Publication 1436 (Rev. 10-2012) - Internal Revenue Service

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CORRECTED (if checked) PAYER’S name, street address, city, state, and ZIP code 1 Gross distribution Brushy Creek Enterprise 5555 Red Street $ 50,000 2a Taxable amount Monroe, LA 71201 50,000 PAYER’S federal identification number 69-0000005 RECIPIENT’S identification number $ 2b Taxable amount not determined 3 Capital gain (included in box 2a) OMB No. 1545-0119 2012 Form 1099-R Total distribution 4 Federal income tax withheld DRAFT AS OF $ 400-00-1032 7,500 $ 6 Net unrealized appreciation in employer’s securities Version A, Cycle 7 Image Dimensions: 7.3" x 5.1" Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Copy B Report this income on your federal tax return. If this form shows federal income tax withheld in box 4, attach this copy to your return. RECIPIENT’S name 5 Employee contributions Sue Magnolia /Designated Roth contributions or insurance premiums $ $ Street address (including apt. no.) 2030 Pecan Street City, state, and ZIP code Monroe, LA 71201 7 Distribution IRA/ 8 Other code(s) SEP/ SIMPLE $ % 9a Your percentage of total 9b Total employee contributions distribution % $ being furnished to the Internal Revenue Service. 10 Amount allocable to IRR 11 1st year of desig. Roth contrib. 12 State tax withheld 13 State/Payer’s state no. 14 State distribution within 5 years $ $ $ $ $ Account number (see instructions) 15 Local tax withheld 16 Name of locality 17 Local distribution $ $ $ $ Form 1099-R www.irs.gov/form1099r Department of the Treasury - Internal Revenue Service February 16, 2012This information is 44
Form 1040 Department of the Treasury—Internal Revenue Service (99) U.S. Individual Income Tax Return 2012 OMB No. 1545-0074 Version A, Cycle 5 IRS Use Only—Do not write or staple in this space. For the year Jan. 1–Dec. 31, 2012, or other tax year beginning , 2012, ending , 20 See separate instructions. Your first name and initial Last name Your social security number If a joint return, spouse’s first name and initial Last name Spouse’s social security number Home address (number and street). If you have a P.O. box, see instructions. Apt. no. ▲ Make sure the SSN(s) above and on line 6c are correct. City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign Check here if you, or your spouse if filing Foreign country name jointly, want $3 to go to this fund. Checking Foreign province/state/county Foreign postal code a box below will not change your tax or refund. You Spouse Filing Status 1 Single 4 Head of household (with qualifying person). (See instructions.) If 2 Married filing jointly (even if only one had income) the qualifying person is a child but not your dependent, enter this Check only one 3 Married filing separately. Enter spouse’s SSN above child’s name here. ▶ box. Exemptions 6a b and full name here. ▶ 5 Qualifying widow(er) with dependent child Yourself. If someone can claim you as a dependent, do not check box 6a . . . . . Boxes checked } on 6a and 6b Spouse . . . . . . . . . . . . . . . . . . . . . . . . No. of children c Dependents: (1) First name Last name (2) Dependent’s social security number (3) Dependent’s relationship to you (4) ✓ if child under age 17 qualifying for child tax credit (see instructions) on 6c who: • lived with you • did not live with you due to divorce If more than four or separation (see instructions) dependents, see instructions and Dependents on 6c not entered above check here ▶ d Total number of exemptions claimed . . . . . . . . . . . . . . . . . Add numbers on lines above ▶ Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7 8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a b Tax-exempt interest. Do not include on line 8a . . . 8b 9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a b Qualified dividends . . . . . . . . . . . 9b 10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10 1099-R if tax was withheld. 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11 Attach Form(s) W-2 here. For Also Testing Purposes attach Forms W-2G and 12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12 Only 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 DRAFT AS OF 21 Other income. List type and amount 21 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income July 3, 2012 ▶ 22 If you did not get a W-2, see instructions. Enclose, but do not attach, any payment. Also, please use Form 1040-V. 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ▶ 13 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14 15 a IRA distributions . 15a b Taxable amount . . . 15b 16 a Pensions and annuities 16a b Taxable amount . . . 16b 18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18 19 Unemployment compensation . . . . . . . . . . . . . . . . . 19 20 a Social security benefits 20a b Taxable amount . . . 20b Adjusted Gross Income 23 24 25 Reserved . . . . . . . . . . . . . Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ Health savings account deduction. Attach Form 8889 . 23 24 25 26 Moving expenses. Attach Form 3903 . . . . . . 26 27 Deductible part of self-employment tax. Attach Schedule SE . 27 28 Self-employed SEP, SIMPLE, and qualified plans . . 28 29 Self-employed health insurance deduction . . . . 29 30 Penalty on early withdrawal of savings . . . . . . 30 31 a Alimony paid b Recipient’s SSN ▶ 31a 32 IRA deduction . . . . . . . . . . . . . 32 33 Student loan interest deduction . . . . . . . . 33 34 Reserved . . . . . . . . . . . . . . 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . ▶ 37 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see 45 separate instructions. Cat. No. 11320B Form 1040 (2012)
Page 1 and 2: Procedures Test Package for the for
Page 3 and 4: INTRODUCTION…………………
Page 5 and 6: INTRODUCTION This Publication will
Page 7 and 8: Test Process Are there Differences
Page 9 and 10: WHO MUST TEST? The Submission Proce
Page 11 and 12: SOFTWARE DEVELOPER ACCEPTANCE PROCE
Page 13 and 14: The IRS will only accept these SSNs
Page 15 and 16: Form 1040 Department of the Treasur
Page 17 and 18: Employer identification number (EIN
Page 19 and 20: SCHEDULE B (Form 1040A or 1040) Dep
Page 21 and 22: Form Department of the Treasury—I
Page 25 and 26: Form 2441 (2012) Part III Dependent
Page 27 and 28: SCHEDULE 8812 (Form 1040A or 1040)
Page 31 and 32: Version A, Cycle 3 Form 8880 Depart
Page 35 and 36: Enclose, but do not attach, any pay
Page 37 and 38: Tax Year 2012 Assurance Testing Sys
Page 39 and 40: Forms and schedules that may be fil
Page 41 and 42: WHAT IS TESTED? The test package fo
Page 43 and 44: PRACTIONER PIN Taxpayers using an E
Page 45 and 46: SOCIAL SECURITY RANGE FOR STATE RET
Page 47: Employer identification number (EIN
Page 53 and 54: Form 2555 (2012) Page 3 Part V All
Page 57 and 58: Version A, Cycle 5 Form 1040 For (2
Page 59 and 60: Form 8938 (November 2012) Departmen
Page 61 and 62: ATS Test Scenario 3 Taxpayer: Sam a
Page 67 and 68: SCHEDULE C (Form 1040) Profit or Lo
Page 69 and 70: SCHEDULE EIC (Form 1040A or 1040) D
Page 71 and 72: Form 8862 (Rev. December 2012) Depa
Page 75 and 76: Version A, Cycle 1 Form 8867 (2012)
Page 81 and 82: CORRECTED (if checked) PAYER’S na
Page 83 and 84: Version A, Cycle 2 Schedule E (Form
Page 85 and 86: SCHEDULE J (Form 1040) Department o
Page 87 and 88: DRAFT AS OF 9 Chemicals. . . . . .
Page 89 and 90: ATS Test Scenario 05 Taxpayer: Zeus
Page 93 and 94: CORRECTED (if checked) PAYER’S na
Page 95 and 96: Version A, Cycle 2 SCHEDULE A (Form
Page 97 and 98: Part III Complete this DRAFT part t
Page 99 and 100:
Form 6198 At-Risk Limitations OMB N
Page 101 and 102:
DRAFT AS OF 5 Meals and entertainme
Page 103 and 104:
Form 1040 Department of the Treasur
Page 105 and 106:
Employer identification number (EIN
Page 107 and 108:
Form 1040 Department of the Treasur
Page 109 and 110:
Page 111 and 112:
CORRECTED (if checked) PAYER’S na
Page 113 and 114:
Version A, Cycle 2 SCHEDULE A (Form
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ATS/PATS Test Scenario 8 Taxpayer:
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Version A, Cycle 5 Form 1040 For (2
Page 119 and 120:
Version A, Cycle 2 SCHEDULE A (Form
Page 121 and 122:
Page 123 and 124:
Version A, Cycle 5 Form 1040A (2012
Page 125 and 126:
Form 2441 Child and Dependent Care
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SCHEDULE EIC (Form 1040A or 1040) D
Page 129 and 130:
Version B, Cycle 6 Schedule 8812 (F
Page 131 and 132:
Form 8863 (2012) Page 2 Name(s) sho
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
ATS Test Scenario 11 Taxpayer: Edga
Page 139 and 140:
Section A—Farm Income—Cash Meth
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DRAFT AS OF b Multiply line 5a by 9
Page 143 and 144:
ATS Test Scenario 12 Taxpayer: Susa
Page 145 and 146:
ATS Test Scenario 13 Taxpayer: Apri
Page 147 and 148:
Form 9465 ATS Test Scenario 14 Taxp
Page 149 and 150:
ATS Test Scenario 15 Taxpayer: Lind
Page 151 and 152:
Test Scenario 16 Taxpayer: Joann Bi
Page 153:
Form 56 (Rev. 12-2011) Page 2 Part
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Publication 1436 (Rev. 10-2012) - Internal Revenue Service

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