U.S. tndlvidual Income Tax Labe!

[Sef ins iructlons on paqu 16.) Use the IRS label. Oth~rwi~~.
:i i~iJ~U

Re;tum

L A B E L H E

Your nrst name and initio'

B~~ACK H
Ii a ioint return. spouse's Hrst name and iniUai

I
'1DU

.26

OMS No. 1545-007.,

Last nama

I. Last name
~O~.

IOBAli~
Apt no.

MI0HELLE

Home "ddr~ss (number and Slreet).1f

L

hava a P.O.

see pa~~ 15.

OBAM~

A Important!
You must enter YDur SSN(s) above.

.'i

~IrTYpe.. E CHICAGO IL 60615 Presiuential L-...L.~""","",,""""-'='..J-.---=~_-==":""""=-- __ . EI'~Gtion Campaign r>.. Nole. Checldng "Yes" vAil not change your IHX or reduce your refund. :3"", pa~I!" 1,".~ 17 Do yo". or I'our 5pOU~5 ifliling a joint ~tLJrn. I"/<inl ':>3 go to this lund? to

oruu

R

1
-;:-;-_-J

Filing Status
Chr.ck only L'IlS 11O~. Exemptions

2 3

r::;o

~ ..'j

Single Married filing s~~aral~II'. Enter .pOU5~'S SSN above and lull name here,

4

D Head of household

!>

CXJ

You

Yes

D No

Spouse

[XJ

Yes

D ~lo
_

(with Qualifying person). (See pago 17.) If
1>_.

0

c..X.J Mdrri8d filing jointly (F.Vf!flil'only one Ilatllncome)

tile Qualifying person is a child but not your dependent, enter

!ll>-

0 QualifvinQ I

this GhilG's name here.

'IIidow{er) with dependent child (S09 pagE 17) "...................... ~~~';; • ~r:;'~~.d •
No. 01 chlld,c""

Sa [XJ YoursetL b Spouse C Do p endents:

W
, 11 Fi
I

If sorneune can elalrn ynu as a dependent, do ~O! check box 6a " "....... ('!lD.p,"doo". 0<:0'.'
L...1::;1'"ILll";'le

_2_ _2

I
.

I!!lo: .:iam!'J

:t>IALIA .A OBAlxTll,.
:ir;: 11:H):' .~~ ____

I! ;0;1)[', mm 10m 'i13!f,H!!iJents.

NhTJ.~SHA
__ "-__ Q~. .________

M OB.l\J::.lA_____ __
.

-·-I---,.!._·--_;_---~"........ " "....... , . i i...........
--F Ic_:B:=b_-'-I

r
I

~=-=__
:::,f'.t::unly
numl:.:.r

I' ....


p) O"l'end.nl'o rel att.ans!iip In.
ytll-i

:nl~:;~;:""I' )"0" ......

DAUGHTER"" F-AUGHTER

(;~'!~t1m
"'\I,JU

vou

0 di d f1QI
duo

'0

II\'I!' wU" dJ'/crc!::!

:~'~~n"UI·mr~:_,.t:Q~~~
~~~~:.i> 3
207
u _

C'~'''''d'n,"on50

--,-,rr,-,-I'~l ilU01Qcr ul exemotmns
ilileresl

.::Ia!mad . ,.....

Income
,lUBell ~iirn'(3)

WilUe:i, saaries, liDS. etc. Attacll Fcrrnts} W-2 ffa Taxable 8a 10 12

7 83 f,-'=9c_::il-+

342 •

1f/,2 here. Also attn~h Fo.ms W-2G and
to9~·>t II tax

Tax-exempt

At1ech Sell.dule B f! r~quircd interest. Do not rnctude on lino 8a iI.t:Wch SdlaLlul~ B il requked

OrrJin;;,y divi!let\d~.

was wilhheld II vou tihl nOT rYJ~!u '1N-2.
';0 ~

[J~atiil2tl divldend5 (see P~DC 20) .. ..... ...... .. L-'9"'b'--'-I_~.---- _=_---1 _ T~'iilit~ ,eltmcs, muils, or orlseis 01 ;!Hle and iUGelin~ome taxes ....... S1'.M:T... J.....'J;'}i;T .4 $ 10

_

305.

Business inClJma Qr (loss), Atticl, Sr.tleuula G ,)f G-EZ .... ....... . ..... CaoilJI ~ai~ or (luss). AWlch f,ctl~()uie 0 Ii reQUired. II not [r,r,llin;Li. ~h~cli here . .........:: Oilier gains m (loss?,) ..~linr.h Fnrm4797 IRA dislribulions ~_ Pensians and anl1l!llies . ,.... ~~-. farm income or (less), Mach Sche~ute F "

~.

~a9fl~.
15.

t:~r
. .. .

11 12

J

Em:IQ5~.Jut 0(' iH I tHi~th, anv

loa 11 16 19 20a 21 22 23

'-'---1
~..... ,..
---'

!

" . b Ta.~abl~ amount tsee page 22) b Taxable amount (see page 22) . . "

16h 17 16 19

f!"'1ment. Also, 1)IFca~i3 use Form 10'IO-V

Ren,al real estate, ruyalll.es. p~rtnerslllps, S ccrnorancns, IfUSt5. r.1C.Attllch Sehedule E .. , UnemplQ'lmcnl compensauon .. SDci" I securir! b~neiilE 1 _,,20"'ae.J.i L (lther income. List type ~nd amount (sac page 24)

b laxable amount (see page 24) 20b ---1 21 .~tld lhe "mounts in the lar riohl cotumn lor Irne5 7 thrfJIJ(ln 21. This is vnur tOI.1 Income "....... l> 22

207

647 .

2~ Adjusted Gross
income 25 ;>0 27 28 29 30 31 32
1'1,1.. d~~u"i1on (see pag~ "6)

,StlJc:wi I~all lnte;~st licdu~tir;n is'''' lillY. 7.81 :uillun and lee:; ;IH(llIct!on (see po~(' 21) .. 27

Hcatt~ savillgs account dedUi;tlun. Attach Form a839
Moving expenses. Atti.lcll Form 3903 •.. . One,hall ot self·empluyment tax, Aliacll Schedule SE '

r=26~ 29 .
30 . 31

~1'

S"lh,mployed health insurance deducuon (see palle 30) Sell·em9loyed SEP, SIMPLE, and Qualilled plans
.

.. 33 _
<....><:34 ....a_,_I

P~naliY on early wfihdra\'lal oi Sllvings 33 34<1 ,\liI]lIJlJY pair! b Rp.ctplent·s SSN fi:". 35 36 ~'i.d. F'1' Di5closura, Ado tines 2J through 34a

.

-1,:· . 35
36

Sub ifile! line 35 from lin~ ~.2. Tills ISvcur ad justed gross income
PrjV'lCl'

207

647.

Act, and Paperwcrk

Reduction

Act Notice.

see paqa i5.

'.",m 10~~PD04i

Taj{ and Credits
SIHJ1datd

:~a ~:~~ntfr{om D3~~~d~~ue~~e:::no~:f~;eO~~)u~;~2:·~9.;O:·· ..·....··....·LI-;==;--lI.· 37 ..···D··B·li~d~···..T~;;i~~~·~~· ..}
if.

BARACK

H & MICHELLE

L OB_2I._M.1l,

207,647-'..
1

~~~'~~~.:'~B.r
CledU'c\i~n rerP.ecpl!l:w.f1o o

0

Spouse was born before January 2, 1940,
relurn QI you

DBlind.

checl[sd
nere

L~ 383_
~

!J

II reur

5PIlU~_~ It~l'rdZ:e5 en a sepereta

"late· a o.::!WRl~·~I'.(]1Lm ~IIEji r, see p.c:9;!1 Jj ant:! o:M(i;;

·88b ..

0

. ,'-'3:.::9-'-'~ 5 ,OJ 8 ,

~~~ ~J"~~;d0 4
"''' d.p"nd,nl

39 . Itemized deductions

(from Schedule ,Il.) or your standard deduction
III

(see left ma(gj~)

.

Subtract line 39 from line 37 .. . '11 If line 37ls £107,025 or less, mulhply .~3-, 00 Dy 1.11(: numller 1 10lal Is over ~i 07 ,025, see Ihe worksl\~et on nane 33 ,

exsrnpuons calmen on lioil 5d. Ii 11Il!!.~7

42
o ~I! olhodfS: Single Married $',,1,1850
MBlTIi;:d JOlnUyor ffllng ~t

43

T~xable lnooma. Sublract line 41 irom line ~(I.II lin~ 41 is more than line 40. enter -0· Tax. CheCk !fany tax is from: aD Form(s) 681<1 ilO form 4972 _
Allelllative minimum In. Milch Form 6251 _

I .j 1 I ~

r
!

~."O,-;
I

.J S:;; , Ei :.~ .

LR.L__

12 , 4: 0 ;J • 170 ,) 1 9 . __:3,,-,-7_,__o19 ,
c.::-----c:-------:_

mlng

.5_~I:;Ia-at!!I~',

Ou.lIlYlnQ Si_9,7r:10

44 45 46 47
4B

Add ilnes ~3 and 44.........................................

.

"

Foreign lID: nradlt Attach Form 1116 II required ::::........................... Credit for child and dependent care e)(penses. Attach Form 21)41 _.. _ Credit ior1he elderly or the disnbled. A~aclt Schedule A _

~·lrdD1,.·Jrc:r1.
H.w<:LQ of heLlsenold, 5;! 150

1-.24-".6_'t1 47 48 I .
. ..

'1'...........

I> 1----"4-"-5-+_ _
-:=_-1

1-1..:.4"',iC4

.---=3"--'-7 ,__,6'---'1"---o::...;~1 ~

700 •.

49' Educalion credils. Attach Form B863 .. _ sa Retirement savings contributions crediL Allach Form

aoaa
" ..

_

.

51 Child lax creclii (see page 37) . 52 Adoptiofl eredlt Attach Form 8839 5a Credits from: a D Form 3396 54 Other credits. Check applicable bO)«e5): b D Form 8aOl G 0 Specify
55 Add 56 57 58 59 60 61 62

I :~ 1-----------11,_-.<
4S
'521 1 53 ~.
r

I

b a

D Form

O·F~;~ ..85:9 3
3800

.

L

lines

46 tlirough 54.These are your total ersdits

----------------

I 5~

Sublractline Socials8curity Mdllional

55 Irom line ~5.1f line 65 i~ more 11lan linfr 45. snifr ·I} Attach Schedule SE _ and Medicare tax on tip innorne not mporled 1'0emplover, Ar.ach Form 4137 .. __ .. :

r,...
. .. .. _ .. _..

I

55 56

other Taxes

Selt-employmentlax.

57
58

tax on IRAs, other qUilll.lied retimmB~1 plans, ete, Ma[;h Form 5$29 If required

59
60 61

Advance earned income credit paymMts from Form(s) W-2 Household employmenllaxes. Attach Schedule H .. _ _ Add lines 5611lrough 61. This Is your total tax .. . .. Federal income tax withhold from rorms 'N-2 "nd 1099 2004 estlrnsred lax paymenls and amount applied Irol1l2003 return .. ::::::::: ..

I I

i I I I

--

__

700.
I"

-.

.

_'_*4_~

~_.

3,5[,)7.

Payments
Uyou nave a qU3_,jrjt.ng 'Chll~, ~tla~ SL":nfldulD EtC.

63 54

! 63 I l-r-~6'-'4'---·-I~-f--------'------I r---:6"'6_t. .. BOSS 67

II>

46

62

40,426.

628 • _

65: ~~~n~:~i;I:OC:~~:~~~;~I~!ti~~ 56 67 6B B9

;·T5·~br· ..
4136 ~DForm

Excess social securily and tler 1 RRTA Lax wilhheld (s~~ page 5(1) Addltion.1 child lax credit, Attach Form 8B12 Amountpaid with recuesttor extenslcn to lile (see page 54) other payments from:
I

1

66

DForm

2439 b Dform

70
Refund
Dir~1 depco;l?
Seo pogo 5,1 a.nd fjU ~n72b; nco 7'd. ~

to,.
If line 70 is more than line 62. subtract line 62 rum Ifn~ 70. Ttus is the amount ynu nverpaid ...
~o"ll~g
1I,"1~"

1
I 70,-+- _ _ 71

71

---=-4§..,_O 2,L, 6 202:.

72a Amountol llne 71 'IOU want re[unded to you

II
73

r-L

--"1 !» G i1pl' [J cn;,:'I"~ 0 . •. _j
70 hom line

_

_._ _

""'"1: !l> d .uml'" L ...._ ._---'1>"". __

.'''''1,---------·

,.,

,,, .. ,_,.

__
---,

'n~

Amount of line 71 vou want applied te vo u I 2005 eslil1l21ed I." Amount you owe. Subtractline

,1---=---73=--_:

Amount

'74

62. For

de12i15 on hiJ'l/ tu pay. see page 55

You Owe 75 Estimated lax Dsnaltv (see nace 55) '. . . '.' .. 75 Third Party Do you want to allow anoll1€l person 10 discuss 11115eturn 'IJilh the IRS I.m page 56)? r Designee ~~~<I'; J> PREPA.'R.ER

!

I

I$O-._i--'-7---'-4----"__

;~~"'I!>

CXJ YES.

Comple!"- tll~ fe'llowing.

~.~~~~,':P;'~f"r.:"r." t>

:J No

.'
C 11 cl TEl)( C red it IN 0 rks f1e e t if
~iErne(S): First Last X$l,OOO.Enlertheresull. __ .__

.. ""C.I.S ~ 'Part 1

.1:L"§:
1. 3.

:MICHEJ;.LE

L

I

(keep tor your records)

, Your SSN 1

,",umberofQualiiyingelliidren:

2

OBAM..~~:==.=-:,_~~~~~=_~=-"=~'"'==_~~=-:="

2. Enler lile amount nom Form i040, line 37, or Form 1a 'lOA. line 22.
o

1040 iiiels: Enler Ihe total Of anyExclusfonoi income from Puerto Rico. and Arnnunts from form 2555, lines 43 and 43; form 2555·EZ, liile 15; ~nd;:m rn '1563, line 15.

e

J
...

1

2,000.

2

-"'2_=0~7!.....<..,_o6c.:4=-..!.7..!..

o.
207 647.

10'IOA m~rs: Ealer ·0-. ~. Aotllmcs 2 al1'J3. EnI~r thll 10lal, 5. Ent;;f lhe amount ~l1owl1below lor your illlnQ stli'U5.
o i',iarfl~d liIino

joinll'l - $I'IO,I}I}O

o Singlp., naac 01 household, Of qualifying wido\\'{er)

.. ;'i;7~.O(l0

'" M.rrled filing separately' $55,000 6. Is Ihe amount on line ~ more thaJl tne amount on line 5?

l J

5

---"'l"'l"-.:O~I_=O!..:O~O~.

m

o

No. Leave line 6 blank. Enter ·0- on line 7. Yes. Sublraclline 5 1rom line 4, ', .. __ __ __ .. 6 Ii the result Is not a mUltiple 01 $1,000, increase it to the next multiple or $1,000 (for r.xample, lncreasa $425 to $1,1)00, increase $1,025 to $2,000, etc). .,

-=9'-'8"-'-~O-"D:...;:O"-'-.

7. Mulliply Ule amount on fine 6 by'5% (.(5). Enter tho result O. Is tho amount on lina 1 more than the amount on linn 7? [][] No. I STClI'1

.7

----"'4"-'-"'9.:::0~O~.

yc~ cannot lake lile c~ild I;].~.;rerllt on Furm 11140,lille .',1, or f.}.m 104U.A line ,'33. ..

~~.
Pa

it. 2

I i YeJ.~!ilJt!3ct U!lll.7 tram [iQ.L:J.!2.!!!1 \!l~.I"~ull. _,.-:"'-_=~_...... ..,.._...;.",=='~"".....~ ......... ~=.b=~-==~~_~~ ,.~__ 9 __ 9. Enler ihe amount 110m Form 1')40, iine 45, or Form '1040A. line i~3. 10. 1040 Hiers: Enter tne :01.1 ollne amounts nom lines 46 tlif[luqh 50. }~ HI
1040A tllers: Enler Ih~ lolal 01 1I1€ amounts trom lines 29 IIlfough 32. 11. II.m yOu ctaiming any 01 the lollavling credits? '" Adoption credit, form 8539
o
0

MortgnQe interest [;mlit, Form 8396

o
I

o

District of Columbia first-time uomeouyer Gradit, Form B859 I~Q. En~r lh~ amount from line lQ. '(e~. Complp.ift The LillO '11 Worl:shecl 10 ligure Ihe amount to enter here. 1'Ilrom line 9. Enler [lie resull.
II ilIll

} ...... ;,__. 11 .
12

~
_

12. SIIU Ir~"lline

13. Is fhe alOuunt un lille B nl lhis wurksheet mor p. inan tim amount on noe 12'(

~~~~~_~LLYes~Enter Iht1 amuullt

i ~Jo. Elltm the ~molJnl

lin~ 3.

'I,

This is your

IrDm line '12..._1

Ghi~ t~!dil;",..,_

.......,<===~~

__

"

...........1 3i....:~~~~_,_~= ....

2.1

SCHEDULES (Form 1040)
oO!~~nnml
Ir"l!Im~

A&B

Schedule 14 ~temgzedlDeductions
N

o-f 'h~ TtG~J
(U1l]

(Schedule

B is on page 2)
tor Schedules A and Ei (Form 1040).

RC!v~UE!! S2rviCij

l> Attach to Form

1040.

See Instructions

BARACK H & MICHELLE L OB1>JvlA Caution. 00 not include espanses reimbursed or paid Ily others, 11J)edica! and Medical and denial expenses (see paJ;Je A·2) 2 Enter amount from Form 1040, line 37 Dental

,

Expenses
Taxes You Paid
(See pageA·2.)

lRL

··· ....

1,-; .!-I'---------I 1 !-.'
L

1;1':

3
4 5

Multiply

line 2 by 7.5% (.075) 3 tram line 1. If lina 3 is more than line 1. enter ·0·. ..

13"---".
..

---,--1 4

Sublraclliroe

State and local (check only one box):

a
b 6

0 General

[X]

Income taxes, or sales taxes (5,.9 page ,A"2) (see page A·3)

1
J
:..

,
.. "

I I.!
;-1.=.5_j-

I

6"-'•~·1=-=3-=5'-"i. .

Real estate

taxes

_I6

3 9 4 6.J

:~~;~~~~~'~~~~~== =====;;;==;.=.=;;.=.~.;.=. -,---l!
r,._:"':-'I'-9 Add lines 5 til rough 8

lnterest

You Paid
(See page A·3.) Note: Parsonal interest is net deductible.

10 11

~__12
13 1·t 15

Home mortgage interest and polnts reponed In you on Form ·1098 Home mortgage interest not reponsd to :fOU on Form 109a. If paid to the person from whom you bought the home. se8 pa£l~ i)..~ and snow that person's name. identifying no .• and address

..

-_=~Attach

-

-__--__.. ..

--

Points not reported to you on Form 1098. See pag", A·,I for speCial rules. lnvastrnant interesl. Form .1952 ~ rsqueed. .. Add lines '10 through Gifts by cash or check sae page 13..... (Sse page 1'..4.) ....

U
Id
I
I ,

-wi

14,395.

I9

J

10,081.

... r;;r :' ..
.. ..... 114:

I

I

U .. 395.

Gifts to Charity
gift and got J beneiillor il.
Cll:!iUl:!II~'

Ii you made any gift of :5250 or more,

A·"

S.E.E. S.r.~~'r.:g(:t':f,E.N'):' .1,\ ..
5.8"

2.500.1

Ii you mcde

il

16

Other than by cash or check. If anv girt Of $250 or more.
You must attach Form 8283 if over $500 Carryover lrom prior year ...... Form -16~'k iS~", oat].;

page ,:1,.. 4.

-I

,
2.500.
_

see page A·,!.
~(!ofl LC!~~~~

17
1B 19 20

Add lines 15 through1?

an d

C;x:;uakv or theft loss(;:,,\. Attach Unreimbursed employee

1.1.:

! 181
.1 ...... • ..

---;-""'"'"'-'--"~~-'.:....:.1:9:..1
,I

Job ExpenssG and Most Miscellaneous
Deduolions

Olhar

I>lftllQJ)[. .N1Jp_
21
22

expensea- loll travel, IJlliondues. lob education. Attach Form 2106 or2·I06·EZ If required. (See paqa A·6.)

61C:['

I

~:gQl!:I~..s_S):.9~1b!! ]2"ll.~S _

2_2jl_:

::..1
201

229.
_,8"-8""_,,1:...!-[.

Tax preparation

fuss
Investment. safe deposit box, etc. List lype and amount -

,~2"'"·-' ' -1'

(See page A·5.)

~

Other expenses·

---~----~----------------~----------~
23 24 Add lines 20 through 22 ... .. .... Enter amount Irorn Form ;0'10. line 37 Multiply Subtract line 24 by 2% (.02) , ~_

__ --_--_--

---

-

-_
1I
! 25,
1(

= = = = = = = = = = = = = = = = = = ~ = = = = = = = = = = = =..2= U-_7"',..6=.~7..' ~~I = ~ = = :.'}') i'~;"·,1·.1._
<J.

11 0 .;

I
0,

25
26

.

,.
..

4 , 153

line 25 irom lin~ 23. If line 25 is more than line 23. enter ·0·

1261

.1

Other

Deductions

Misce llane ous 27

Total Itemized Deductions
':i'lil'SQl

28

Is Form 1040, line 37, over $142,700

o

(over $71,350

if married filing separately)?
}

ST1:'.IT 5

No. Yes.

m

Your deduction is not limited. Add the amounts in the tar light column lor lines 4 through 27. Also, enter this amcurn on Form 1040, line 39. Your deduction Reduction rnav be limited. 5se page AS (or 11,e amount se e Form 1040 instructions. h) enter

I
---''''-=-

J>

28 1"-

25

L028~.

1:2·::W·DJ

LHA

For Paperwork

Act Notice.

Schedule

A (Form

'1040) 200 ..

3

Child and lDependielll1t Care !Expenses
CiiJC:r':;fii,;n:

~r ttir.!

TrcrlDU!'1 (91))

i>- Attach

to Form

1040.

r-,I{IIIn!J.1 P"l".!'IlJ:j1r1'! ~~r_"c!:.

I> See separate

instructions.

j·Jarne(;;;

HhOWll

on Form 1040

Your snelal security number

~:;~~~"ilc. 21

2lrn((]4

~B~AR~~~.(~~~K~H~&~M~I~C~H~E~L~L~E~'-=L~O~B~A~UiA~~·, ~~
B.. tore \'OU b6gin: You need to understand the f(!lIowing terms. S~e Definitions c Qualifying on page 1 ot tne instructions. Person(s) this

~

i

'" DBpendent

Care Benefits

o Qualified

E;:penses

.::, p=a=n=' i=P>;e:;r;:s;;o~n~s =1:::;-1 or Organizations
la) Care provider's
name

Who Provided
of page 2.)

the Care - You rnusf cornplete

part.
"

Iii )'QU need more space, use tha bottom

L

I

(number,

streei,

(b) Address apt. no., city, state, and ZIP code)

SONJil. HAf'{~ . M.!-,\RLEASE BUSm"ELL

.s.__

----------------------+-------------------+-------------:Err. \~.~

(e) Identifying number (SBN or EIN)

(el) Amouni paid

____'_':Ins;:.".· ..:::.: _ I" r: 7 ~ ..-;'_.:~:;'~: _:

J,: __

,_,

___

I, •. -: _::,,:._,

~'';~_

.r.',

17 550.

•...:.),.

.

.L __

~

5,388.

Old you receivs

----------;i>
•---Yes --------I>

Complete only Part II below .
Complets Pert Ilion page 2 next.

dependent
Caution. If ,he

care benetlts?

care was

provided

in )lour home, ~'ou may owa employment

ra,~e5, See

the Ins/ructions

(or Form 1040, line 61,

I Part
2

ill

Credit for Child and Dependent Care Expenses

ln_ju_'r_n_12_t~io_r_'a_b_o_u_t~y_o_u_r~q .. u_a_lh~y_In~g~p_e_r5_0_n~(~5)~._lf~\~'o_u_l_la_\_~_._m_o_re __1I_1a_n_t_~_lo~q_uD_I_il~yi_n~g~p_e_rs_·o_n~s~,_s_e_8_t,h-e_in~s~t~ru~c_ii_o_n .. s_, ~'"~,~~~~~ ___ Ie) OUClliiyiflOperson', name (h)Oualifying person's Ie) QU3liifed expensesyou Finil L £1St social S8curity number 1~~C:~~dtJ~~j~~~;t:~I~m"'nr(!)

,

'OBAM,lI,

__ .. ._. -'---'person or $6,000 3 4 " "" .. " .

+-_--'1""'1=.l....,
..,._c--'1--

.::,.4"",6"",9.:c.'

N:<.:/.I' ?'-~J..i_A"--'·'-"'Mo..-__________
:j

iQBAMA ..

""'''''1'''','-4''-''..6,-9~. " 3 500.
85 432 . 121,910. 3 500.

t,.,·kl lhf;': amounts

In ~r,l!Jrnn (c) o~ :In" 2. Do no! enter rnore than 't:3,OuO lor cne qll"lifying you completed SeE' instructlons earned income Part ll], enter the arncunr lrom lin= 32 ..... ..

for '·.vo or more fJer~ol1s.lf ., 5 Enter your earned income.

C;;Ol"."..tCJ ... J,r.I~J.TE.P.

Ii married 'filing loin!I)" antsr your spouse's di3a!;lied, see the instruclions):

[if your sp,0use was a studerrt or was 5
6 ,,",.. "...... .."

all others, enter the amount from line <\ ,
.•." .

6 Enter the smallest
./ F!.

of IIn8 3, <1, or 5

"
". ".

..
.

Enter the amount from Form 1eifO, line 37

207
Decimal
amount

647.

Ent~f' ~", Il(1e S !!1"~~I?clr i::iJ amount shown be!ow that aoplies to ,he amount on line i , Illin~ ~~ Tis: But not aver DeCimal . amount

IF Iill~ 7 is:
But not ~O~v~e~r..,o~v~e~r __ ~i~

is

__

$0· '15,000 '15,000 ·17,000 H,OaO·19.0()O 19,000 . 2'1,000 2; ,000 . 23,000 23.!JOO·:<5,000 2S,COO·2',OOO
27,:lOG· 29,ODO

.35 .34 .33 .32 .31 ,30
,29

$29,000,31,000 31,000·33,000 33,000·35,000
35,000' 37,GOO 37,000 ·39,000

.27
.26

.25

8

x .20

28

39,000· ,1, ,000 41,000 . .13,000 43,000 . No limil

,24 .23

.22 .21 .20

I'

!J ~.-Iu,tloJyline

(j

by lile osclmal

amount on line 8. If you paid 2003 expenses in 2004, see
9 " " " .

(he mstructlons

10 t:nt~r Ii;.; amouor from Form 1040, line 45, minus all)' amounl on FiJrm 1040, line '"6
1 i Credit for child and dependent care expenses. Enter the smaller

10
11

700. 37,619. 700.
Form 244'1 (2004)

oi line"" or line 10 here and on Form 1 040,

LHA

For Paperwork

Reduction

Act Notice,

see separate

lnstructlcns.

4

.t.

rr

~F~o~rm~244~'~'1~(_20_04_"~)=B~AiU~~~C~K~H~~&~M~_~I~C~H~E==L~L~E~;L~O~B=lU~l~~~~~ t' ~aFfJtq Dependent Care Benefits ' -;-_-..,12 Ente.r ihe total amount of dependent care benefits you received in 2D04. Amounts you received reponed as an

D6g~

2

' .. . _

_

employee should be shown In box 10 of your Form(s) W-2. Do nat include amounts
box 1 of Form(s) W·2_ If you were self-smplnyatl dependent care assistance or a partner, include amounts

as wages in under a

you received

program from your sale proprietorship

or partnership

" _"

,

.
13

2.500.

i 3 Enter the amount forfeited, if an)' (see the instructlons] 14 Subtract
15

line 13 from line 12
of qualified . expenses

" incurred In 2004 ror the care ot
,..... .. _ .. __

_ __ ••__

,

14

2.500.

Enter the total amount

the qualiiylng

person(s)

15 16

+1

-

_

_;;!::..::

2~,

9'--"'3~8~'1
.1 -

16 Enter the smaller 01 lins 14 or 15
17 Enier your earned income. See lnsttuctlcns 18 Enter tl,e amount shown below that applies to you. __ ..

_._ _
_ ,

__
.

I

!

2 , 5 00

171
"

85 432.

o If married filing jointly, enter your spouse's
spouse
c o

was a student

or was disabled,

SS9

earned income (if your lhe instructions for line 5).

'1

,

If rnarrted filing separately, All others, enter the amount

see the instructions from line 17.

for the amount to Gnter]

18
..;

121910.

19 Enler the smallest

of line 16, 17, or 18

_.

,.,

, "'.

. ,.

,__ 19
,~r partnership,

2 500.
If y,~u did not

.

20 Enter the amount from line 12 that you received jrcrn your sale prcpnetorshlp

I
• ,_ ._ _ _~

21

::::::C:~i::::hi~O:o::s~:nt~r

~,'"." rnarrieo

,

:'."":

22

En,,, $5.000
line(s)

,".500'

""0,
22

separately and

Income on line 1 B)

23 Deductible

'.' . 'benefits_ Enter the srnalluat
return (see

of line 19, 20, or

or your

in"

.""··::'·':::·'I··~:·l'" " ~ -.~·~O 1 ,00 w," ,~w'" ,,=" ,.,,00 j 22 I
-. to enter vour _.. . . . . .. _ _
"'_

.1- ---'2=0=---+-

.. .

!-'

----'' ' '.,=----;.. __

Q.9_Q...~

Also, include this amount ,, ,_ ..

lnstrucnons)

__

' '-or ..:..
251
.

on the apprcpnate

:,_f

..:9"'3:!...,!.1

24

Enter the smaller

of line 19 or

1241
r

2 500.1

25 Enter the amount from line 23
26 Excluded benefits. benefits. Subtract Subtract line 25 from line 24. 11 zero or less. enter ·0· _,

----..__

.. .1
26
on Form 10~D. , ..

:2 1500.

27. Taxable

linG 26 from line 21. If zero or less, enter ·0·, Also. include this amount

line 7_ On the dotted

line next to line 7, enter "DC8"

To claim th~ cflild anti dependent complete lines 213-32 below.

care credi t,

..---~---

28 Enter $3,000 ($6,OOO if two or more qualifying
29 30 Add lines 23 End 26 Subtract _ _

persons)

,

. tal,\) ill? .;;r,;dil. Exception. ', In column \c)any ,.. ,,, beneflts .. .. , shown . If you paid 2003

~~,------~6~Q~O~O~. I;.' 2=.9;<...:.I . ----'2"---,5 0 0 ~

line 29 from lin8 28. If zero or less, stop. You cannot in 2004, see the Instructions for line 9. __

ey.penses
3'1 Complete

line 2 on page 1 of this rorm, Do not lnclurls

on lin€: 29
.. 31

above. Then, add 1I,e amounts in column (e) afld enter the total here

32 En!er the smaller of line 30 or 31. Also, enter this amount on Une 3 on page '1 of this form and _...:c"'0~m!.!!p=.::'e::.:l::..e~"n~e"'s-=4:..·1!...!1...:."'__.. ......-'........ =~-~"'-"-' ~- '''' --~ ... __ ""_"'''''' -"' .. ''' ..'''"'''.'''"'''''."''-'''''' .. ---'.'-''---. ~-------'--"'---"'"'_'_........,_=~'=--"~;="'_'""""''''''-'=-'_'_---'-' ..
__ .............'______ .... "''''

I
!
--=----3 , •• 5 G (I. Form 2441 L:~GC:.:.IJ

...:3::!.!2:....L1

,~l.li::;2
~1~1=.\J~

5

SCi,EDULE H (Form 1040)
C~NJ~ ~:"FI~ntcl tM 7.rJiJa.;r~ :.. ...:.. rl"'i)·q"="I~l'..!t! ~~Iil"

Household !Employment Taxes
(Fo;- Scclal 3ecuriiy, Medica/e, Withheld lncorns, and Federal Unemployment or 1041. Social (FUTA) Taxes) j';~ Al':tach to Form 104(1, 104Q~JR. 1040-8S,

OMS No. 1545·0074

~-=rv:;.I!

ll'>

See separate instructions.

..l\Ua~hrnan' ti.:1 Sequence tee. • •

('Iame 'J! arnplover

security

number number

Employer

Identification

=B~A~J?~t~F.~_C~I~\~F~l~O~B=P.J4~·~-iA=~
A Did you pay anyone household employee cash wages of $1.400 or more in 2004? (If any household

~
employee was yaur spouse,

.
your child

_

under age 21, your parent. or anyone under age 1S, see the line A instructions

on page H3 before you answer tills qusstlon.)

[Xl

o
8

Yes. No,

SI\lp lines Band Go to line 8.

C and go to line 1 ,

Did ',ou ·"it.hhold Federal income tax during 200'~ for any household

employee?

CJ
C

L _J

Yes. No.

Si'.ip !Ine C ..nd go to line 5, Go to iir1e C. cash wages of $1.000 or more in

Did you pal' total

any

calendar

quarter

<:If 2003 or 2004 to all househoid

employees?

100 not count cash wages paid in 2003 or 2004 to your spouse,

your child under ago; 21, or your parent."

t~~

o

No. Yes.

Stop. Do 1101 ill" this schedule. Si~fr-lings 1·9 and go to line 10 on page 2_ (Calendar yea I taxpayers do not haVE to cornptste this form Tor 200.ol.) having no household employees in 2004

..._----------__.:.__------'-------------------------

..._---,------

SrJcia! Security, Medicare, and Income Taxes

Total eash \'/~ge~ subjsc;

10 scclal s~curity

taxes Isee ;JaQo H·3)

L_1 _ __,__1
.._ _ _,

__

----"2'-"2'--',-=e5~5'_='5'_'__\J
".........

2

Social securit'J taxes. Multiply line 1 by -12.4% (:124; :-0(;:;1cash \'lag,;; ~l>biecllo
Medic~rR taxes. Multiply Medicare taxes (ses page 11·3)

.

Il~2-t4 5

-=2---"---'-7-=-9-'-7..::....

:?

I
_

3
"

I

22 555,
_..

!ins 3 by 2.9% (.029)

,

654.

6

Total 5(1';'<11 sncurttv,

Medkare,

and income taxes

(a,1d

III,"';

2,

Il.

and 5)

............................................ -1 11--'-+7
, __ __ , _ employees?

.•

.. c._

_

_.

!-"'S......,.,

..:3:...L_,4,_,S",___,,1:...:...

Net taxes
[)

(sut.lract

line 7 from line 6)

. quarter

L_;:8.....J.

~3:...Lr ",4",5,,---=,1'--'..,

Did you pay total cash wages of $1,000 or more In any calendar

of 2003 or 200410 housenold

~DI) not count cash wages paid in '2003 or 20C4 to your spouse. your child under ag'3 21. or your parent)

o
_"i"~
~.h.:::'

No.

Slop. Enter IhR 3mOIJnI from line
'!ilF

a ab'l'/Ei

en ~Qrmlr_o40, I'n~ 61. tf you are not required

to file Form 1040, see

Ime 9 lnstructions

on page lI·4.

Yes.

Gc rc li:1E' '10 on page 2

For Pape,,',-.;rwk Reduction

Act Notice. see Form 1040 instrucuons.

Schetluie

H (Form 1040) 2004

,i1·:;:·::'iJi 14.-~..!,·o,:

6

,

,

1':Ri:li-t Ii~,: I
.11 Did you

Sol,.duloH(Fcrm

10~O),OO~ BARACK H OBAM..i:\ Federal Un employment (FUT A) Tax

'10 Did you pay unemployment pay

contributions

to only one state? (11you paid contribuuons 2004 by f..pril

io New York State, check

'No.") ... " ....

j
.

allstate

unsmployment

contribunons fer

15, 2005?

Fiscal

year

filers. tax?

see

page .'1-4

12 Were all wages that

are

taxable for FUlA tax also taxable

lor your state's

unemployment

I

L1.L!

10

I

1,(,,5'
X X
i

i'lio.

l'-

12 : j['j

r~ext; If you checked the "Yes" box on all the lines above, complete Ssctlon Ali you checked the "No" box on any of the lines above, skip Section A and complete

SEction B.

Section A
13 Name 01 the state where you paid unarnployrnent contributions

I> 8 59 ,4.-.,2, 3':5
1

IL ,.,

~1.

::

16 Total cash

:~a;:i:~~O::::i:~::n:: wages SUbj6Ct

to FUTA

:~a:::::::::~::mr:~~:::i;::a~~~~ ,,..
,.[;>."'" •••.

_ ,.,1.)," •. .. ..3.,
1-1:.:6,--;__ ,

tax

(see page H-4)

. .....

7 000. 56.
(il
'!':-:"Itr;b'~IIc.t"i!
:Jiild

~1~7~F~U~-~IA~t~a~x~.~M~u~lt~ip~l~y~li~n_e_'_6_b~y_.O_0_B~,~E~n~t~e~r~th_~~"_rs_5_u_l_t_h~~_r~~,~S_I\~iP~S~e~c_;i~o~n_8 __ .,_I~'d~g~r_'I_o_!_ir._,e ~~6 ~~~~~~~~~~'~7~ , __ __ 18 Complete (a)
Name 01
.statE)!

all colcrms

below that apply

M you
(c)

need more

(b)
Slater~p:;r11"9 r,umb'!!,. ea snDwn on state I)",emp!lt~~nl Ia,\:

space,
(ell
?J'!'11r,l~

Section 6
Si!e page H-4): (e)
SI::lla excertence I ,at.:.

(f)
!i"luIHply eot

TW::::JbJe ecee {ru:i w dcf.lni!!:c :;hl~a.:Id' In .

~.ta:13e_).,ot'fl~flC:;l ialit r;,,cm in

te,

by ..1::5.1 (

tc
r..rf)oCl

:u.1I\ol

1Jn*·"n.:.Ji"'j.'j11~rl~

19 Totals
20 Add columns (h) and~) or line 19 ... __ ........ ,.....

'",
~ 20
FUlA. [a.~ (see the ],r,E '16 msrrucucna

--

.. 1LT-'19=-1'-T-

21 Total cash wages subjectto

em

pagE' 1-\·4)

22 23

Multiply line
Multiply

21 by 6.2% (.062!.. ..

,

..

J-22

~

__

~_

I

I

Um~21 by 5.'1% {.054J.

24 Enterthesmallerofline20oriine23
(New Ynrk

" .. , must use the worksheet

Slate

employers

in the

separere

Instructions

and check here) "

D

.. , .

I p.arllll'l
26

25 FUlA

tax, Subtract

line 24 from line 22. Enter the result here arid go to

line 26

Total HOllsehold Employment Taxes
:26 !-=~:.:.7_·--"-t
from line 27 above on For rn 1C40 !Ine 61. Do riot complete Part IV. See page H·<\ for details. pa.rt only if reqUired. Sae the lirle 28 Instructions on paglO H--L
• '·I:'::!•• :O::(J<.'1'!I ... " !:j[j·I .....',",.. 1 dE!']1\~~;;Ij,OJ street i:ld'cr;:,SE;

Enter the amount from line 8

_____

,3_1.j_SJ"-".

27 Add line 17 (or lirle 25) and

(inp.26
Fan IV below.

3"'," 50'

,

28 ArE! you required to file Form 10,)07

[X] Yes,

Stop. Enter the amount

I 'Parti\! I
';'=~~~!Ii(n.umhOr

o

No,

You may have to complete
end ~!ri!i!t'ot

Address and Signature - Complets U,is
P,o. D':;:':: ii m;;11 i5.nD~

----~~~-~~~~~--:--~~~-~~~--~~--~~---,.--:-:----Under nenanles pnyment madr;

or

'0

perj!.nv, I ::te:c.l,jlra 'hH~ ,I ocve =-~;amlrH!" ,hr:::. ::or.JlDdul-:.. Il1cl't.ldli'"J il:::'~I;_mf ••1n.:..'."'-; :;! .... t~I";'~~·,H•• u"'l~ 7'1."I;;!:! t1c!:=.[ .-::Ii u etete lJn-ern[}IO"imcn~ fun.d cl.ilImud,£ a cr~dil ',','o!!,~', I;Ir I~ tc tI';" L.hIOl.fl'.:I~~ r~_"!M1II,,,, mi(j,:-':'!i: .e ~...... -vjIjI'J-..:'~.

=~. .

m~'

knQwl'i."~:;:

c;1..J ::ir:lUl';!r. t i

f.Q uuc

...

=c.u!!u:~, Jna

------

:-::;:m:.lt'H,,; N.c· r;;=r: -:-1 ;;I~',

-noasa

I~--------------------------------------------------" E.mpfQyet'!!i ~1ijn~lLlre

-- r~~
Schedule H (Farm 104012004

'~·O-1-1J4

7

-_.-STATE ;U>TDl,QCM .. HrCmm , Tl\.X REFUNDS

-.--

---_
1

STATEl'1ENT

2003
ILLINOIS GROSS INC TAX REFlJl'lJ"DS LESS: TAX PAID IN FOLLOWING YEF~ NET T.'L,{ REFUNDS ILLINOIS STATE/LOCAL

2002

2001

305.

305.

1'O'1'A_L NET

TF_]-~ F.EFL"lIDS

3 05 •

8

STATEMENT(S)

1

BA...,l=lACI< NI CHELLE H &;

L OEAl-iA

FORM

1040

TAXA.BLE

STATE·

J.>._NDLOCAL

INCo:iYIE TA...X REFUNDS 2002 305. 2001

2

2003
NET TAX

LOCAL

REF~lDS FROM STATE M{D INCOME TAX REFUNDS ST:EiIT. BE~mFIT DUE

LESS:REFUNDS-NO

TO

J.>.~~

1
2

NET
TOTAL

REFUNDS

FOR RE~~LCULATION

305. 26,995. 305.

4
5 6

3

ITEMIZED DEDUCTIONS BEFORE PHASEOUT DEDUCTION NOT SUBJ TO PHASEOUT NET REFUNDS FROM LINE 1 LINE 2 xrmrs LINES MUL~IPLY LINE 5 BY 3 AND 4 80~ (.80) THRESHOLD

21,352.
238;327. 139,500.

26,690.

8
9

7

PRIOR YEF~ AGI

ITEM. DED. PHASEOUT

10 11

12
13A 13B 14

SUBTR.ll,.CT LINE 8 FROM LINE 7 (IF ZERO OR LESS, SKIP LINES 10 THROUGH 15, A}TD ENTER ~~OUNT FROM LINE 1 ON LI}ffi16) MULTIPLY LINE 9 BY 3% (.03) ALLOWABLE ITEMIZED DEDUCTIONS (LINE 5 LESS THE LESSER OF LINE 6 OR LINE 10) ITE]lIDED. NOT SUBJ TO PHl',SEOUT TOTAL PRIOR
ADJ.

98,827.

2,965.
23,725.

YR. PRIOR YR.

ITElHZED STD. DED. ALLOWABLE

DEDUCTIONS AVAILABLE ITEM. DED.

23,725. 9,500. 24,030.

15
16

17
18 19 20 21 22

THE GREATER OF LINE SUBTRACT 13A OR LINE 138 FROM LUTE 14 TA..K..AELE REFUNDS (LESSER OF LINE 15 OR LINE 1) . ALLOWABLE PRIOR YR. ITEllf DED. ILAIl LE PRIOR YEAR STD. DED. F._VA SUBTP..ACT LINE 18 FROM LINE 17 LESSER OF LINE 16 OR LUTE 19 INCOME PRIOR YEAR TAX..l'l...BLE

305. 24,030. 9,500. 14,530. 305. 205,025.

305.

AMOUNT TO INCLUDE ON FORN 1040, LUTE 10 '" IF LINE 21 IS -0- OR lvIORE,USE ';:\lIiOUNT FROM LINE 20 ;, IF LINE 21 IS A NEGATIVE AHOlTIlTT, NET L:::lifES AL'1D21 20 STATE TOTAL
F~D

305.

LOCAL

INCOME

TN{ REFu}TDS PRIOR
10

TO

2001

TO FORM

1040,

LINE

]05.

9

STATE:MEN'l'i E

I

~

E!1>..RACK H &. MICHELLE

L OBAlifA

FOR11 1040

li>TAGES RECEIVED

]\.j_\TDTAXES

WITHHELD

STATEMENT
CITY

3

T S EHPLOYER'S rll 'T

lIJj.\_l'iE

AMOUNT PAID 32,.144. 53,28B. 121,910. 207,342.

FEDERAL TAX WITHHELD
5,733.

STATE Tll.1{
WITHHELD

Tj.\..,X W/H

SDI

FICA TAX

MEDICARE

Tll_X

THE i.m IV"RRS ITY OF ILLINOIS COHPTROJJLER
cr'IIC.Z\GO 8'I'?.:rE OF

934.
1,544. 3,657. .. 6,1"3"5.

1,993.

466.
874.

5,81l. 35,084. 46,628

S f_THTiTERSIT1-

OF CHICAGO

HOSFI'l'ALS 'l'OTALS

5,450. 7,443.

1,783. 3,123.

-----------. ------------------------------------------------------------------------DE3CRIFTION
NI SCEI,LAN'EOUS SUBTOTALS TOTAL ORGANI ZED CHl>..RITIES MlOUNT 50% LINIT
.lll,{[OUNT

SCHEDULE

7>..

CASH

.CONTRIBUTIONS

'

-4

30% LII1IT

2,500.
2,500.

TO SCHEDULE

A, LINE

15

2,500.

1(:,

STATEMm~T(S)

3, 4

B_!l,__'R.AC1<H

&:

MI CHELLE

.L OBAN]l~

SCHEDULE

]l.~

ITEMIZED

DEDUCTIONS

t-TORKSHEET

STATEMENT

5

1.
2•

3.

4"

5.
6.
7.

LHl:ES 4, 9, 14, 18, , ..•....• ADD THE Jll.fOUNT S ON SCHED ULE P_, LINE S 4, 13, A.J,fD 19, PLUS JiliTY GAMBLING fI.NDCASU.~LTY OR THEFT LOSSES INCLUDED ON LIN'E 27 . ., , . . . . .. . .• ..".... IS THE )I._l10UNT ON LINE 2 LESS THAN THE )I._IyIOUl\IT ON LINE 1? IF NO, YOUR DEDUCTION IS NOT LIMITED. ENTER THE JL'10UNT FROM LINE 1 ABOVE ON SCHEDULE A, LINE 28. IF YES, SUBTRACT LINE 2 FROM LI,NE 1 • MULTIPLY LINE 3 ~~OVE BY 80% (,80) 21,581. ENTER THE AMOUNT FROM FORM 1040, LINE 36. 207,647. ENT.ER: $142,700 ($ 71,350 IF MJ"I.1mIED FILING _A..ND 27 ••••.....
I

A.DD 'rHE 19,26,

)I..MOUNTS ON SCHEDULE 1'.,

26,975.
0,

26,976

..

8.

9.
10.

IF NO, YOUR DEDUCTIOl>J IS NOT LHHTED. .ENTER THE AMOUNT FROM LINE 1 JI..BOVE ON SCHEDULE ~b", LIl:>iE 2.8. I.F YES I SUBTR.~CT LINE 6 FROM LINE 5 MlJLTIPLY LINE 7 ABOVE BY 3% (.03) .... ENTER THE SMALLER OF LINE 4 OR LINE B . " TOTAL

ON LINE 5?

BE]? ARATELY ) • • . •• IS THE _ZiMOUNT ON LINE

...•.

14 2

I

700 .

6 LESS

TH.!lli THE AlIiOU1\jT

64,.947.

L948. 1. 25,028.

ENTER

ITEMIZED DEDUCTIONS. THE RESULT HERE MID

SUBTRAC'I' LINE 9 FROM LINE ON SCHEDULE A, LINE 28

11

S'I'AT'EHEN',r! S

I

..

Tl/llo .. Year ·

Comparison 'Norkshee"i.:
_._L.l. ~S()C_i.al.~e~UrilYnum_b~_.r ._

;;ame(s i R, sllO~m nnreiurn BF_RACK H &, MICHELLE L OBAKW__ ?Oo:!. FII,ng StilTliS MARR I ED F I""L""I""N_,_.,G,,-' -,J",-,O""I=:l\~1.=.T ~D03 Ta~ (jrJ(:k~1 O. 0 %

.

__

I
1_ _ .. .... ~~

Dmiiptio'Ti
_=___; __ _;

TJ..JVl.BLE REFUNDS I' TOTAL INCOME
i;;DJIJSTED GROSS

"\oIAGES, SALARIES,

OF STATE/

AND TIPS

, :· ,niYeal':' . ~ 1',"- '".:~ :·~~.:,;'y'ear-[,-' , ' ,. +_---2-IiO-·3-· -,-_+-"_' __ I
2004 Tax Bracket
r'

-::20:::0:-:-4 g7S_ta7"iil-:-S"",:MAR",,:' -=FiI_in :"""",R,:,-,I:,",E""D""---,F"-"","I"""L=I~N""",G,-",J,"""O,""I,,,,l\,,,,JT,,_

28. 0 %

..• .~-

"'liq'i]:H~{ _;.
,+_

.: "

~-.
-_,

:.

__ ..:.;;' . . ~ .-~ '2Q~O-,-lt' ~ 1 ••'_"_"+-"·_',_~ _' '~._.:-(_:._o~_"o_re_as:_:e;),--"--""'--:---1'-, -~._!J. ...~"= ~ ,.... ~:I ..~'~~" ..

I,QeAL

TJ<x .....

238,327.1 0

238,327,
INC01<lE

.j

207,342.
305.

207,647. 207,647.

~30!9B5. 305. ~30,680. -30,680.

LA:,(ES jeONTEIBU'1'IONS i 'I"'OTA,L ITEMIZED ,
,

~TEREST

(DEDUCTIBLE)

DEDUCTIONS

11,354. 12,241. 3,400.
24,030.

10,08l.

14,395.
2,500
>

-1,273.

2,154.

25,028. 182,619. 12,.400.!
170,219. 37,619.

-900.
99B.

i:::HCOlY'ill BEFORE EXE.;.iPTIONS !PERSDl'·TAL EXEHPTIONS
T,A.;;~:'_i3LE INCmlE
I

214,297. 9,2'72.
205,025.

-31,678. 3,128. -34,806. -11,485. -11,485.

!:,!.~~...
I~--"

49,104CREDITS

T;'_X BEFORE

49,104. CREDITS TA..'l\:)

37,619. 36,919.

FORM
18CH.
!

TJl...x AFTER

2441

(CHILD

CJI.RECREDIT)
EMPLOYMENT

NON~REFUNDABLE

4.8,404. 3,452. 51,856. 53,381.1

700.

700. 55.

H (HOUSBHOL,D
TP'_x

TOTAL'

3,507.

!FEDERAL,

INCOHE TJ>._.XvHTHHELD 'rOTAi, PAY1~EJ,JTS

i

40,426. 46.628. 46,628. 6,202. 6,202.

-11,430.

T OVf'~HP AID ~",-HOUNT P.EFUNDED

xx

53,3.8,1" 'I' 1,525. 1,525. 230,327.

-6,753. -6,753.

4,677. 4,677. -3-0,985. -9.30. -896.
13.

'ILLINOIS

STATE

RETURN
,, "

fI' ,">-."'{
1

iTjl._JUI..BLE INCONE
I

6,910, 305.

199,34.2.
5,980.

!l'TON~REFUNDJl.BLE iPAY.MENTS ~l,mUNT REFUNDED

CREDITS

184. 7,031.

197. 6,135 "1
352.

47.