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1 Department of the Treasury Internal Revenue Service (99) 1040 U.S. Individual Income Tax Return 2016 OMB No For the year Jan. 1-Dec. 31, 2016, or other tax year beginning, ending Form Your first name and initial Bob B Last name Bobster If a joint return, spouse's first name and initial Last name IRS Use Only Do not write or staple in this space. See separate instructions. Your social security number 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)., Foreign country name Foreign province/state/county Foreign postal code Filing Status Check only one box. Exemptions If more than four dependents, see instructions and check here 1 Single 2 Married filing jointly (even if only one had income) 3 Married filing separately. Enter spouse's SSN above and full name here. Head of household (with qualifying person). (See instructions.) If the qualifying person is a child but not your dependent, enter this child's name here. Qualifying widow(er) with dependent child 6a Yourself. If someone can claim you as a dependent, do not check box 6a b Spouse c Dependents: (4) if child (2) Dependent's (3) Dependent's under age 17 social security number relationship to you qualifying for child tax credit (1) First name Last name (see instr.) 4 5 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 Boxes checked on 6a and 6b No. of children on 6c who: lived with you did not live with you due to divorce or separation (see instructions) Dependents on 6c not entered above Income Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld. If you did not get a W-2, see instructions. Adjusted Gross Income d Total number of exemptions claimed Wages, salaries, tips, etc. Attach Form(s) W a Taxable interest. Attach Schedule B if required a b Tax-exempt interest. Do not include on line 8a b 9a Ordinary dividends. Attach Schedule B if required a b Qualified dividends b 1,00 10 Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or (loss). Attach Schedule C or C-EZ 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 b 16a Pensions and annuities.. 16a b Taxable amount b 17 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.. 20a b Taxable amount b 22 Combine the amounts in the far right column for lines 7 through. This is your total income Educator expenses Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 06 or 06-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 Penalty on early withdrawal of savings a Other income. List type and amount Alimony paid b Recipient's SSN 31a IRA deduction 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 Add numbers on lines above 1 50,00 1,10 1,50 16,00 68,60 68,60 Form 1040 (2016)

2 Form 1040 (2016) 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, $6,300 Married filing jointly or Qualifying widow(er), $12,600 Head of household, $9, Amount from line 37 (adjusted gross income) a Check You were born before January 2, 1952, Blind. Total boxes if: { Spouse was born before January 2, 1952, Blind. checked 39a 0 b If your spouse itemizes on a separate return or you were a dual-status alien, check here 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) Subtract line 40 from line Exemptions Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c Alternative minimum tax (see instructions). Attach Form Excess advance premium tax credit repayment. Attach Form Add lines 44, 45, and Foreign tax credit. Attach Form 1116 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 8812, if required Residential energy credits. Attach Form c Add lines 48 through 54. These are your total credits Subtract line 55 from line 47. If line 55 is more than line 47, enter Self-employment tax. Attach Schedule SE Unreported social security and Medicare tax from Form: a 4137 b Other Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59 Taxes a Household employment taxes from Schedule H a b First-time homebuyer credit repayment. Attach Form 5405 if required b 61 Health care: individual responsibility (see instructions) Full-year coverage Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) Add lines 56 through 62. This is your total tax Payments 64 Federal income tax withheld from Forms W-2 and estimated tax payments and amount applied from 2015 return 65 If you have a 66a Earned income credit (EIC) NO a qualifying child, attach b Nontaxable combat pay election.. 66b Schedule EIC. 67 Additional child tax credit. Attach Schedule American opportunity credit from Form 8863, line Net premium tax credit. Attach Form Amount paid with request for extension to file Excess social security and tier 1 RRTA tax withheld Credit for federal tax on fuels. Attach Form Refund Direct deposit? See instructions. Amount You Owe Third Party Designee Sign Here Joint return? See instr. Keep a copy for your records. Paid Preparer Use Only 73 a 2439b c d Add lines 64, 65, 66a, and 67 through 73. These are your total payments If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here a b Routing number c Type: Checking Savings 77 d Account number Amount of line 75 you want applied to your 2017 estimated tax 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions Estimated tax penalty (see instructions) Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. Designee's Phone Personal identification name no. number (PIN) Your signature Spouse's signature. If a joint return, both must sign. Print/Type preparer's name Firm's name Firm's address Preparer's signature Date Date Date 77 Your occupation Spouse's occupation Page 2 If the IRS sent you an Identity Protection PIN, enter it here (see inst.) Check if PTIN self-employed Firm's EIN Phone no. Daytime phone number 68,60 6,30 62,30 4,05 58,25 8,84 8,84 8,84 8,84 No 9, Form 1040 (2016)

3 SCHEDULE B (Form 1040A or 1040) Department of the Treasury Internal Revenue Service (99) Name(s) shown on return Attach to Form 1040A or 104 Part I Interest 1 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 this interest first. Also, show that buyer's social security number and address Amount US Bank Foreign Bank 10 1,00 (See instructions for Form 1040A, or Form 1040, line 8a.) Interest and Ordinary Dividends 1 OMB No Attachment Sequence No. 08 Your social security number Note: If you received a Form 1099-INT, Form 1099-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 Attach Form Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a Note: If line 4 is over $1,500, you must complete Part III. 5 List name of payer ,10 1,10 Amount US Brokerage 1,50 Ordinary Dividends (See instructions for Form 1040A, or Form 1040, line 9a.) Note: If you received a Form 1099-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. 6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a Note: If line 6 is over $1,500, you must complete Part III. You must complete this part if you (a) had over $1,500 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. Part III 7a At any time during 2016, did you have a financial interest in or signature authority over a financial Foreign account (such as a bank account, securities account, or brokerage account) located in a foreign Accounts country? See instructions and Trusts If "Yes," are you required to file FinCEN Form 114, Report of Foreign Bank and Financial (See instructions.) 8 b Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those requirements If you are required to file FinCEN Form 114, enter the name of the foreign country where the financial account is located During 2016, 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 1040A or 1040) /08/ :30:48PM 5 6 1,50 Yes No

4 SCHEDULE D (Form 1040) Department of the Treasury Internal Revenue Service (99) Name(s) shown on return Part I Capital Gains and Losses OMB No Attach to Form 1040 or Form 1040NR. Information about Schedule D and its separate instructions is at Attachment Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 1 Sequence No. 12 Your social security number (d) Proceeds (sales price) (e) Cost (or other basis) (g) Adjustments to gain or loss from Form(s) 8949, Part I, line 2, column (g) 4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss 7 Carryover Worksheet in the instructions Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any 6 long-term capital gains or losses, go to Part II below. Otherwise, go to Part III on page Part II This form may be easier to complete if you round off (sales price) (or other basis) cents to whole dollars. 8a Totals for all long-term transactions reported on Form 1099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 8b b Totals for all transactions reported on Form(s) 8949 with Box D checked Totals for all transactions reported on Form(s) 8949 with Box E checked Totals for all transactions reported on Form(s) 8949 with Box F checked Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from Forms 4684, 6781, and Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K Short-Term Capital Gains and Losses - Assets Held One Year or Less See instructions for how to figure the amounts to enter on the lines below. This form may be easier to complete if you round off cents to whole dollars. 1a Totals for all short-term transactions reported on Form 1099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 1b b Totals for all transactions reported on Form(s) 8949 with Box A checked Totals for all transactions reported on Form(s) 8949 with Box B checked Totals for all transactions reported on Form(s) 8949 with Box C checked Long-Term Capital Gains and Losses - Assets Held More Than One Year See instructions for how to figure the amounts to enter on the lines below. (d) Proceeds (g) Adjustments to gain or loss from Capital gain distributions. See the instructions Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover Worksheet in the instructions Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on page (h) Gain or (loss) Subtract column (e) from column (d) and combine the result with column (g) 2, ,00 ( ) (h) Gain or (loss) Subtract column (e) from column (d) and combine the result with column (g) ( ) For Paperwork Reduction Act Notice, see your tax return 01/08/2017 instructions. 02:30:48PM Schedule D (Form 1040) 2016 (e) Cost Form(s) 8949, Part II, line 2, column (g) 2,00 14, ,00 14,00

5 Schedule D (Form 1040) 2016 Part III Summary Page 2 16 Combine lines 7 and 15 and enter the result ,00 If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line 14. Then go to line 17 below. If line 16 is a loss, skip lines 17 through 20 below. Then go to line. Also be sure to complete line 22. If line 16 is zero, skip lines 17 through below and enter -0- on Form 1040, line 13, or Form 1040NR, line 14. Then go to line Are lines 15 and 16 both gains? Yes. Go to line 18. No. Skip lines 18 through, and go to line Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet in the instructions Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in the instructions Are lines 18 and 19 both zero or blank? Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44 (or in the instructions for Form 1040NR, line 42). Don't complete lines and 22 below. No. Complete the Schedule D Tax Worksheet in the instructions. Don't complete lines and 22 below. If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of: The loss on line 16 or ($3,000), or if married filing separately, ($1,500) ( ) Note: When figuring which amount is smaller, treat both amounts as positive numbers. 22 Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b? Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44 (or in the instructions for Form 1040NR, line 42). No. Complete the rest of Form 1040 or Form 1040NR. Schedule D (Form 1040) /08/ :30:48PM

6 Name(s) show n on Form 1040 Your social security num ber Qualified Dividends and Capital Gain Tax Worksheet Supporting Details for Form 1040, Line Enter your taxable income from Form 1040, line 43. However, if you are filing Form 2555 (relating to foreign earned income), enter the amount from line 3 of the Foreign Earned Income Tax Worksheet ,25 2. Enter your qualified dividends from Form 1040, line 9b* ,00 3. Are you filing Schedule D?* Yes. Enter the smaller of line 15 or 16 of Schedule D. If either line 15 or line 16 is a loss, enter ,00 No. Enter the amount from Form 1040, line Add lines 2 and ,00 5. If filing Form 4952 (used to figure investment interest expense deduction), enter any amount from line 4g of that form. Otherwise, enter Subtract line 5 from line 4. If zero or less, enter ,00 7. Subtract line 6 from line 1. If zero or less, enter ,25 8. Enter: $37,650 if single or married filing separately, $75,300 if married filing jointly or qualifying widow(er), or 8. 37,65 $50,400 if head of household. 9. Enter the smaller of line 1 or line ,65 1 Enter the smaller of line 7 or line , Subtract line 10 from line 9. This amount is taxed at 0% Enter the smaller of line 1 or line , Enter the amount from line Subtract line 13 from line , Enter: $415,050 if single, $233,475 if married filing separately ,05 01/08/17 02:31PM

7 $466,950 if married filing jointly or qualifying widow(er), or $441,000 if head of household 16. Enter the smaller of line 1 or line , ,25 17 Add lines 7 and , Subtract line 17 from line 16. If zero or less, enter Enter the smaller of line 14 or line 18. This amount is taxed at 15% ,00 2 Multiply line 19 by 15% (.15) ,25. Add lines 11 and , Subtract line from line 12. If zero or less, enter -0- This amount is taxed at 20% Multiply line 22 by 20% (.20) Figure the tax on the amount on line 7. If the amount on line 7 is less than $100,000, use the Tax Table to figure this tax. If the amount on line 7 is $100,000 or more, use the Tax Computation Worksheet , Add lines 20, 23 and ,84 26 Figure the tax on the amount on line 1. If the amount on line 1 is less than $100,000, use the Tax Table to figure this tax. If the amount on line 1 is $100,000 or more, use the Tax Computation Worksheet ,34 27 Tax on all taxable income. Enter the smaller of line 25 or 26. Also include this amount on Form 1040, line 44. If you are filing Form 2555, do not enter this amount on Form 1040, line 44. Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet ,84 *If you are filing Form 2555, see the footnote on the Foreign Earned Income Tax Worksheet before completing this line. 01/08/17 02:31PM