Document mm5bEX315DR6QamNjaXX63nM0

1 U4P* U.S. Individual Income Tax Return TUPPI (8) Label (See instructions on page 11.) For the year Jan.-Osc. 31,1991, or other tax year beginning YTM ir first name and Initial Last name , 1991, ending 19 OMB No. 1545-0074 Ynur Qnrlat RAruritv mimhar 1 Use the IRS label. Otherwise, please print or type. Presidential Election Campaign (See page 11.) l&Do you want $1 to go to thisftund?.............................................. r' If joint return, does your spouse want $1 to go to this fund? t-or privacy a c i ana Paperwork Reduction ' Act Notice, see instructions. Yes 4-- ZkL No Note: Checking "Yes' will not change your tax or Yes No reduce your refund._______ Filing Status iib, ! 31. Single :. Married filing joint return (even if only one had Income) Married filing separate return. Enter spouse's social security no. above and full name here. r jmptions page 12.) ore than six . ,, i pendents, ,f ? *n page 13. Head of household (with qualifying person). (See page 12.) If the qualifying person is a child but not your dependent, enter this child's name here. ; Qualifying widow(er) with dependent child (year spouse died 19 (See page 12.) 6a E^F'Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax No. ot boxes return, do not check box 6a. But be sure to check the box on line 33b or page 2 b^OP^Spouse checked on Ga and 6b j - k c;. Dependents: i; (1) Name (first, initial, and last name) ipm------------------ ------------------------------> ' \ It',',' ' ` l. Jll`. ... (2) Check (3) II age 1 or older, ii under dependent's social security age 1 _________ number (4) Dependent's relationship to you .04 u. tMM,. (5) No. ol months lived in your f home in 1991 r No. of your . children on 6c * who: lived with you didn't live with Zck. _ . you due to divorce or - , " separation (see tx. pago;l4) [Income Attach Copy B of your Forms W-2, W-2G, and 1099-R here. If you did not get a W-2, see page 10. Attach check or money order on top of any Forms W-2, W-2G, or 1099-R. A No. ol other A dependents on 6cA ifa?; if your child didn't live with you but is claimed as your dependent under a pre-1985 agreement, check here 0 ' Add numbers entered on e Total number of exemptions claimed......................................................................................................... lines above m ;.,7. Wages, salaries, tips, etc. (attach Form(s) W-2) . . . . . ... . . 8a Taxable Interest income (also attach Schedule B if over $400).................................. b Tax-exempt Interest income (see page 16). DON'T include on line 8a 1 8b 1________________ XCf 2 38a I.if 9, Dividend Income (also attach Schedule B if over $400)................................. . 1 Taxable refunds of state and local Income taxes, If any, from worksheet on page 16 . 11 / Alimony received . . . . .. 12 * Business income or (loss) (attach Schedule C)...................................... . .. 10 11 12 13 Capital gain or (loss) (attach Schedule D)......................................................................... 13 14 Capital gain distributions not reported on line 13 (see page 17)................................. 14 15 Other gains or (losses) (attach Form 4797) . . 15 16a Total IRA distributions . 16a . 16b Taxable amount (see page 17) ' 16b 17a; Total pensions and annuities 17a . 17b Taxable amount (see page 17) 18 A Rents, royalties, partnerships, estates, trusts, etc. (attach Schedule E) . . . . . 19 Farm income or (loss) (attach Schedule F).............................................. 20 A Unemployment compensation (insurance) (see page 18)................................. . 21a Social security benefits, 1 21a |_________ _________ I 21b Taxable amount {see page 18) 22 Other Income (list type and amount--see page 19) ............................. ..................................... 23 17b 18 19 20 21b 22 23 Adjustments to Income 24a Your IRA deduction, from applicable worksheet on page 20 or 21 b Spouse's IRA deduction, from applicable worksheet on page 20 or 21 25 One-half of self-employment tax (see page 21) ... 24a 24b 25 (See page 19.) 26 Self-employed health insurance deduction, from worksheet on page 22 . 26 27 Keogh retirement plan and self-employed SEP deduction 27 28 : Penalty on early withdrawal of savings................................. 28 29 30 Adjusted 31 Gross Income Alimony paid. Recipient's SSN . ________ : : 29 Add lines 24a through 29. These are your total adjustments Subtract line 30 from line 23. This is your adjusted gross income. If this amount is less than $21,250 and a child lived with you, see page 45 to find out ifyou can claim the "Earned Income Credit" on line 56................................................................. . ............................................................ Cat. No. 11320B 31 M Form 1040 (1991) Tax Compu tation 32 -Amount from line 31 (adjusted gross income).................................................................. . O D 33a Check if: You were 65 or older, Blind; Spouse was 65 or older, Blind, i..' Add the number of boxes checked above and enter the total here 33a ; ' b If your parent (or someone else) can claim you as a dependent, check here 33b If you want the IRS to figure your tax, see page 24. ! ' c - If you are married filing a separate return and your spouse itemizes deductions, or you are a dual-status alien, see page 23 and check here........................... 33c I Itemized deductions (from Schedule A, line 26), OR !34 Enter the Standard deduction (shown below for your filing status). Caution: If you checked any box on line 33a or b, go to page 23 to find your standard larger of your: deduction, if you checked box 33c, your standard deduction is zero. Single--$3,400 e Head of household--$5,000 Married filing jointly or Qualifying widow(er)--$5,700 Mamed filing separately--$2,650 35 Subtract line 34 from line 32. . .............................................................................................I . . a 36 If line 32 Is $75,000 or less, multiply $2,150 by the total number of exemptions claimed on line 6e. If line 32 is over $75,000, see page 24 for the amount to enter . . . . . . 37 Taxable income. Subtract line 36 from line 35. (If line 36 is more than line 35, enter -0-.) . 38 Enter tax. Check if from a ED Tax Table, b CD Tax Rate Schedules, c CD Schedule D, or d CD Form 8615 (see page 24). (Amount, if any, from Form(s) 8814 _________ I___ ) o Credits (See page 25.) 39 Additional taxes (see page 24). Check if from a CD Form 4970 b CD Form 4972 . 40 Add lines 38 and 39......................................... ........................................................................ ...... ,41 Credit for child and dependent care expenses (attach Form 2441) '42 Credit for the elderly or the disabled (attach Schedule FI). . ,43 , Foreign tax credit (attach Form 1116) page CD4.^ j Other credits' (see 25). Check if from a Form 3800 CD CD CDf)\ b Form 8396 c Form 8801 d Form (specify), 41 42 43 44 .. . > I j 2_ .45 . Add lines 41 through 44 . . . . . ... . 46 " Subtract line 45 from line 40. (If line 45 is more than line 40, enter -0-.) 46 CP Other Taxes 47 X Self-employment tax (attach Schedule SE)...................................................................................... ,48 Alternative minimum tax (attach Form 6251) ............................................... a CD b CD cD49 Recapture taxes (see page 26). Check If from Form 4255 Form 8611 Form 8828 ;50 Social security and Medicare tax on tip income not reported to employer (attach Form 4137), " 51 Tax on an IRA or a qualified retirement plan (attach Form 5329) .... v 52 Advance earned income credit payments from Form W-2................................. 53 Add lines 46 through 52, This is your total tax. . . . . 47 48 49 50 51 52 53 T7 Payments Attach Forms W-2, W-2G, and 1099-R to front. CD)54 Federal income tax withheld (il any is from Form(s) 1099, check 55 . 1991 estimated tax payments and amount applied from 1990 return . 56 Earned income credit (attach Schedule EIC) . . . . . 57 Amount paid with Form 4868 (extension request) . . . . 58 - Excess social security, Medicare, and RRTA tax withheld (see page 27) . CD59 Other payments (see page 27). Check if from a Form 2439 bCD Form 4136.................................. 60 Add lines 54 through 59. These are your total payments 54 55 56 57 58 59 60 61 Refund or 62 Amount 63 You Owe 64 65 If line 60 is more than line 53, subtract line 53 from line 60. This is the amount you OVERPAID. Amount of line 61 to be REFUNDED TO YOU......................................................................... Amount of line 61 to be APPLIED TO YOUR 1992 ESTIMATED TAX I 63 I1 - . If line 53 is more than line 60, subtract line 60 from line 53. This is the AMOUNT YOU OWE. Attach check or money order for full amount payable to "Internal Revenue Service." Write your name, address, social security number, daytime phone number, and "1991 Form 1040" on it. . Estimated tax penalty (see page 28). Also include on line 64. | 65 1___________________ I 61 Sign |-|@fg Keep a copy fo/your^U'11 records. Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all Information of which preparer has any knowledge. w Youcsignature * \/ W Spoyse's signature (if joint return, BOTH must sign) Date Your occupation lyi/fMen__________J Date Spouse's occupation * \/ '4 ii n i ^ Firm's name (odours'k /L \ hgT.use omy ar"- igi-ra-sV) 3h<s/V ' Check if f--, self-employed Li Irfcx n E.I. No. ) ZIP code Preparer's social security no. ,. :: > ) \ 67C7S9/-7 (jQQ~?(~ 0007-SWP-005802959 CONFIDENTIAL SCHEDULE F (Form 1040) Department of the Treasury Internal Revenue Service (X) Name'pf proprietor REDACTED Profit or Loss From Farming Attach to Form .1040, Form 1041, or Form 1065. See Instructions for Schedule F (Form 1040). 0MB No. 1545-0074 1191 Attachment Sequence No. 14 Social security number (SSN) ___ A Principal prI UoWduUctrt ^Describe in one or two words your principal crop or activity for the current tax year.) . fwi f~ &>/pAJ i B Enter principal agricultural activity code (from page 2) |^7| Q | D Employer ID number (Not SSN) C Accounting method:,) Sfc, - C1) Cash (2) Accrual E Did you make an election in a prior year to Include Commodity Credit Corporation loan proceeds as income In that year? . . C3 Yes E^No F Did you "materially participate" in the operation of this business during 1991? (If "No," see instructions for limitations on losses.) J3CYes Q No G Do you elect, or did you previously elect, to currently deduct certain preproductive period expenses? Does not (See Instructions.).............................................._.._._.._.._.._.._._.._.._.._.._._.._.._.._.._.._._. _.._.._.._._.._.._.._._.._.._.._.._._.._.._.._.._._.._.._.._._.._.._.._.._._.._.._.._.._._.._.._.._.._._.._.._.._.._._.._.._.._.._._.._.._.._.._.._._.._.)_&__J_a__p_p_l_y_________ D Yes ONo Part I Farm Income--Cash Method--Complete Parts I and II (Accrual method taxpayers complete Parts It and III, and line 11 of Part I.) Do not include sales of livestock held for draft, breeding, sport, or dairy purposes; report these sales on Form 4797. 1 Sales of livestock and other Items you bought for resale . . . 2 ; Cost or other basis of livestock and other items reported on line 1 1 2 a i7z^b/7ci 3 Subtract line 2 from line 1 .... ................................. 4 Sales of livestock, produce, grains, and other products you raised 5a Total cooperative distributions (Form(s) 1099-PATR) 5a 6a Agricultural program payments (see Instructions) 6a 7 , Commodity Credit Corporation (CCC) loans: a CCC loans reported under election (see Instructions) .' . . ... , b CCC loans forfeited or repaid with certificates 1 7b | ______________ 5b Taxable amount 6b Taxable amount 5b 6b 7c Taxable amount 7a 7c l 8 Crop insurance proceeds and certain disaster payments (see instructions): a Amount received in 1991 ....... I 1 ___________________ 8b Taxable amount c If election to defer to 1992 Is attached, check here D 8d Amount deferred from 1990 . . 8d 9 Custom hire (machine work) Income ..................................................... '........................................................................... 10 Other Income, including Federal and state gasoline or fuel tax credit or refund (see instructions) . . . 10 11 Add amounts in the right column for lines 3 through 10. If accrual method taxpayer, enter the amount from page 2, line 52." This is your gross Income 11 Part II Farm Expenses--Cash and Accrual Method (Do not include personal or living expenses such as taxes. Insurance, repairs, etc., on your home.) 12 Breeding fees 12 25 Labor hired (less Jobs credit) . 25 .............a </*?7 13 Car and truck expenses (see instructions--also attach Form 4562). 14 Chemicals........................................ 13 14 15 Conservation expenses (attach Form 8645) ...... .. 16 Custom hire (machine work). . 15 16 17 Depreciation and section 179 expense deduction not claimed elsewhere (see instructions). . 17 18 Employee benefit1 programs other than on line 26. 19 Feed purchased . . 20 Fertilizers and lime . 21 Freight and trucking . 22 Gasoline, fuel, and oil 23 Insurance (other than health) 24 Interest: a Mortgage (paid to banks, etc.) b Other 18 19 20 21 ~ 22 23 mna mm 24a 24b V TJTTZT cfU~ afyn 3 r*f 26 Pension and profit-sharing plans . . . . ... . .... 27 Rent or lease (see instructions): a Vehicles^joachinery, and equipment' b Otheirflandjanlmals, etc.) . . 28 Repairs and maintenance . . 29 Seeds and plants purchased . 30 Storage and warehousing . . 31 Supplies purchased .... 32 Taxes............................................... 33 Utilities........................................ .' 34 Veterinary fees and medicine . 35 Other expenses (specify): a TmdCZ b- c ...........' d ........................ -........ e ....... :. f 36 Add lines 12 through 35f. These are your total expenses....................................................................................... 26 27a 27b 28 29 30 31 32 33 34 VAm, mw, 35a 35b 35c 35d 35e 35f 36 v/70 /ZL&3 7/0 IS'S'6' ' a3n 323 / 7S' \ > 37 Net farm profit or (loss). Subtract line 36 from line 11. If a profit, enter on Form 1040, line 19, and on Schedule SE, line 1. If a loss, you MUST go on to line 38 (fiduciaries and partnerships, see Instructions)........................... 38 If you have a loss, you MUST check the box that describes your investment in this activity (see instructions). } If you checked 38a, enter the loss on Form 1040, line 19, and Schedule SE, line 1. if you checked 38b, you MUST attach Form 6198. 37 38aJX.AH investment is at nsk. 38b O Some investment is not at risk. For Paperwork Reduction Act Notice, see Form 1040 instructions. 123 Cat. No. 11346H Sohedule F (Form 1040) 1991 N41621.01 0007-SWP-005802960 CONFIDENTIAL 4562Form K'PcpaiUfiont of the Treasury Internal Revenue Service NarriAtel chnwn on rAtu W REDACTED Depreciation and Amortization mb no . 1545 0172 (Including Information on Listed Property) See separate Instructions. Attach thl3 form to your return. 91 Attachment Sequence No. 67 Business or activity to which this form relates. Part I Election To Expense Certain Tangible Property (Section 179) (Note: If you have any "Listed Property," complete Part V.) 1 Maximum dollar limitation (see instructions) . . ................................................ 1 $io;ooo ` 2 Total cost of section 179 oroDertv placed in service durina the tax vear (see instructions! . . 2 3 Threshold cost of section 179 property before reduction In limitation...................................... 3 $200,000 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- . . 5 bppimm (a) Description of property (b) Cost (c) Elected cost 6 ^m 7 Listed DroDertv--Enter amount from line 26 . . ........................ L 7 8 Total elected cost of section 179 property--Add amounts in column (c), lines 6 and 7 . . . 9 Tentative deduction--Enter the lesser of line 5 or line 8......................................................... 10 Carryover of disallowed deduction from 1990 (see instruct ons)............................................... 11 Taxable income limitation--Enter the lesser of taxable incc me or line 5 (see instructions) . . 12 Section 179 expense deduction--Add lines 9 and 10, but do not enter more than line 11. 13 Carryover of disallowed deduction to 1992--Add lines 9 and 10, less line 12 13 8 9 10 11 12 Note: Do not use Part II or Part III below for automobiles, certain other vehicles, cellular telephones, computers, or property used for entertainment, recreation, or amusement (listed properly). Instead, use Part V for listed property. Part II MACRS Depreciation For Assets Placed in Service ONLY During Your 1991 Tax Year (Do Not Include (a) Classification of properly (b) Mo. and yr. placed In service (c) Basis for depreciation (Business/investment use only--see Instructions) (d) Recovery period (e) Convention 14 General Depreciation System GDS) (see instructions): | a 3-year property b 5-year property Wmm c 7-year property d 10-year property e 15-year property wmmm< fllSPI wmA f 20-year property wmmm. g Residential rental property 27.5 yrs. 27.5 yrs. MM MM h Nonresidential real property 31.5 yrs. 31.5 yrs. MM MM (f) Method S/L S/L S/L S/L (g) Depreciation deduction a Class life b 12-year c 40-year mmwM 12 yrs. 40 yrs. Part III Other Depreciation (Do Not Include Listed Property) MM S/L S/L S/L 16 GDS and ADS deductions for assets placed in service in tax years beginning before 1991 (see iiretn irtinns\ .................................... 17 Property subject to section 168(f)(1) election (see instructions).................................................. 18 ACRS and other depreciation (see instructions)............................................................................ 03HEI Summary. iO 1 fetor! nrnnortv Fntor amniint frnm linft .............................................. 20 ' Total--Add deductions on line 12, lines 14 and 15 in column (g), and lines 16 through 19. Enter here and on the aDDroDriate lines of vour return. (Partnerships and S corporations--see instructions) 16 17 l * 18 19 20 >SJJSS/?S77};S;JW7777SS;/?7S77, For Paperwork Reduction Act Notice, see page 1 of the separate Instructions. 283 Cat. No. 12906N Form 4562 (1991) 0007-SWP-005 802961 CONFTDF.NTT AI M41621.02 Enclose State copy of Form W -2 and Form 1099 here REDACTED MAINE INDIVIDUAL INCOME TAX RETURN 1991 1040S-ME RESIDENT SHORT FORM FOR FULL-YEAR MAINE RESIDENTS ONLY V ToT STEP! Uh PnprinM Label, Othenriee Print or Type L A B E L Spouse's first name anu initial Last name L STEP 2 Indicate Your Filing Statue and Number of Exemptlone FILING STATUS (CHECKONLY ONE) 1 HU Single CD4 Married Filing Separately 2 fi^-Manied Filing Jointly. Spouse Social Security # ______________ _ CD CD3 Head-of-Household 5 Surviving Spouse with Dependent Child i n--.___ rour occupation Spouse's occupation 6 NUMBER OF EXEMPTIONS CD CDCheck if: You were Over 65 Blind CD CDSpouse was Over 65 Blind STEP 3 Figure Your Taxable Income 7 FEDERAL ADJUSTED GROSS INCOME. (From your Federal Form 1040EZ, Line 3 or 1040A, Line 16 or 1040, Line 31) ................................................................................................................................ 8 MAINE STATE RETIREMENT CONTRIBUTIONS ................................................................................ 7 (/&, 8 V- 1 9: U.S. GOVERNMENT BOND INTEREST included in Federal Adjusted Gross Income............ > 10 MAINE ADJUSTED GROSS INCOME. (Add Lines 7 and 8, subtract Line 9)......................... 11 aSTANDARD DEDUCTION. (See Instructions)..................................... 10 (/& 11 a ( cf txjrn 11 b EXEMPTION. Multiply number of exemptions in Box 6 by $2,100 . 12 TAXABLE INCOME. (Line 10 minus Lines 11a and 11b) ................ nb< ^ 12 V /.f/I 13 INCOME TAX. (Find the fax for Ihe amount on Line 12 in Ihe tax table) 13 14 USE TAX (SALES TAX). (See Instructions, an entry must be made on this line) 14 ) ) ) SJEP1 Rgur* Your 15 CONTRIBUTIONS. a Democratic Party...............................................>- 0$1 Tax and Contribution* b Republican Party ............................... ............... >- $1 c Endangered and Nongame Wildlife Fund...> $1 $5 $5 $5 $10 $10 $10 Other $. Other $. Other $. BE SURE TO: - ENCLOSE W-2 FORMS -SIGN THIS RETURN SIEEi Figure Your Refund or Amount Duo Total 15 16 TOTAL TAX AND CONTRIBUTIONS. (Add Ones 13,14, and 15) ...................................................... 16 17 WITHHOLDING. (Enclose W-2 and 1099 Forms).................................................................................. > 17 18 REFUND. If Line 17 is more than Line 16, subtract Line 16 from Line 17. Enter result here ...>- 18 19. AMOUNT DUE. If Line 16 is more than Line 17, subtract Line 17 from Line 16. Enter result j here............... ................... .................................................................................................................................... > 19 o o J? -?3 33 HestYwris Rahim To reduce state printing costs and postage, if you have your return done by a tax preparer and do not need Maine income tax forms and instructions mailed to you next year, check box at right.................................................................................................................... Office use only FD LFP NM CK MO CA Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief thay are true, correct, and complete. (If filing jointly, BOTH must sign even if only one had income.) You^gnawre *n rf) ... t>9 Signature ot preparer other than taxpayer Date Date Spouse's signature Date Preparer's Federal Identification Number or Social Security Number .b,*T...a_xpayer's Daytime Phone Number (Optional) *; - v^ r HomeWork. Please file this reium; together with check made payable to TREASURER, STATE OF MAINE, with the: DO NOT SEND CASH WRITE YOUR SOCIAL SECURITY NUMBER ON YOUR CHECK. . Bureau of Taxation Income Tax Division State Office Building Augusta. ME 04332-1066 Attach check or money order here N41621.03 0007-SWP-005802962 CONFIDENTIAL