1040 U.S. Individual Income Tax Return 2013

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1 F or Department of the Treasury Internal Revenue Service (99) U.S. Individual Income Tax Return 23 m OMB No IRS Use Only Do not write or staple in this space. For the year Jan. Dec. 3, 23, or other tax year beginning, 23, ending,2 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. 65 Ocean Way City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Gulfport FL 3377 Filing Status Check only one box. Exemptions If more than four dependents, see instructions and check here Income Attach Form(s) W-2 here. Also attach Forms W-2G and 99-R if tax was withheld. If you did not get a W-2, see instructions. Adjusted Gross Income 2 3 Single Married filing jointly (even if only one had income) Married filing separately. Enter spouse's SSN above and full name here. Head of household (with qualifying person). (See instr.) If the qualifying person is a child but not your dependent, enter this child's name here. 7 Wages, salaries, tips, etc. Attach Form(s) W a Taxable interest. Attach Schedule B if required b Tax-exempt interest. Do not include on line 8a b 9a Ordinary dividends. Attach Schedule B if required b Qualified dividends b 3 Capital gain or (loss). Attach Schedule D if required. If not required, check here Other gains or (losses). Attach Form a IRA distributions a b Taxable amount... 6a Pensions and annuities a b Taxable amount... 7 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E Farm income or (loss). Attach Schedule F Unemployment compensation a Social security benefits 2a b Taxable amount Other income. List type and amount _ 22 Combine the amounts in the far right column for lines 7 through 2. This is your total income 23 Educator expenses Penalty on early withdrawal of savings a Alimony paid b Recipient's SSN 32 IRA deduction Qualifying widow(er) with dependent child Boxes checked 6a Yourself. If someone can claim you as a dependent, do not check box 6a on 6a and 6b No. of children b Spouse on 6c who: () c Dependents: (2) Dependent's (3) Dependent's Vif child under age 7 () First name Last name social security number relationship to you 2 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 26 or 26-EZ Health savings account deduction. Attach Form Moving expenses. Attach Form Deductible part of self-employment tax. Attach Schedule SE Self-employed SEP, SIMPLE, and qualified plans Self-employed health insurance deduction a Apt. no. Foreign country name Foreign province/state/county Foreign postal code d Total number of exemptions claimed Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or (loss). Attach Schedule C or C-EZ Student loan interest deduction Tuition and fees. Attach Form Domestic production activities deduction. Attach Form Add lines 23 through Subtract line 36 from line 22. This is your adjusted gross income For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. 5 qualifying for child tax credit (see instructions) Make sure the SSN(s) above and on line 6c are correct. Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund You Spouse lived with you did not live with you due to divorce or separation (see instructions) Dependents on 6c not entered above Add numbers on lines above 7 8a 9a 2 3 5b 6b b , 2,2 7,2 5, 5, Form (23)

2 Form (23) Tax and Credits Standard Deduction for People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions. All others: Single or Married filing separately, $6, Married filing jointly or Qualifying widow(er), $2,2 Head of household, $8,95 Other Taxes Payments If you have a qualifying child, attach Schedule EIC. Refund Direct deposit? See instructions. Amount You Owe Third Party Designee Sign Here Joint return? See instructions. Keep a copy for your records. Paid Preparer Use Only 38 Amount from line 37 (adjusted gross income) a Check You were born before January 2, 99, Blind. Total boxes if: Spouse was born before January 2, 99, Blind. checked 39a b If your spouse itemizes on a separate return or you were a dual-status alien, check here 39b Itemized deductions (from Schedule A) or your standard deduction (see left margin) Subtract line from line Exemptions. If line 38 is $5, or less, multiply $3,9 by the number on line 6d. Otherwise, see instructions. 3 Taxable income. Subtract line 2 from line. If line 2 is more than line, enter Tax (see instructions). Check if any from: a Form(s) 88 b Form 972 c Alternative minimum tax (see instructions). Attach Form Add lines and Foreign tax credit. Attach Form 6 if required Credit for child and dependent care expenses. Attach Form Education credits from Form 8863, line Retirement savings contributions credit. Attach Form Child tax credit. Attach Schedule 882, if required Residential energy credits. Attach Form Other credits from Form: a 38 b 88 c 53 5 Add lines 7 through 53. These are your total credits Subtract line 5 from line 6. If line 5 is more than line 6, enter Self-employment tax. Attach Schedule SE Unreported social security and Medicare tax from Form: 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required a Household employment taxes from Schedule H b First-time homebuyer credit repayment. Attach Form 55 if required Add lines 55 through 6. This is your total tax Federal income tax withheld from Forms W-2 and estimated tax payments and amount applied from 22 return a Earned income credit (EIC) b Nontaxable combat pay election b 65 Additional child tax credit. Attach Schedule Amount paid with request for extension to file Credit for federal tax on fuels. Attach Form Credits from Form: a 239 b Reserved c 8885 d 7 72 Add lines 62, 63, 6a, and 65 through 7. These are your total payments If line 72 is more than line 6, subtract line 6 from line 72. This is the amount you overpaid... 7a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here.... b Routing number c Type: Checking Savings d Account number 75 Amount of line 73 you want applied to your 2 estimated tax Amount you owe. Subtract line 72 from line 6. For details on how to pay, see instructions 77 Estimated tax penalty (see instructions) Do you want to allow another person to discuss this return with the IRS (see instructions)? Designee's name Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date Your occupation Daytime phone number Spouse's signature. If a joint return, both must sign. Print/Type preparer's name Firm's name Firm's address Date Phone no. a 37 b Taxes from: a Form 8959 b Form 896 c Instructions; enter code(s) 6 66 American opportunity credit from Form 8863, line Reserved Excess social security and tier RRTA tax withheld Preparer's signature Manager Spouse's occupation 6a Date Firm's EIN Phone no. 7, a 59b a 76 Yes. Complete below Personal indentification number (PIN) Page 2 5, 9,387 32,3 3,9 28,3 7,8,27,27 No If the IRS sent you an Identity Protection PIN, enter it here (see inst.) PTIN Check if self-employed Form (23)

3 SCHEDULE A (Form ) Itemized Deductions Information about Schedule A and its separate instructions is at Department of the Treasury Internal Revenue Service (99) Attach to Form. Name(s) shown on Form Medical and Dental Expenses Taxes You Paid Interest You Paid Note. Your mortgage interest deduction may be limited (see instructions). Gifts to Charity If you made a gift and got a benefit for it, see instructions. Caution. Do not include expenses reimbursed or paid by others. Medical and dental expenses (see instructions) ,7 2 Enter amount from Form, line , 3 Multiply line 2 by % (.). But if either you or your spouse was born before January 2, 99, multiply line 2 by 7.5% (.75) instead 3 5, Subtract line 3 from line. If line 3 is more than line, enter State and local (check only one box): a. Income taxes or ,5 b. General sales taxes 6 Real estate taxes (see instructions) ,2 7 Personal property taxes Other taxes. List type and amount 8 9 Add lines 5 through Home mortgage interest and points reported to you on Form ,7 Home mortgage interest not reported to you on Form 98. If paid to the person from whom you bought the home, see instructions and show that person's name, identifying no., and address _ 2 Points not reported to you on Form 98. See instructions for special rules Mortgage insurance premiums (see instructions) 3 Investment interest. Attach Form 952 if required. (See instructions) 5 Add lines through Gifts by cash or check. If you made any gift of $25 or more, see instructions Other than by cash or check. If any gift of $25 or more, see instructions. You must attach Form 8283 if over $ Carryover from prior year Add lines 6 through Casualty and Theft Losses 2 Casualty or theft loss(es). Attach Form 68. (See instructions.) Job Expenses 2 Unreimbursed employee expenses job travel, union dues, job education, etc. Attach Form 26 or 26-EZ if required. and Certain (See instructions.) Union dues $8 Miscellaneous _ Job-hunting expenses _ $925 _ Deductions _ 22 Tax preparation fees Other expenses investment, safe deposit box, etc. List type and amount _ Other Miscellaneous Deductions Total Itemized Deductions _ 23 2 Add lines 2 through , Enter amount from Form, line , 26 Multiply line 25 by 2% (.2) ,28 27 Subtract line 26 from line 2. If line 26 is more than line 2, enter Other from list in instructions. List type and amount 29 Is Form, line 38, over $5,? 2 22 OMB No Attachment Sequence No. 7 Your social security number,725 6 No. Your deduction is not limited. Add the amounts in the far right column for lines through 28. Also, enter this amount on Form, line ,387 Yes. Your deduction may be limited. See the Itemized Deductions Worksheet in the instructions to figure the amount to enter. 3 If you elect to itemize deductions even though they are less than your standard deduction, check here For Paperwork Reduction Act Notice, see Form instructions. Schedule A (Form ) ,33,7 9,7 2,36,297

4 SCHEDULE B (Form A or ) Department of the Treasury Internal Revenue Service Name(s) shown on return Part I Interest (99) Interest and Ordinary Dividends Attach to Form A or. Information about Schedule B (A or ) and its instructions is a OMB No Attachment Sequence No. 8 Your social security number List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see instructions and list Amount this interest first. Also, show that buyer's social security number and address Beach National Bank 2,2 (See instructions for Schedule B, and the instructions for Form A, or Form, line 8a.) Note: If you received a Form 99-INT, Form 99-OID, or substitute statement from a brokerage firm, list the firm's name as the payer and enter the total interest shown on that form. Part II 2 Add the amounts on line Excludable interest on series EE and I U.S. savings bonds issued after 989. Attach Form Subtract line 3 from line 2. Enter the result here and on Form A, or Form, line 8a Note: If line is over $,5, you must complete Part III. 5 List name of payer 2 3 2,2 2,2 Amount Ordinary Dividends (See the instructions for Schedule B, and the instructions for Form A, or Form, line 9a.) 5 Note: If you received a Form 99-DIV or substitute statement from a brokerage firm, list the firm's name as the payer and enter the ordinary dividends shown on that form. Part III Foreign Accounts and Trusts 6 Add the amounts on line 5. Enter the total here and on Form A, or Form, line 9a Note. If line 6 is over $,5, you must complete Part III. You must complete this part if you (a) had over $,5 of taxable interest or ordinary dividends; (b) had a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. 7a At any time during 23, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign country? See instructions If Yes, are you required to file FinCEN Form, Report of Foreign Bank and Financial Accounts (FBAR), formerly TD F to report that financial interest or signature authority? See FinCEN Form and its instructions for filing requirements and exceptions to those requirements... (See b If you are required to file FinCEN Form, enter the name of the foreign country where the financial account is located _ instructions.) 8 During 23, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If "Yes," you may have to file Form 352. See instructions For Paperwork Reduction Act Notice, see your tax return instructions. Schedule B (Form A or ) 23 Yes No

5 OMB No Form 68 Information about Form 68 and its separate instructions is at 23 Attach to your tax return. Department of the Treasury Attachment Internal Revenue Service Use a separate Form 68 for each casualty or theft. Sequence No. 26 Name(s) shown on tax return Identifying number SECTION A Personal Use Property (Use this section to report casualties and thefts of property not used in a trade or business or for income-producing purposes.) Description of properties (show type, location, and date acquired for each property). Use a separate line for each property lost or damaged from the same casualty or theft. Property A Property B Property C Property D 2 Cost or other basis of each property Insurance or other reimbursement (whether or not you filed a claim) (see instructions) Note: If line 2 is more than line 3, skip line. Gain from casualty or theft. If line 3 is more than line 2, enter the difference here and skip lines 5 through 9 for that column. See instructions if line 3 includes insurance or other reimbursement you did not claim, or you received payment for your loss in a later tax year Fair market value before casualty or theft Fair market value after casualty or theft Subtract line 3 from line 8. If zero or less, enter Casualties and Thefts Diamond ring bedroom dresser 6/5/82 7 Subtract line 6 from line Enter the smaller of line 2 or line Casualty or theft loss. Add the amounts on line 9 in columns A through D Subtract line from line Add the amounts on line 2 of all Forms Add the amounts on line of all Forms If line is more than line 3, enter the difference here and on Schedule D. Do not complete the rest of this section (see instructions) If line is less than line 3, enter -- here and go to line 6. If line is equal to line 3, enter -- here. Do not complete the rest of this section. 6 If line is less than line 3, enter the difference Properties A B C D 7,6 Enter the smaller of line or $ Caution: Use only one Form 68 for lines 3 through 8.,, 7,6 7, ,6 7,5 7,5 7,5 7 Enter % of your adjusted gross income from Form, line 38, or Form NR, line 37. Estates and trusts, see instructions , 8 Subtract line 7 from line 6. If zero or less, enter --. Also enter the result on Schedule A (Form ), line 2, or Form NR, Schedule A, line 6. Estates and trusts, enter the results on the "Other deductions" line of your tax return For Paperwork Reduction Act Notice, see instructions. 8 2,36 Form 68 (23)

6 Form 68 (23) 2 Insurance or other reimbursement (whether or not you filed a claim). See the instructions for line Note: If line 2 is more than line 2, skip line Gain from casualty or theft. If line 2 is more than line 2, enter the difference here and on line 29 or line 3, column (c), except as provided in the instructions for line 33. Also, skip lines 23 through 27 for that column. See the instructions for line if line 2 includes insurance or other reimbursement you did not claim, or you received payment for your loss in a later tax year.. Attachment Sequence No. 26 Name(s) shown on tax return. Do not enter name and identifying number if shown on first page of this form. SECTION B Business and Income-Producing Property Part I Casualty or Theft Gain or Loss (Use a separate Part I for each casualty or theft.) 2 Cost or adjusted basis of each property Fair market value before casualty or theft Note: If the property was totally destroyed by casualty or lost from theft, enter on line 26 the amount from line 2. A B C D Casualty or Theft of Property Held One Year or Less ( ) ( ) ( ) ( ) ( ) ( ) 32 Enter the amount from line 3, column (b)(ii) here. Individuals, enter the amount from income-producing property on Schedule A (Form ), line 28, or Form NR, Schedule A, line, and enter the amount from property used as an employee on Schedule A (Form ), line 23, or Form NR, Schedule A, line 9. Estates and trusts, partnerships, and S corporations, see instructions.. 33 Casualty or theft gains from Form 797, line Total gains. Add lines 33 and 3, column (c) Add amounts on line 35, columns (b)(i) and (b)(ii) If the loss on line 37 is more than the gain on line 36: a Combine line 35, column (b)(i) and line 36, and enter the net gain or (loss) here. Partnerships (except electing large partnerships) and S corporations, see the note below. All others, enter this amount on Form 797, line. If Form 797 is not otherwise required, see instructions b Enter the amount from line 35, column (b)(ii) here. Individuals, enter the amount from income-producing property on Schedule A (Form ), line 28, or Form NR, Schedule A, line, and enter the amount from property used as an employee on Schedule A (Form ), line 23, or Form NR, Schedule A, line 9. Estates and trusts, enter on the "Other deductions" line of your tax return. Partnerships (except electing large partnerships) and S corporations, see the note below. Electing large partnerships, enter on Form 65-B, Part II, line If the loss on line 37 is less than or equal to the gain on line 36, combine lines 36 and 37 and enter here. Partnerships (except electing large partnerships), see the note below. All others, enter this amount on Form 797, line Note: Partnerships, enter the amount from line 38a, 38b, or line 39 on Form 65, Schedule K, line. S corporations, enter the amount from line 38a or 38b on Form 2S, Schedule K, line Properties 28 Casualty or theft loss. Add the amounts on line 27. Enter the total here and on line 29 or line 3 (see instructions). Part II Summary of Gains and Losses (from separate Parts I) 29 (a) Identify casualty or theft 3 Totals. Add the amounts on line Total losses. Add amounts on line 3, columns (b)(i) and (b)(ii) (b) Losses from casualties or thefts (i) Trade, business, rental or royalty property 28 (ii) Incomeproducing and employee property 3 Combine line 3, columns (b)(i) and (c). Enter the net gain or (loss) here and on Form 797, line. If Form 797 is not otherwise required, see instructions Identifying number 9 Description of properties (show type, location, and date acquired for each property). Use a separate line for each property lost or damaged from the same casualty or theft. See instructions if claiming a loss due to a Ponzi-type investment scheme and Section C is not completed. Property A Property B Property C Property D 2 Fair market value after casualty or theft Subtract line 2 from line Enter the smaller of line 2 or line Subtract line 2 from line 26. If zero or less, enter a 38b 39 Page 2 (c) Gains from casualties or thefts includible in income Casualty or Theft of Property Held More Than One Year 33 ( ) ( ) ( ) ( ) 35 ( ) ( ) Form 68 (23)

7 Form 68 (23) Name(s) shown on tax return. SECTION C Theft Loss Deduction for Ponzi-Type Investment Scheme Using the Procedures in Revenue Procedure 29-2 (Complete this section in lieu of Appendix A in Revenue Procedure See instructions.) Part I Computation of Deduction Initial investment Subsequent investments (see instructions) Withdrawals for all years (see instructions) Part II Required Statements and Declarations (See instructions.) I am claiming a theft loss deduction pursuant to Revenue Procedure 29-2 from a specified fraudulent arrangement conducted by the following individual or entity. I have written documentation to support the amounts reported in Part I of this Section C. 3 Identifying number 2 Income reported on your tax returns for tax years prior to the discovery year (see instructions) Add lines,, and Subtract line from line 3. This is your total qualified investment Enter.95 (95%) if you have no potential third-party recovery. Enter.75 (75%) if you have potential third-party recovery Multiply line 6 by line Actual recovery Potential insurance/securities Investor Protection Corporation (SIPC) recovery Add lines 8 and 9. This is your total recovery Subtract line 5 from line 7. This is your deductible theft loss. Include this amount on line 28. Do not complete lines 9-27 for this loss. Then complete Section B, Part II Name of individual or entity Taxpayer identification number (if known) Address I am a qualified investor as defined in section.3 of Revenue Procedure If I have determined the amount of my theft loss deduction using.95 on line 6 above, I declare that I have not pursued and do not intend to pursue any potential third-party recovery, as that term is defined in section. of Revenue Procedure I agree to comply with the conditions and agreements set forth in Revenue Procedure 29-2 and this Section C. If I have already filed a return or amended return that does not satisfy the conditions in section 6.2 of Revenue Procedure 29-2, I agree to all adjustments or actions that are necessary to comply with those conditions. The tax year(s) for which I filed the return(s) or amended return(s) and the date(s) on which they were filed are as follows: Page 3 Form 68 (23)

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