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(See
lnshucllcns

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U.s. Individual [nODine ~"'" J,". H'", 51. ZO~9,"'Glnor ~

H.

Tax ReilJrn
YOO:.osmnl"D

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A

Your U~I nama ana Inilial

• Z~Q;;. ondfilO Last nam~

.ID
YlllJr.::i;:lco\;Jl""o.r.llriiyn~rnhl:r
.

on page 16.)

E.8.RAClt

Ii 0 joint return, spouse's fiflit name and initi;:.]

OB..8MA

t.ast name

SFl"l!(1lin ,..... ... "~'-"~"'J ""1 1 ,",um:'Gr

-~
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Usedl0lFL9 Inbijl. otherwise,

or !y.QI1..

olanso orint

I. ill CHELLE L. OB~JllA Ii Homo Booress l~umUor ana S1i"~" !.you nave av.u, 001', ~CDpage rs. '1 AIll. ~O. You muS1emer E ..:; h. your SSW.) snove. I, R '-:::.' :::_ . '- -....".-----•. --~. -:---------'-----+--=-=--_:.-=----=Cjl~. L'D~I.riI·...: :J~t

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IE: r'CIrClh:1"I[]U~lmill

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Cl";Wti.1fil a be.::

beic'iIi

,,..iU

PrMldcntJ~1 Elelltion Oampaign

CEI~..-GOt XL 60615 I> Check hera Ir you. or your spouse

1 2 :1

riling $tzJtus
one
ChCGK onll'
DOl<.

0 Sln~ls

if hung jomtly, wanl.i.."31Qgo 10thl1l1lirld (;~e p;J8~ '15)' ." I> 0 YDU
<1

~h~~~i"~lnl~,(::ulc.lunD.

• rv1 LX.. Married filing Jolntlj' (even If only one hac Incom~) MarriEd'lling ~cpunrtely. Enter spouse's SS~J Dbove and full name hem. I>

0 f1e@cIQfil~lth
D

C SpOlI~~

fi

qUilillylnqpilfBon), I[IIle q",.1l1ylng person 1, a GnU!1 but not your d€pandanl, onter Ihls chlld's nama here. r>Qualliylng WI~(\~-~·:-er-~W~llh-' (~J9-pe-o-oe-n~1 C-h'::"II(i~('""$Q-~-p,,-_g-~-1:-:-7)-

If more tJ1a11 fOUl' dependents, SDO pags 1Q.

Dcllond~m~
1-.0\ un1t!l'M

OK'; 13e. !n~Oltl:!

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Ail'-rll1'Unl~l!'fii
,.,.

lncorne
A\ta~1Iform(o) 1foJ-2 hera. 1\I~o Pollucll Forms W-23 and 10B9"fl11l.u was wllhhIJld. It you did not

d TCltal nl.Jrl1o'Jr of ~;t.aml).ticH'l.S! clalm6" .~.~ __~,." . 7 Wages, sOl~I1es,lIQS, etc, Att.ch Form(s) W·2 "" 8a TaKfi~lnintemsl At:a~h Schedule B il rnqui'ad " b Tn)('uxfimpt internst Do llotinclud8 on line B3
ga

_ ,.,
"

, " "......................
"j.•"'''i ..'

,~
" " , , fL...:6"'b_J..-I

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4 '71 , 009 •
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ueta

see p.age22..

w·a,

OlIllnar} IllVldon~ AUllcll SOll~(llIlO B It ruquirarl ,." ,' " .., , b Qualified dividends (se2 page 28) " "." ..•. I 9b I 10 Tm.'atlle refunds, credlm, or aNgOlS QI Slale nnd IQIillJ illtOrM tl~as ....... 1'1 Anmonyeceived .. "" .•. ".""." " r ".". "." ,.. "" ,"" .. "" .. ,, ,.". ,"", , 1~ Busln ass Incnma Or (10ss). Attach Sched ulll C or c·cz I 13 Dapltal gailr. or (lOSS). AtllIch Sc;hedule 0 II requlrsd,J not required, olwcl( hera Orner ~ins or (Iossea), Attach Form 4797 _ 1lia IRA rllslrlbuUons ~ Jea Pcn~lo~s and annUI;I'~"':: :::::::::: 17 Rent~lrsal eSUlte,royailloo, pllriMrship~, S oorpoflHion~,lrImls, 10 Farm Income or (loss). Allaoll SQtledulo F ., '19 UnDmploym~ntcom]lGnSlltlon ., , , ,.,'" "" '." 20a Socllliswurily benolil:; ) :lOB [ 21 Oth~r InGome. LISt1y~e and amount (see page 29i_· 22
:18

"~.1'*.r,r".~ ,, .S.W~"';I;' .
, , ,'

2 , 7511
'

---'3::.:)::.'".::2:..:-:..

14

not attoGfl, any p"ym~nt. Also, please use F~rlD1040·~,

Enclose, b ~[tdo

I m£_ _ ,

.I> D'3

" I-::l~l-r~..---:;-:;--,;_;;-;::Y,. !-"=-2 +-_;::1,-,,-=1=-4=-1~. s...;,4c;9,",-5,_"~"

- 3 , 00 0 ,

" .. ' " l-'1~4 -1J b Tuxoble emoent (soe Pl!!)O::6) 1§b b Taxable amount (Geepo\1!l 25) 11-_':':lG"'b-tr--""_-' _-_----' r.W. Aitlch SChDdul~ E ,, " ,' f-'1,,:-7-Fl __ ~~~

" ,

__I

,, lJ Ta:ta~l~all1ount (5ea paga 27)

]-:-1::.B +r__ 1-'''-9_1-1 2UIJ.'4 ~_~ .. •. 1

__

_
_

•• ~_. _._

AdfUSi:e.d Gross
Income

AIld 11mamounts In the f<!r right column for lines 7 ihwu~h 21. Thi~ is your lotullncrnme .~ .... ~.. ~ducaiore.,pensc~(sea pagB2.91 1>;' '0: ,.. ,. ~Zo.:-3+_~_~ 1-='2::.~+~_~=~~--I

~fr 25 Health savings aocaunt deduGlio~. AltMh Fon'l18BB9 26 MovlTlO oxoon369. Attacll Form 390'3 ..
27 26 29 aa ~10 32 39
:jl.

~ __~~~21~-~~45,OOO, n... 2.2. 1 , 670 , 9'95 , -1 o~~~~:'=rl:;~~::: ~.~~~.~ i~~~~~~ ~~~.~~~~'~~~:.~. .. _.~~I.~.~~~~~ ~ r~~~+~---~---1
nn..

SEE STATEMENT

r26::'+__

"""'~",","""'-f

One-halfe! fl~lI--Bmploymonlla:l.l\t~Gh Sch~lulo S~ " " .. " Sell·emplav~d SEP, SIMPlE. Rod mJalifled plans "." "" Solf'Bmployed IlealU, insurMM deducljon (see pagE 30)

F27:...+~ __ ·_:"l::..:.5-'-:..:8_:8:.:9:..:.'1 " .. ~20:-+ 1 ".. _;2:.;9'-1-__ ~_ -----1 1~3-:-{) -1---------1 31n -3:-:2"'-1--------l 63 7

,~1~g.15
lHA

3S 36

POllalty on early withdrawal of savings ...• .•...•.. Alimony paid b Roclplont's SSN I> IRA dedllGllon (saa I,age 31) ' StudantlD~n interest deduction (see pag9:l-3) TUition a~d iees deductiDn (see page 34}.. Oomoo11cproduetlon actlultiu oeduutioll. Alillch FornI 6903 Add lines 23 through 31a and 32 IIJrou~h35 "

r8 4+-----,

35 '-....:. -..'-.. -.. -,"-"-,,,-,,-,,.-. - -.. - - -..+-::C~-6+-.

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Gubtr.m line S61rom IIn~ 22. Tills Is your udiuslell grass In~arrm .". ""';c""'''':':''''''''';;;;'''''''_;';''''''''';':;' For DI:solo$lAre. PrivBCY Aot, and PaperworJc Redur;.lon Act Notrce, see pase 18.

37

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8,107

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CrEdits
u F:"",pl':

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[0

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lC

YOu Wllr~ tram b~IQreJ.nual}' 2, 18·11. Snouee I'IM burn oElore Jililuary 2, 194 '1.
(In
"3

Ll Blind_}_

"

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~G ti[l~

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GoI!fI;u-;;]".g r.jIllJrn

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0.

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~ljen

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as

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Itemlzod d~duot_lon~(Irom Scllcduj\i AJ arYOUI ulilodard dsdllctlon (see I~!j marDin) "."

4(l

<;u!ltr.!ct line ~O from iina SB " " ,." tf lille ~a i~~'Ief $10S,4ifi, Dr you pravioeli ~ousino 'to a pernon dl~olaMd by HIJrriG3no l(alIin~, sc~ pag~ 37. 0Ihelw;s~ muHlpl1' s:3,200 by 1I1e 101~1number oi BXllmpllonn olaitn~d on Unll ~d 43 T~xable Income. Suulrs[;llina 42 irom lIna 41.11 nne421~mQr~lhan lim; ~ 1, enler ·0·
~.lj

41

1,542,6"98.

112,408.

42

!iiIr,l,;lJ.:,o;J

M~j~Nling
tlJ,::tL-;]:-cly. :5I~.~Cfl

Mr;rtll:dfiltl~g
1-::1111111)£:1' Q::!it.ltlylnl}

u,:rt![l;\·_i!!I}.
~1n,(l{J1)

45 4(; 47 q~ ,19 50

tax. Ghecl( Hany1llx 13irom; forr\1(~) 3814 110 Form 4972 ::::::::::::::::::::::::::::::::: 44 Altom~III'B minimum 10..'. Allath form 6~51 ," ', __ , , . 45 Ad(lll~c~ '14 ~nd 45 ... _."............................... I> 40 Forclgn IBY. r~dit. Form 11'16 ifroquirlld _ ~ Arlllr.n "_ ". r4.;.1+ -:r---:~-.o--_I Gredit for cf1l1rl ami depr.nd~nl care oxpense;. AHOlCIlFerm 2441 ." da 1,2 Credill"r lh~ elderl)t or the dlsebleu P,IMCh $,ilsdule R _.,_ " ,. <19 Eouonlion erecits ..~itlGh Fonn ssea _ __._ . , _ ".... l--=ff'::'O +--------\

aD

O. 1,542,6.98,
513,456. 513[456...:.,

aa •

H~~gr rtO'.s~!:~L'!Ild. ti1.JQO

ff'l Retiremenl s8vi~[lS corrtrlbutians cradlL Attar.h Form BaSI) ."..................... ij2 Ghildlax credit (sa. pagB 41). Ati2ch FOflll 8901 if required "................ GS AdopUDn Anach Form 8839 , crerilt, , 54 GrAdim from: a 0 Form 0396 b DForm aSS9 55 Olliar credits. Check ~pplicallIil box(.sj: n Form 3eOO ".. b 56 S7 56 S9 6a

51 r-::-I---~-~-I 52

1-:'55:--1--------1
64 F=--I----~=-_I fiB b;;;;.....L...~
__

0 Ff,lml SM1

0 Fom1

~~-l

Add lines 47 lhroQyll 55. TMge are YDur toml cr~~IUl __ ""',, li6 SU5h'~cllin~ 56 from Ilfle ~6. If Une 66 fs more tha~ line 46. onlo,-Ot...,. DI Se[l-empIOyme~llD.:t. Atl!lch Sohe(lule SE " " " _ sa Sl,lcial seCUl'lty and MlidiGnm!ax Dil tip Incoms flot l'eJlort~d IQ employ~r. Alraoh ,orm 4137 _ _ 1-'5~9-t-Mdl\lonallll~ On IAAs, ether qmLlllled f9tlmment pt~n5. elJ;. Attn:h Forn153.29 il require~ __ . ,." .__ &0 Bl I\dl{;mceeam~d lncom81:redltp~~mDnts from Form(s) VJ.2 ,_'... . .. _ '".................... '61 02 HousehDld!l!Tlpk;lyI1Wrn1 ..~e,.ArtachSch9,jula H " _ .. __ _ _ 62. ~3 .ll.ddUnes 571lifOUgh 62.. This is your iotilllOIC _ " ~. 53 FOflllr.W-2ond109g _:_ .. G5 2005 e::limJt.d 1Er. paymerrlR and amount ~ppll~ lrom 200~ relllrn

.1,200. 512,256.

:n,7'16,

P<llrm~nt$

~Ba Enrn~tI lncome credit (lim) : ·;: 1· 1.. · ·.. · ·· !--='a6~·a+~~_-t <~.~. ",!-',h • b NQI11aXabieombat pay olact,on .. c ,... ~66:;.:bO-''-_--:-:::-1 , ~<-""''''.ao. 87 Excess soci:;!! Sllcurily and tier 1 RFiTA t~x wlll,i1flld (Me P~IlB 59) _.... r--:a::-T+ ~~~'-l 00 i\d(lItiolial chTldtnn ciedlt Attach Form 8812 ,,, r--::e:::.B+~ 1 69 AmGul1tj!al~wllh requssi for eldJ:nsion to me (sea page 59) •._ ~o:::g+ __ ~ -l 7U Paymem... frum: a DForm 2.4~$ b DForli\ 4136 G DForm eaes 70 t.....:..;'-'-----~-f 11 Add lines 64. 65, G6a,and a7 Ulfougll 70.1hr.sem<ly~\lr total DQymenle ".................... IJ> 71 n Iftlnr. 711" :J10i\; IIWL tiM B3. ,ubtroctlinc B~ jwrr, floe 71. ThlEls thE' amounlYo~ ou~rpaTd " , Refund c·"." 73;1 ,~mOIlIlI arline." vou ""um rMundad to l'0u .. _ ..__ ,,,. .. _............. _ i> 7Ba ",::"",,~ t> b l!~ii:b;r R":lnI!I--~ ')~~ ~:!.,lJ~ ~g l~ t; T7~V: D rNdtlng D ~hllli!!i 1)1- d .1,"''''11 ~1Ir._l-ii1, ;~.':,,~.;~:' 74 .~'"L'lmtoflill~ 7:2 ~ou want eQpli~d Il'lyour 2006 eijtlm31cd l~~ ......... !i". .._-r-:-7-:-4.... ~=------l .

~~:~~~~ J

64 Fi1dai31ncomatlH'/)t.Ilhcld1mm I

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6,1
~a~:.6+

114,747,
---I

545 614.
I

1,582.

114,747.

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entl ~:!:!:.Qmp2:l~1i1{1

tiGnl:!t::ul::l!:i cna :;l:t1IU.l1F,1(l~~, IJ:n~ 1D ttlO bR".lil til my

mel'll:.

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·Spcc;.o·:p :;1W,fl\tUi.l, sjalnt rat\lfji_ D1 mu:,t t:ii~, U Di!tlt

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09121/2006

9:45AM

00/21/2006

08: 42 FA! 1 312 :1,2 3'~Oi

WSHS, PC, CPA's

Nam>!(s); fln>t

BJlJUi.CK H.
1.

& HICHEJL~

Numberofq~aliryinuchIWren:

2. EnoorthBamoumirol11

.2 . XS;:ODO.EniBTthareSUIL Form 1040, IInB 38,Dr Form iO"OP.llna~ .... "." ... : 2
.}
. 3 ~~~

L.

OEAM.A

1, f5 55,106.
O,;._:_.

" .•"

"."

__

__

2_~'--,o_-_01F'_~.

S. 1040 tuers: Enlerll1e lOla! 01 any·

c bGI~slon of Inc1lmf trnm Puerto Rico, and I) Amounin irom ftlrm 2551l, [inllS ·13 and 48; FO(1'I12055-EZ, line 1S; Md Form 4563.lln615. 104 CA iiie rs: Enler -0',

4. Add Hnes 26ndS. Enterliletotal. " .. " ~ 5. E.nter the smoun; shown below loryouf filing atatus, o MilI1Illd jilin g Join fly - $1 11),(loo
o Sin~le, hesd of household,. or qualifying wldoW(er)' $75,000 <l Married filing sflpallljBJy - :1;55,000 6. 11l1he amount en line ~ maro Ulan the amount on line 6? '10. LeDlif nne 6 blank, Enler ·0- on Iino 7.

,
}

t_........:l;o...,'-6~f5_5-",_1....;(J:....6:._~-'--.
8 .

....;1;,.1_0-,,-,~O_o-'O_.;:..

!Xl

Yell.Sublract line e Jrom IIn64. ~"""""""''''''''''''''~'''''''''''''''''' • __ 1"-,:....5::..4..=..::6-'.1-"0..,:0:...0:...:... Iflllil resuli is nota multlple 01 $1,000, Increase it 10 11mnexl lIIul~plB QI $1,000 (rOf e~~H1plo, Increase S425 10 81,000, increa~e $1,02fi TO &:;'000, eIO). ~~.~ 7

7. MulUplylheammmton rme 6b1'5% (.OS). Ent~r lila result. ~~. ~.~ . "' " .. " e. IS·lhe amoun t on Una 1 marE:thsn the .mount on line i? [X] No. STOP] YOU (;lInno lllll<o Ih e ehlw UK oredit 0 n Form 1Q~0, linE B2, or Fmm iMoA, lin a 33. vee, Subtrncllln81trom lI!lQ 1. cnlerlhe result. .. .. "" __~

'7_7"",_3_0=0_,

~,..'"

~~:2'

..

'

11. Enterthil 8mOunl1(om Form 1040, line 46, or FOrr)1104M, line 2a, 10. 1])40 JIIers: EnlBr1helot~1 oj Ihean1Qun!s Irom IIne5 <l7Ihro~gh 51. 104M filter,;: Enter the total olthll amounts irom linus Z~ thr01J~h32.; 11. Are you clalmino any oi Iha jollowln~ cfcdihi?

"
10 _. _

"

o Adoption Gredl~ r- 0 rm SSag ., MQrloage interBlit oredlt, FOHn 0396 o OiSlrict of Clllumbi. Hrst-lime homebuy~r cro(,il~FOrM SSag No. Enli'ir the ~mounl from ~n61a~ yo~, Complote ih9 Line i~IWorl!5h~etto figure me amount to entllr nolO.

} ...... ,,, ... 11 ..

~.~ ~ ;'. ...I

~ __

12_ SubtraDllina 11 from Ilne~. Enter tile rasou. ~ , '13. Islhe amount on line 6 aimis worksheo[ more lhnn the emouol on tine 12? D No. tnlar the amount from nne B. } Thie 10your

Yu, Enl6f tho amount irom line 12.

Ghlldj~CGr"tlit.

~~

"

"

1S

O~270331 131470 40CDIF

2!J 0 5.

ns 03 0

OBAM..~~. 3l'.R.\Cli; a. 1

5.3

09/21/2006

9:45AM

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08:42

FAX 1 312

3'72

8407

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CPA's

rg 005

SCi-jI';;oULES A&ffi {Form 1(40) ~hlan6~cn~~:";";"~c~. .

Sclhed~~eA .. ~tl~mi2ed il)etila.ncti1ClfllS

(Schedule B is Oil pa~e 2) r", Atbmh to Farm 1040. Ii> SEe Instructions for Schedul&;
'1040).

~~~;;:,~~;~~~'l I'!")

AIH:I (Form !."~~--~~~------~=-----~~~-------=~--------~----~----~~--I~~,O~Unl"r. .• ~~.~'.t,~~-u~"~~~""~m~"oo"'r----

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Bi'..P.l-\.CK E. ~~~~~~&~.~M~r~C=H~E~L=I~~=E~L~.~O~B=_~ATh~1A~ __~~~~

Medical Caution. CD not include C)(jlCnSC3 relmnursed or paid by OII1eTs.

~ __~,."

~I.__ ...
--r_-i
4

<l,lt!

Delltal
E)(pel1ses

:< Em~r amount lImn Fonn 1040,

Mr)ltlplylllle

"l5Cicalst1d

dental

"'KPel1"."';

(se .. t:rage A·2] "'''''''''''''''''''',(''''.'.1'''''''''''''''''''''''''''' , line 3B " """' .•, ".. 2

f-,'_:_I +------~r=l

""',.\ '~""f

2 by7.5'loS (.07S) ,,,.,"

,,.,,

",, .. ',,

Sui:ltt.1et line S tram II~e

3 Is mora 1hat; lil1s 1, enter

~you
Paid
(So~ ~ag9A.2.j

-n. .. "" .. "

,,

b,:o.~\I

'" .""

State and IO~l'l1 [cnecle O-I~l'l one bOll):

" 00 IncOnlete~ll, i;r 0 Geileral $~ru

~l!~:J:
'~{j;:;
IW1!1

01'

taxes (sse p~gs A-3)

.••_._

} .. S.ll:.!?...~.~.~';r.J;lJ~m-I':[' . . ...,7
_ ...•....... ,.., .

5
6

47,950.

Fls\ll estate ~i:n\f;;l~ {see pageA~)

".,~ .. " .•...•.......... ",'.,.,

PQl'Sonal prapart)! raxes O:har taxes. Un[ type and amount j>'_,- - - --- - --- - - -----

"
- -- --

",
-.~ - ---_

,
--

,.

lnterVsl YO\1 Paid ~b~e, f1,,~e.".·~.l

Not~. P~~~.nal

lCJ Home mIJr.:gage ini<lr!V$ial,d pOint5 report~r:J tol'';uon Fol'il\ 1096 "" 11 Hams' ntortg~gEllr1t~rast not rspertad to you on F0l111 1096. It paid to the person irom whom you bo"~tTt the home, l;l;!a page A·S and ."owtl1at person's name, Id2l1tiiyi"9 rm., and nddres;;;

~--_- __ ----_---~---------------------PolntB not r~p!lrIBd bWe51m6'nt int",rsst. to yo" an Form 1096. "" Attach
'1:;1 .• " " ,'

'10 ,.' , ;.:,:;.:.~ •

32

418.

47,950 ..

~~
'11 r1"'2cl ~
,',....

intswf:sn I~
no! d8duc~bl",

12 13

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,,, ,, "

_I

Form 4952 if requIred. (See p~g .. A'!l.) ,

l..l.:;3;.J,.

:--_1
14

Gift$'t~ "".Charity
~If! Rnrl g!lt r. bijnei;tJor iJ, QOcpagcA·7.

'4 Add li~~" 1 n '[hroogh

b Gift!> b~' oa~h 01' check 16

~5a loral gifts by C-;;;Chirok

Blecha 1nlCit all qualme~ <;:Or'ltrlbulions: "

"".(;1.~.l!i .'?';l;'l?T.filJ~Nr.

after AI.IgLJ~t '2.7, 20Q5, that. you ".

I[
~

~""

~2,U8.

1!ia
.,' 'il

~f~

'77 ,315.

ItYQu mad"

Other th"l1 by cash or chsck, from prlor year 15",16, and 17

II any gilt 1;11250 or rnora, eaa page A 7. $

'I~., I1!<iJl;,
--1
1.:.,:7_' L----~--r-__l " .. " 18

you must att~Qh Perm 8.263 if over !BoOO 17 Carryover 1<1 Adcliines

"
,

,,"
"."

" .. " r1:.::6+-

.:..r-.:::.;'~O;"' __ . .;:t.::~""""'· ,,JI1~ 8;I.ellse9

" " " ~~M,~~---~~~~~~~~~-~,~·~~~~~~~~~~~~~l~~~~~~~~~~~~~~~~~--~~~~~

77,315.

·;.,;;l9;...,;C:;:a:;suaINtheft lassIes). Attaoh or

20

Form '1664, (.Se~ page A·6 " Unr;;;;bu ... ed employe!;leXpensl'$ . ,ob tnavel, unkm dv",ljO, Job education:

"......

19

"rD.

; ..::1

~~~G~~I~~i;Dll~ Oerrlll1l1unlf 21
2'2 (See
\:lit~~e p."il.)

r!».

At-rn<:1i Form 21 O~ ~r 21 06·EZ if r'S9uit&lCJ. (SeG P<l9~ A-lL)

~_ __ _

_ __

:.:';:1;:1

"".~

20
tees " ", , Other ;a>:'~anse5 ~ 'nve5f:m~~nrsate depOSit box. etc, Llst typFi ~nd Zl.i11ouf'it Till': preparatlcn _ 1-,2_1-:+

0_1.-;;8;..."'1

p~~~r~i~~E_

.?~~TIill~JTi Y~]l§_ ~_ , _ ~ _

0-

__

:?!_.~5~0.9..:

~::Jo~'r
,~II,.I

'\iJ"~

: ~1~;I:~~~~:~;;:~~~!·104o;,i~~3ii::::::::::::::::::::::::::::::"j';4ji';'.1C~~~~~ct'__3";'fo'6' -· fj'S'i i ....;;.3,;.,-=1:...:1'

25 21> Multiply .line 2<1 b)l2% (.02) , , ,.,:.......... SuIJ\TOIO;:\ilI1a 25trom liM 23, If line 2$le more than rille 23, enter ,Ct· Other- from list

:<1,500.
.::.6-,-\,

Othu iIlia~~IIM~UOS

27

on pS9s" ..9. Us! typs anel al'llounl

"

"

"'2"".5....",_ 3-"0.3-:.,_1""0;.,;2;;., 'I " , 2;6

o,

ONtuoaOfll

27 Tot<ll 28 I~ Form '1040, "n~ :35, over S145.!;JoO (oller $72,97(; I! married liIi~9 ~~Illlrat~~/)? ~ No, Your deduction ia not lintte.d, A<W lha <lI\10Un\S In tM 1m'rlQht column fQr lil,es 4 through E7. Also, enter thk; amount Oil fOIJTl 'IO~(), line 40, Ycurdeduatlen l'Iedut:r:IOl\

Itemized) Dlilductiom;
29

00 y"",.
If you al.ee\ to For Pap5rworl,

may ballmlted. See p"'9a A'9 lorth~ ~mOUl'ltto enter, n~nliID deduebcns oven illough th91'~re loss Il1anynur sia.lltlard d~~U~tlDO,ch~clt hOI'S
Act Notioe,
SGI'!

STMT 9 ~ } ......" .......... b>-.2B

Schedule

112.JOB.
,,:,.

r.>D:;:' "':.'"
A (Form

h"':':'I:i""

: .'

LHA

~orm' '1040 il1S'J-uCitlons.

09270331 131470 40C01F

2005.05030

OBAMA,

5.4

1040) 2000

09/21/2006

BARACK H.
9: 4-5Atvl

40COlli'_J,

09/21/2006 08:42 FAX 1 312 Ji2 8407

r

WSIIS. PC, CPA's

~OOfi

Yoof.(!(tcfr,l!;!!r;:mi'qon.l:"llDEf
~ =

EARACK E. & MICHELLE L. OE~~

Pari: I Interest
,

'I

tJst name Qf p01\19r.i an)' Intarast Is jrnm" I

"$U~r·ftn",n()~d mDrlg~ge and tha buyer used jjl~

......

'An1~"

propeTiy ru:. a personal ;',,~ldlmQe, sae page 1'1·1 anr;! 11$1: interl;sl this buyer's soda.16ecurlty numpsr fll".d addreas r.:... .

~m. lso, A

show jh~t

DBS JP 1-,10RG.~l\T CH.1\.SE NORTHERN TRUST BANK

Ncte, IIyou racaived a F':Irl'" 'I09'loJl>lT, FOIm 10es.OID, orsubsti1:ure statement from a brokerage fl.rrn,
list the finn's narne as thl< payer lmd enfer tl'e [Otal interast

11,206.
2 034,
1

145.

-"
-~

sho"m on that
torm,

-----~-.
, •••••••••••.••••••••••• , •••••••••

,_

_.
,---_· ___••• ~ •••••• _ , •• , ••••• , •••• ~ ........... , •••••• u ••••••••••••••••

Add the smcunrs on Un.. 1 Attaclj Form 8815

13,385. 13,385,
Amount

Excludable lntereet on :!"ll'IGSEE and r u.s. saving~ bend:!! Issued after1!3S>J.

•• ~a ..... ~." .,,..~.~ ••• " ••••••••• ' I ..... '

'u" .............

, ..............

______ ..

_0.11i'

8utJtmOl Une a fmmllt'le 2. Enter the fe$Ult here and on Form 1040, line Sa ._ yew mu.st rompl"w PooH:111. )\!olt;!· 11Une 415 0Ile($1,500,

<I5

..

••••

,~

••••

, ••

, ........

3 f,'>

----

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

..

Peril!
Ordinary !:lIividerids

bi<St arns of pay~' n

NORTHERN

TROST BAlof..l{

I>

2,751.L

Note; jiYDU t~(;a.lyed a Form

..

10gg·orVor
substfurte

!;tatemen' from iii I;lrc]~ar..9Gfirm, pay er ;;no <>l'It sr jhe ordInary clillideI1ct~$\10~m on thatterm,
lI~t the firm's narne as the

"--

,----

6 i!'61rt III Foreign Accounts and

ArId the amcunts on line 6. Enter thslOtal

here and on Form '1040, lU1a 9a

...

--

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

.. ...
,

l.'J>

I
I)

2,754<
...,_-,Yes ~~I_~-I . __ No __

l~ota, If "ns 6 is aver lIi1,5DO, veu must C~1)1~!~. Part III. You mUG! cornpl~t~ tl'jls p..n if you (6) had over li1,500 cria;,ai;Jl", it'"srestor

• ordinary cllvld®nds: or (1;)) had a foralgn

account;

Qr .(.::)received a dl"'rlbutloll

frum., er

"""r9

a [Im1lb;lr of, ora transferor 10, a fors.1Y!:!..!s:';.;.' .:;tru""e",t:;.' lI'I or a signature o;lJ'omllr authority ever a financial

~ __

7E1 At anytime account 8

m ulorslgn

cI~rin~ 2006, did you have an inla,iM

country. auol1 as" bank account, securities account, or other finMcial account?

Trusts
$~i5m 1"Z,.V5

b 11 "Yes," emer tim nama oflhe iomign ~~untry iJ... __ .

~~

-,-_~

----,~.--:""'"':_:-~ •. •..;;; ;;.;;;.. "' ...;.;. . .."" 5ch",dul",

DUfil1g 2l106, did you rscelve a di6Uibl,llioh irom, or .,... )'01,1 ..."" It,~ qrarrtor "f, or transferor to. a tor",l~n trusl'l II "Y.. ",' you may have to m", 1'61'rn 8520, See page &2 Reduction [~etIIr;I1'11;;","as f"orm 104fl inst!'uctlol'S, I

""""=,,,,,,,,_.__-,-_i_~
6 (FI/rm 10.-lQ) 20D$

LHA

Fell' Paperwork

09270331

131470

40C01F

2005.05030

OBF~.f

5.5

B~CK R. 09/21/2006

9 : 45A~'1

40CDIF_1

II'SH5. PC, CPA's

~007

8G~"lEDI..lLEC

(Form 1040)
I) &pi"r;mliI'U ~ftil!) irn~IolJY In l&hJ~1 fl-sI1,oo,tI(j. i3f1l"1rtl;!

Pm'Qfit O~·bI.J'Si51 F~'gm IBws[~'iIe$S

'!i=,~I

I>

J\1tac~ to rormlO'lC

r~~ rme roh lpg, Pa

[Sole PropriatOfohlp) jn lnt vp.nlllrns, ele., m IJ ~I ill e f mm 1065 Dr 106S·Il, or 1041. !i,·Sen 1"&lmqlfon~ tor 3~hedul~, C (F~rm 10dO),

BARACX H.. OBAlifA

f\ Prinr.ip~1hu,im;~'1 Of proios~ion, Incluoing Dmliu~t or ~~rviGe (see pags C-2) .

A~'B07R~'~~~~~~~~~~==~~ EB,j'5!;;"'~~Gllidl~Q
f

C 8Ulini!~~ n~m~_ no ;,liloarail) i)uslnes~ name, leeveIlluok. Ii B.",R~CK H. ORAl.::', .::QA:.::___

~
~

-=-===~~

sUllcor room no.) 1"- ~

~~_~=~~

~~~
Qlhcr (~~~~;iY)

15 1 ~I~~~~~~~~~~1I 0 ony
'mplayo<

reon'''' ",,~':~m
.~

O'7'·1".C- 5 ,H~O'lnII ·

10"umb"I.'Nj.;1
~~

~~~~__l__,__~

_ m __

~ ~ ~-_

City, ";'-"11or I!O~Io~lr;a. sliil~, ~n~ Z:p eodz t,,:~ountillg 'n~tllo~. (1)00 G~~h(2)DAccru~l-

(a)O

r--- -:_ ~ ~ ...

...
.," , , ", ,.. "_.,,.,

~ __

~ H

Dill ~OU "ITL(lIorinlly l)arilcl~~'le'11l1he opsraiion of jhl~busl~eSi3 outing 2.005? n '/.0,' sea p:l9.c C-3 lor 11mII on losses Il YQU.iarico or ,~CQuiru~ thi~~u.lne~s during 2005, ~heGkhare .. -,_,_,_" _ _.._,'-_._ -... " ','"'' ,,,

00 y~ 0 " 1>- 0

NQ

- GmM r~~ai~ls 01 ~i!los,. CllutlQn, It UIT91nnome \'la,l-rOOOrl~~ to )'o'U on FDrm W'2 and the ·St,1Iutory employee" hex an fhatj~rm wa9 r.he~r~d.~o~ p3g6 G-~ and check hera ' __-. _.. , -._" .. ,' ,." _, " .. " , " ~~ D Rsll'rn~ and ~IJQl\:an.<)OJs , , ,.. ,""'-" " .- • .,,_ -' ". ,"-._••",,' _ , .-__ '" , ,,__ ."'_." "._-." .. Sut~mct tlne'~ irum lin; i .. ., "'_-'.'__ .. ,." __ ,_ ..", " .._ ', " .. , , _ , _"". .... Cu~i 01 gD~tlS sol~ Ilrom line 42 gO r1ilQe 2) .. "_" ..... __._..... _,, ... _.,_. ...... "."'" .. ,, ...... _......... __
Br~"~prulit. SUblraCllln~ !r~nl IM ~ ~ ) ". _"._._.'.",', __ , ,"", " ,.." Dl~"r inccrn~, incluDingF~llernlandsteta gfl~olin8 or ruellm: credit Of reju~d (soc.pugc G-3)

,i

s.:ro.W ~,~.~'I;.:s.N.ljn'f!,'_. lQ_ .

,'

,',

'''

"

".,

I·p.elit:.!J:1

3ro~~ i~COIM. Me IIM~ (i nnd 6

Expenses.

"" ,'_-.' " .. , " "."., -." ...• ~,~"" [Ont~re xpenses lor business use Qf Y(llir horne only on Iln~ 30.

;;;:--;;.;:<.:_""'-"-"".'''''-.'''u.~ ''' •.:.;.-''' ::.:' '-' _:!?;__.J_7:....L....:;:;_!_!,_;;2:;_· 0::..9:;,.' .. ••• .. ..!,~8:_.7;..3;:;_::_..

20a

2ub,

D spre~I~IIQ <no (iP.oim1 179 n I C~M 11 a 00 (klC un 11 (~ot Inci udod in G Panllil (S€~ pnoe c·~)" ... ...,,'.-._.EnlPIOt~9 bBn~jll ~Ioilrilms (uUJOr
1[, 16

24 'ID j·1
16

Ta.en and IIr::msus , " Trauel, meals, nnd 8otertail1m~nt; a Tmvel -. " , .., b De dUOIib Is meals and eni,rtall1mnnl (~fie pa~Q (;.fj) ""
UUliij~3 _ _ _ _

,.. .

2.3

Ulan nn Jin~ '19).-" ...... "', .... ,.."., t~5L1l'l1nGe (11thli] tl1~n ~"illlh) .-' ,
1~I~re'it

. .

"

co ....

~~ ~~':::::;
168 161.i

._.•

26'

MOrlflar.f (paid to nanks, ~ln_) ......... 17 OIh(], ., .... "-. .... ,,.," ...... , L"Q21 "oil prole5sion.n1

W"g~ !le~~ ~mploymerrt Greilils) Olher fl~pfln,fS (from tin6 46 nn

•"_.,, .__.... , ,, ,_ 27

page 2.) 34,80.:.. ..:..7.:..••1.

,,,

,_

,,

sP,lvim " .."

"..17

.,.--------------1
,__ I>-

.. +:_"----.=-::---::-="...-1 -.
na 2.9

I
•

Tr!:~1 MpOI,(;e. ~elui""~lpel1S~510r bClSIMS5' use 01 110 me. Add IIne~ a throuUl1 27 III cOlumnr. _, T~nlllli,," profit i1f)!>S). S"I)tr~t:t lin~.2B rmm li.~e-, ,_ , ' " " __ E~pt'!I~<s lui IIU~w~sL;5e Of i'our nom •• A!I~~h Form B~29 ..... " ...... _-'_", .... __. . I! (;1 I) rom 0 r IIQ ~~), SulllrDJ: t Ii ne 30 tnm line 29, <" II ij profit, enter on Furm11)'oIJ, IIn~ '12,find ulsu on senedure SE, llne 2 (mahrtur) ;mnIQy~e~, ~ee DoueG·(j). ESI6103 ~l1d IrUBIS, Mlil( MI'O(m 'IMl,llns S. o II J los" yuo mu.! gn 10 I:n~3<\I you II;"~ a lo,s. ohsck tile bO)i tllal da50ribOs YOUi'inVD~lmanllii tIli$ a~livity ($oe ~age C·Il). <> II YQu chac,l'~d 2?~, ~nI~r iho IOB8 00 rorm 104Q, lin~ 12, ~nd 21G(l on Schooulo SE, line 2 (siatutcr; omployoBS, SBe pa ge C.·51.Es lulc~ an d \Tusts, emer 0 n Form 1(}4'1, lin e 3. e \I yO ~ G1:~cl:friJ2h, yOIl mlm t a~ach F0 rm 510 e. Yo U i los 5 may be lim~~d. J

6 B r 3 78

so

1,141,495,

32

} }

311,141,495.

32a 52b

D~'~~~~mcD'

0 ii;"~im~~'il."'~"

U9270331

131470 4oeOll

2005.05030

5.6 OBlIMA, BARACK H. 09/21/2006

40COIF_1
B:45AM

OQ/21/Z006 08:43 FA! 1 312 372 8407

Il'SBS, PC, CPA'S

~008

SCliEDUI..ED

IF orm "I 0401

EAR...n.CIi:

a.

& MICH:E:I.JLE

L,

OBAL'1A
t DIJJDr!:i::.~I~

(a) c •• er

£i!JD~f

('1)"",",,10: ... ,
~~j-um i
~~j

i3400 SHS AVI BfoPF~

Z 5 0 0 SHS' SRYTERRJ\.. COMM, INC
I:r..iC

02/22/05

10/28/05

;1.0,915,

8,843,

2,072.

:2

Total short-term \11;;1...., priCE!.al1l~llnts. Add nnea 1 ~nd 21n colurnn (eI) , Short-term SOlin irom
1"'~J'Ii'!

" ' .. ' et:<!i:;'l and short-term sOlin er '(l~~e)

"" " , , "

'

'. ..._;'J.;._,__ __ "~ .. ~_

, , , ", ,

as , 8,37

" !,::,.,;.;~~'.:i),.1.:j:•• ;:·.J~"_·:~'J::,'"ii'::·:':',':.':.:'

'--'--_-'.-_:_T-

_,

I
4 " . ., , , .

from Form~ 461>4., !l11H, and SB24 from Soheduli,(~) 0:·1 .. , ,

loJgt l,orHermg aln or .llo5~)from p~rtn6Jt;hlj!J!1, eorp orallons, esitrt(.!S,. t"" .... s 8 ,"~d shornerm capl till less carryover, O:ntolrih a ameunt, Carryover 7 Worlwh~et in thO' in$lttl~lionS If ;my., from Une B 01you rCOIpibll Lass "" " ,
"

................•..•.•........•

,
, ' " .., , .

..

N~t shoff-term c~~i~1 gain or HO~Q)'Cortll:JIJ'JQ 1 lllrtlUr"h 61r1colLlmn (i) Jines

. :.111, 1~6 .
(e) (ko,«
I::u,!!!f

b:;!:!!ir~

.sUtllrn~t

l1ll'ol"o'II"'''i

[fl;' iTem (dl

s 10

~lar your lonll·!eml tO~B. if any, Iri;lm $Qh~dula 0·1. line 9 Total km .. -term ~:mleHnrice mllQU!\;s.

l--a.._l_~~~_~-+i,""~:·...,.: ..,.·.,.,'.;,...'·-:·"':-:-'-:;' . ,.: ...,/..,-;-:-±-..,....~

i,::i,~,:~ _"',', ;' k....:.,D::-t_===>", __
.;,:, il'!~!.,;,':,:I·",:'.~,",.:._." •• ~ ' .
.l;:._..;..)...;.;.;..

."

Add IIllss

e ~nd [I lITool\lm,,!d)

,.

,..," ' "

_,..."';"',f--_'::""'_-_

"

1.1 Gnln from Form 4797, p(!Jt I; long·t~rm b~lntroJTI Fmms2439 ~.nd 6252; and long-t~rm 9"'" 'or(lo~~l jro'\'Ip(l!TI1~ 41164,G7I:I1,Ii'Inrj81:1.24 .. , ," 1.2 I~at IOI1(j'!erm gain or (los<»from pilrtn~",hips, S eerperancns, estetes, and tnJol~
'13 , ,'

[-'1_I+ [---;'':-2+
1-'1.:;.$+

_ _
_

14

frornSohedw<l('» K-l ." , "" , Ol'pirol !l~I'" <!1I~trlbutlon$ , ,' '." " , , ,. " ,,' long-term c:apitailml5 carryover, iOn I"" th .. amouot, If any" from llne 'lS <;;1 y,,~,r C.,pitill Lo"" C"r:ry~lI""W~rI,th~at.l~ lnstructlone Ihe " " .."
nns~ 8lhrough

,.., , ,., , ,.............. " ," .."., ".." "...

,
'14 in coiurm (fj. Then 9.0 to

is

rft-l..-~.-~---)
~_

I~Qt ionfl"lerm

eapfwlgain

PI'

(10$"), CambjM

___ ~p~a~rt~U~lo~n~P~6~9~~~2~..~ ...~ ..~ ..~ ...~ ..~ ~ ..~ ..~ ...~.~~~~.~ ..~ ..~ .. ..~ ..~".~ ..~"~'~.~ ~ ... ..~.~~~~.~ ...~ ..~"'~ .. . ... ..~ ~ LHA For ~pen\lcr!1 Retluc1;lon ,'l,ot Notlca, SM ~orm 1{).10 Instructions.

...~ R ~ ~ ~ ~ ~ ~ ~ ~ ,~ ~ ~.~~~_'~IS~ .. .... ........... . .. .. .. ... ... ~

09270331

131&70

'OeDlF

2005.

050::J 0 OBAl.'"IiA.,

5.7

BA..1'lACJ.{

n,
9: 4·5AI"l

40COlF_1

09/21/2006

Of;

ai

'20Llll

08:.J3

FAX 1 312

:Ii 2 8.!Oi

II'SHS, PC, CPA's

~:".'"cu,.0 ifc,m

'''.j ,oM B_i.I..R,ACKH,

&.

M! CHELI,E L.

O'BAMA
_ '
19

Pop.

~ri:'11I1
16

Summa!""}!

Combln", IIn"'~ 7 and 15 and enter 1M resulL If lin.. '16 io a loss, "Idl) lInGS 17 through 20, and go to IIrrs 21_ If a gain, enter tM g~Ji,"on Porn! 1040. line 1S, and lI'~n go to line 17 below

-13,136.

17

'~IG lin~s 15 and 16 both gains?

CJ

vss. CiD to IIna rs,

No, Skip 11';005 '18 through 21, arld g~ III line 22.

irstrocuons

"

" secnon

, on , ..

I?~ I'.>

f-:,-!i.::::S+

'.'
~I

Ent$l' U~~ ;!rTIoum, Ii any. rrom line 1£l 01 the Unn:cllptured p;.ge D·e of the lnstruoltona ",., 20 AI'~ li!1!l~ HI a;-d ',!;IllOUl zere or blanll'l ,."

1200 8;;ln Worl{5l'ieet __

~:,~:} : ~
19

/,

CJ

Yo;$. i)J;lmpi;te Form 1040 lin&' 21 and 22 b,,'r.II'J.

through line ~S, "'1'1,1 th~fl cemplete me Quallii~dDivlt1,;,,~cl~

01\

ancl

Cnpltal aeln .(~;( Worl\~h""t

pagll36

of the lnstnrctiona for Form 1O~O.E:lo not complel;e

D No. Complete
21
11' lim; 16 ls "loss, o
(>

P!!gs D·S ot the Instructions.

Porm lO<!() Ihrougl1l1ne~, lind :h.m ccroprete the Bchedule D i'ax Worksheet on 00 nat campltl"t!! lines 21 ano 2;~ b~lo\'J_

enl,.r Il.toreand on Form 1040. lin~13, 1M t"lltmller ~f:

ThE! 10;;:; on flne 16 or ($3.000). or ii rnerri"d filing separately, ($1,500)

...
• 1'1

;~~

Do you hS'.·9 'l'Ja;ifIAd dNidendS

LKl YeG. Completo

on Form 'I O~O, .UM 9b'!' Ih9 Qullllflccl for Form 1040. 0lvid,.nd9 and

Form 1040 thrn'.l%lh llna 43, anc then complete

U NQ. c.:",~pl~t\"ltl1"

CajJrtal (Join Tax W"tf~sI-lMf (JI'I page 38 01'Ih., In;:lrvl:ltioI1!)

rest 01 Fcrm '10'10.

~t~(i::ii;j!i;;·;,;,;:: .•....

09270331

131470 40C01F

20

as.

05030

OBAMA.

5.8

BJ.l.JU".Cl-tH.

40C01F_1
9: 45AI"I

09/21/2006

09/21/2006

08: 44 F!I.x 1 312 372 8407

\I'SIIS. PC. CPA'

141010

I~Mne{s) shown on ratum

BARACK

n.

&; MICHELL!!:

L.

01'$ȣ:1.1.

Yow$S~1

Befo~~ you b€gil'1: J

8118the in~tr1.lc!iClnsfor lln.. 44 on )Jags 37 to ~~.. Ir I'IIU can use thls workuh8"i tc ~gurQyoul'1a:!(.
If' you do nQ~I~"'v~ 10 llt~ Scl1edule D and yoU receivlld caoltal gain dimnbutions. be sura you checked 1h~ bOlllln 1'119is of Form "1040,

1. 2. "',

Ent\!r th~ amount from Foml1040. lins .13 Errtflrthfl amount from F0fTT110'IO,line 9b ··.. Are. yQU fiDn9 $"ha.:Jule D?
0' lin~

···:i:··············,···,,·2","'i£i"4··:· ..
3.
--_.

1. __

.;:1~.5:;,,.:4:.;2;:..<./,.:6..;:9;,..8.::...:...

Cl[] Yes.

50'or "'"

6maller

'5 (I,'

, ••

} "_

D NOr
4.

S'm-:.dLio D, IJLlI ~IO I"'IOlanro:;r LC!i:I uren -0~:ui!:r,.taIRJ!lOIIfl\ffOOmFQ1TI1,'1C1.!1.O"lfn81J

Add U~~ 2 and 3

,,,

, 4.

:2 , 754.
-'0:...;... 6. _--::'--;:=-'i2::-",-:7~5i-.d:i-~ ,,-. 7 -----'~'--'--:.......:....:....-= 1,53.9,944. .

e.

s. I (you II rEI 01~Imlng Investrnent int"re~l Bv.pe.nse on Form 4952, emer 1.h$ ;ll1'1ountfrom [ins '19 of thattonn, Oth~""ise Ohler ·0· .... ", .... "....... 5.. e.. Subtraot lin.. 5 fn;IIY1llna4.11 zero or 1<'.J5~, ·0· ",nh,r ,. SlJl;itr;:;:ct1I11~ from line 1, If zero or lasa, eI'lter ·0· I:'i
Enter th~ srn ..llar at:

The amount on line 1. or $ 29.700 if ~iflgl ... 01' m~I"IQdtiling <lep<lral:$!ly. } ....• ••• •..•.•. .•• $ 59,400 rr I'nlIlTledfiling joimly or quaJl~/h\g wldow{erl. $ 39,800 If hsad of household, 9. Is the ~mouot on Jill" 7 "'''Iuello or mere th~n the ennount en 11M61 00 y~. SI~I" Iln~s !iJlhrougl1 '11, go to ITna12 liJld tlh~cl, th~ 'No' bQ);.

"

' __

........;5::..:9;;..,!:.....:4:.:0:...::0~.

D No. EIlierthe

amDLlnt ircmllne"/

.. ,

"

"...

9.

~_=
~_

~O. Subtract line OJ frQm fins a, " , ". 10, 11. r\01ul~plyline10by5% (.05) " _.._ _ , "., i2. Are the wnounts on lin.... 6 ,.nd , 0 tJ1Q sam B? y"". Silip lin..~ 12 through '15; go to nne 16. !'l\;l.EnMI·ihssmaJI&tofITne1 or[,ne6 " "., , ·I:t. :3 I 1:3. Eni .. rth!il """OUI,t from line 10 (if lill" 10 il; tJl~I'IJ(.I!IFirer OL · , 3. 14. Subtract rrne '13 from lil1'" 12 "......... .....•... 14. 2I '16. Multiply DniO141;l1' 15% (.16) , , , "" " ••......•........ _ ...•.•.•...•.....•..• '16. Fi9"'''' lil~ tal( 01' the amount an Hne 7, Us", thB TID: T~bl" orTEIX Gamplrtatlan Walirnheei, whiClwvsr

11.

00

754. 0• 754 •
" •.• ""
~5. , 16. ".,

413.
513,043.
514,007.

.. ppliEQ "17. 18. Add lings '11,15. GIld 16 " applles , "

"

, ,

17.

513,456.

Flgurell1e tax on the ·amQunt on line 1. US8 the Tax Tabl" or iw: Computation Worl'sh"'~t, \~hkhaver " " ,•.•.••......•.•..... ''',., , •...•............ " ,' , , ,., " ••..• , .. '16. ,.,'.

19. TaJ: all all t~lIabll' inoome. E11'lflrthe smaller of line 17 or line 1B. Alao inolud6 thiB erneurt on Farm lOAD, li,.,,,,44 1111.

513 ,45 E '_

~104<11

11·1.·05

09270331

l31470 40C01F

2005.05030

OBAbu~.B~~CK H. 09/21/2006

5.9

9: 45Alvl

WC01'F_1

nfl/~l

2006

OIl:44 FA,i': _l 312 372 8:107

\\'sas, PC, CPA's

@Oll

N<lm~ of person with Mlj-!lmploYll1l!!nt

inocm~ (as shown on Form i 040)

Saci al s~our~y number of person with s~lf"eJ~ployment Income "

BAlThC!\ H.

DEAl-fA

!>

Section B - Long Scheduie lSi!

~ S{Jlf-6mploymentTa.'"!.

No!e. If your ani)' income subject \1;> ~ell·€mpllJ) ....",nt tax 16ohurch (lmplcY9D Income, ::.Iop tines 1 through 4b. Ertt£1r ·D· on line 4c sno go to 1I~f' 59. lncorns from .,.rvlc.'ils YO\I periClTTTled as e mlnist",r or a member Q1a religiou5 order Is not ~i'lulch employM Inr.ome. See page SE·1. A If you S.M a minister, member of a 1'llligioua ol·cil'.lr, or ChrlEUnn Sci~n~e I:l..~[;titioner more of other nat ~arn,ngll from self'employment, oh~el( here a'l(l Cl)ntlnue with

"rut

.. nrj YOu fil~r;l r:'orm 431Sl, but you har;! ~400 or I _ _ ,......

1>0

!~M I!lml proftt or (loss) frQm Schedull1 F, ~nB 36, M~I farm partnersblps, SohiWuI81~'1 (Form 1065). box 1 a. cede A. I~Ot8. Ship this IlnQ i~ u::;~ fhe farm oJ:;llonal m~U1ocl (see page SE·4) you 2 N~I pruiil Of (Ioas) from 6c!1e.dUle G, liM 31; 50heoLlie C·EZ, linl;1;1; 6ch6dlJla 1<·'1(Fonn 1(65),lJox

"
14, COM A

..

'I

(omar than mrmlng); ;;no;l Schedul~

pa[l~

1<·'\(Form 10f;6·2), box iii. Mlnlstero; !!]",d marnbers oj religious Ol">:h.r~, see
(seQ pllge 5104)
••.• _. ,._ ••• ·,.

S~·1 for

llflloun'O) to report ,,11111isline. Sea page SI;·2 lor ather lncerne to WPI;1·rt.Not!;. 511ip 'this line

ir you use tha nor,f!IfITI optil;>n~1nwthod

t"

$.#!K..!?r#:T.ID.~
__ •• n _ ••• " •• ,

l2.
_

C~ombin8 JiI.. e.51 and 2 D

D

U&.u

••

_._

~_.'"J1

•••

""

•••.••••••••••

a
4a
41;1 ~4:;:;c;.,.I __

4 ..

If fil1e:3 is mere than ?('rQ. mllmpll' lin~ 3.by 92.35% If yO\) elGct one or oath of the optlonal IT I,,~s than mmhQds, emplo'{BB tram FOlm

(.9235). CthQfVlis",

enteramount

fr~rn 11m,S "

.
.

1,054,171.

1,:1.11,495. 1,1111,4950

emer1he Income,

total of lin",:; 15 and 17 hers enter·()- finr;! cOJ"lllnue SE·1

I·

CombifJ<llin~£· 4a and iJb.1! less tnan $400, lItQP: you do not ewa sel~·employmlilnl ta;;.l:;(ccptj,;rn.

MaO

OI~d you had employee

cnurch inoome

!l a

Enter y<"tur church

W·2. SeE>page

rcr lleflnl!lon 0; church cmploy"~ l!'\Com" .. -.. - _ " _ • 1.....:5o.:11:....L_ b Multiply lin,.;;e by 92.35% (,$235). If le~s than $'IOD, 9f1tar'(} " B Nd mln9s from $",rf'!}mploYl"91~t. Add linEls .ole and 51;> _.......... M.",imlJm omoo.JT1; i eornblned w~ge!l and self·amploymant ~ ~amin9S sub]Qct to geoial security hilt 01' i
!h~ 0.2% POrfiOI', ot tne 7.65% W.2) and ri1lll,o~d rotlrernent llnes f)b"hrou~h h
Q

I---------r~'~:·;:
I>
!.:;-; :::~
,

_:~::.1 . ..:4;,.J'L.:l~ .!_1..:.0;.,;5;. ..:7..:1::..:,.'

F5:;:;p+_-:r-;:n:"'7"--:r~.--

J-..:G;:._I-_.:::l~,'-0:::..:::S..;4;;.f..,
.

;::1..:7..;1::....:..

rallroar;! rBlIr;;merlt

(lier 1) tax lor 2005 or mnr.., skip Sa L.:8;::,1;r~_~~ _..

r
'•.. ' '. \;': .•

90,000.00

J; 1) T0;",1 <,oclal seour't-i \"lagos and tips (!otnl of bcxcs :3 ana 7 on FO:m(5)
(ti~r 11 ,:ompen~~ilon.ltS\lO.OOO iO, and go to linG"

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

90,000

I)rJfBporlt.-:J tips ~bj~c;llo

~~;Ii,,' ~9CUrity Is;: (from Form 41::17. line 9) I'terasild

•. -l·}·~:.,·:
I>

J~: .: ..,'
So ,0 1'1 '12

Add fine.s B~ end Bb _ Subtrelllllnl'l6cfrum 11M T.lfzep,;> (\)'1886, enter-D' MultiplY the smaller
Q~

_............................................................. r;m line 10~nd gO to Iftl!! 11 _" ' '._..

~I;l~+--

_
30,571.
30,571.

IIns 6 Of line 9 by 12.4% (:124) , "mpl Ol/ITI apt tax. Multipll' ·!(M·D, line;;;, Add lines 10 and ·'1. !;I'lMrhere Ilnd en Form II"", ·12 loy

"............. _._ _

1"

f.tlUltiF'~ IIm·\ 6 by 2..9% (.02.9) 6elf-en,pIO)ll1'lenttsli. iJa<1uo.'Jon for r;m"'halt

12

10~o,lln" Q13 " ...,.... '/"

Qf

lll![f·

!'.I
n ",'

't
•• '" •••

50% {.5i- En!ertlie result h~rtHIr:r;l.OI1 Form

15,286. ":, ...

-,',

', '.'

' ••

Fsrrn OP~OMi
(bj

MEth~d.

You rnav U~~ trus method

only if

/"J

)'000' <]r035

[s;", Income 1·.vera not more than $2',400 or , ..

yournO!t mmi or~;ij,,· werole@sll,,,n$1.733.

~'.;,:<IIl1Un1

14
15

itl"om~ lor optio~all"l'i~lhod5

Ellterih .. smaller of; two-thlrde lnol :8S.~ than _;;E!PJ) or $1,600. AJsc IIlClud,;, this llmount ol1llnB 4b ..i;lO\l~ _ _, "", ";0. i\loni3fm Optlon!!1 M""t>o~. You may usa ·tlli~ method only If (a) your net nonterm prom~3 w .. r~ less than $1 ,733 and t' " also 11iI~ than 72.1 f.l1;"~ "I your 9(lJSS nonfarm il1comB" and (b) 'IOU had nat eamlngs from Eoelf'employmant 01 at :,:,":,', :, : lea6! $400 i., 2 olfur;pllor3 years, r', (' ;-:. Os utl 0 11. You may use this rne thOd no rnors til en five tim~~.
~ '. I ,

' (2/'J) of gross fe,m meome!

"

,21
"

'14

16

SubtrOlctfine1(5fl'llmline14 Enter tha smaller 1i11~1e. Alr,o Include oj; tWQ·1Nrds (213) of eroslll1onlllrm till,; arnount 011111164b abou~ .

_ Income 4 (not ,~~~ than ;mro) Dr the amount Cl'l " _ ~ .

f-1:.;:6'-+

~~

"!7

; F;;:rm S~h. F, 'Ine 11, and Sch.I(·1IForm '1065), bar-H, oode B. ~ FrcI1l5c~.~, :Ine 35. alld 5011.1\·1 (FIlTlT1 1065), om: 14, cllde A

II' FromK·' C • line 31; S~I1.c·~Z, line $; SC~.IH Sell. ·lllUti·S), 9,

(I'orm bnx ·1 From Sn~. C • line 7; sen, C'E<:, line 5011.

17

(Form 1065), box 1i1, coda Po; and

14, G()((OC; and

. -------!i:;:,,~~:!.:,
11.jl'i.aiJ3l

.. -.----.-~---.--I-.
40C01F

Seh. I'·j (Form 1065-B). bOl(9•

'1; Sell. K·' (Form 1065), box

gnhr.dul~ S~ (r-orm lU40j 2005

09270331

131&70

2005 , 0503 0 OB..~

5.10 09/21/2006.
~;lI.'RAr:Tt E"

9 : L~5Ar"1

40C01F_1

09/21/2006

08:014 FAX 1 312 3i2 8407

WSHS, PC. CPA's

[iJ1112

Name 01 person wilh ~elt-r:mpll;ly;'l'i~nt

Income (e. shown on Form 1 0.10)

~~~~~~~~~~--------~~---~=-----~--~----~~~~~~~se
IflCEBlrLE L. OBAM..~
inoam6 __ ,_... ~.

Social ~~wrlL)l umber of n person with .'leli.emploYM1en!

SectiOIi1 B - Long Schedule

Nole. 11your (Inl)! lneome aubJ"~t to ~elf·amploym"'l'Jt tID( i"llhUl'ch ernplo~(;!e Income, sl<.ip)ln98 1 thmugh 'lb. enter ·0· on I1ne 40 und go to line Sa. Income rrom se:vice1;: you performed as s mlnlster ora memoar of a r..li9ious order i~ not church employ"", Income. See p~g~ SE·,. A If you Bfe a minister, m~Il'IMr of ~ teUgious altier, or Chl'lsoon Soiern:e pr<l<;ltltloner Ilnd you -mali Farm 4361, but you had ffi~OO or mora Qf other net erunlnga irom selr·amploymenl; eheck hem and oontlnulil with Part I _ --.._ __ , I~",t fmrm pront or Iloss) from Sc:11edul<')F, line 36, and TEIITl1 partnerehlps, 60hedllie K"I (Form 1065), box 14, code A, Note, Skip this line iFYoU use th .. farm opliO;Jriajmethod (see pags SE-4) ". No3tprofit or Qoss) TroI'l1 Schedule C, ITn.. 31: Sch6\iule C'EZ, ~n'" 8; Soh~dule 1~'1 (Fortn '1066), lJO)( 14, cQr;le A ~O'IhSrthan f!!rming)i and $~hadul" .

I--'-t--~~-~=--

K,' (Form 1085'8), b<;ll( 9. Mlni"tsr.s and m!1lmbers of religious orders, see

.. "ge SE·1 for amoun!$ re report on thIs Uml. See PElg" SE·2 lor O'II11Or lnogme to report, l"IIote. Silip !hIs Tlll'il -

:;:

ii~ou useth", no~farm optional method (see page SE·4) ,., " (iJ_~_1:;) ~.?;',~';t'.~W r.-;2~:--=~--;4"'5~ Combin", lines 1 and 2 __ .__.__ . ".. ~ 4<1 If line:3 iii 11':0r;; lh~n zero, mlJl!iply line S by 92.. 5% (.9235). Cllhs'''''se, ental' amount trorn Ime 3 3 ,', , 4" b If you elect on.. or both Qfthe optionall'l'lethods, stoter the iotal 01 line~ i;; and '17 herE .. " "............... 4b
c 5a Combine lines 4" ~d ~b.lfl,,~s then $400. stop; you do not<;lW~ self·employmen1 tox. E~Cfi'p~i"n. emp.ioy",e Incom~, 9I'1ter'0' .. nd (:ontlnue IIIGSS than :!i.:.OO and Y"'" hgd ohurch

JJ

• .,:;O...,O;..:O~.

45 , 000 , 41 , 55 B ,

Enter youI' church employ",,, income frQm for defln~ion QI churdl emploYge InoomE:l. Net earl'lln~6 fr<>ll1 Ge[j-employme,nt.

rorm '1'1·2. S!l~

.. , _ and fib

page SIO.·' ",

-I
, ,..

i_ L'-'5.;."~ _
"" ,

"............

1;-

~~,,, __ __ , .

{- ,_
!;b
7

r....""'0-:f_~_~_4_1_,,'-5_· _5_8_. .:.,,;,!/:'J 1....;::6~1---~--'Of4"'1=,=5"'-"'5"'8.-',

b Multiply linll! 5~ by 92~5% (.923;;;).If less than 9100, enter ·0·

6 Add lirle~.lIc

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

7
8~

Maximum amourillJI
Total s(iolaI5e~urity lin"'l; abthrough b c Ul'lrepor-wi;l Adi;llinos

oOl"llofned weges and Bl1lf·amploym;;<nt aarnini3" vUbJoot to llodal SOOllril:y I:aY. or

(lier 1) tax ror'20Dli If £130,000 or mQ!OJ,aMp " .. "._ wages end tipll (total of' boxes 3 and 7 on FOrm(s) (tier "I) compenr;al:io/\.

the 6 .. % portion .;lIthe 7,65""(' railroad ralirnment 2 W'2) and railroad r ..II",rr.Bnt

10, and goto IiI1G'11 _.. , _, __ "

_._
:

.,
", , , ,"

"
",

!I
.-~l
,',

so.eco.oo

~a;;;,_a+~ __ ,.. ,

.....;;,9..;O~1 .:.O..;O_O~':": :;": ,

,

III'S SUbject to soclsl g~mJrlry lID< (from F'orm 41.;Ji, 1I.~eg) •__ O:aand Db

.'~ ':.,::~::
eo
1'1

1~ ~~~I~::~~:::;~~;~~~~:~~iQ:~:eD~~:~,;;~r(~~~~r~.:.d ..~.~.11.~,~.~~.~~~.~~.~~.~i~:.~.1,,::::::::::::::::::::::::::: ~ I---'.~:..o-l-----~---11 12 13 Ml)lllplyline 6 by 2.9% (.029) " _ .. "t tax. M'lltiply une 12 by V' . ._ " .. _' .. _ . , " . , S!lli.employm~nt 50% (.6). errterth~ t<Ct.Add lines 10 and 1'1. f;rrtsrhere . re<>ult
11816

"

5ni;! 1;11'1 Ptm-I1'IOoJ.O,lh~e66

DIi!<;tUI:t!_Onfgr one·l'mlf ofself.employm

end on F'orm 1040,lin",

I
1<1

2,205.
1.205,

12

6a 3
0, "... ..

l,p~r;t:18 Optional
FBtm Optional 14 15 Mmlimum enter1he this amount ")QtlwmOpU,;Jne.l MOihod. (b) Your nSI farm prt;lflt!;2 smaller

Method$

'ro Figure II,!Gt r.:arnin!;ls (Me page SI:·3)

only Ii (al your gross fulrm illCOn1t;' ws~ net more th~1i $2,400 , ' -__ .. , , . __ .. _ " " __ . __ ;,::. ';1

You may use this method \'Iereless than $1 ,733. of~ methods _
U5I!)

Income for opllonal on line 4b ahove

t\'Jo-thirdc grQ$s
(2/3) of -.. "" .. --

~ ,__:!.i.I-_~
'1;;

:'i'~'f'~

1 ,6_0_0~.O_O

iarm inct;ll11e

(not 16S~ than ;cero) 01' $1,600, Aleo Include

Il1Is method onll' if (u) yo:>urnet nonTerm pro-fitG 3 wore tess th;l!n $'1,733 "nd rl,"',:l ,,1$0 less than7:L189% of your gmll5 nontaffi1lnoon'l~ and (!;oj you had not eaming~ Iro,r, ",,,If'employment of al . '., ,",. least t40Cl in :2 of the prior :!I years, Cautioll. You may 1,1$!lt thlll metrod no mor", 1M" five times. M(lttiocJ. You may
11;1 17 Sub\l'~c! Rne 1S from lin" 14 Enlerth~

~tn:lllcr ot tl'lO-lhlrds

" ". __ _. " ,.. _ ,,, .. _ . (2/3) of oroos m;",'<lrm income 4 (not le:w thali zero) or tl'Is amount Qn on line41J aIlove _ _,
3 From

IIn~16. Also includB this

1 Ff'om 2

5[]101.mt

"

,.. , L-·I'--'j'-'-

~-_

Sell. ~, una 11,and Sch, 1(-1(Form 1D65), bQ~14, code 6. Frvm Seh. f, lin. 3t', and Sell.il· i (Form 1055), box 14, code A

Sch. C, IIna~1; Suh. G-EZ,IIn~ S; Seh.I<·1 (form '1065), ~~. 1~, code.!J,:, end 8ch. ](-, (Form 10il5·lJ), bell( 9. ~ Fr~m Sch, C .Iine 7; Sch, C·E2, IIn6 'I; Sch.II·1 (Form 1065), oot 14, code C; arnl Bell. 1(-4 (Form 10,.;~·a),bQ~ S.

G2.SIl2 11.. 1G-<l5

09270331

131470

40C01F

2005.05030

5.11 OBAlfLA, BARACK H. 09/21/2006

40CO :i.F_,.l

9: 45AI"1

WSHS.

PC,

CP!\.'

Bel~ra you bogln: Ye<.1 n~ed tn understnnc o Oepl.'llde.nt Core 9t'lMmS

\h~ rollowing terms, See Dennltion!l on paR'" 1 of th'1llnsnuotions. 0 Qualifying F'ofllQnls)

If:~itfi1 .

Persons or Organization:;;
(U)'Q'J ,.,.. ~d
Il'Q~

lal C~rg ~mvidd~ nem!!

space,

WGe thB bottom III page 2.)

who

Provided

tne

Ca!"0;3 You mustccroplete Ihi:l part, "

.~~ ..._ ....

~_~~

=_
(dJ Amount paid

(l1\lmber, straat, apt. M., city, ~tE.le,an" ZIP aod~]

(b) Add",!;:)

Ie) Identifying number {SSN' or EINl

I"

BU8liliELL ROSA QU'l'IEHRElZ

I" ....

~-------------_,
I.1.J
No ~ Ws ___ Did you receive

7,200
- __ ~L....~-~:....=--=--:c",;.,.

...

~,t;;,L..LN~'

2,640.

'>

Compls!,e Complete

only Par!: II below. Part III em page 2 next,

d~per.dent

01'1'''' beneilts1

----...;l>

c~1
2

CautlulI_ II'll,e (;3f~ w~s provid~d In Yl;JUrilome, you may owe employYIl6rrt tro:eG, See !h,B irml]l.lctlons for Form 1040, line El2.

C.edit

for Child allcl Dependelflt

C"m~E;,(_:;;P:""'::;,'li.:_:s;-:e~s_...",-~
La5~

.,---.-~-:-",,,:,:,,
(b) Qualifying llerS;;;;'a ~ocialsecurtiy nUI,lb~r

Informiltklfl

~bl;'''l your Q\tallfying pe'&!m[~). Fir;l

Ii yaw heve more tl1an t\'IQ qualiiyirl9 person~, see 1he instruction,..
IriCUrmd ~(I ~,IUr.J1:1 20051oC!'" (he flQl"""""" 1;c.1~tJ Ifl cahJli"In ti)

In) Civallriinu person's narnc

u1'1l~alljl~d e.xpCIIS~SY,,"

Y~IA

A~.

~B1=~~~
BAM./!..

-+_

'--I--~--'.~-""";'"

4,920. 4,920.
-=Oc.;O~O..:...' .=2:._5:_:.6~.

NA'l'ASIL1l" M.
3 Add tile ;l.mQU~[S In oclumn

[e) of line 2, DC! net enter mOrSillElJl $3,Qoo ior one (jualjiylng person or P;;.rt III, Mter the !!mount " oam",d InCome from line ~2 """" , _,_.. , cl' was ",............. _ _" " ,

36,UOO--· ~
_...... '" _..

fl):'Iwo or rnora oeraons. If vcu Q.omplew"

1-':l=--t-_-_~6::.L!
1--4.:.-+- __ 1,-"",2:;:.• ..:8_0,-,-,
l_s'--t__

4 Erllsr your ~ ~rii!l)d In ~Qme. Sel;! in~tl'ucHol1:; ~ It marrien tiling JQI~UY. enter your Spl;ll,l'S'~ dlsElJIEd, 5 GEnter lh,;, Imrt""c:i~ns):

0~your

;;:PQUSOW~$ ~ student

;;,11OU\Crll, ",I'IIS" the al'tlQunt from line 4 "

3_6_2.:.l359 •
6;..",:_, ..::O_O'--'-O..:..,.

Ine5rngllest

oi liplll S. 4, or 5

~6""""+-

7 Emsr the amOl,Jnt lrorn FQlnl1 040, line SS , _.." , ,... Eilts; on. rille a Ihe dedmsl erneunt shown below thllt applies to tile amount an line 7
HUne1 is: aLit not ",O",v::_e1c.· _..:";.:v.=:iM':.._ __ $0· '!i,I'lOO 1$,000' '17,000 '17,000· 19,000 Declm1'l1 --"a:.:,m""'OUl1! Is ,3'1 ,33 If HnElI Is:

II
7 ,27 .26
.25 .24 22 21

1 , 655 106 • r~.(':,,:!

J

.~~,
~~~t;., Ir~

j., : ".:'

Elm not
S 29,000 . 000 31,000 ,33,000
M,COO ·35,000 M,OOO·37,OOO

Deolmal
,···,.'ll

.as

.::Q~v.::c:;,..r_.:c~'~l.=:er:...,__~_.!!:amQunl: is

!;I'.

21,000 - 23,OO() 25,000 - 27,000 27,1]00 • 2-0.000

19,003,21,000

.32 .30

'2;:_.000 2:;,000 .

.3-1

,::;:£1 ,,28

3f;l,!JOO' 41 ,000 011 ,000. 4:J,mo 42,00D. No limit

37,000· .;19,000

.22

:'.;:':~: '
,I', "I,

x.2D

20

;,"r. ' ~;.

eJ i,;)"lt1pl, ITne is t>y Ihe decimal

tna ins[f1Jctj'Ofi£
u

amount

on ling 8. If yo" p!lJd 200<1 ~.xp()n5\l13 In 20CS, 5139

'1 , __.•••••.• __•.__ .•••• ,_ ••• • __ ._ ••••..•••.••••

"q'

,•...••.... ,

'10 iOnterttm a;;ioulil from Forni 1040, Iln<' 46, minus O1nyarnoent on Form ,a'IO,iifllO '11 Creditfot lin,,48 LHA
:515751 1'01'

41 " ", chile! end d",penq~.nt care Ill(pmS<l-$, Efitrerth" smaller al line S Of 11M 10 her", and on Form '1040,

'10

1,200. 5:1.3,456.

..0 Pap"of'work Fleduotlon

;=

,'

·"

l"·

""11nw""''''.''

..

u:J=

Aot Notlce, 1>09sep<JHi~e InstnloUoos.

",''''.i.W,."l .:.!''''= 1~1;.,Jo_~~_;1;;..:;.,,;;2;..O;..;;O~. .. .. Farm ,W~1 (2.005)

n-rs-os

09270331

131470 40C01F

2005,05030

OBAbl\, BAP.ACK H.
09/2'1/2006 9: lr5AlvJ

5.12

40C01F_:1.

II'SBS, PC, CFA's

li'll 0.15

SCHEDULE H
(Form .! 040)
a:
O";l ::nrn.::nt tno '1"r.lil=:iurj jrur.Ji'..3JflC~li:'Ifllrll;:;c:"'llic

Household IEmp~o~fmefl]t TS1-~es

(For Soc;J~1 Securily, Medicare, Withh&ld lnoome, end Fedoral Un~mploym~r1t (FI.1TA)Ta~es) 111<10-98, or 1041.

OMB No. 1545-1971

Ii>
(:em

Atu. .. h to Form 1040, 'I040h!R,

2[Q)(l1)@
number
_

t\:'o- Se!!l s t'lt:rilrale imilructlo ns,

"I~meolemoloY8!
EtnploYOl.r 'dsl1tlfloation

K<UlACK
A

H.

&.

MIC:m!!L~.;;.L-..:E;,_._;,:L_,._O B· ..;_A!l.C-Ml;;,.,I~~ ........

L_-,-

Old ~'ou pay Wly one household emp"wae cash wa.g,,~ of ~;1,'IDO or mars In ~()OS? (If any household employee was your OPQv<!~, 0I.Jrchild Y under a\1'" 21, yovr pan?lnt, or 8l'iyo.1L'l under age , a, s..,e the OneA in~.t[1,lr;:li<;J ~n p ~ge H·3 tl!'lfcra nl; YOU an~I'I"f this ttuestlan.)

[X]

Yes.

Skip lines 8 and C and go to line 1.

1'I1'l.

Go to l[n~6,

Did )'DU ~Jj~'n"ld iQderal income I~ during :l.OO5tor any househr}]d gmploy~a?

=:J
I -I
Q

V",,,, iii".

S~lp lina C antl go;o 111'1" 5. G" t(1llng

c.

Dir,!~'OI,J ~\' toml r.a~h VJa(J!!!"l; !jl1,OOOor more In ar,ycaJ8n!larqullrtar P cr

(II[]

of 2004 or 2 DDSto.,11 hOI,J""'hol~ empl[]y"..,,?

not ~jlunt cash wages paid in ?O04 or ~005 \9 yo,lr spousa No. Stop. Do nat file tilis schedols.

I'our thlld Ul,d~~ .:.g~ ~1, or you, plOr"nr.)

DYes.

Slrrp Iiniil9 ,·.9 .. nd i;!" 10 tina 1 Q 00 P~>I!. 2. (CaJend!lryp~::!I'taxpayers do net have \0 oornptste thl~ torm rr;>r2005.)

having no household

employees In 2005

Tot;:.! ~ash wJge;; I'

~ubiec:t to

social s~~uritytmr.(lS (6~S page lin:; 1 b;' '12.4~'(' (.124)." ...... _..

1-1-41

.. ".. "".. "

'1

dO 9 r S .......

"I

;: ,;, :,:
' •

••

e·,)(:I~1 ~~,;ur1ly

=,,~t ultlpl\' M

1,220.

.. " _ __ I " ..... I !;l ...... .. ....

,I M~dl('.~r'~ taxes, Mult!pll'llnB S til' 2.!l% (,Oa9) , "." .. ".,' .. "" , , , .. _

I'

EJ , S4 0 .':
,.. ,

::.?::
205.
~

"f',

() Fad~aJ lncorna

= wllhh~ld.lf

any

_ .._

,' ;-,;5-+_=...--

1,505.
..
1;1

,~\fancEl aarnad In~'omg of~dlt ('"Ie) paym9m~, lt any N",t 'Iaoo<ao:; [sUbll'ti.:t II"".
'j

,,, .." _

"

,, "

, "

,,, ..

[-7:......1- __

--

{,'o'l'lll,,~ 61

:1.,505.

!;I

Di<J Y"I.! P"Y totel ",,5l1 wag":; c: $1.000 or more In any clllendar tlutll'tm' ot 2C04 or 2005 to !1Du$ehold employees?

ltlo

1'10<count

~~r.hI'I'''Qes pald in 2004 or ::!00510 your ~PQI.I~e,)'o~r chllc

under

eg~::11, 0" your J'l",,"ol.)

L_J
LX:
LHA

,~o.

Sta~. ENOl'lha ~ITlQLlmfrom line 8 above O~ FOlm 'I 040, li~", 6:<, If you are m)t rl.'ql,li,.,ct i;r;l HIli!Form 1040,
the line 9 lnstructinns on [,Ia90 H,q,.

5""

Vas. Gr>10 IhlP.10 on pa!lEl 2. Reductiol' Aot hI<:l!ICiQ, soa separate If'lSlfuctJons. $ohedLlle H (Form 100JQj 2005

F<,1r ri~"oy Aot ~nr.l r""p~rworJ( P

=-~~":I;, , • '-r!l-'Of

U9270331

131470

40C01F

2005.05030 OB~~~, EA~~CK H.

:i.l1

40C01F_1
9: 45Ai"I

09/21/2006

09/~1/200B

08:45 FAX 1 312 3i2 3407

II'sns, PC. CPA's

1'~'"ttr~nr,l Dependent

Form:M41 (20D5)Bll..RACK t.: MICHELLE Care Benefits

a.

L.

OBAlY~.J"
.'j

--,----------~~,

'12 Entar the total amolJ"t oitloR"ndcnt C:lI"ebeneTitr:;you reo"ived in 2005. Arno.mls you r.."elved as an .,mployea should 1;1" ~hol/l'l1 in bo~ 10 of your Fr,lTm(s) W·2. Do notincludeamQl,lflts report~1:I as wagasln box 1 of Ferm(s) W·2. If you warG self·employer.! t'Jra partn ..r, Include amo..,ni~ you receiVed under a d5pend"ni 0"''''' a~~isti:ln"e program from your sale prn(ll'lllIlcffihip or partns,,,,hlp .. ' " , 1$ Enter the amount iorleitsd or carried torwerr.l to 2006. if

..

,,"'y (sel.'!Me 1i1StrUotiDI1S)

is

Ental' the i"t;JtB1 amount Dr qualiiled expenlOsli Incllrred 1n-:200S fQrthE car~ of the gUlllltylng per9cm(sj .., , , _ ,.., ..

16 EfllGrUlellmall9"0lHne

'1<1

or'5

_
,

"

"
..

..

'17 Entllfy<;>IJI'BIlTfl"o;I lneerns, Sa" InslNotlollS

1:;1 Entgr 1)1" amount shown belOWthst appli5!.\l o you. t o If m,mied filinfj IQinUy. enter your SpOUGo's "~m"'d Income (iFyour -) ~PQua8 wa~ a studtlint or W~S dlsabled, the inotl1JClionl; far line 5).

~"'!l

e Ii mllrlh.dfJli119 I<9parately, ~M tne Inot"uclion~ (mille arnaurrt to ilnt;lr'j " All 01h1;lr.:., enter U1S J!lmlJuntfrom line '17. '

'19 EI,[er!h~ ,.tnalieBt of fine 16,17.!;It 113 .. ,." " "" ,', " .., L-1;,:e-L._~ ~....,_, 20 Entw Ihe amour;! from lirm '12 that yo~, rscalved irom your Boleproprietor;;hlp or Ilfirtnetsl,lp. Jfyeu did not .,'~ ',:, r..Qeiva an.YB~¢i'Iamounts,.",Mor.o , "'.,

ill

'; '''J,

' 1'

21 Sul;!traclline 20 from fjrJe14 " ""..... 2~ Zl: Enter $5.000 ($2,500 if m$yrl!lcl filing EOGparatefy'Ind you were ,'equired to enter YOlJr$pousa's ..",mad I lncorne on ling '16) ' .." " " " , ,', 2S De>;!uctlble b..nefis. Enter the :smol!e~t of line HI, 20, 01'22. AI.e, rr'lclucJ13 amount on Iha appropriate Ihj~
IU1e(s) ofyourretum (saeth9Insl;n.l""~Ol'\sl :" ,' ""

,.........

::·j~!r~,~ I,:'
!'r1r,)::::

2D

i,:t;: ~q
!-"!.L=9+

~
•• -

2:;\

c__.

24 Enterth$z;ma!(crofhne1Sor22
25 ~ter1ho

" " " " "

, ,
..

t±=~41
25
u

._~: ..; :'~~

•• I I

Illmount from lina 23

.
..

as

(II 'j.~I.~
Cl(o-Iuded b""llfits. SubtrEct line 26 ii1:>m line 24,1(~ro or I.,SY, "ntar -0.
o'lnt6f

:;i;::':
26

'/.,7 Taxable benefits. SLlbtrnt:t line 261rom line 21. 112~ro or lesa, line 7. 0,., the ctottli'c;lU,,1ol next to lIne 7. enter "DOS' '

·0·. Afl:lo. Includs this amount 01'1 FomI 104D.

"" "" care erli'dl!:, ..

27

To ol"im the ohild Md Clep~nd8.,t

oomplete lil1"'S28-32 balO'.'!. ZEl Ent~r $3.000 ($6,000 If two cr mere qUilliiying pSl50ns) :ZS Add lint'ls Z3 and 26 _ , " you paid 2004 ' r3..;.O-+ __ , , ..

...&!LI-_~

_
_

30 Subtract IineZ.9 from liM 25. It zero or less, step. You cannet take the ornclli.. ~:ceptiol1.lf
e)(peIlS~SIn

200S.

",6" tho

instruoUons for line 9

'

3'1 Camplst ...lills:2 0" page 1 (Ii this torrn.Do (1J;)t ln~hJda In cO!lJrnl'l(c) ~r·v b",,,,,ntl; ~ihow" on Jil1e 29 abovs.11·,en, add tM arnounte In cnlumn (..) ~Fjd enter th~ total hen ""

"

1-":3_·1-1-

~-_~

,3

2 ~::~::

::l~~ ~
131470

.I~~~.~~,~~.~~.: ,~~,~:.~~~~.~~.i:.~,~.~.u.~.~~.Ii~~.~.~.~ ~.~,~~ .~,,~.~~~~~~.f~.~.~~~......

......132
Fonn 244 i (2:JCJ5)

513152 1,·Ui-Oil

09210331

40C01F

5.13
200'5 • 05030 OEAl1'1..i)",BARACI{ H.

40COlF'_1 9 : 4-5 AI'i

09/21/2006

OU/21.1 2006

08: 46 F.U 1 31ll 372 8407

WSEIS, PC, CPA's

141016

,0

Did you PilY unemployment contributions 11;1 only OM ~1:ab;l7 (If you paid ""rrtrlbutlon:;
ohecll"i'lo,") ,., """ ,,

to N..,w Vork Stato,

..

Yes

r~o

10
1'1
'12

11 Pi~ YOI,l p"y all slats unel11ploym0nl contributions i2 Were

for 2005 by Apn117. 20007 Fr5~~1year file",. tax?

ss e p ago; H-4

.'"

. ..

wi w<lges

thod are taxabte

fur FIJTA tax alae. ti!X;iliI" 101'your state's unamployment

Next: If you checJ""d !h~ "Vas" box on all me Hnes above, cQmpl~ie S.,<;:tionA. If you checlled the "No" box on any of the linea above, ,Mp Section A and comptsta Section 9.

SectIon

A.'-__;_-----~~---.~~--~.
i~4,.2
j
"""

1~ Name of the stElleVAl"!" you P'li~\'n"mployI'nElrit eIl11trlbu\J"I~S ...

·r.. Slat~ rapMing (]umb~I' e~ ~howII Oil stuta un.,mp\[Jyment p

II.
3 ;) B 5 '!5

ta.~rerum

.9

-15 Contrtbuti-ns
'16 Total cash

""<\9"'..

'!o your mate un;;mplcym"l~t

fUnd (sao page el·4)..................

rrsc •. ".
~

~:~q: :!~~r~
1"'('1"

':;
1__ •

clblect to FUTA 12>: (saa pags H-4]

9:......<..1..:6-'4:..°"-'-.

17 I'UTA

~)l.

M":Upl)' iine 1 e

l;Iy .ooe·

Enter Ih~ r,;$ult hara, skip Section G, and .~5'tonne 26

77.
(il
(9)
(~J +~lli~Jr
eel.

18 Complete all colurrns b~'~w that apply (J)}

Nfll"M (Ol)

01
:ilalc

~ryou nee"
(0)

more .p~ce. ~..e (:1<19<' I'Hi):

St.i:!'IQ.open]ng nurnllut

taJ
Si~~ II!:I[p~eno:'! r::lo:!

'I")

~~:~~I~;~~l'~~
lii~Utl'l

T<!X~bIQ W.!I!:I9!t ~O:D

r;:t\l~

MlJlttp!y ~.

lel

(h)
Sublri!:C;(

defined in etate oml)

pe:l'io~ Ft-onl

I-_T_._+

e};p:!n~

by JJ~

by eel, (O)

\I~~~~~_J.~~l +.....:::orn:::'·E!.::.. • ..:.O:.:; -,--+-_;::r ... ' ~.-:....._

Il~~~ r;'iJIl3,

(ClJ.ln1

OJ
COI"1\rtb1JI;:n!:

19 Totsls
QO

..

..............................................
" tax (see the line 16 " " .. " .. , " .."., " "

,
""""

,,,
"......

,,.,"",,

,,

,,.,, ,.,. 1c,'' '9....L:-r-li{~l:.~ I_;;:!!:..:l+

..

Acid colum"~ (h) aru:l (i) of lin~ 10

:;:1 Total cash wa~es subject ro R.m; ~ Muldply IIna:21 by 6.2% (.06~) 21 by5.4'ib (.054)

in"lP.i,.nr;'fU'

II '--2_0'-1.

j~'~~~:j~'J
_

..~:l:.; , 'r

-'-

!;In page 1--1-4)

23 Mulilplyllne

"

, 1-7.:23;:...l..-nj

-l~·';j

;',!~~:~; .

24 ~~~;::::;:~:::~::;~~~

:~;t\lu~:

th~·\~~~;~~·~~·i~·;h~ .. ~~~~~·;~~~~i~~;·~·~d·~h~~I~ ~ hero) . Cj' 24·

0,; .•"' '""';;;

1~;Pali:!rn:1 1"crtal HO~l$iI)Mld Er(jpl~wmentT9)[es

~6 ent\>rth"<ll1101ln~frcfTlline8 2.7 AcId Ima 17 (or lin" 25) lll'rd liIi<ll26 _.......................

2B FUTA te)(. S\lbtr~at line 24 tram 1~1e 2. Enter tll9 result here ana go ('llill!) 36 2

--~
..

==---

,;;.;0"='

:.0 "'. ='-...:2:;:5:..L~

~ . Part IV below.

1.505.
r

sa

..

..

Are you required to ille Form 104D? (X] Yt=1i_ Stop. Enter tho amount rromIlns27

hl__ __......;.l...o_ ..:.5-,8",2_,

above on Form '1040, One 62. Do not complete

Vh~U

Jlei~lTlenl

P'L'!l"OHill'! pI j:lcr;1.5'(,II1I!'cl:!:rd i!cl nUII'JG tc II. :Jliilij) UIl.Grf!pltlvm:l1'llt

ttl:!.IJO t1J;:!IT"Jn!l:d[hi~ Clc.h.t!duh"t."'t;;t\J~I'\Qiacc;).~~Il."Jtlrl.!J .(Il9.1-j""';'-l1!~1n~ " IUM t~,1m~tl (1:;0 I'l DI.atlll l'.I';l!:I. or i=ll.!l1J=:!, Ij.Q;<Iuc.ic:: t;OlC'l Lhc.:: Jl:lI'III::inID!!l

to UdJ DD9t

~m?'ID1iI;!,=,r.:.

rot

m~

l:tlti'.'J!uc!3'a

iI.,(I

balSl,

rv IIUD,

C,{:lTfl::l.

:If'I(]

ClIT'plote.

I~ICI p~.:;t

.::.n1

Sci'~dul~

H (F<:lrl1l10401 2005

09270331 131470 4oc01F

2005.05030

5,15 OB.A.!."\lA,I3Ji~CK

H. 9: 1~·5AH

40C01.F_1

09/2'l/2006

IfSflS.

PC,

CPA'S

BJ!RACK
FORM 104,(,)

H.

&;

IHeliELLE

L.

OBM.iI._l'\_
loiISCEJ ..LANEOtTS INCOME

STATEMEiiTT 1l.H01]NT

DESCIUPTIOH
Bh'i

TREEHOlJSE

Vllj.LLEY FOODS FOODS LINE

:j3,QOD. 12,000.
21

TOTJ:J.L TO FORi.'i 1.040,

45,000.

STATE

AI'IDLOCAL

IhlCOME TAX REF~~S

2004 2003

2002

HrLINor8 GROSS S'l'f1mi:/LOCAL INC TAX REFffilIDS

L,BSS:

~r.l'.x PAID

IN

FOLLOWHTG

YEAR

352.

NE'!' TAX REFuruJS

'J,'OTJl.L NET

ILLINOlS

352,

'l'A.:li: REFU'rIDS

092'/!l:i31

131470

aocnrr

.2 0 0 5 • 050 30 OBA'il'It'\, BAPiliCK H. 09/2'J 120015

5.16

STAT~NT(S) 1, 2
40C01P_1
9: L~5AM

09/21/2006

08: 46 FAX 1 .312 312

81l0';'

\\'SHS.

PC.

CP_'\.· 5

I4J

018

E~JRACK E. & MICHELLE L. OBA}~.

FORM 1040
1. PEftBON.fi:L EXEMPTION 'I'10RKSHEET

STATEMENT
AlY10UN'l' SHOWl\1 ON LUTE
(1

NO.

2.

4.

3.

STOP. MULTIPLY $3 r 200 BY THE TOTAL N'''0}'JBER OF EXEMPTIONS CLAn-mn ON FORJ.'Yl1040, LINE 6D r .AND ENTER THE RESULT ON 1IN"'E 42. YES. GO TO LINE 2r MULTIPLY $3,200 BY THE TOTAL NUMBER OF EXE~{f'TIONS CLAINED ON FORM 1040, LINE 6D ••••• , ••.••• 12,800. ENTER THE AMOUNT FROM FORM 1040, LUTE 38 . . 1,655,106 ..
j •••• ,

BELOW FOR YOUR

!S THE AMOUNT DIll' FORM 1040 t LUIE

FILING

STATVS?

38,

MORE TR.i!lif

TEE

ID~TERTHE AMOm~T FOR YOUR FILING STATUS

M.. ll.rutIED

5.

6, 7.

8.
9.

FILING JO~lT OR W!DDW(ER) $218,950 SUBTRACT LINE 4 FROM L!NE 3 ••• ,.. IF LINE 5 IS !!WRE TRA"J'\1 $122,500 ($61,250 IF MARRIED FILING SEP~~ATE) illYTERZERO ON FO~I 1040, LINE 42, DIVIDE LINE 5 BY $2,500 ($lr250 III MFS) l-IDU.rIPLY LINE 0 BY 2% (,02) 5u~D ENTER 'rEE RESULT , AS A DECI~~ . . . , . . . .
~JU~IED MULTIPLY

HEL]l.D OF HOtrSEEO!,D

SINGLE

FILING

SEP]>_R_7!,_TE

$109

t
I

$145,950
$182 450

475

218,950.

1,436,155,

LINE 2

BY LnqE

...,
TO'.rAL

..

"

...

II

SOBTRACT

LINE

a fROM

1..INE2.

TO FORM 1040

LINE

42,

D.

09270331

131470

40C01~

2005.05030 oa~~,

s . 17

BML~CK E, 09/21/2006

STZ-i.TEMEII/T( S)

40C01F_1 9:45AM

O[!::?l

'211f16 08:-16

FAX 1 H2

372

8407

Il'SHS, PC, CPA's

IaJOIO

El.i>'p.J>.CKH, F'ORil'I :I. 0 4, 0

&

i6ICHELLE

L. OBAM_~ Al'iID I,OC.A.L

TAX..~B1E

STll.TE

INCOMJ!: TAX REFUNDS

STATEMEN'l'

;;1004
i\''ET 'l'A.X 1'!.EFIDIDS FROM ,STA.TE ,1I.,.ND LOCAL !NCOME 'J.'A1~ REFUNDS STL<1T.

2003 352.

2002

r.sss

EEFOND8-NU BE}TEFIT :DUE '.1:'0 1>JYiT SALES Tl1d"r "BENEFIT REDUCTIOlif

NET REFUNDS FOR HECALCO'LATI(JN

:2 3 4 5
6 8
<)

352.

'1'O'.l']:_LITE!HZED

DEDuc'rlON9

BK1'-ORE PIil-,Si1:OUT

DBDiJC'rIONNOT SUBJ TO PHASEOUT NE'l' REPmIDS FROIJi LINE 1 J.. IJ:1E 2 MINUS .LINES 3 AND 4: M1J!_,Il'IPLY LINE 5 ElY B0 % (.80) PRIOR YEAR AGI
ITEI}1., DED. l?F.ASEOtfT .sUBTl<,JI.l.!'r LINE 8 l?ROlYl LINE

26,976. 352. :21,29.71, 207,647. 142,700. 64,94.7.

26,6'24.

THRESHOLD 7

10 11

:2

10 TllROUGH 15, }~ND El,TTER AJr.iOU}TTFR0l1 L niE 1 ON L Il-iE 16) HliL'rIPLY LINE 9 BY 3% ('-03) ALLOl'1AJ3LJll ITEMIZED DEDUCTIONS (LIN:<i: 5 LESS THE LESSER Oli' I,}::rl'E 6 OR LINE 10) !TEM DED. NOT SUBJ TO PHASEOUT ITEtllZED DEDUCTIONS

(IF ZEP.O OR LESS, SKIP LINES

1,,948. 24,675.

13B PRIOR YR. STD, DED. AVAILABLE 14 PRIOR YR. ALLOWABLE ITEl~. DED.
15
16 L7

1311. 'f'QTAr, ADJ.

24,676. 9,700. 25,028. 352. 25,028.

9,700.

StJB'J:'1{ACT THE GREA'J.'ER OF LINE

13A
!

OR l,I:NE

BB

~RO:M LINE

TJI...KiUlLE F"EFUlmS
IJESS.t:R OF LINE _;:;_L!,OW~1.BLE PRIOR

1.4

1.5 OR I,nm
'):1\,

ITEM.

1) DED,

352 ..

18 19
20

PRIOR Y1.Jl~ S'!'D. DElD. AVAILABLE S1JR'I'R~CT LIl:Il~ 18 FROM LUTE 17

LESSER OF' LINE 16 OR tINE 19

21 .",r, .. ...
:.,

?RIOR YE~~ TA~iELE INCOME

170,219.

15,328. 352.

Ar([CDN"I' '1'0 INCLUDE ON FORM 1040, LINE 10 w :eli' LIllIE 21 IS -0- OR MORE I USE p.1-iOf;JJ:\TTROM IJ:mE 20 F " IF LIl'ifE 21 IS A NEGATIVE AMOUNT, NET LINES 20 AND 21 STATE AND LOCAL,

353.

!NC01>.Hl: TAX REJ?m.ms 10

PRIOR

'1'0 ;W02

TOT~~ TO FORM

1040, LINE

352.

09270331

131470

40C01F

2005.05030

OBAMA,

5.18

BAJL~CK R. 09/21/2006

ST 1tTEMEHT ( S ) 4

40COIF_1

9:45AM

W9HS, PC, CPA's ;BARACK E.

& MICHELLE

If!] 020

L.

OBAM..t>..
RECEIVED AND 'rUES WITHHELD STATEMENT 5

FORM 1040

~lAGES

F~DE1Ut.L

T S E:tnPLO'fi;R ' S NAME T UNITED STATES SENATE Wl'.SFInTGTON I D.C. B UNIVERSIT'~ Oli' CHICAGO

AJ."'lO'Ol\lT PAlD

TAX WITHHELD 28.273,

86,474. 114,747,

STATE T~ iHTHHELD

TAX ~l1E

CITY SDI

FICA
'I'p.x

MEDIc..~

'l'p...};,

154/047. 316,.962. 471,009.

4,/!41. 9,509, 13,950.

5,580.

:1.,320.
4/743. '7,063.

HoSPITALS

TOTALS

----

5,580.
11160.

FONH 1040

QDF~IFIED DIV!DENDS ORDINARY

QUAr..!FIED DIVIDE:r.mS

NAME

QEl'

PAYER

lJ1VIDENIlS 2,'754.
9E

NORTHERN TRUST BANK

TO'l'j~.L INCLUDED IN

2,'754.

FOP~I 1040, LINE

:2,754.

SCHEDULE

STATE ~~

LOCAL INCOlQE T~~S

S TATEHEN'I'

DES CRIPT 101:-J

UNITED STA'I'ES SENATE - WASHINGTON, UNIVERSITY OF CHICAGO HOSPITALS ILLINOIS 4TH QTR ESTIMATE PAYMEN'I'S D. C ,

4,441. .9,509, 34,000.

TQTl'..L TO SCHEDULE A,

LINE

09270331

131470 4QC01F

2005.05030

5.19 OB~m,

BARACK H. 09/21/2006

STATEMENT(S) 5, 0, '7 40C01F_1 9:45AM

(19/21 '2006

0(\:

:!i FAX 1 312 31'2 8'101

lI'SHS.PC, CPA's

~021

Bl'.B.ACR H.

&: 1Y1ICFIELI,E L"

OBAMA

CASH

COJ.ITTRIBU'TIONS

S TATlilMEJSIT
AMODl'lT

DESCRIE'TJOlli MISCELLAl~OUS
TRINTTY C.~E

50% LH'l!T

30% LIMIT

M~OUNT

lL j;',Ei>DJ:NG couscrr, .tWCH.I:~LLE: LEE FlJI'.JD

illJl.TED

RECOGNIZED

CfffiRITIEB

CHURCH OF CHRIST

2D,000 • 5,000. 16,000. '77,315,

11,315, 25,000.

SUBTOTALS
'.1'0'1')1.1:., O SCHEDULE T A, r~INlii 15A

77,315.

5,,20

nQ270331

131470

40C01J

2005.05030

OBru1h,

B1L~CR H. 09/2'1/2006

STATEif.IENT ( S )

40C01F_1
9: 45Ai"1

09/21/2006

08:,17 F.li 1 312 372 8407

lYSES. PC. CPA's

141022

BAR.4.CK H. SCI-IEDULE A

&.

MICHELLE

L.

OElJiJ>l'A STATEMEN'r 4, 9

I'J.'EMIZED DEDUCTIONS ~JORKSH:eET OF THE }'illlOr:r~TS FROl'l'J SCIiEDULE

u • v •• ,

1. 2.

9, 14, 18, 19, 26, .t'I..1lD 27 •••• ENTER THE 'l'O,):,AL THE 1'l.MOIDITS OF
13, lSB, AND"19 , PLUS

ENTE.R THE TOTAL

,A.,
•

l,IJ.I'lES

THEFT LOSSES Il\fCLODED ON LINE :27. • • , . • • • IS TH:E AMOUNT LINE :2 LESS TF.li'-Jlj THE p..1t!OmifT ON LnTE 1? IF NO, YOUR DEDUCTION IS NOT LIl>II'I'ED. ENTER THE Al".l:OOl\lT F1WM LllIL 1 ABOVE ON SCHEDULE A, LINE 28.

ANY G]!..1ii:BLING AND CASuALTY OR

FROM SCHEDULE

A, LINES

4,

157,683.

on

o.
157,683.

4.

5.
Q. 7.

MO'LTIPLY LINE 3 BY B 0% (.80). .•.• EN'I'ER THE AMOUNT FROM FOR..1\>I 04 0, LINE 3 a . . 1 ENTEr:.; $H5, ;J50 ($72,975 IF MARRIED FILING SEP]l.R.~TELY) • • • • • • • • • • • • • , • • • IS THE M\>iOmTTON LINE 6 LESS TEAIiT THE m40Ul\JT
OliT LINE S?

IF YES, SUBTRACT LINE 2 FROM LtNE 1 .

126,146, 1,655,1(16. H5,9S0.

.9.

B.

IF NO, YOUR DEDUCTION IS NOT L1MI'I'ED. Kr\1TER 'l'RE p_l1110UNTFROM L D~E 1 ABOVE ON SCHEDULE A, LINE 26. IF YES, SUBTRACT LINE 6 FROM: I.,INE 5 , • • • • MULTIPLY LINE 7 BY 3% (.03) •••••• ENTER THE SH..Zl.LLEROF LINE 4 OR LINE S

1,509,151$.
45,275. 1-

45,275.
112,408,

10.

TOTAL ITEMIZED DEDUCTIONS. SUB'l'RACT LINE 9 FROM LINE ENTER TIiE RESULT HERE .MID ON SCHEDUiJi:!: A, L lIVE 28

SCHEDULE DESCRIPTION

OTHEn

INCOJa

STAT E!-.!ElilT

10

AMOUNT

DYS~EL ~ GODERICH
RAT.l.lDOM HOUSE

335,706.
874,167. L:nm 5 1,2G9,H'73.

TOTAL TO SCHEDULE C,

09270331

131470 40COIF

2005.

05030

5.:21 OElJ.l..M1'~,BA-RACK

n.

STATEMENT(B) 9, 10 40COIF 1

09/21/2006

9:45AM

119. ~l:~nrlll

08:H

F:I...I 1 3l::! 31"2 8407

WSHS, PC, CPA's

BN:,ACK

Hr

£.: MICHELJ ..E L,

OBMrjA

CAPITAL

LOSS

CAPJRYOv~R

STATEMEN1'

11

2. 3. 4.
5. 5.

1, ENTER THE AMOUNT FROM FORM 1040, LINE 41 ..••

EN'1'ER THE LOSS FROM SCHEDiT.I..!E D, LINE 21, A,S ,A, POSITIVE AMOUNT. COHEINE LINES 1 J:Il.m 2. IF ZERO OR LESS I ENTER -0E11'1'ER TEE SlviALLER OF LIl.JB 2 OR LINE 3 •.•",•
SCHEDULE D LINE .." AS A POSITIVE ,A.Wi, .FRQl\~SCffEDDLE D, .•-•••.,•
J

"

..

1,542,698 • 3,000.

1,545,698. ~,OOO.

s.
1. 0,
g.

'7.

EN'.rlm. THE LOSS FRON ENTB~ THE G·AIN, IF L INS 15 •..•• ADD LINES .:1 P.1>ID 5 SEfORT- TERM C1.j? I TAL

.il.MOUJ.lTfI'

13,136. 3,000.

.....,...
LO,';:S Cll..RRYOv'"ER TO 200 6.

S®TR,'\CT LINE 7 FHOM LINE

5,

IF

ZERO OR LESS,

ENTER -0F.MOvNT.

10,136,

12.
:!'J.

11. SUBTRACT LINE 5 FROM LImE 4. BNTER -0- .• . . • . • ,.

0

ENTER THE 1,088 FROD! SCEEDUT"E D, tINE 15, ENTER THE GAUl" I IF AJ:.TY, FROM SCHEDULE D, LIDTE '7 • • •
< • • • • • • • • II fI

AS A POSITIVE
..
& •

!J

II

ADD LnmSl0 1l.ND11 .•. I,m.Tt"iI-',l'EPJ.li CllJ?ITlili LOSS C]\_RRYOV'ER TO 2006. 8iJBTII.ACT LIl'JE 12 FROM LINE 9. IF ZERO OR J.:ESS,
, • • • • , • •

IF ZERO OF. LESS, •...

"

. ..
STA'I'EI".IENT
AMOlJI'iIT

ENTER -0-

SCHEDDldl:

SE

NON-FARM

IlIJ'COME

12

DT!:SCIU.PTIOliJ

1,J,4L495. 'ro'rAt. '1'0 SCHEDfJL:G:SE, LIl'ffi 2

1,141,4.95.

SCIIEDm~E BE

NOllT-FARlIj INCOME

STATE1.ffiN'T

13

DEBcnU"rION
BpS VALLE"f FOODS

JI..NODlitT

TREEHotrSE FOODS
TOTAL TO SCHEDULE BE
I

33,000.
12.,000. Lnili\ 2

45,000.

09270331

131470 40C01F

2005.05030

OBAlIiA, EAUCK H. 09/21/2006

5.,"22

STATEMElilT(S)

11, 12, 13
4.0COIF_1

9:~5AM

09/21/20013

OIl:.:17 FAX 1 ,')12 ;)72

5:107

wsns.

PC, GPA's

@O:'!.j

21005 form HlL-l040

~ro,.iIIil1oIG.gt)v

!Ilinojs Oepartmeni: 0'; Flell<!lll.le

nr fol·';SCElI yell!' emilng

Imihlidu:;3i Inoome Tax Re~L!m

1015

Step 'I: Personal Information

MICHELLE L, OB~~

BARACK

H.

OB.A1!m

C Rllns~1"lu~

o
'0/'
2.
3

Check it you wt:>(9 a member adjusted

(~G<'J InstnJo~r;Jm;)

5ingiB nr heil.d of hDusehold

n Step 2: lneorne 1 F'e~eral

--=-----~=-----~~--~~-~-~~---~-~~--~.~-,,of iii prr.>tesslonall>lhletio team o;Iuring 2005 W9,>$ IJie<lmo irom YOIJr U.S. 1[MO, Line 31; U.S. 10AOA, Line 21; or

00Married filing jolrrtly 0

Marrilld li11ng sepsmlslY

~~dD~lEd

U.S. '1040EZ, Lirls <l Federally 1'<;l(·;'Jxampt interest

Or

1,555,106.
an'; dividend income from you, U.S. 1040 or 'IO<lOA, Une Bb:

U.. .1040EZ. S .. r;lI;fition~ YI?u:rincome, to Attmch Schedule M. ~--

:2

ather

g g

~ S Step

3i Sasa lncorne ----

AddUn~SjmrOUgh,:3.~lli~i~~ls~y~0=u~rt=o=t~~in~oo:m~3~.=-

3 ~4_:====1=r=6:::5:5=r:l::0:6::~

.5 Income F.i!caivedfrom Scciaf $ecurlty benefits and Q6tbAl1"l Qllmment plans ( if Included In Step2, Lins1.Attach federal "'9~1. P 5
6 MU~a'1' pay earned if 11101I.ld,,~In Step ~, l.ine 'I. Atl:!ml, bi1l6, ~O'\BG, ~~vinfls bonds, mlllt~ry W·2.

8 u.s. T..... ..,.uI'J bonds,

9
othersubtr~"llons

illinois lncorne Tax oVerJJOlYment Includel;i in U.$. '1040, Uno 10. anc;! U.S. agenc), '1.

6 7 9

352.

h,terltfs\ from U.,s. 1040, S~lledule S, Of U.S, l04DA, Schedule

to

yourinoomB. '!,tlach

S~h"dule M.

C1160i( if L.IM 91ncludee erlY amour,! from SohedUla 1299·0. llns$ 5 through 9. Thlals the total ot-your 5ubtraotJons. '1'[ Sub!I·.:let UnB '10 from Une 4. this Is your illinois base lncome,

10 Add

0
...

to
Ii
)( S2.(lOO

1,6;'4/'154.

352.

step 4: EJtemptiollS --~-----~~~---~

A 12 a ;"".;,::~."" b
""~~~05
Un. 1i!.

Numb"'f QTe:(QrnptionB from YQl,lrfederal return, If :;;omSorJ9 elsa olaimlild you or your spoua\i' vJrlm here,
<11;1 "

4:
d~j:Jendenl

8,000.
b -

on their return. saa lnslructiona to ii~Uf~ ih~ number to

c
.,
~

Ch~QI' if 65 01' older: Check if Jcgally blind:

YoU -IYou 'I-

D SpOUSIl

D Sppua~

)Ii

$2,aOi'l

'"
Q

X $1,000 X ~11.00[)

d----

!,; Step 5: Net Income

Add Lin~s iii \hn:lllt;lh d, This is YO,Trtot9IIUlnols e~emp'tj~11 ~Upw..nce. SubtlOlc\

!
J!I
0)

g.

is 1'lF.!:;;lcient::. only:

.:....:. _:~_:_...::....__:__:_~=o=:...:...::..=:......__,==~~=~ _
p~rt-ye:W reslden-re only;

__

Un." 12 Ircm Llne 'I'. This la your net income, 5l!ip I.ln~ 14.

9 ....,.._~~~=-====:::::::::==:
12
'13

13r 0 [) ,

1_, __6_4_6...:-, _7_5_"-_~_.

~14NQtlJ·G'SJd~n.tsand

8t.epB:Trut-=~~~~~~~~--=-~~~~--~----~~========~-15 Residents:
rvlLlitlply Una 1rJ by S% (,O~). Wr;j" the result here. Thls il;; your=. iIIonre5'itlSl1t~ and part-year fGsidents; Writ\! the taR trom SChs.dUle ~IR. Tille> amount mey aot bo less 1h~n zero,

Check 1118box that «pplies to you during ihe year 2005. D Honre:;idsl'lt IIImoi3 .t;ls",. lneom~ from Sche'dul<; NR, Attac:h 5r.h~dlJlcNR" . ~4

o Parl'Y,,6f

f;;:;idenl

~
16
r~UUJIlfD

..:4:.:9'-'--,..::4:..;O:..;3~.

IL~

U14[] p::'UI! 1 ~-12J05)

~:~-P~l

TIlle. 'orJTJb :iillJl,tlri:tuI lIS llUlnno rI D;I lIi" 1~1no\!:ltI~i';il'J j;t£f, A..:-1. OI~cllJ:lmo 01 till!:! inh::"rm=lllnn liJ Ai:QIJIA-5:[;J. provfd"CI in:lCitI\t!_1I0" c-owld ft.'3Jn t=, IJi ptlnwl;'.11l18 r\l~mlI.as tlGQII'i i)pp~a'l1i:;d b)' lliil fo.."m!] Menn~Jru::nt t:~'ltcr.

IL·Q'02-DDtiS ~

09/21/2006

O~I ~l·~UO!:i

llS:.JS

FA.\: 1

ai a

,TrZ 8407

1I'SHS, PC,

CPll'

Ig)025

B;'ill.....l1CK E!.

& MI CHELLE L. OBfu'\ffi. is Taxamo\Jl'lH'.:.mP"gB1,$tepe,Ur!e1~ Step /: Payments end C~'edi1:s i 7 Ullnoi3 lncorna T"J< wKhheld, Attac.h W,2
1S Estimated pavrncms ovsrpayrnent

:::'~:":=~:':::"~.:._------------------:_:_:::..===~:=~==
and 1 D[1g fQrI'Tl~, lneJudir'ig

1$

4.9,403.

'17 __

~1_3""",_95._,_O_. ....

[rom R:mno IL·S05-1 and IL-1 040Hl,

<lpplieo trcrn 20D4 rsrom resident, AltMh

i8
19
_

~3~4~rO~O~O~.
_

1!j

InCOIilB tall paJd ID anolh(>! l!;ttlte whll .. an liIillois SCMdul" CR WI.. Qth<:!r ~\;;\te£l' rannns, IIJjmJi~ Prop.rr\, Tax ere:llt. CamlJlate PT WQr1';:.hest Line 3 amount L;n~ i;I .. nl~unl 206

20

PT WQrka~eelin in:;truGlio05.

rT W."I,r,i1egl
21 K12
orSohmluln
ttl

---20b
or $cl]edyle ED. 21 a
F.1C Worl,;;l1eet

Education -'!)(per,s"s ¢f"r;Jft. COlilpll!tr. F.UWDrJ[~llfetin In"1ruc:i~1~ liO_ Attaoh rec",lpt

RI11Ij,'!I.lnl

~--~--_

no '..L.rt~fr.~.hC,~. S~lmriu1D ec. Ur'lln ,

22 EIC Worlcsheat

_
2'1 b
In InS1:rLlctlotiS.

ED Workshea! or S~h~~\Jkl ED I.lne '10 amount Eamed Income Credit You must complete

una

1 ",m~\I[lt

22a

~ __

~_

Ele ~r'?Oi( amount rrom the EIG Work5l~l!!et :22b Cheoll fi you hava a qualifying child (living woh IOU) bom aftsr121'3i187. 23 lneorne I~~ ureal!

-,.--r-------

amount

from 80hedule 1299·C. Att,,,,h

$<;h"duie

i 29'8·0

23 --:-_-:-_....,..

__

--;~

24 ,\dd UMS 1;', 1<I, 1 P., 20.~I;1,~2~1~b~, El:n~d~2_3_._Th_IS_I_S ~2:2~b~, _th_a~t=o~t~~I_O~f \~'o_u~r~p~a:}'~m~ent~, ~S~!IfI::._:d_c_r_9d_'_lSStep 8: Ol!o;ll'f,lsym<ilm 01" Tax Due _
25 Ifline 24 is greater
i6

2:.:4..:====4:7::':' ~9:5=O:::::.
25 ;;- ..... "".."

than Una

ie, SU~n'!ot

Llrie 1G from

Une 24_ Thla Is yourov6'1lGIYment.

26 11 Line 16 Step 9: penalty ------,

a b

gre~l.e_:..rt1l::a~n.:.u=·n.::e~2=-4.:.,_:S...:U...:bO ...:a.:..I;:_t_L_ln_ .._2_4.:_fr.:.om_L:..in..:e:_1:..6~.~li_'ll:,.iS..:I_S.:Y.:.OU:..I_' i_::tl:.:lt_:tI.... '1_9_, 2.7 I.Bte-p-aymem pel'l~[Y for Unclp.rpp.yment ot e~lirnated tax, Z7
Ch<1Clllf you annu3112Gd YOUI'lnlJom~ E5 or older "nd permanently on Form 1!.·221 D, step 6, 01' II you a", nome. living In "nur"in~

=.:.2:.:Ei..:=====1~~1:4:5:::3:.:
_

Am.c"

FOI7TIIL-2210.

Checic If at 1"ll!;t Iwo.:hird" olyo~rfederlll grass Income Is trom farming. Qontrtbl.ltioll

Siep

'10: D.msticli1$

Any o;;iJ;lnertignwill redllG6 Yllur roiulicl cr Ih!1r..."~ "the amount you OWol) _=~~= .
fU!1ds

==_~
_ _
~

2-8.
MAKE GIVING
EASY

Amount you \".IISI,10 don .. l e to one or more of lhe [ollowlng VOlunt"ry Wlldlflo a MllilaryFamlly 9 Child Abuaa b Lou G~hrIO'G h AlZhnlmor's c IL Veler~m;' Home Homeles~ d Epi.lep5y J
8t,usIC"ncer
<'

.__
23

SarcOidosis m !luUsm n Bfindncss 0 Pc! Pap~I~Uon p Brain Tumor q

_ _

DiEltl~I~3
CQlon Gano~r

k______

.'t.\jI~pIB SoIeroSi5 r .. •

StL'!jJ

1i; Refund or ):\..m0!.lI1t You Owe -_-.~ 30

If

29

Add U,,<'~s thr\lugll ll. Tni;;;.\1 yow' !Jonations ~t;t":. AdLi Une 27 arid L1na 2B. Thl~ is ynurtetal pe~8!tv ana donations.

--=
==== __ __.
29

__ .

--_==
~al:.

:'1;1',.1 hil'.'e <'.11 overpayment

on

U"a 25

anc :hi. <lmo<lnt is I"r<:BIer than

UnG 2~, 4ubaact

Lina 2~ from 61.ne25.

SO

Direcl Deposit

J'/ Ame'lIlt trem t.lne SOthat YOLI w,mt "'!mlied to mUG "gtlmatod $2 Subtro~tUnl'~11 irom 1-ine 30, lilis Is ycur refund. 38 GomplB[B to dlrsct deposit ~o'ir ll<iCI'1d.

3'------------~ 32 _

I~.'_' flo~'lin!l number .•' 1, Account numb91'~-~~--ityo,J

Ilal'W I"

x <iLIa on Line 26, sod Un~S' 213 ~Ild 29. or

Step 12; Sign and P~te ==__ ~~-=~~=~~-----~~=Undo, p~Mlli~" of pp.~'Ir;',

111'0\1 have an :lverpayrnant 011 Ulle 25 ~Ind this amount Is 1113$:11"", Line 29, El.lb!reot Une 2S irom Un" 29. Tl~la~ t."e amount you owe.
I state that l hava e:~amlnM th'5 J'l;rum

$<,'1-

~~

_;:1::....:,_;:4:..::5~3-'-.

___

~.,d.o the t
[1I~miJcr •

best 01 my ImowledS6,

it i6 true, correct, and compl1![a.

';"'Orr;ij,-;~I"'!:1l"'"'"lu;;;;ro:-----------On..Hl<or---

UIJllilriD p~r.1!!

)I no

p~ymenlls

enoli)uell. mall to: ILLlflOIS IJ~PAFlTM.IIT OF AEVENHE SPRINGFIELD II. 6?7'!.I-OOO~ ___ Pf _ CA

II payment enGlcsed, mail !Q: 11.1.1ii10IS~Ji1>ArrrMENT I'!~VEi'lI.lE SI'RIIJI.'!FIEI.IlIl- 62726·0001

or

M~

r./S

PR

RR

IW

WA

WV

ZZ

1o

09/21/2006

9 : 45Fl~1

09/21/2006 08:48 FAX 1 312 372 8407

WSHS,

PC, CPA'!;

IlIilllois Department of Revenue

= Atiaoh to your Form 11.-1040

mL 22 ~ [ffi ComputaftUon
ffilr®it ..

off fo~eli1aitles fraU"Irrl[lJiuid~o:,jis

Aitacnmelyt

Seqll~llCG No,EO

2(OjmJ~

Read
'j

1!:llilis ijlf~fiiJI[J"maitio[f1 FOI mlglnal mwrr.~ only, Do nQtvse thl5iorm Ilyou are fillno FG,m IL-'IO<lO-X, Armmdfld IndMduallncomc T~~Roturn, .nsr lim El;d~ndcd due dliE oi Ilia return, We eorourage you to 101s 119Yr~our pen~Ii<~" und ,end yuu a bill insmad 01 compl~tlng and mlng lhl~ 10rm yourself. u ,
r

Sil:ep 1; fP'lrovod$llie '~Ollgwing ill11clfmatDon

1his rorrn Is for c31Qltdar yMI' 20D5 orfel' fl~,,~1yaar be~jnning
r .•lanlJ,
"t'~r

and endlflg

~=-_--',=::-,--- __
MQluh '(11..,(

2
3

Write your name as II appaars

on yaul' f!1ornn IL,1040_

2 BAAACK
;3

fL

!·!J.CHl!:T.tLE 11, OB.ltl:iiA

Write your Social Security number as It ;;.ppoo~" on thi" year's Form 11.·10<10. Ii you, prior year FormlL·1 040 wa~ 111M usin~
(l

<;Iifi"r,.,,( $~<;:i~1SaQurirf number

Ih"'l1 the number snown on Un~ 3, write that nUll'Ibel' h!ll'~_

4 This yeaf 5
A

S'I!:ep 2: lFiguHi'e ym...!ll"required insitallmeruts

of ywnlltnlll,coma tax irom e~~h !"tlrm 11.-1OdO. $,,~in9truOJtions, Wrrtethe amount of credits from each Form 1/_,.-I040. See InSll1.Ietlolls. 7 Subrraet lJM 6 from Un .. tia Wnle the total amaum Of this yaaJ"s 1II1i~ols withholding from your w-~ forms. 9 SUl:>tract LiIW B from Line 7, 10 Multiply Column A. Una 7, by 90% (.al. 1'1 \f I..ine 91:1 $SO{) or less, writs ·0,' ~nd go to Srsil S. OtIi~twj~"" ... me lesser ·;rite Of COlumn A, Line 10, or Column 13.Line 7. ..2 Drvide the amoun t wrl ttan on L1n~ 11 by four. this is Ih", amount oj e~oh requir~d in1li~llm~nt. (If you use the armlJalized inoome lnstallrnent mel hod, SSG Inslrut;tklI'lS_) Writ" the arnourrt 6

Lasi: yea.

e
1 8

49,40:3.
49,403, 13,950. 35,453. 44,lJ63. 5,783. 1,446.
QlJari:el'S
Sepi.embl;!r 15, 2000

5,980. 5,783.

197.

9
10 "1

12

Quartet' 'l
'ij S Writ<;! the r"":r,lired inst~lIm!lnt,
Sea 1i,${nJctlOM_

April 16,2005

JUltlllto, 2Il05

Quarter :2

Qualtel'4
Jen>.J';o'Y '17, 2006

'l4 15
'16

1,446, 3,488.

1,446,
3,498.

1, 446 ,

__

J..445
::1,466.

Writ>? any credl! ~fliod telJ'IlJard trom tha prior year :;Ind the erncunr Sam Imm-ucrlons_ Sul;ltl«qtUne14iromLine13,lftile arnourrt Is negauve, us .. brackets, Itthe amount on Line '17 Df II1Il withheld.

3,488.
<2,042.>

.... 2,042.>

<2,041.>

previous t:juartat is nS!;j$.tivlO, rite w

1hat a mount as a pos~ive hal·s. Otherwiae, write "0."

17

Suhbar;;!wn.. 1e from I.ine '15, If the

an'IDLJrills Mg~tlva, ~1il J;lIv,r;:I(e\ie,

Sttt~p 3; rFigullre YOUr unpaJiJd "[tax

18 Write the amount from Column
A, Llns 7. 16 __ 4=-:9'-',c._4..:....:_0....::c3-'....

i9 Add your etedlt caniad forward from fua prior year, your total $5f:rm..te,1 Pilymenls made thIs yeW', and your withl10lding <16' shown on your W-2 forms. Compare that total to either the arnourn \'ll1usn 01'1 U'l;l! i 1, or, jf you
annnallaed, the tDtaI of Line 13, QUart"fE 1 IhrllUSh a, and writa the gTlml1J!l' urnount h~re. made on or before Apn117, 20013,

20

19

47,950.

Write olhsrpsymentB

a WritB1I11l amount ~nrJ IhE! d~t8 01your r-arm IL_.!;;05-1. b Write the amount and the dare oi any othar pnYftlel'1t
Add Un .... iDa ",1'Io:! 201;0. rilljf Eh~ l1mo..,nt here, W

zOGl
20b

20
21~

1,453.

21
22

Add lines 19 AAd 20. Wrltl'l th~ 10lal am1!lUi'I! hete. S!,!btr;lol Une 21 from tlne 'I S, If the amount Is

c POSllill"', Wl'it", lila! amount here. Continue to step 4, and write this amount 11\ aliifllty WorIOl;h~ '1, lIns 24, Column C. P ..1 o zero or n~gatJv~, \\Irl~ In.. t ... o;,Ul'Itl",r';;l,if neg<itlve .IBe bro.ckirt5, Cominus to step 4, skip P~n;:;,ltyWor~"M?t 1, m I mi;l 91;> P~natty Worl"'heet~. You may apply this amount to any underpayrneni when 'ijgwing your Penalty to 5~glal Work$h~ ..t 2. e lm.tructions. 22 -,-

s...

0::....:....

t2-El-CS

09270331

131470 4oCOIF

2005,05030

OBAM..J:>., BARACK

13:. 9: 45Al l
y

40COl.F_1

09121/2005

Ilg;;:ll2IJOG08:48 FAX 1312 DAP.JI.CK g.

Co frr!CHEL1E

372 84CJi L.. O!lAMB.

WSBS, PC. CPA's

IgJ 02'1

g,tep4:lrigure }fOUli" ~Zl1teglPavmen'~lPeU1ailjr

U·~eP~l1slty Wom~h~eI 'I ro ilgme ,'aUF 1<lI,;cp;oy.l'~nl penally In,' unp~i;J to:,. U,~(' p.,.naHy Wmk~heal ~ !!111,rur't; y"ur la~",-pay;";'l~nj ~~rH.lly j,wu'lderpaj'morrlci Not", -j~' YOI.J must tellow the in:;lnmtians in ordertc proPCIW complete

me p~nalry

eotimallld i,,"~, w"rk~h"'~!$.

N~mber of days late

1 - 30, :;1'1 or more ,

I"I,,,,,ally ra\~
,02 :10

I-~~~~~~~~heei
I~I. 2:3

oil - Late"payment

penalty 'f~runpaid t~;,

. --=.=======-=_=-=-""-::=.~=',,,,'-J:o='

·=l·1 .

""ritil ~.,.. ~rnou,'~ and ~"" d""" r;>'. "")'

p~l'n1ent }'01J m1l<le on or after ,'Iptii18,

200;';, &;e lnsrructlone.

Amol<nt

Date paid __
all

I I 124
A

;;

0 ----~

Wrl!9 (he amount from Ufl~ 22

1;,s firct.lin~ of Column C R~IQw,

PCIIO~

Due ~.I~

SeD

amnunt

iJnpald __

Pilymeflt .pp~ed

B~IBnc~ due (Gol, ~ - GoL 0)

Pa~lI\Ilnt
dDta

hlurnher oj d3Y$ late

PanBlty rata

tI

(Seeab~ve)

PenalPI

flet!Jrfi Aurill7, 2U06

25~~~~

i Nut",
'26

rJFieni2l~t.y·~~;~ri.~~:::~:: -Li'l~e~p_e:=~~~ penalty

=~ II Y"U p~id
11.1"required amount

fQf underpal/msm:

of estimated

ta}(

:==J
_
Oate. paid

from Line 17 by the payment due dare fpi eech quarter, do n()~completethis VlorllSheel

Virile [he amount am! the dme of each esttrnated income till; peyrnentyou made. S"" ih.slromlon5,

Amount a
2.7

osteiPaid

Estimated !ncarn$ Tax iPa)fments

Amount. bla1e paid

b----~-

c d------

e~
f

Amount

Wr:te 111~ unpaid amounts

from Step 2, Una 17, Quarters 1 I/1rouoh 4, onlhe first nne "ltr.~ approprlale

quarters

in Column C balow.

A
1

i P ~r'otl

n~le

i)1'G

~mount

Un ~~H1
. __

D
Pa~rn9/1t

applied

9al<m[;~ dUE (Col. c: - Cot D)

Numaer ui days I~tc

PCIl;]

Ity raie (S~BubQ~~)

II Oh'

'L~_~ __ ~ __ ·"" ~-~~-. __ ·----.

C1tr.2 JUlie 15, 2005 ~ QIJ' 3 Sflpt. 15.•200!l ~_
Qtl''''

~ April 15, 2011S

':'::~~~I

Jan , '17,,WM

128

.<\ctd Columfll,

()uarl!)~"

'I H1FOUgh This Is your lale'PQvmont 4,.

penalty

for und0i'paYn1Mt

o1~;,i:im;'l,~r:l"".;(.

!Nrit~ .~.,~ IDI~I ",,',auntloB...

ILJ~.11121

"'nd On yeur

Form IL·l 0110, 1.;=,,,="'''''2=7,================

2=8=· ======;;;
IL~~2'lo(.A-12105)

f.1:~'~~

i ::,,~:j,,[i~

P~~n~Of ~ :;;

09270331

131470

4QC01p

2005,0503·0

OBAMA, BA.RACK H, 09/2'1/2006

.9

9:45AM

0[)/21/20(16

08; 49 Ffut 1 .312 372 B41)7

\\,,'JHS, PC,

CPA'S

~028

BARACK H. & MICEELLE

L. OBAl~~
anl!1 If

S1!:ep 5: Fi91o..1l1'e your

~a~e-'fm01gellUa~iy ~ and trfle J]!Moimrov; yOIUl owe

Note -!;. R!ilI,I~ yi;l~r l<it!i!"fllil'tI:J p"~l'llty

o you at!! ftl.1n9 yo u r Form IL-1040 R Her O~IObo(16, 2005; and o your \ax l'/Il ~ not pa id by All rll i7, 2005.

Fi9ure your late-filing p..nalty.

29 Wrilethe amoulit fiom FI)(m IL·104(l, Step 6, Line 15, minus any time!y payment51lMg grad/Is, 30 MulUply 1M gmount on Line 29 by 2% (.02). S'J Wrke tl1a ISSS:afoll.ln~ 30 or S250. ThIs is your Inte·fillnu peMlty.
29 00 _

;;;1

Figure tile amourn you owe.

32 33 S4 35 Write allY lalG-pnymentpennltyjgr Im~ni(l tAl!lrom Smp 4, line 25. Write any lale·filing psnaltylrom Step 5, Line 31. Wr~e the nnlountyou owafrom your Form IL-1040, 51ep 11, LlOB 34. !\tid lln~. S~ IIlrnugh 34 and.wrfill.lhB tornl here, Thl$ 15VOIJI'tr.ml tt!X elld pauallles. Reierto Form Il·1040, une B4 instruoilonsioral1l'cuf paymonl oplion~.
33~ _

=========

Step 6: Complete the anl1'luaiizatfitJIIl wOlrkslrieeit for Step 2s line li 3

Complete thlG worksheet only if your incom<l Was not rem.lIV6d evenly tilrolJgho<.rt th" Complete I.ines 36 through 52 of on8 column bofofCt solng to the n~lIt, be~inning

Y'"'' and you cheess

with COIUll'Itl

e..

to annua,ize your iru;ome.

sa Wrll~ your 1111 basg Income now (or &!Icll pBrlod. see Inslruciions.
AnnuJIiz3tion metar:;. 38 MuI~p,y Line 36 by Line 37, Til I, Is your &11nuilIl1.~d IncomQ. 39 ExempiiDrlS. S~e InstilJoiions. 40 SublractLinf, 39 from LIne 38. This is yaur !lIino~ nci lncorne. 4'1 MulllPIV line 40 by:3'/o (.03). 42 For en~h PBrlod, wmB Ihe amo unt you VI(Ot~ in Slap Z, Golum n A, Lln~ (i_ 43 SubtractLlnB "Umm Lim 41. -14 Appll~able percenmga, 45 Multiply Uno 43 by Line 44. This Is YQ\lr annlll!lIlEld Imrta~m~nt oW Add tlIc amounls on Line 52 of eacn of the preceding Golumns anti wrilll tlm
37

45

totaJIl$r~
47 Sultu-.JctLinn «5 from line 4l'i, It tssa jh~n ze 10, wrilG"O....8 Write the arnonnt Imm Slop 2, Line 12. in eath rDiumn. 49 Write !~e arnauni lrom Une 51 01 the precsding colui'Il~, so Add Lines ~aano 49_ 51 If Line 50 m gre;;terthan Une 47, 5ubtr~¢t Li~~ .17 ((0111 Llno 6Q. Dtherwise, wrlle ''0,'. 52 Wrile me i5Sssr or Lilla 47 or line 5D nere and on Step 2, Line 13. This is your required instRllmenl.
n.·~~11'Jt;l·'~lDu) IC::lO~ 1 BdS1o-tJ 12-2:H)5

4$

Ship

,Itl.n ••

rer (lotu"",,-.

41 <!.S_~
49
e:l':lp li1tc lint!
[Of

_ _
Cdb..", A.

6t:l

5'1

52 __

09270331

131170

40COIF

2005.05030

.0 OBAYL~,

BARl~CK R.
09/2'1/2006

\l.QC01F_1 9; 45AIVI

2004 1L!J0(RElfUlRf~ f'~IUNG INSTRUCTIONS

U.S. INDIVIDUAL INCONE TAX RETURN

FOR THE YEAR ENDING :pg9.~.mQ.g;I;"... ).1. Prepared for

L ....

;W.Q.~.

Cnlcago,
Prepared by

~~

uuol~
P.C.

Lawrence A. Horwich & Associates, 125 S. Wacker Drive - suite 2800 Chicago, IL 60606-4475
Amount

of tall

TDtal tax Less: payments and credrts PIus: int;;, rest and penal tie"

,.."

$
.'j;

~Q.,.4.~.!? 9..9. r , ~ 4Jl.

0

Overpayment -------+-----------~/lj~cell;:meous Donations

...... _. 6,292 .. __ ". ... __.. ,._-----------_._-------

Overpayment

Credited Refunded

to

your
you

estimated

tsx

_,

9
0

;0

s .·:.:.::::::: ::..}.;.~:9): ....

Mai(e check payable to !Vlail tax return and check (if applicable) to Return must be mailed on or before Special Instructions

Not

applicable

IntErnal Revenue Kansas City, MO

Service Center 64999-0002

-~----,,-.----.---.April 15, 2005

..---.--.- ..---.

The

return

should will

be

signed

and

dated. into your bank

Your refund account.

be deposited

directly

';(InOral
0.5.-01-011