from Form f041, Schedule G, line

Caulion,lf you are completing lne 19 fot separate categorye (lump-sum disttbu tions/, see mstuctions.

20 Mllply line 19 by line 18 (maximum amounl ofcredl) 21 Enlr the smaller of lne 13 or line 20. lf this is lhe only Form 1't 16 you are filing, skip lines
complete the
line in Parl lV

22 through 26 and enter this

22 Credlfor taxes on passive category income 23 Credit l0r taxes on general cale0ory income 24 Credl for taxes 0n cerlan income re-sourced by treaty 25 Credit for taxes on lump-sum dstributons 26 Add lines 22 through 25 .............. 27 Enter lhe 6maller of line 19 0r line 26 28 Beduction 0f credit for inlernalional boycott operations . . 29 Sublract line 28 from hne 27. This is your forei0n tax credit, Enter
.

here and on Form 1040, line 47;

Form 101

o11511

12.10-10

14400916 786859 630

2010.03060

25 PERRY, J.AMES R.

630

,",_
Nmc

1116
>

I.,TERNATIVE MTNIMTIM TAX

Foreign Tax Credit

Dprmnl of rhe-rrasury lnlqnalFvenuService {e9l

(lndivdual, Estate, or Trust) Attach to Form 1040, 1O4oNR, 1O41, or 990-T.

nu

2010
!i'![?l,,.
mbet
as shown on oe 1of your

lg
retlrn

ld

ljsc a separate Form 1116 f0r each calegory of income lisled below. See Cateoories of lncome in the nstructi0ns. mounts in U.S. d0llars excepl wherc specified in Part ll below.

one boxon each Form 11'16. Rep0rl all

a b

Fl f]

Passive category

Generalcategory

income income

E dE

Section 901(j) income

f]

Lump'sum dislributions

Crrtain

inror,

r-sourced by lrealy

Nole: tl you pad taxes to only one lorcgn counfly or U.S. possesslon, use column A in Paft I and line A n Pat Il, Il you pad taxes t]|'ore lhan one foregn country ot U.S use a se,arcte colun and lne fot each country or possesslon

Taxable lncome or Loss From Sources Outsde the United States (fo' Category Checked

Enter the name ol lhe foregn country or U.S. ossession

Gross inc0me from sources wilhin counlry shown above and ol the tYP cncked above:

Check if li0e 1a is c0mpensatiofi for personal services as an employee, your total compensalion from allsources is

$250,000 or more, and you used an alternatv basis t0 instructions) determlne its

Deductons and losses (Cuto0l Se instrucfiotqi

2 3

Expenses defntely felated lo the income on lne

la

(tlach slalement) Pro rata share olother deducti0ns n0l defnltely relsled:
.

f 4

a Certain itemized deductions 0r standard deduction . b 0ther deductions (atlach slaremenr) c Add lines 3a and 3b d Gross lorei0n source income e Goss income lrom a,l sources
Divide line 3d by line 3e

g a

Multply line 3c by line 3f Pro rata share 0f interest expense:

Home mortgage interesl(use worksheet0n page 14

oflhe instructions)

other interest

expense

....... ..

Losses from foregn sources

taxes pad or accfued

Taxes withheld atsource on:

Taxes withheld at source on:

{s)Totalforeion laxes paid or

accrued {add cols.

(o)throgh (r))

LHA
011501

For Papework Reducton Act Notce, see nstructions.

26

AIJTERNATIVE MINIMUM TAX

I
'to
11 12

Enter lhe amounl from line B. These aro your total forei0n taxes paid 0 accrud

for the caleooy 0f ncome checked above Parl

Carryback or carryover (atlach detailed co.pulation)

Add lines 9 and

10

Beduction in foreign laxes

l3
14

Subtractlinel2fromlnell.Thisisthetotalamountofforei0ntaxesavalableforcredit....
Enler the amo{nt from line 7. This is your laxabfe ncome or (loss)om s0urces 0utside lhe
United States (before adjustments) for the cateoory 0f income checked above Part
I

15

Adjustments lo line 14 Combine the am0unts 0r lines 14 and 15. This is you net foreign souce taxable income.

l6

(lf the result is zero or less, you have no foreon tax credit for the category of income
you checked above Pat l. Skip lines 17 through 21. However, one torm l l l6, you must complele line
rf

you are filino more lhan

19.)

l7

.. . ...

lIdviduals: Enler
exemplf0n

the

amountfrom Fom 1040, line 41, or tom 1040NR, line 39.

Istates and lrsls: Enter your taxable income with0ut the deduction for your
Caulion: ll you lgured yourtax using the lower ites on qualied dividends ot capitalgans, se instructions.

18 19

Divide line 16 by line 17. lf lne 16 is more lhan line'17, enter'1'

lndviduals: nler lhe am0unt fom Form 1040, line 44. ll you
lines 36 and 37

are a n0nreside[t alien, enler the amount from

'1a,

torm 1040NR,

line 42. Estats and trsts: E0ter the am0unt from Form 1041, Schedule G, line

or the total of torm 990-T,

Catlion: ll you are completing lne 19 tot sepamto categorye (lump-sum dsttibutons), see nsttuctons.

20 lvlulliply lne 19 by fine 18 (maximum amount of credt) 21 Enter th smallet of lin 130rline20. lfthisistheonlyForm1116youarefling,skiplines22through26andenterlhis

22 Cfedil for taxes on passve category income 23 Credit for laxes on generalcal00ry inc0me 24 Credil for taxes on certain ncome re-sourced by lreaty ... 25 Credit for laxs on lump-sum dislributions 26 Add lnes 22 through2' 27 Enter the rmaller ol line 19 or line 26 2a Reductr0n of crdit f0r internati0nal boycott operali0ns 29 Subtract li0e 28 from lire 27. This is your torei0n tax credt. Enter
.

here and on Form 1040, line 47;

01151r 12-1-10

14400916 786859 630

2010.03060

PERRY. ,]MES R.

2l

630

.",_

9903
as shown 0n feturn

OMB No. 1545-1084

Domestic Production Activities Deduction

>
Attach to your tax return.

Doatment ol lhe frosury

lnlsnl Fvnuo Sorvic

>

See separate nstruclons.

ldenttying number

'l

2 3 4

Note. Oo not complete column (), unless you have oilrelted roducton ctlvltles Entr amounts for all activities in column (b), ncluding oitrelatod production activitios Domostic production gross recoipts (DPGR) Allocable cost of goods sold. lf you are using the small btrsiness simplified
overall method, s,,ip lnes 2 and 3 Enter deductions and lossos alocable to DPGR (see nstructons) lf you are using th small business smplified ovrall molhod, enler th amount

(b)

of cost of goods sold and othor deductons or losses you ratably apportion to DPGR. Allothrs, skp line 4 .. 5
7

Add lines 2 through 4 Subtract fine 5 from lino 1 Oualifiod production activitis ncomo from estates, trusts, and certain panerships and S corporations (see inslructions) SEE -STTEMEf{T.,,1.6 Add lines 6 and 7. Estates and trusts, go to ljne 9, all others, skp line I and go to

line 10 ... . . .. .. Amount allocated to bnefcries oftho estato ortrust (se instructons) .......... lO Ol-related qualfed producton actvties ncome. Estates and trusts, subtract line 9, column (a), from line 8, column (a), all others, enter amount from line 8, column (a). lf zero or less, enler.0 here .......... Oualfied producton actvles ncome. Estates and trusts, subtract line 9, column

(b), from fine 8, column (b), all others, nter amount from ln 8, column (b). lf zero

or

lss, ontor-0- hre, skp lnos 11 through 21, and entor-0- on line

22

.............

lncome limitation (soe instructions):

lndvduals, estates, and trusts, Entor your adjusted gross income fgurod without domestic producton actvities All othors. Enter your taxablg income fgurd without the domestic actvitios deduction (tax'xempt organizations, soe

tho

deduction

I
I

producton instructions)
l3through21,

f )

Enter the smallor of lin6 and enter-o. on line

13

10borline11.lfzeroorless,enter-0'here,skplinos

22 .. ..

..

Etler qYo ol line 12

14a nter the smaller of line 10a or lne 12 .14a by 3% b Reducton for oi.related qualfied production activtes income. Multply line '15 SJbtracl lno 14b from line 13

l6
17

Form W.2 wages (see nstructions) Form W.2 wages from estats, trusts, and certan partnorshps and S corporatons (se instructons)

la

n
21

19

Add lnes l 6 and 17. Estates and trusts, go to line 19, all others, skip line l 9 and go to ln Amount allocatod to bnoficiares ofthe ostato ortrust (seo nstructons) ...-........-. Estates and trusts, subtract line 19 from line 18, allothers, entr amount from lno 18
Fofm W-2 wag lmitation. Enter 50% of ln Enter the smaller ol line 15 or lino 21 Domstc producton activties deducton from cooperativs. Entor deducton from Form 1099-PATR, box 6

20 ..... ...

20 .......,...

2.

24 25

instructions) .. ...,.. . Domestc producton actvties deduction. Combino lngs 22 through 24 and enter th result her and on Frm 1040. lin 35: Form l l20- lne 25: orthe
Expanded affrliated group allocation (sgo

LHA

For Paprwork Reducton Act Notice, see separate lnstructons.

Form

8903

(Rev. 12-2010)

010e1r 12-20.10

28

Form 1116
N,4E

U.S. and Foreign Source lncome Summary

J'4ES

R. & M. ANrr PERRY

TOTAL t32,995.
4,17 4.

lC
FOREIGN

U.S, L32 ,995

PSSTVE
.

Compensation

Dividends/Dstributions
lnterest CapitalGains Business/Professron RnURoyalty

4,t]

73.

4.

23,935.

23 ,935 .

s,388.
18,839.
4

5,388.
18.839. 4,601.
65,000._

State/LocalRefunds Partnership/S Corporation lrusVEstale other lncome

Gross lncome

65,000. 255.005.

,60t.

25s.005.

Less:

Seclion 911 Exclusion CapitalLosses

Capltal Gains Tax Adjuslmeot

26 ,935 .

26

,935.

fotal Income - Form 1116

228,070.
4,72!.

228.010.

Deduclions: Business/Prof osslon Expenses

RnYRoyally Expenses

1,057.

4,72r.

1,057.

Part0ership/S Corporation Losses

TrusLtstate Losses
CapitlLosses Non-captalLosses lrdivdual Retremenl Account
.lovng Expenses

Self-employment Tax Deduction Self-employment Health lnsurance Keo0h Contributions

AImony

4,845.

,845

Fofeited lnterest
Foreign Housing Deduction

0lher Adjustments
Caplal Gains Tax Adjustment Total Deductions

Adjusted Gross lncome

Less ltemized Deductons: Specfically Allocated Home l\ortga0e lnterest

LO.62 2L7.447.
L2,500.
2

10,623,
217

,447.

,079

12,500. 2,079. 3,708. L8.287,

199 . 160.

0ther lnterest
Ratably Allocaled

otalAdjustments to Adjusted Gross lncome

Taxable lncome Belore Exemotions

3,708. L8,287. 199 .160.

o27931 05-01-10

I nalo'l 4 ?QQEo <2n

tnl n n?n4r DEiv

29

TMETA P

6?n

Form 1116

Allocaton of ltemzed Deductons

Taxes

lnteresl - Nol lncludng lnveslmenl lnteresl

Conlributions [iscellaneous Deductions Subject to 2%

0ther [iscellaneous Deductions Not lncluding Gambling Losses

Foreign Adiustment

Total ltemized Deductons

Subjecllo Sec. 68
Add ltemized Deductions
Not Sbiect to Sec.68:

Mdical/Dental

Investment lnleresl

Casualty Lossss

Gambling Losses
Foregn Adjuslment

.:...

. .......

Total ltemzed Deductons

o27A7l

f0,19.t0

Oepletion

6570 of Taxable ncore

A ocation

2OlO

Taxable ncome incuding PIus attowabte Mnus cost depletion

deptetion

available NOL

cayover

19 1 ,

60 .

809.

Taxable income before percentage

65%
65% of taxable Property
Number

deptetion

income
Property Description

t92 , 669 . 0.65

125 ,235
Percen'lage

.
Allocatior
Ratio Lmted

Depletion

Percentage

Cosl
Depletion

Percentage
Depetion Final

Bealocation Ratio

Ailowable Depl. after the

Excess

Percentage

I.R.

PERRY CO.

oar

t.000000

arlo

809. 1.000000

809.

Iotel
025531 051.10

ono

arlo

809.

.00000f

aq

.fA}fES

R. & M, NITA PERRY

MISCELI,ANEOUS INCOME

JSTATEMENT
1

FORM 1040 DESCRI PTT ON

TEXS ASSOCIATION GAINST SEXUL ASSAUI,T

65,000.
6s , 000.

TOTAI, TO FORM

1040,

I..,INE 21

32

STTEMENT ( S ) ', a

.fMES

R. & M. NITA

PERRY

FORM 1040

STUDENT LON INTEREST DEDUCTION

STTEMENT

7. . 3.
2

I,OANS. DO NOT ENTER MORE THAN $2,500

ENTER THE I{OI]NT FROM FORM 10
4O

ENTER THE TOTI-., INTEREST PID

IN ,

2O1O ON QUAI,IFTED STUDENT

2,500.
222 ,292.

I-,TNE 22

ENTER THE TOTAL OF THE MOUNTS FROM FORM 1040, I,INES 23 THROUGH 32 PLUS NY WRITE_IN D.fUSTMENTS YOU ENTERED ON THE DOTTED I,INE NEXT TO I.,INE 3 6 SUBTRACT

,845

. .

4. 5.

LINE 3

FROM

LINE

2L7 ,447

ENTER THE MOUNT S}IOWN BELOW FOR YOUR FTLING STATUS. * STNGLE, HEA OF HOUSEHOLD, OR OUAI,IFYING WIDOW(ER)_$60,OOO * MARRIED FIIJING 'IOINTI'Y_$].20, OOO

120,000.

6. IS THE MOUNT ON L,rNE 4 MORE THAN THE MOUNT ON I-,INE 5? t I NO. SKIP LINES 6 ND 7, ENTER -O^ ON LTNE 8, AND GO TO LINE 9 YES. SUBTRACT LINE 5 FROM LINE 4 [X] 1. DIVIDE LINE 6 BY $15,OOO ($3O,OOO TF MRRIED FII,ING JOTNTJ,Y).
ENTER THE RESUI-,T AS A DECTMAI, ( ROIJNED TO AT I,EAST THREE PI,CES). TF THE RESULT TS 1.OOO OR MORE, ENTER 1.OOO

97 ,447

1.000

8.
o

MULTTPLY

LINE 1 BY

I.,TNE 7.

2,500.
0.

I,TNE

STUDENT LON TNTEREST DEDUCTTON. SUBTRCT LINE 8 FROM 1. ENTER THE RESUIJT HERE ND ON FORM 1040, LTNE 33

FORM 1040

WAGES RECEIVED AND TAXES WTTHHEI,D

STATEMENT

AMOI]NT

EMPLOYER'S NAME OFFTCE OF THE

GOVERNOR

PAID

WITHHEI,D
t9 ,97!.

FEDERI\T-, STATE TAX TAX

CITY

WITHHEI,D TX

SD FICA MEDTCRE W/H TAX TAX

L32,995.

TOTI,S

L32,99s.

19.911.

6,622. L,928. 6,622. L,928,

r rrrnol

?o a

o "

?n1n

n?rn

33 DErDv

.f l'lfF'q

STATEMENT ( S )

?n

2,

JMES

R. & M. ANITA PERRY

OUALIFIED
DTVTENDS

FORM L040

STATEMENT

ORDTNARY

N.}fE OF

PAYER

DIVIDENDS
3

QUAI,TFIED DIVTDENDS
. .

FROM K_ 1 _ REVOCBI.,E BLIND TRUST STATE AGREEMENT FBO RICK PERRY DTD 9-13_96 FROM K-1 _ RP 2O1O MANAGEMENT TRUST

,467

3,

101

413. 690.

TOTI., INCLUDED TN FORM 1O4O. IJTNE 98

,103.

SCHEDULE A
DESCRI PTTON

MTSCEL,LANEOUS DEDUCTIONS SUBJECT TO FLOOR

STATEMENT

MOIJNT

FROM

TD 9-13-96
FROM K-1 *

K-1 _

REVOCABTE BLIND TRUST STATE AGREEMENT FBO RICK PERRY

1,000.
3,

RP 2O1O MNAGEMENT TRUST

370.

TOTAL TO SCHEDULE

A,

LTNE 23

4,370.

SCHEDUI,E A

CASH CONTR]BUTIONS
MOUNT

STATEMENT

AMOUNT

DESCRTPTION

508 I.,IMIT
CHURCH

308 LfMIT

I,AKE HII,LS
SUBTOTAI,S

TEXAS ASSOCIATTON AGAINST SEXUAI., ASSAUI,T

2,500. 10,000.
12,500. 12,500.

TOTAL TO SCHEDUI,E

A,

I,TNE 16

SCHEDUI,E
DESCRI PTION

STTE AND LOCAI, GENERI., SAI,ES TAXES

STATEMENT

AMOUNT

STATE SAI,ES TAX ],OCAL SAI.,ES TX

TOjtAI-, TO SCHEDUI,E

1,829.
585.

, LINE

2,414.

l rr^^14

tQao

o 4?r

an1^

f^4^

rrErDDv

34

T'\rfltc

STATEMENT(S)

4. 5, 6,'1
?n )

.JMES

R. & M. NITA

PERRY

SCHEDUI.,E A

GENERAI, SALES TAX DEDUCTION

WORKSHEET

STATEMENT

3 DID

4 5 6

TX RATE, BUT OMIT PERCENTAGES. AUSTIN DID YOU ENTER - O - ON I.,INE 2 ABOVE? IF NO, SKIP I-,INES 4 ND 5 AND GO TO T-,TNE 6 . IF YES, ENTER YOUR STATE GENERI-., SAI,ES TAX RTE, BUT OMIT PERCENTAGES. DIVIDE I,INE 3 BY LINE 4. ENTER THE RESULT AS A DECT}.,AI, ( ROI'NDE TO AT I,EAST THREE PI,ACES). DID YOU ENTER _O- ON I,TNE 2 ABOVE? TF NO, MULTIPI,Y LTNE 2 BY I,INE 3 . TF YES , MULTIPI,Y LINE 1 BY I,INE 5 .
6.

YOUR T-.,OCAL]TY TMPOSE A T,OCA], GENERA]., SAI,ES TX IN 2O1O? RESTDENTS OF CAI,TFORNIA AND NEVADA SEE INSTRUCTIONS. IF NO, SKIP I.,INES 3 THROUGH 5 , ENTER - O - ON LINE 6 .AND GO TO LTNE 7 . TF YES, ENTER YOUR LOCAI, GENERL SAI,ES

I-,OCAL GENERL SALES TAXES FROM THE APPLICABLE TABLE.

VIRGINIA TN 2O1O? rF NO, ENTER *O_. IF YES, ENTER YOUR

ENTER YOUR STATE GENERL SALES TAXES FROM THE PPLICABI.,E TABIJE. TEXAS IF, FOR AI.,I, OF 2O].0, YOU LIVED ONI,Y IN CONNECTICUT, THE DISTRICT OF COLUMBIA, INDIANA, KENTUCKY, MATNE, MARYLAND, MASSACHUSETTS, MICHTGAN. NEW'JERSEY, RHODE TSLND, OR I^IEST VIRGTNTA, SKIP LINES 2 THROUGH 5. ENTER _O_ ON LINE 6, AND GO TO I.,INE 7. OTHERWISE , GO TO I-,INE 2 . TD YOU LIVE IN LSK, ARI ZONA, RKNSAS. CLIFORNIA (LOS NGELES COI]NTY ONLY), COI,ORDO, GEORGT, TLI,TNOIS, LOUTSIANA, MISSOURI , NEI,I YORK STATE, NORTH CROLINA ' SOUTH CAROLINA, TENNESSEE, UTAH, OR

I ,829

O.

2.OOOO

6.2500
.3200
585.
2

6A DD I,TNE 1 ND LTNE

,4L4. ,4L4.

6B PART_YER DAYS RTE . 6C MUI,TIPLY I,INE 6A BY LTNE 68.

1.000000
2

7 8

ENTER YOUR GENERL SI,ES TAXES PATD ON SPECIFIED ITEMS, fF ANY. DEDUCTION FOR GENERL SALES TAXES. D I,INES 6C AND 7. ENTER THE RESULT HERE AND ON SCHEDUI.,E A , I,INE 5 AND CHECK BOX "8" ON TIIT I.,INE.

2,4L4,

1^ A^nO1 ? aO CO "n

tnl n?nr Erw .TMEq p

35

STATEMENT ( S ) 8

6?n

.JAMES

R. & M, ANITA

PERRY

SCHEDUI,E D

NET SHORT-TERM GAIN OR LOSS FROM PRTNERSHIPS, S CORPORATIONS, ND F]DUCIARIES

STATEMENT

DESCRIPTION OF CTTVITY

GAIN OR I-OSS
'ir

RP 2O1O

MANAGEMENT TRUST

TOTAI, TO SCHEDULE

D,

PART

I, I,INE 5
STATEMENT
10

SCHEDULE D

NET LONG_TERM GAIN OR LOSS FROM PARTNERSHIPS, S CORPORTTONS. AND FIUCIARIES

DESCRIPTION OF ACTTVITY

GAIN OR
23

LOSS 28T

GAIN

RP 2O1O MA,NAGEMENT TRUST

TOTAL TO SCHEDULE

,93s.

D,

PART

II,

LTNE 12

23,935.

L,,1 alaO14 tO4OEO

42al

a^l n?rn

t,ErDw

36

AMFC

STATEMENT ( S )

?n

9,

1O

JMES

R. & M. NITA

PERRY

SCHEDUI,E D

CPITAL I,OSS

CARRYOVER

STATEMENT

11

1, ENTER THE A.I'IOI'NT FROM FORM 1040, LINE 41 2. ENTER THE LOSS FROM SCHEDUI,E D, LINE 21, AS A POSITIVE .AMOUNT. COMBINE L INES 1 AND 2 . IF ZERO OR I-,ESS , ENTER _O_ ENTER THE SMALLER OF LINE 2 OR I,INE 3
t

199,160. 3,000. 202,760, 3,000.

zub , t6.

6. ENTER THE GAIN,

ADD I,INES
o

ENTER THE LOSS FROM SCHEDULE

LINE

IF ANY,
6

FROM SCHEDULE D,

D, LINE 7,

POS

ITIVE

A.I.OUNT

15

SHORT_TERM CAP ITAI.., LOSS CARRYOVER TO NEXT YER. SUBTRACT I,INE 7 FROM I,INE 5. IF ZERO OR I,ESS, ENTER _O_

ND

3,000,
203 ,7 62
AMOIINT
.

10. ENTER THE GTN,

4. IF ZERO OR I,ESS. ENTER -O_ ADD LTNES 10 AND 11 13. LONG-TERM CP ITAI, I,OSS CRRYOVER TO NEXT YER. SUBTRCT LINE 12 FROM IJINE 9. IF ZERO OR LESS, ENTER _O_
L1. SUBTRACT L]NE 5 FROM LTNE
SCHEDUI,E E
.f

LINE

ENTER THE LOSS FROM SCHEDUI-,E D , LINE 15 , AS IF NY , FROM SCHEDUI,B D ,

7

A POSTTM

'

330,841.

330,841.

OTHER EXPENSES

STATEMENT

1.2

.R.

PERRY

CO. _

ROYAI.,TY AMOIJNT

DESCRT PTTON

ROYALTY INCOME DEDUCTION

TOTAL TO SCHEDULE

'J.R. PERRY E, PAGE 1. LINE 18

CO.

248. 248.

SCHEDULE E

INCOME OR (I,OSS) FROM ESTATES AND

EMPI,OYER

TRUSTS

STATEMENT 13

NME

ID

PSSVE
LOSS

NO.

PSSTVE NONPASSIVE NONPASSIVE I,OSS INCOME TNCOME

REVOCABT,E .'BLIND " TRUST AGREEMENT FBO ANITA PERRY REVOCABI.,E BLTND TRUST STATE AGREEMENT FBO

03-6092780

74-6467584
27

0.

RP 20L0

3,065.
-6832469
1, 536.

MANAGEMENT TRUST

1n

^^^at1

4 ?oao

<2ll

.)at1a.l n?r4n

Enav

37

'rr\Mc I

STATEMENT(S)

TT, L2,
?

T3
')

.fMES

R. & M. ANITA

PERRY

THE P

2010

27-6832497

MANAGEMENT TRUST

0. 0.
4

TOTI.,S TO SCHEDULE E ,

LINE

34

,607.

SCHEDUI-,,E SE

NON_

FRM TNCOME

STATEMENT
AMOUNT

1.4

DE SCRT PTT ON

TEXAS ASSOCTATTON AGAINST SEXUAI., ASSAUI,T

6s,000.
65, 000.

TOTAL TO SCHEDULE SE, LfNE

SCHEDULE SE
DESCRI PTI ON

NON_

FRM INCOME

STATEMENT 15
AMOI]NT

J.R.

PERRY CO.
2

18,839. 18,839.

TOTAI, TO SCHEDUIJE SE, I-''INE

FORM 8903

OPAI FROM PASSTHROUGH ENTITTES

STATEMENT 16

NAME OF PASSTHROUGH ACTIVITY

OPAI

I.IOIJNT

WAGES AMOI]NT

\T.R.

PERRY CO.

L4,tt1
8903. LINES 7 ND 1.7
L4,!T7

. ,

0. 0. STATEMENT 17

TOTAI., TO FORM

roRM 1116

U.S. AND FOREIGN SOURCE INCOME SI.]MMARY TOTAL PARTNERSHIP / S -CORPORATTON INCOME/ LOSS
NCOME

DES CRI PTTON

LOSS

J.R.

PERRY CO.
INCOME / I,OSS

18,839. 18,839.

TOTAI, PRTNERSHI P / S _ CORPORT] ON

STATEMENT(s)

13, 14,

Ls,

L7