Document 70e3E03D3VKaNGQm8zdgR4098
11040
Label
Department ot the Treasury--Internet Revenue. Service
U.S.: Individual Income-Tax. Return <B>
93
Fbr the year Jan. 1-Osc. 31; 1993, or other tax year beplnnlno
Your first name and initial
Last n---
IRS Uo Qnty--Po not write or staple In thie apace
1993. ending
.19 OMB No. 1545-0074
Your social security number
(See Instructions on page 12.)
Spouse's social security number
Use the IRS label
Otherwise, please print or typo.
Presidential
EElection Campaign
(See page 12.)
:>^Do you want $3 to go to this fund? ;'.-'-. -- . ...' . / If a joint return, does your spouse Want S3 to go to this fund?
For Privacy Act and Paperwork Reduction Act Notice, see page 4.
Yea No
Jyl
Note: Checking 'Yes" will not change your tax or reduce your refund.
Filing Status ?2->
Single
V/ \ '
Married, tiling Joint return (even If only one had Income)
''
(See page 12.) j. 3: f;
MahtedfBingseparala*tetumi Enter spouse's sodai security no. above and full name here.
Check only one box.
-7 Head of household (with qualifying person); (See page 13.) If the qualifying person Is a child but not your dependent,
'enterthlsehlid's name here.
..............*
_______ '
________ ;
Qualifying wldowtari wlth dependent'dilld (year'spouse died 19
). (See page 13.)
Exemptions
(See page 13.)
If more than six dependents, see page 14.
6a S' Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax : ' return;do not check box 6a. But be sum to check the box on line 33b on page 2
. b - 5*1 Spouse
o v Dependents: c - (1) Kama (lint. Initial, and last nam)
(2) Check
it under
age 1
(3) If age 1 or older,
dependent's social security
number
(4) Dependent's
relationship to you
(S) No. ol months lived in your home In 1993
Aa j z l .
/ i.
Ne. ol boxes ducked on 6a and 6b
No. of your children on 6c who:
lived with you . didn't live with you duo to divorce or soptrallon (toe page 16)
Dependents on 6c not onterod above.
\ d: It your child didn't live with you but Is claimed as your dependent under a pre-1985 agreement, check here 0 Total number of exemptions claimed1^ . "V". V . ' '. ; . . . . . . . *.
Add numbers entered on lines abort *
m
Income
Attach Copy B of your Forms W-2, W-2Q, and lOBB-Rhere.
: If you did not r get a W-2. see
page 10.
If you are attaching a check or money order, put It on top ot any Forma W-2, W-2G, or 109B-R.
r 7; n Wages, salaries, tljs^ etc.' Attach Forn{s) W-2:' | Ba'^TaxaWe Interest income (see' page:1 6).'Attach Schedule' B If over $400 . . V
bj Tax-exempt lntere^ (see pas}e'17). DON'T Include' on llne 8al_bJ______'__________ .
r B H Dividend Income. Attach Schedule d;If over $400 . ; '. .
'/./; . . .
10 Taxable refunds, credits, or offsets of state and local income taxes (see page 17)
11 1* Alimony received1- ..;- ;
:.
12^Buslness income or (loss). ^^hjSd^ule C or C-EZ . ` .
. ',
13.Capital galnor(loss). Attach &h<thria.D^'-v5
/
14. j'.Capltal gain dWritnrtlona riot
line 13 (see page.17)'.-'^
..
15 pother gains or (losw).;Attach Fom
.1
!
IGaWTotal IRA distributions ' ; 16a
b Taxable amount (see page 18)
8a
10 11 12 13 14 15 16b
Adjustments
`..'TV.,.
-jv *nsr*if
"out. IRA'deduction (see page
r-ir> 'to'. 24a 24b
to Income ' ` w* One-half of self-empioyment tax (see page 21)
28
(See page 20.)
tv ' P-.
26^' S` elf-employed health Insurance deduction (see page 22)
28
27s?Keogh retirement plan and self-employed SEP deduction j 27
Stt.; : Penalty on early withdrawal of savings.... ,7
; 28
'2BjrAfcnony paid. Redptenf* SSN
29
30 Add Bnea 24a through 2& These are your total adjustments
Adjusted
31 c 5 Subtract. Hoe 30 from Rne 23. This Is your adjusted groes Income. If this amount is less than 323,050 end a chBd lived with you, see page EKM to find out If you can cfelm the "Earned
Gross Income
income Credit'online 66 . .
r
.___ t___
31
Form 1*0 (1993)
age 2
Tax Compu tation
(See page 23.)
32 Amount from line 31 (adjusted gross Income) ................................................ .....
Q O O G33a Check If: You were 65 or older,
Blind; Spouse was 65 or older,
Blind.
Add the number of boxes checked above and enter the total here . . . . 33a
If your parent (or someone else) can claim you as a dependent, check here . 33b
If you are married filing separately and your spouse itemizes deductions or you are a dual-status alien, see page 24 and check here.................................... 33c
Itemized deductions from Schedule A, line 26. OR
34 Enter Standard deduction shown below for your filing status. But if you checked
the ` any box on line 33a or b.-go.to page 24 to find your standard deduction.
larger
If you. checked box"33c, your standard deduction is zero,
of your:
e Single--$3,700
e Head of household--$5,450
e Married filing jointly or Qualifying widow(er)--$6,200
l e Married filing.separately--$3,100
35 Subtract line 34 from line 32....................................................................................................
36 if line 32 is $61,350 or less, multiply $2,350 by the total number of exemptions claimed on line 6e. If line 32 is over $81,350, see the worksheet on page 25 for the amount to enter .
l( you want
the IRS to figure your tax. see page 24.
37 Taxable income. Subtract line 36 from line 35. If line 36 is more than line 35, enter -0- .
38 Tax. Check if from a Q Tax Table, b Q Tax Rate Schedules, c Q Schedule D Tax Work
sheet, or d O Form 8615 (see page 25). Amount from Form(s) 8814 e___________I
G G39 Additional taxes (see page 25). Check If from a Form 4970 b Form 4972 . . ,
40 Add lines 38 and 39. . . . . . . . . . . . ................................................
38 39
Credits
(See page 25.)
41, : 42' ! 43
Credit for child and dependent care expenses. Attach Form 2441 Credit for the elderly or the disabled. Attach Schedule R. . Foreign tax credit. Attach Form 1116 . . . . . . .
41 42 43
44'. Other credits (see page 26). Check If from a O Form 3800 b Q Form 8396 c Q Form 8801 d Q Form (specify)
44
;'.45,,; , 'Add lines 41 through 44 T..........................................
i 1
48 Subtract line 45 from line 40. If line 45 Is more than line 40,' enter -0-,
45 46
Other Taxes
' 47 ' Self-employment tax. Attach Schedule SE. Also, see line 25. . ;..........................................
48 ' Alternative minimum tax. Attach Form 6251 ... .
....
49 . Recapture taxes (see page 26). Check if from a O Form 4255 b Qform 8811 c Q Form 8828
60 Social security and Medicare tax on tip Income not reported to employer. Attach Form 4137
51 Tax on qualified retirement plans, Including IRAs. If required, attach Form 8329 , . , .
'52 Advance earned Income credit payments from Form W-2 S3 Add lines 46 through 52, This Is your total tax. ,v . .
..............................
47 48 49 50 51 52 53
O
if
Payments
Attach Forms W-2, W-2Q, and 1099-R on the front.
G54 Federal income tax withheld. It any is from Form(s) 1099, check
55 1993 estimated tax payments and amount applied from 1992 return.
55 Earned Income credit Attach Schedule EIC . . . . .
57 Amount paid with Form 4868 (extension request) ....
58a Excess social security, Medicare, and RRTA tax withheld (see page 28) .
b Deferral of additional 1993 taxes. Attach Form 8841 ....
59 Other payments (see page 28). Check If from a Q Form 2439
b O Form 4136 . .
.V. . . . . .
60 Add lines 54 through 59. These are your total payments
54 55 56 57 58a 58b
59
Refund or i 61 Amount 62 You Owe - 63
;64 65
If Sne 60 is more than line 53, subtract Fine 53 from line 60. This is the amount you OVERPAID. Amount of line 61 you want REFUNDED TO YOU, . ... . ... . . Amount of line 61 you want APPLIED TO. YOUR 1W4 ESTIMATED TAX ` 63
.
If line 53 Is more than line 60, subtract line 60 from line 53. This Is the AMOUNT YOU OWE.
For' details on. how to pay. Including what to write on.your payment, see page 29 ... .
Estimated tax penatty (see page 29). Also Include on line 64 | 65 I________
I
60 61
O <o
Sign Here
Under penalties of perjury, 1 declare that I have examined this return and accompanying schedules and statements, and to the best of nty knowledge and: belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on ail information of which preparer has ^ knowledge..'
Y/o'or signature
Date
Your occupation
for your records.
^ Spfxjisstei''s signature. If join: return. BbfH must 'sipn.
Preparer's V -O,
(AS*
Preparer S
name (or yours k
fJJge OnfV H eeH-emptovedi and
Tistf
Ssajaaeri rccccottoor
A/*/?<,
-------------------- ----------------- ^E.I. No.
__________
ZIP code 0 U "7
0007-SWP-005802973 CONFIDENTIAL
vs/p
SCHEDULE F
(Form 1040)
0*p*rtmnt of tf* Tr***ury InM A+v*nu# S4rvtc (X) Nm* o< proprietor
Profit or Loss From Farming
Attach to Form 1040, Form 1041, or Form 1065.
See Inatructlona for Schedule F (Form 1040).
REDACTED
. 1545-0074
Attachment Sequence No. 14
| Social eecurlty number (SSN)
A Principal product. Describe In one or two words your principal crop or activity tor me curre____
nB Enter principal agricultural actlvtty
iPdUiri &
01M v.
, i/rfojtufa
code (trom page 2) `i&M>\
D Employer ID numberrt (EINJ, IHf any
C Accounting method:
(1)
(2) Accrual
-1--i. i.1.. L 1..LI
E Did you "materially participate* In the operation ot this business during 19937 H "No," see page F-2 for limit on losses.
OffYes Dn o
Part I Farm Income--Cash Method. Complete parts I and II (Accrual method taxpayers complete Peru ll and III, end line 11 ol Part I.)
Sales ol livestock and other Items you bought for resale . . . 1 --
Cost or other basis of livestock and other Rems reported on line 1
2
Subtract line 2 from ll'ie 1 ...................................................................
3
Sales of livestock, p.oduce, grains, and other products you raised 6a Total cooperative dWbutlons (Form(s) 1099-PATR) f 58
Sa Agricultural prop: am payments (see page F-2)
6a
Commodity C'edR Corporation (CCC) loans (see page F-2):
JS1
Sb Taxable amount 6b Taxable amount
4 5b
8b
AT*
J?,> G#*?
CCC loan* reported under election..................................... CCC loans forfeited or repaid with certificates i 7b I
7o Taxable amount
Crop Insurance proceeds and certain disaster payments (see page F-2):
Amount received In 1993 .....................................I 88 I _____ ___________
8b Taxable amount
If election to defer to 1994 Is attached, check here
8d Amount deferred from 1992
7a 7c
8b 8d
9 Custom hire (machine work) Income....................................................... ..................................................................
9
10 Other income. Including Federal and state gasoline or fuel tax credit or refund (see page F-3).........................
10
11 Cross Income. Add amounts In the right column tor lines 3 through 10. H accrual method taxpayer, enter the amount from page 2. line 51.
11
/Z3S37
Farm Expanses--Cash and Accrual Method. Do not include personal or living expenses such as ta^es, insurance,
repairs, etc., on your home.
Car and buck expenses (see page F-3--also attach Form 4562). . Chemicals....................................
12
13
25 Pension and profit-sharing plans.....................................
28 Rent or lease (see page F-4):
Conservation expenses. Attach : Form 8648............................... Custom hire (machine work). .
Depredation and section 179 expense deduction not claimed elsewhere (see page F-4) . .
17 Employee benefit programs other than on line 25. Feed purchased Fertilizers and Bme . Freight and trucking . Gasoline, fuel, and oil Insurance (other than health) Interest: Mortgage (paid to banks, etc.) Other 1 ehnr hired (less k>bs credit)
14 15
18
17 18
2019
21 22 23a 23b 24
.3/7%
l/.Vttf >vrjr
/TJ&kt
a Vehicles, machinery, and equip .' ' ment '. .............................
b Other (lend, animals, eta) . 27 Repairs and maintenance 28 Seeds and plants purchased 29 Storage and warehousing 30 Supplies purchased . . . 31 Taxes ............................... 32 Utilities.................................. 33 Velerinaiy, breeding, end medicine 34 Other expenses (specify):
a CecttStikmw.
b ...... o LfetfTJj. )jw.(Sr.
d
28b 27 28 29 30 31 32
34b 340 34d 34e 34f
itt
JJISL <?? *?
1
/C3L
j el
$8 - Total expense*. Add lines 12 through 34f: .q., .... : Net farm profit or (toes). Subtract One 35 from Sne 11. If a profit, enter on Form 1040, Roe 19, and AISO on Schedule 8C, fera 1. If a toes, you MUST go on to Ine 37 (fiduciaries and partnerships, see page F-5) . . .
97 If you have a toss. you MUST check the box that ijeecrtbee your Investment In this actlvtty (see page F-5). I
H you checked 37a. enter the toss on Form 1040* feral*, and AL80 on 8ehe<kito 8S, Hne 1.
J
If you checked 37b, you MUST attach Form 6198.
38 /C&,79%
38 37a JW^JAaDj i IInnvveessttmmeenntt IIss aatt irisk. 3Tb O Son* kwtttmort It not M rirt.
i For Paperwork Reduction Act Nottoe, see Form 1040 Instructions. 125
Cat No. 11346H
Schedule F (Form 1040) 1993
0007-SWP-005802974
CONFIDENTIAL
i: -4562
-
"1 V
'
Oapartmw* of ttw Tnmy trtamal Ravanua Sarriea PQ
f Nama(*) ihown on ratur,
Depreciation and Amortization
(including Information on Listed Property)
See separata Instructions.
Attach this form to your return.
OMB No. 1545-CM U
1l@93
Attachment
Sequence No. 67
ktantlfyino number
Buaineaa or activity to which thi* form retUta*
REDACTED
P;irt I Ejection To Experts* Certain Tangible Property (Section 179) (Note: If you have any "Listed Property,'
1 Maximum dollar limitation (If an enterprise zone business, see instructions.)........................... 1
2 Total cost of section 179 orooertv Disced In service durino the tax vear (see instructions) . . 2
3 Threshold cost of section 179 property before reduction in limitation........................................... 3
4 Reduction In limitation. Subtract line 3 from line 2. but do not enter less than -0- .... 4
5 Dollar limitation for tax year. Subtract line 4 from line 1, but do not enter less than -0-. (If married filing separately, see Instructions.)...........................................................................................
5
(a) Description of property
(b) Cost
(c) Elected cost
6'
$17,500 $200,000
7 Listed property. Enter amount from line 26...........................
7
8 Total elected cost of section 179 Drooertv. Add amounts ir column (cl. lines 6 and 7 . . .
llilill* 8
9 Tentative deduction. Enter the smaller of line 5 or line 8................................................................
10 Carryover of disallowed deduction from 1992 (see instruct ons)..................................................... 11 Taxable income limitation. Enter the smaller of taxable Inct>me or line 5 (see Instructions) . . 12 . . Section 179 expense deduction. Add lines 9 and 10, but d o not enter more than line 11. .
9 10 11 12
13 Carryover of disallowed deduction to 1994. Add lines 9 and 10, less line 12 ( 13 1
Note: Do not use Part II or Part III below for listed property (automobiles, certain other vehicles, cellular telephones, certain computers, or property used for entertainment, recreation, or amusement). Instead, use Part V for listed property.
Pnrt II MACRS Depreciation For Assets Placed In Service ONLY During Your 1993 Tax Year (Do Not Include Listed Property)
(a) Classification of proparty
(b) Month and to) B*aH for depredation
yaar placed In (burtttss/lnvBstment uu
aarvlca
only--aaa Instructions)
(d) Recovery period
(a) Convention (1) Method (g) Depredation deduction
a 3-year property b 5-year property c 7-year property d 10-year property 15-year property f 20-year property
g Residential rental Drooertv
h' Nonresldentlal real Drooertv
IRRi
.I
llllllih
*t 1
-r-
Yxffi
^ ir<
/-/,? _ &Y/? fSc> bB-<Af
27.5 yrs. 27.5 yrs.
MM MM MM MM
S/L S/L S/L S/L
* ST3^ --------
a Class life b 12-year o 40-year
1 1
12 yrs. 40 yrs.
MM
S/L S/L S/L
Pnrt III Other Depreciation (Do Not Include Listed Property)
16 ,. QOS end ADS deductions for assets placed In service In tax years beginning before 1993 (we Instruction*) 171,?.Property subject to aectionl68(0(1) election (see Instructions) . . . . , . . . . . . 18 ' ACRS and other depreciation (see Instructions) ........................................... ...............................
16 17 18
PnrtIV Summary
19 Listed property. Enter amount from line 25. .... ......................................................................
20 ? TotaL Add deductions on fin#12, fines 14 and IS In column (o). and Hnes 16 through 19. Enter here and on the appropriate fines of your return.' (Partnerships and S corporations--see Instructions)
19
-2.1 Wip
21 For assets shown above and placed In service during the current year, enter the portion of the basis attributable to section 263A costs (see Instructions)
for Paperwork Reducboo Act Notioe. see page 1 of the separate Instructions.
311
Cat. No. 12S06N
Form 4662 (1093)
0007-SWP-005802975
CONFIDENTIAL
hi Ad 9 9 0 9
Mvio* 2
REDACTED
?co
-4
oo
Control number in
Employer's identitication number
.)1-0442817_______
(Employer's name, address, and ZIP code
CEDAR RIDGE NURSING
CARE
CTR
IR #1 BOX 183
41 SKOWHEGAN, ^Employee's social security number
ME 04976
Employee's name, address, and ZIP code
Copy B to Be Filed with employee's FEDERAL tax return
1 Wages, tips, other compensation
________7 BBB. 80
3 Social security wages
7, aaa. aa
4 Social secunty tax withheld
489.11
5 Medicare wages and tips
7, aaa.aa
6 Medicare tax withheld
114. 38
7 Social security tips
8 Allocated tipis
9 Advance EIC payment
10 Dependent care benefits
11 Nonqualified plans
12 Benefits included in Box 1
13 See Instrs. for Box 13
14 Other
O CL.
my knowledge and >as any knowledge.
B-1E5 1991. 9
Employer's state 1.0. No.
| 01-0442617
15 Statutory Deceased Pension legal
employee
plan rep
912 emp
Deleted compensation
17 State .ages, tips etc
18 State income tax 19 Locality name
7888. 8C i
3.0:
20 local wages tips etc 21 Local income tax
J_ _ _ _ _ _ _ _ _ _ _ _ _
1993Wage and Tax
Statement
13-2671063 Department of the Treasury--Internal Revenue Service
This information is being furnished to the Internal Revenue Service. OMB No. 1545-0008
0007-SWP-005802976 r.ONFIDF.NTI A T.
N41623.03
1993 MAINE INDIVIDUAL INCOME TAX 1040ME LONG FORM
For the year ending December 31, 1993 or other tax year beginning.
Your first name and initial
Last name
SIET-t Um
Scous;
uw, OtWWrift* Prtrtf Of
tyi
8E
.1 name
REDACTED
______________OHice Use Only
1993, ending.
19_
Your social security number \
Spouse's social security number
Youroccupation
, Spouse's occupation
Attach State copy of Form W-2 and Form 1099 to back
14 Cjidckhere if youymra engaged h commet^
or -^. Check if: ' 2a ` You were
n 1^ fishlno '(kjrino1993. fSro instrticteriadn iwioe 11); fi
.... 2c ` Soouse was>
65 or over 2b 65 or over 2d !
Blind ` Blind
v.3 Single.^..^
' ' ;
RESIDENCY STATUS
SIEE.8 Met*
FWnc and
IW*ld*ncy dutus
r'4 :;.s
Married filing joint return (even if only" one had income) Married fifing separate return. Enter spouse's social security number above and full name.here > Head of household (with qualifying person). .
(CHECK ONLY ONE) 8 St RESIDENT 9 D PART-YEAR RESIDENT 10 NONRESIDENT
V7
QuaRWnfl widoW(er) witirdependent dilld (year spouse died 19
)
11 NONRESIDENT AUEN
J2i.a-;fci; Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax return,
-u-.i. i
-1 ::.. -;.
...
No. of boxes
araa
--'--
............................................................. checked on 12a
^ ` b ^' Spouse............................................. .....;...;...............:..................................................................................... and 12b......................
Enlar Your
ExompSon*
c
Number.
of*vb. ;ur
deToen. d.en. ts..V..............-..
".....--....................."...--....--.......................
...........................................................
.'...............
Total Add
dependents...... numbers .
entered on
/ Total number^of exemptions claimed.................. ........ lines above..;...'......>
r?-
^/
|13S FEDERAL ADJUSTED GROSS INCOME: (From your Federal Form 1040, line 31 or 1040A, line 16 or
Ti1p40Et|ne.4) (t^Jnstiuctions If fifing Schedule NRH)
...... ...........
aiEEi MjfiNCOME MODIFICATIONS; (From Page Schedulbti; line 33; Show a negative in parentheses.) ;..
ngura Your *15^ IMNEAbdUSTlIid GROSS IN^OMEt ^
14; " ""
Tsxabto
(Sea Instructions) ITEMIZED (From Page 2, line 38).
tnccm* |iii^EM^p^.^i^!jiiumber pLExemptions In Box 12d by $2,100.............--
from IneiS^jlL:;^.................
19jyNCOM&jTAXFi6d the lax for the amount on line 18 in tl)e tax table..;,,..............,,.................. )a^pTi^-APCOTIQ8jg^giByHbiy^^:Sche^ toft 4^ ......
15 16
t17
18 19 20
jQ_
8TEP S 21#USEj^(SAliKii^HS^In*tructidrttianontrymus bemad* on thla line)..;...........;..
Rflur* Your * ------------
$t:O^O M0:O Other $.
Tut and Cootrf.
button*
*>'
'r
$1Du. $5.uQ$iu1.0u.t)wOattheer r*$. _ Www^WMBIe Mmd.JD $5 `Q $10.0 $25.0 Other $$. _
21 o 22a -- 22b 22c
*:,v'`
$io $25^0other$$. _
22d
23STOTALTAX AN'
llne19.20.21 and 22).
23
STEPS Subtract Tut Cradle
I^S^^SIDE^^^^^^^^e^kxN|t^SidTciulejiRH) (Attach copy of federal return). Wlgy^f^6:66l!^0T^^^^'B^^4(Wd25 from fine 23) -v--.......-.............;...
STEP 7
EntarTax Paymanta
Tax Payments).
'. ...... a... , .... ..... .........
,,~ r jfc Numlngifdme'partf.CfeditYSee liMwctlons;Attach oopy of 1098-ME)..........
a'28? If line27d Is ku^YhilftTIff*^^
24 ( 2S ( 26 27a 27b 27c 27d 27e 28
-- o
Of
&L
STEPS
Hgtr* fl*tund or Amount
Duo
29 sAmwtttto te'C^
'fTb " a&#''TbTAMii^
29a
REFUNDED.
29b
.. 30a
......... 525___________________
.............................................. 30c
o(
NntYo*r`* Ratum "heed Maine Incomd tax farm* and Instructions mailed to you next year, check box at right;..........................1
1
r ev er s e s ips
^C^^on^r^.Q-22'l6-`3^t-^0fv^^f^<^,:* - '.kM;-i>O`fa^fff7/^r-^ CA ;> -
Bureau of Taxation.,, P.O. Box 1067,'-. "' '
. . Augusta, ME 04332-1067 - ' --------- .........
c 0
0007-S WP-005802977 CONFIDENTIAL
t
2
Attach chock or money order hero