complete_return_president_obama_2012.pdf

7/28/2019 complete_return_president_obama_2012.pdf

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E 1040 (.S lndiydua !C1 Tax_!tr9) 120_ OM N.'s4-o?4 1 IRS Usa nly-DooJPaplaj pa_ .0For te year n D 3t 20, ohe t y bginnin , 1, endin 20 Seseprat intucos.Your fist name and ntial ast name Yor soal seity nm

BARCK H. OBAMf a jont eun, spouses fist ame and Intial Las name po's socia seuty num

MICHEL . OBMAHome address (numer and sree) I you have a ox, see nstrucons ApL no A Make se te SSN{s above600 PNSYLVNA ANUE, N and on ne 6c are coretCity ton post ofice, stae, an ZIP od 1 ou hae a oi ades, also ompt space blow rslna _ !on ampagnCh re H y, you sposWASHINGTON D 20500 i fing intl, an $3o go otis nd Chkl a box boworegn county name I Foreign province/staecounty oeign posal code ill no cane yo ax rfund

Fhg Sas

Check onlyone o

Eempos

Single You 0 Spose4 L ead of household ih qualifying person f he qualiying2 Maried fng ointly (even if nly one had Income) person s a child ut no your dBpenden ener his child's3 Married filing separately Ener spuses SSN aoe name ere

and full name here 5 D Qualying wldow (er) -wi-d.e -pe-n-e-nt-,h cil-6a X elf f someone can claim you as a ependen otceck o a sehd 2

b [ Spous . oo chldrenC Depndts: (2)ependens socll 3)Dsndent' 0 ',17

'" wh y 2elationship to rag ve w oserit nub you uaif nIQrchld di natUvswlth-=--+"' yo to dioceMIA A BMA

{) Fst name ast nae

I more than fourdependens seensucons a nd

check ere .

NAAH M OBAM"AC UG HE:; Ri--X_ feef\t?onsJ_AUGHTER X Dependts on 6o

nt ntrd abo

Add nums rdIncome 7

8

Ach Fom(s)b

W2 hee Also 9tt m bW2G d 101099R f twa withhel 11

1 2

If you did no

13

ge a W-, 14see Insructions 15a

67

ncloe ut do 18not aach anypaymen Also 19please use 20aFm 1040V 21

22

3Ajsed 4Gss 25ncme 2

27

2829

3031a3233

343536

03703

oa numer of exemptions clamed . .. . .. .. ..ages salaries ips ec Attch Foms) W- .. . .. .... TaxblInteres Atach Scedule B lf required . ... . ..Tax-mpt nteres o t nclude on line a . TshOrdina diidends Atach Schedule B f equed

.. . ualied divdends . .

.. .l9b(

Taable efunds cedts or ofsets of ste and local income taxes ... . Alimony received ... . ... . .. . ... . . usiness ncome r loss) Atch Schedule C or C-Z . .. apitl gain or loss) Atach Schedule i requred If not required check hee

..

D

Oer gains or (lsses) Attach Form 79 . .' . .. .... .IR disiutons

.... 15 b Taable amount . ..Pesons and annuites . 16 b axable amoun enal rea esate royalies, patnershps, s corporatons, tuss ec Aac Schedule Farm ncome or loss Atach Schedule . . . . ... Unemploymen compensation . ' . . .. . ..Social secuty enefits I 0 1 I b axae amount .. ..Oer ncome Lis type and amoun

omne the amouns in the ar right column for ines 7 hugh 1 his is you otl incme ducao expenses ta busines xpnsas o evits erfomg artiss, and sbas!s ornmntoflal ch om o 16-E

. . ..eath savings account deducton Atch Form 8889

. .

ing epenses Attach om 39 . . .eductible pat of selfemploymen tax Atach Scedule S

..

Selemployed S SIMLE and ualifed plans .. .Sel-employed health Insuance deduction .Penaly on eary wihd aa o f savngs .. .Almony paid b eclpiens SSN IR dedction

. .

.

. .. ... . .Suden loan Inerest deduction ..uiion and fees Attach om 91

... . . . . ...

omesc poducon aciles deduction Atach Form 89.

23

24252627

28

9

3D31a3233343

Add Jines 23 though 5 . .. . ..Subac line fom line 22. his is you djst gros iom . .

3,465

50,000

. ...

.

. . .

78

9

10

11

3

145b6b

17

18

19

2Db

2122

3637

LH For Dtsclos Pnvay A d rwok Reco A Noice, e pae Juco.

ge 394840.

,462.

2

28,772-3,000

662076

53465608,6

Fom 1040 (2


2/38

Fo\040(21) BRACK H & MICHELE L OB Tax nd

-Credts

ddDclon f l woh yb n ie39 o 9b owho c be\adaendent

All ohe:Sige Marid lingty$5,Q50ld lngjoty Qaifigwl{e1OH ohusod$87

OthTxes

Pymts

f you have qn"hd, aahe EIC

Rfund

Amoun rom line 37 (adjsted gross ncome) .... 9c fE vo wee obeoreanuary 21948; Bnd} o boxe - - -J i D Spose as o befoe Jary 21948 D Blnd cee a

you sose emes o a seprate etr or you were a dual-sus alen chec here.. 39b Db

40442

43

444546474495051553

54

5

565756

emze euo (rom Schele A) o your rd dedco (see ef mrgn) . .Subtract ine 4 rom line 38 ... ... ... .. . .. .xemp Mlipy $38 by the mer o line 6d .... . xbe Iom. Stract ie 42 fom ine 41line 42s more th ine 41, eer 0 . .x. f any om: a Form(s) BB4 b Form 472 c 962 electon . ...Alteraive mm x. Atch Form 6251

... ... ...Add lines 44 and 45 ......... Foeign a credAtchForm 116 n required ....Credit or child ad depenet cre epeses. AttchForm 2 ..Ecation credits fomFom 8863ne 19

. ... .. ...Reir emet saings cottns credi Atch Fom 8880 Chi t credit Attach Schedle BB2 if reed . .. ,Residen! enegy credls AtchForm 569

d"ait

. Other cred its rom Form aD 380

Add lnes 47 through 53. Tese are yor o cedUs ..... ......

47 40248495051

525

.. .Sact lie 54 from lie 46 f line 54 is moe than ine 46 ent 0 ...... ....

Sefemloyment tx.Attach Schede SE . ..

.

...

Unepored socia secriy d Medicare tx romFom aD 437 bD 8919 Additioa ta o IRAs, othe qaed retiemet plans, ec. AtchForm 329H eired

. ..5 Househl empoyment te om Sceue ... ...... . . ..

Firstime homebye credt repayme AachForm 5405 f equire ....... . ...60 he tes Ener coe(s) rom Instctions61 Add nes 55 thoh60 Ths syo o x .. . 6 Federl icome t withheld from orms W2 a 099 . 62 5146 22 esmated t pymes and amount applid from 201 retr .... 6 2 51564 ed ome ce(EIC) .. . ....... . .. 64

b Notabecom at pay elecion I 64b I65 Additio a chi d cred Aach Schedule 8812 ... ... . .. 6566 Americn o ppounity credit rom om 8863 lle 8 .. .... 66 .7 Resered

..... ..

... .... .. 7

6 Amoun pad wth reest for etesion to ile .. . 66 xcess socl secry nd tier 1 RTA wthheld

.. .. .. 6970 Crei for federal ao uels. Atach Form 436 ... 77f CreditsfomForm 2439 0Rmnoc0BB1 d088 7172 Add lies 62 63 64a. ad 65 throuh 7 These reour opayments ... ... 73 If line 72 ls more h ie 6, suct line 61 from line 72 hls is the amont yo oepid ....

. 74a Amount o line 73 ouwa eed o you If om 8888 is ached check hee Dir deo? Rou I 1 ,. 0 e:Cutee b nmb 0 T: Chtklp Svg mruon

7 Amoun o lne 73 vouwt lied o o 013 etme x 1 75 16 815Amou 76 m yo o we. Subact le 72 rom lne 6. o deils on how o py, see nstructios

. . You Owe Esmatedtxpenl{see structions) ...... . I 77 I

e 2ae 608 611

.

-40 258 8541 50 2264 15 2004 5 0244 87 46545 21 22146 108 686

,

4 40255 105 284

56 6 057a

061 112 214

!

2 12 02 73 16 815

74'

76

Thid Do yo wt to alow anoher person to iscss this return wh he IRS (see nstrucios)? [ Ye omplete elw. o -,Design nu$,.MICHAEL S SOLHEIM -oe r:galfMnuieao.[-Sgn 10pw,_oi'ft.-hat I hv exmied hi e an apyn heus d a;mn d t the bs o ) ked d th)2 pepw (ot Ihan xar Is baed n al nmtion o Wh re ha any kowld.He Dae Yrcpation aylme phoe ub/s S PRESDENJn eunSee nsnKeep a y yrrBrds S FRS LY

If ! IR sn you al Itit PIN,

PVype e' a1

dPrepar MICHAEL S SOLHEIMUe nl .WINEBRG SOLHIM WELL & SIN

2-13

180 N LASALLE ST, SE 2200"'- .CHICG IL 606 01

a6

ent i he

hek D ! PN!e!oe


3/38

Underpayment of Estimated Tax b-Inviduals; Estatesand rusts

OMS N.15450

2012Depatment of he Tre5UyInl Reveue Svic

PIormation about Fom 10 and ts sepaate insrctos s at wwwlrsgov/o

. Aach to om 040, 00A 040NR, 0NR-EZ o 101.AhSeq N 0

Nam(s) show o tx t Idntyig ub

ARAK H & MIHLL ODo You Have To Fle Fom 221?

Comee Jes 1 ogh 7 eows e ess a $ ,000? Yes Do not e om 0 o do ot owe e.

, Noomete es ad 9 eow I e 6 eq o o moe a es o do ot owe a eat Do ot fe om 0le ? (t f ox E Pt II aies, o mst fe ge 1 f

om 20).t Noo m owe a eay oes o Pa II eow ? Yes o ms l om 210 oes o B o D 1-?

No l vesNo I o mst e o eayo ot ie om 0 o are o eed o ge or o e not eed o e o eat ee te IRS wel ease te IRS w fige ad sed o a i fo a ge ad sed o a o ad o I o wa oad o Io t o ge , o m se Pa Il o ge t o ma se Pa Il o a V as a woee ad etea IV as a woksee ad ete o ealy amo o o ta o ea mo o o tax e fe o page 1 oe, o not e om 0 om 101 Pat 1 1 equied nnua ayment Eyo 1 t x a cdts fo Fo 4 l (s Istctos o f Fom 4) . .. . 1 105,284.2 Oth txs cld slfmploy tx (s Isctos)

..... .. . . . 6,930

fd cds { Istctos) . . .. . .. . . .. . 3 )

5

9

t ya tx Co Hs 1 d If lss th 1 sop; yo do o ow pralty,to ot o Multiply ne 4 by9D%(.0} .... 5 100,993.Withhold txs D t icld statd tx payts (s istctios) .. . .

tct l fo 4 f ss th $0 tp yo do ot ow a plty n t t Fo 1 ..

.

Max qd a pyt sd o po y's tax (s Istcos). . . .

d nu al pt t th s l o l o l 8 . .. ... .. Is 9 o h l ? Yo d t o a ply t l Fo ss ox low appls Y_s Yo y ow plty t d t fl o 1 lss o o mo oxs I P J ow ppls

If ox , o ppls yo s yo palty ad l Fo 221

. .

.

4 112,214

6 99,14. 12,700 78,281.9 100,99

If ox A o appls (t o o ) il oly pa 1 of Fo 1 Yo a Qtqd to f yo ply th will f t ad sd yoa fo y d ao Uyo w to f yo plty yo ay s P Ill o I s woksht d t yo p ty o yo t x t f il ly p f 1

Yo qst a wv (s stctos) of yo ti plty Yo s chc ths ox ad fil pa 1 o om 1 yo ot qdto f yo plty

B D Yo st a a (s sctos) of pa of yo palty Yo st i yo plty d w ao d fl Fo 1.C 0 Yo Ico id d th ya ad yo paly Is dcd o liiatd wh fd s th lz d I Istal t thd Yo st

f th pty s hdl I d fl o 1 Yo palty is lo wh fd y tat th dl Ico tx wthhld fo yo Ico s pd o th dats t ws ctly wlhhld std o i

qa aots th py d dt s Yo st f yo ply ad Fo 1 . Yo fl!d o a l joi t fo ith 11 o t ot fo oth yas d l 8 o s sl tha ao o st fl pa 1 o

o yo t id to f yo pl (lss ox o ppls) or aeok Redution Act Note see separate nstructons

220-413

Fo10 (1)


4/38

Form 2210 (202) K H & MHELLE L OPa V I R_guJr MtgJb ns!qp fyouar fiin Form i040NR or10Q-EZL _ - .

Payment De DtesSecion A Figre Yo Underpayent

1

19

20

1

3

4

Required instllents. ox C Pa I applie, ee

the amo frm Sele AI lie 2 erwe, ee

2% 25 o f ie Fom 2210 ea olm ..Es!mted tax pai an a w!hl. Fo column (a) y, as atrt mout f e ! n n 3. t n a91s q o re thane 18 ! t pe sop he: you nt we a nl

D ile For 10 nless yo ceke bo I

Colee ins 0 rough 26 n cob ging o lin 0 th ex l

Eer e amo f a rom lie 26 e previo

om A lie 1 a 20

. ... . .. ..

.. . .. .....

....

Ad te ats n B 4 and 25 I th rvious colmn Srat lie 22 om ie 21.Jfzero or e eter -0:

Fo olm a oy eter e amou from lie 19

f lle 23 i ero trat lie 2 from e 22

Otewie eer 0 ..... ..

Underet. If lie 18 eal to o moe t lie23, a lie 23 rom lie 18 Te o o lie 20 of

e ext olm Oewie go t ie 26.... .

eamet f lie 23 i more a lie 8, ua lie

18 from ie 23 Te go o li e 20 of e ex olm

b (c)4/15/12 6/112 9/1/12

1 25,248. 25,248 25,248.

1 49,394. 24,879 29,89.

0 24,146. 23,1 49,025. 53,656.

49,394. 9,025 53,656

24 0 0.

24,46. 23, 28,408.:ecbon B Fgure te enalty (U h Workh fr o 220, Pa V, Son . Fir Pna n th intct ions27 enay. te e oa el from He 4 o f e Woee for om 2210 Pa IV Seto - Fige e ealy Alo ilue

ti amot o orm 10 l ie ; Form 1040A lie 46; Form 1040NR, lie 74 om 1040RZ le 26 or Form 04 1 ie

26 nt fie 10 unes ceke b n at II .

90-

.. .. .. ..,... . .... ....... . 2

Page 3

d1/1/3

25,249.

24,8

28,40853,285

53,285.

0 orm 22102012


5/38

SCHEDUL A- {Form 1 040)

Itemized educionsOMB No. 154-07

our sca secumy nm e

BCK H & MICELLE L OB

Medical

ndDentlxpeses

Tes YuPd

Iterest

ou Paid

Note.Yor mogageInterestdeducto maybe lmed seeinscons)

Gifts tharity

2

Cao Do ot include expeses rembrsed or pad by othersMedica and dental expenses (see stctonsEnter amout from orm 00 ie 38Mutipyle by5% 0 ) ...

- cr'-Subtact Un 3 fm ne If ine 3 Is more an ne ente

_ . . . I 4

Stae and loca {ek one bo:a C Income aes, r }b D Genera sales axes

Real estate taes (see instctons) 6 26751

7 Persoal pope taxes 7

911

11141117

Oher aes ist tpe and amoun t

Add s 5 though 8 9ome mogage terest and poins repoed to you o o 08

. . f-Home mogage terest not repoted o you o Fo 098 I pad to the persofrom whom you bogh the home see nscos ad sho tha perso's name

dentfng no, ad address P

1onts ot repoted to you on Form 08 See istrctons for speca ues f12'----Mogage nsrace premims {see insucions 13----Iesment nteest Atach om if required (See nstctons) 14Add lnes houQh 4 15Gts by cash or chec If you made any gf o $5 o more see nscos f+Oher ha by cash or chek If ay gif of $0 or moe, see Instuctios

If yo made a ou mus aach Fo 883 if ove $0 17gift and got abeefit fori, 1 ayover from pror yeasee sctios 19 Add nes 6 throh 8Casualty

aThe sses 2 Casa o thet loss(es) Atach o 4684 See Inscions.) Job xpese s 21a CeaMiscellaeusDeuns

neimused empoyee epenses-job tavel union dues o education ecAach o 06 or 06EZ if rered See nstucions)

2 Tax prparation ees .2 Ohe expeses ivestmen safe deposit ox etc List pe and amount .

22

Addlines21through23. .

Ti.te amout from Form 0 lne 38 ... 2 Multipy lne 5 by % . .

27 Sutrac ie 6 from ln e If le 6 Is more than ie enter-0- .

e 2 Other from lst in instructions Lst ype ad amotMscellaneousDedus

18

212

324

TtaIteized

29 Add the amots n the fa right com for !nes through 8 Also eer ths amont on Form 04,lne 40

Deductis Ifyou eect to Itemize dedctios eve thogh they are less than yor standard dedctioncheck hee

9

0

27

8

2

63,5

,6STM

88

HA 219 13 For Paperwrk eto Ac Noe see Fr 14 stis Seue A (r 104) 21


6/38

SCHEDUL B OMB No. 4

{Form1040A-o140) I - - . - Interest and Odinary Dividends - Atch to Fo m 100A o 1040 - 20-1Depnt o1 th TrasuyItnl Rvnu Svic (99) !-.Information about Schedul (Fm 4A or 104) an Is stuctio Is a n.0amtsl sown n u u o cuy nu


7/38

SCHEDULC{f![ 1040)Depatmnt of the "reasuJIeal Rvee Sev (99)

Profit or Los Fom Buine -- _ _ . S_@i _ . . -Fr Ifri Shedue G d t stui t wwwirsga/schdule, Ath t r 1040, 1040NR, r 1041; erhip enerly mut file Fr 1065

OMB No. 54-H

Nme f pi c erty mb N

BCK OB

A rincpal busess or professon Incudng product or sevice (see lstucons)

UTR Business ame If o separe usiness name leave blank D Eoye ID IN, elBK B

E Busiess ddress (lncludg suteor room no) Ciy to or pos ofice sae ad ZIP codeAccoutin g metod: (1)L ash (2)DAccrual (3) her (specfy) . _

Dd you "materially patcpae in the operation of this busiess during 2012? If 'No,' see isucions for mi on losses . [ Yes D NH f you sated or acured this usess durng 212, check here .. p

Did you make ny paymets 22 tat ould require you to file Form(s) 1099 (see instrucs} Yes 0 NIf es did you r will you Ue reqired orms 199 Ye N ..... I Pa I I Income

1

2

34567

ross receps or saes ee Isrucions for line 1 and check the bo if hs Income as repoted to you o orm W-2nd the tatutoy employee box o hat form was checkedeturs and allownces (see Insctions) .

...

.....

..... ....

. ... ... . .

ubract lie 2 from le 1 . . . .. ...... .. .. ...... Cost of goods sold {from lie 2)

........

.. . .... .. .....Gr r urct lie from lne 3 .. . .. ........her come including federa nd state gasoie or fel ax credi or refund (see Instructons) _:_:).rg-NT:jGr omeAdd l es 5 ad 6 . .. ..... ...... . ...... . . .. .

3456 7797 779I Par I Expss Etr expess or busiess s o you home oly o ie 30.

89

1011113

14

1516

b

1789303

Adve sig . 8 18ar d tuck eeses 19(see stuctons) . . ... 9 0ommssos and fees ..... 10 8 Coact labor {see suctos) 11 bDepleton . .. .. 1 1Depreato and secton 19 2epese deduco (not ncuded n 3

Ill (see Isuctions) .

..

.

13 4Employee benefi programs {ohr

than o n ie 19 . 14 bInsuance other han heth) 15Interest: 5Mogge pd anks, ec) .. 16 26Othe ... ..... .... 1Gb Legal nd professioal sevices ... 17 b

Oce expense ........ ..

eson and profisharig pins ......ent o lease (see structions):Vehces mchine, d equipmen ther busness popetyepairs and maneance .. .. ...uppes (not Included In a I!)Taxes ad licenses Trave, meas and enetainmenTave . .. Deducible mes denetanmet {see Isrucins)liies

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

ages (less employme credis} .Other expenses (from lne 8) Reseve fr fuure se ... ..

Tt expene before epenses o business use of home Add lines 8 hrough 2 ...... . ,.Tetative profi or (oss) ubact ine 28 fom ine

. .... Expeses for usiess use of your home Attch For 889 Do repo such epenses elsewhereNet prfi r ss) ubac ne 3 from lne 29

... . . ..

f a profi ener o oth Fr 040 e 1 (or Fr 1040NR, lie 13} ad on Sele S ine {f you checked he o o le 1 see istructons) Estaes and truss, eer on Fr 1041 ie 3,If a oss you ut g to line 32

... ...

.

32 If you have loss, check he ox hat descies your Ivestment i this activty (see Instructios)f you checked 32 eer the oss on both Fr 1040 ie 1, (or rm 1040NR e 3 and on Seue S e {If you checked e o on line see the line 1 strucions) ses d trusts, ener o Fr 1041 lie 3,If you checked 2b you ut atach r 619 Your oss my e limted

LA r Pperrk Reducti At Ntice, ee se rte struti

200181

18 5919

0202123

24

24b256

27228 9679 57730

31 577

Shee c Fr 00) 01


8/38

SCHEDUL. (Form_1 040)

Capital Gans and LossesAac oom104oForm0NR

Depamnt of h TesuyInal Rvn Seric (99)

Ifomato abo cdD ad s sarat strcios s a wv/ 0Use Fom 84 o is o asac os o s 1 3 8 ad 0

ams) sown on eun

ARC H & MIELLE OM

I Par 1 Short-Ter Cpit l Gns ad osss- Asses d O Year r essopete For 849 efor completing line 2, or

is form may asie o compt ifyou ound offcents o whoe dolars

3

Shoter totals ro al orms 899 with

box A chcked in ar I

.

Sho te totals from al os 899 with

bo B checked in a I Sho-tr totals from al Forms 899 with

box C hckd n ar I ....... .

(d) Poeds {sals ( Cos\ o ot asom Fom(s !99 Pat!, om Foms 99 a I

l 2 lm ( l olm e

992,000 992,000.

4 Shoterain fom Fo 6252 and shotr gain or oss fo Forms 4684 678and 824 shot ter a in or (loss from paneshps S coporaions, estats, and trsts

() Ajsm ogan o loss om

Fos699 P ln 2, om

from Schedules) K ......,.. . .

.. .. ....

.

.....

. ......

Shoerm capia oss carroe Ente he amount, if anyfrom line 8 of our Caa oss

Car ov Woset n te nstructons . . . .... .. . t so cata ga o (oss} omine ins togh 6ln colu mn (h) f ou ae any longtercaiins orosss, go toPa below. Othls, qo toPa on age2 1 Pr 1 Loge C Gas ad sses- Asses d More a Oe Yr

ompt r bfr cotig lin , 9 r . (d) es (sl ( Csto o bass ( Ajsmens oan o ls rom

OMB No. 154-007

-201

Y sal sey mb

( Ga o {oss)Oa mn ( rom

om { om s! w olmn

0

4

5

6 I7

() Ga or (ossr ol e fom

Tis or ma e eas o cople if ou ound of om Fos 949 Pa U om Fom[s 99 P 1 om{s 699 Pa 1! chm {) a mln olmn ( ln 4 (cens to whol dollars rw 4 olmn () th es wl om ()

8

10

1

1

13

14

15

Longtrm toals from all Fors 899 wth

box A checked in at II ..

Longten totals from all Fors 8949 wh

box 8 chcked n Par I .. . . ...

onterm totals fom al Fors 899 withbo C chcked in Par I .

1016000 1 015365

an fr om Fom 4 9, at ; ong-tr ai fom oms 249 and 622 and ongte ain or loss)

from Fons 4684678, and 8 8 24. . .. ... ... . .. .. ..... ...

et longte ga n o loss fro paships S corporations estates and trsts fro Shede(s) . '

apial an distiuos.....

.

..

. ... ...onm capital loss cayove nter the aountf an, fro lin of ou aa ss Cayov

oks in the nstructons

.

.. .. -

Ne orm cap a l ga n or (Joss ombn ins 8 throug 4 i n column (h) Ten go o

Pa on pa 2 .. .. ... ........ .. .... .. . .. . LH For a peok Rdcto Ac Noc s yor ax scos

22011123

65

11

1

13 '

14 116'151.}1


9/38

SchedulD (Form 1040) 2012 BARCK H & MCHELE OMAPar Ill .Sumar

16 Combin ins 7 ad 15 and nter the esut

If ine is a gan, enter the amount from i 1 on orm 1040, in 3, o orm 1 040NR in 14.n o to in 17 bow

f lin 1 is a loss, skip ines 1 thouh 20 beow n o to ine 21 Also b sure to comptlin22

f lin 1 is zeo sip lins 1 trouh 21 bow and enter -0- on o 1040 lin 1 o o1 00N, n 14 hn o to n 22

1 re ines 15 and 1 bot ains? Yes Go to n 8D No Skip ines 18 thuh 21 and o to n 22

18 Entr the amount if any, from ine 7 of th 8% at a Woseet in th instutions. ,.

9 Enter the amount if any, rom ine 1 8 o f th Uc atrd Sction 15 an Wost Inth instr ctions

re ines 18 and 1 ot ero or ban?D s ompt the Qaidividends and atal a Ta Wosht n th instrutionsfor o 1040, ine 44 (or n the insuctions for orm 140 in 42o not compt ine21 and 22 bow

No ompete te Scdl a Worst n th instuctions.o not complete nes 21and 22 below

1 Jf lin is a Joss enter here and on Form 100 in 1, or orm 040NR ine 14 th smallr o: oss on ine 1 or $000 or if mad lin separat ($1,500

Not n urin which amount Is smar treat oth amounts as postie numbrs

o ou h a qualiied dividnds o-n Form 040 in b or Form 1 040N, lin 1?

220513-

D Yes ompt th Qaed ivdnd ad aital ai ax Wost in th instrctionsfo om40 n 44 {or n e instuctios or For 100N, i 42}

0 No ompt the rest o o 1040 o om 1 040

age 2

16

8

19

3 ' 0 )

Scd Form 4) 212


10/38

894OMS No. 1545-007Sales and Other ispostions of Capita Assets

.. 201FonDpnt of th TrsurIteal Ru Srvice (9}

Iformatio about om and its separae isuctio is a -wwwirs.gov/fT. l wih yor ScheduleD s ansans r nes 1, 8 9 and 1 f cedue .

ame(s) so o e

BARAK H & MIHEL OB

ocial ecury umber otaxae detic ao o,

Most boks Issue ei w sttut sttmet ste of sg Fom 09 8 y so may rovd ss fomto usuy ou ost) to o o t sttn H 1 ot rpoe to the I,

Bore yo Box A 8, o C o datrine et yo eceve y stteets so t \so!1s o ss s eoe to IRS roers e rqure to ror si to tI l mst stoK o boht I 20 t.

You mt ceck Bo A B o belo Ceck oly oe box f more a one bo ales fo or s-erm asactios comee a seaae om899 age , fo eac alcable bo Ifo ave more soem tasactons an wfi o s age fo oe or more of e boes comlee asmafos te s ame b o c eced as o e ed

D {A) oterm rasactios reoed o or{s) 1099B soig basis as eoed o e R B) oem ansactios eoed o orm{s) 1099B soing basis as reoed o te RD (C) otem asacons o epoed to vo on om 1099B1 a) {b) {c) d) e) Ajsmen ny gan )

Descio of oe Dae acqed Dae sod o Proceeds ost o oerss u ee Gai or loss) (y. ee e I

{amle: 10 s XYZ o) Mo da r) dsosed saes ce) bass ee te (. ee Inscns b (e

{Mo da ) ote belo ad {f ) )

see Colmn e) i bie e ete nscos ode{s) Amot of w n )adjsment

us TREASURY NOTE 04/07/1104/02Jl2 992,000. 992000. 0.

Totals dd e amts coms {d) e) g) ad ) sbtacegatve amons) Ete eac toa ere ad cde on o

cede D l fr Box A above s ceced) ie 2 Bo Babove s checked), r line 3 (if Bo C above s checked 992000 992,000 0

ote f o ceced o A above b e bass reoed o e R as corect ee m colm e) e bass as eoed o e R ad ee aadjsme colm ( to correc e basis ee olm g i e seaae sctios fr o o figre te amo of e adjustmen.:0 0-03 LHA aeok eductio Act otic1 see seaae nsuctio om 4 212)


11/38

rm 894 201- Atcht Se en N. 12A P eNs) shwn n rtu (Ne nd SSN r tpyr dnticti no nt reqired i shwn on ter sid) Scil scity nbr

yr identficon

BCK H & MICHELLE L OBMost brokes Issue their own susttute sttet lst of using f 1099-B They aso my povd ass formao (usull ou st) to ou o he seme ee llt s o eote o te RS.8eDe ou ce BoxA, , o C eo eeme \hee o reve a sleteels nd so te asaon loc ass as reot e te S. Broes ae eque to eort ass o te D most to ou u 20 or ler

Pa II Long-Term. Trnsctins nvlvin c t! ssts au hd e thn on r r Jn te. r shter trnsctions, se e 1Y ceck Bo A, B C e w C hc o ne o x I thn one ppls yr lgter trnsctis cpt seprt Fr899 pg 2 r c pplcl y hv re lngter nstins thn will i on this pg r n r ore th s copete sny rris wth the s bo chc s yu need

D A Lgt trsctins pd n os) 199 showing sis w rpd to the RSC (B) gte trsctins rpd n os) 199 shwing ss ws t rpod to the SD C) Lnq-tm trnscts nt repod toyu on 99

3 () (b) (c ) (d) (e)Dscripti ppy Dt cird t sold or rceds st thr

pe: 100 sh. XZ ) M dy, y) dispsed (sls pice) sis See tht lw d dy yr)

se nth stcions

us TRESURY NOTE 09/02100831/12 ,06000 05

tl Add th nts in clns d) ) g) h) st rctnegtve unts) Entr c ttl hre d ncd n yuSchdu D ine (i Bo A ve is chced) in i B Bv is chckd), ie (iBx C ve s chckd} . ,06000 06

Adjusmet, i y t i lo y nt an aounn oln (gJ, nt a cod inl {f). trti

!) (g)Cde(s) Amountfadjstmnt

()Gin (ss)

Sbtr ln ero cl n ( on h lt

w cln )

635.

63o yu chcd A ov t th ss rpod t te RS ws cct eter n cn ) th ss s rpd t the RS nd nter

adtmet in clun () t crrct th sis S o in th sarat nstctins r hwto figurethe nt te adJstmt.2230 003 or 894 1)


12/38

Schedule SE (Fom 1040 2012 ae of persowth se emoymet inome (as shown on Form 1040)

BC H OBSection B - Log chedule SE

Pat I Sef-Empoymnt Tax

Aahmt Sequnce No 7

Socialsecutu mbeof-peron wth selemoymetincome .

Paqe

Note If our only ncome subjet to sefemplomenttax is r emoyee nome see insttions Aso see instctions or the dention ofhuh employee income

A I ou ae a minste membe of a eligious order or Chistian Siene practitioner ad yo led Fom 4361 bt ou had $400 ormore of ote net eangs from sef employment, hec hee ad continue wth ar I . .. ..

a et farm prot o (loss) rom Scedule F line 3 4 and fa parnerships Schedue (Form 1065)box code A ote Skip lnes 1a and b f you use the farm optional method (see instutons)

f ou eceived socia securt retirement or dsabiy benefis ente the amount of Consevation Resev e

a

rogram paments inluded on Schedule F lne b o listed on Schedue 1 (Form 1065) ox 20, code Y l+ et profi o (oss fom Schedule C line 3; Shedule EZ ine 3 Schedule 1 (Fom 065) box 14, ode A

(other than armng) and Schedue {Fo 1 065) box 9, ode J1 Mnstes and membe of eigousoder see nstrctions for pes o inome to epor on this ne See Instrctions o othe lnoe to repo

Note Skip this line f ou use the nonfarm optional method (see nstctons) 9- J?MT. ombne lines a b, and 24 a If line 3 is more than ero, multip line 3 by 2.35% (235) Otherwise enter amont om ne 3 .

Note l line 4a s ess than $400 due to Consevation esee Pogam paments on lne 1 b, see instutons

b If you eect one or both of the optional methods, enter the total of lines 15 and 1 here . Combne lines a and 4b If less than $400, sto you do not owe self-emploment tx xeto

2 7

4a 39

4b

f less than $400 and ou had emp oyee om e, enter 0 and conbnue 1 r . 4 395 a Ente our hrh emoyee ome frm Form W-2 See instructons

for defntlon o churh empoyee ncome '5"-------1 Multipy ine 5a b 235% (9235) f less than $100 ener0 ..

Add nes 4 and bMaximum amount of combined wages and self-emploment eaings subject to socia sec tax or

the 42% poion of the 565% ailroad etirement ter 1) tx or 2012 . .. 8 a Tota social seurt wages and tps {total of boxes 3 and 7 on Fom(s)

W-2) and rairoad etirement (te compensaton If $110100 or moe skpnes b through 10 and go to line 11 . .... .... a

b Unrepoed tips subjet to socia seu tax (from Fom 4137, line 1D Wag es subect to socal securty tax (from or m 8919 line 10) ... d Add lnes Ba, Bb, and B .. .. .. .

Subtt ine Bd fom ne If zeo or less enter 0 here and on ine 0 and go to ine 11 .

.

Multiplythe sm ae of lne 6 or line 9b 104% (104) .. . ... ...

Mult[ply line 6 by 2% (029) . . . .Seempoymet ta Add lines 0 and 11. Enter hee and on om ne o om N e 5

Detio o emoyeeqivaet oo of seemoymet tax Add the two folowing amounts 56% (596) o line 10 nehalf of line 11Ente the resul here and on om e or om NR ne I 1 I 3 r 4 6 .-at I Otoa Mthos To Figre Net Earnings (see nstrctions)

am oa etho You may use this method ony f a) ou grss arm income was not moe than $680, or(b) our net fa pros . wee less than $4894.

5 39

1010000

93

93

14 Maxmum Incomefor optional methods .... . 1-

Ente the mae of: twothrds (2/3) of goss farm ncome (not less than zero) o $4520 Also inludeths amount on e 4b above Noam toa ethod You ma se ths method oly f a) o net nonfarm prots s wee ess an $4894 andaso ess than 728% of your gross nonfam income ad you had net earnings from seemployment o ateast $400 in 2 of the por 3 earaton You may use this method no moe than fe times

Subtract ne 15 frm lne 14 1 nter the sma e of twothrds 2/) of gross nonfam income4 (not less than ero) o the amnt on

1 Fom!nt!

s nn! lr6lix.8ces:- - '"3Fromsch:;ilne1 Sh:c Eze SC. K;orm1), bx 4 codeA,

2 om Sch ne 34 and Sch K (r 165) bx 14, code A mnus the ad Sch K1 (rm 1058), ox 9, cde J.amo yo wud have enteed on ine 1b had n ued the optiona om c C line 7 Sch CEZ le 1 Sch. K1 (r 10), bx 14, code c;mehod ad Sch K- (m 1) ox 9 cde J.

Shedule SE (Form 2


13/38

Dmn o TesuyInl Rvu Svc ()

Foreign Tax Cedit- - - (lndivdua;Estte, orTst)-

Atach to Fom 1040 1040NR 104, or 990T.' 1 ab Fo 6 and Is s

OMB No. 542

-20Ahnqun o 19

Name Idetfg nmbers shwn on page 1 of your txn

BARACK H & MICHELLE OBMA

Ue a eparate Form 16 fo eah ateoy f ome ted below. See Cateres f cmem

the trto. hek oly oe x o eah Form i Rep alamot i .S doar exept where pefed Pa beo

a Pave ateo me c D Seto 90(j ) ome e D Lmp-m dtbtob Geeral ateory me d D ea ome rered by treay

f edet ofame o outry UTED STATESte: you paid taxes to only on foreign coun o U.S ossession, us oumn Ain PaI an in Ain a if ou pai taxes tomo han onogn coun o U possssi on use a sepat column an n for ach oun o possssion. '! ar I xble Inome or Loss rom Sores Otsde the Unted Statesor Ctegory Checked Aove)

ore n Countryr .S Possesson olA Add l , ad

Enter te nme of te oen ontry or S

possesson . .. . 1a Gro me fom re wth oy how above

ad f the ype heed above

he f le a ompeato for peroal ee aa employee yor tota mpeato frm al ore

$50,000 or mre ad y ed a alteratve a todeterme t re ee t rto .

Dedctons nd osses (aton: ee nstion!

3

a

b

c

de

g4

5

Expe detely rmto Xf1t' 7aah taemet Po ata hare f other dedt t dentely reted

e temzed dedto r dard dedto Other dedotah aemet . .... .Add e 3a ad 3b . .. . .. . G fre oe me

.

.

.

Go me from all ore.. ..

Dvde e 3d by le 3e . .Ml le 3 bye 3f

.... . Pro raa hae f teret expee

Home morae teret e worheet for

Home oae teret he tto Other teret exee

. ... .. ... .oe frm fre re . Add Je 2 3 4a 4b a d 5 ..

PTHERkDUTRIES

39,875

7,702

63,305

63,305

39,87568,67.058581

3,708

2639

14,049 Sbtrat le 6 frm le a Eter the relt here ad o e 5 pae 2 . ...1 Pat I I Foreign axes id o ccued

Credt s a med oren taxes d or acedfr tae

fore rreyy mthe e

.. .

S dolar

1a

6

7

h OPd xe wthheld at re o

nOher r Otherfoe axe wthheld at oe fore

0 0ud axe pad u.Uagd k Dlns \} ;:a (m) ns ared

A

B

c dd e thrh C clmn. nte the ttl ee and l e 2H or aerwok edto Act Notce, see strctons

4-3

taxe pad r

Di lPJ rYi10 q s aed3,402

.. .. . 8

39,875

14,04925,826

Ttal foeaxe pad

aredadd olo hrohr

3,402

3,402Fom (2)


14/38

form 1116(2012 BCK H & MCHELLE L OBAI Pa Il . Eguting h_Credi - .

9

3

4

6

8

9

Enter the amou nt rom line 8. These are you total oeign taxes paid o accruedor the catego o Income checked above Pa I

....

Carback o caryove atach detailed computation) ... . ...

Add lines and 10 .. .

Reduction in oegn taxes .

Taxes reclassiied uner high tax kkout

. .

, .... . ..

. ...

9 3,402.

3 '402

3

Combie lines 1, 12, and 13 This is the total amount o oeign xes available or credt nte the amount om line 7. Ths is you taxale ncome or Joss rom sources outsie theUnted Sates {beoe adjustments) o the category o income checked aove Pa I

... .. 25826.

Adjustments to l!ne 15.. .. 6

Comine the amounts on lines 15 and 6 hs Is you net oeign source taxable ncome the esult s zero or less you have no oreign tax crdt or the categoy o Income

you checked above ar I Skip ines 18 through 22 However, i you are iling mor thanone Form 1116, you must complete ine 20 . . .......

17 25826.

ndividual: nte the amount rom orm 040, line or Form 040N, line 3tate and rut nter your taxable Income ithout the deduction or yourexemption

. .. .. ..... . 8 350226.aton Ifyou fged yor tax sing he lower res on quafd dvdnd o capita gains, e nttonsDivde line by line 18 I line 1s more than line 18, ente "'

. . .. . . . .

ndvidal nte the amount om Fom 100, line 4you are a nonresdent alien ente the amount rom orm 1040N,line 42 tate and trut nter the amount rom orm 1041, ScheduleG, ne 1a, or the tota o orm 0,lnes 36 and 3

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

autonyou ae omeng lne 0 or spaate tgoe (mp-s dibtion), ee nsion.Mltiply lne 20 by line maximum amount o cedit)

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

nte the mal ler o e 14 o line 21.this Is the only Fom 1116 you are ng, skip lnes 23 through 2 and enter ths.

amount on lne 28 Othewise complete the appropriate ine n Pa V . . ... .. .

I Pa lV Smmay of is Fom paa Pas l234

6

27

8

9

Credit or taxes on passve category Income...... . ...

Credit o taxes on general catego ncome.... .. .

Cedi o taxes on ceain income resouced by treay . .

Ced o taxes on lump-sum distrbutons .. . ..

Add lnes 23 through 26.. ..... . .

Enter the mal ler o line 2 or lne 2. . . .... .

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

.. . .

3

25

6

. ... .. ..

.. . ...

Reduction o credt or internationa boyco operations . . . .

3 Subtract line 2 rom lne 28 This ls your ren tax reit Enter here and on om 1040, ne 4;orm 00NR line 4 For 1041, Schedule ne 2a or orm 0T, ne 40a

2150-3

.... .. .. . . .

Page .

4 3402

9 .07341

846.

6450.

3402

27

8 3402

3 3402

orm 2012


15/38

FO


16/38

Fom 251 2012 BCK H & MICHELE L OBA

. :arJIJ TaCompution Using Max aptal Gas Raes

Page 2

Complte a Ill on ifo re requirdto do so b ln 31 obyth Forign Ead Income Tx Wokshet in th nstuctions 36 Entr th a mo nt fom Fom 251, ln 30 If yo ae filing Fom 2555 o 2555-E ente th am ont fom

lne 3 of th woksht In th Instctions fo line 3137 Ent th a mou nt fom lin of th Q alifidDvidnds and Capta Gan Tx

Woshet the instctions fo Fom 1040 in , o th amount fomlne 13 of th ShedD Tax Worshet in the instuctions fo Sched 0(Fom 1040} whic he apps (as igud fo th AM If ncssa y) (senstuctions) If yo a fling om 2555 o 2555E se instctons fo thamont to ente . 1-38 Ent t h a mou nt fom chedD (Fom 040) li n 1 (as fged fo theAMT f necssay) {se nstctons). If yo ae fiing Fom 2555 o 2555EZ,

s instctons fo the amont to nt 3 If you d!d not complete a chedeD Wokshet fo the rgula ta o the

AMT ent the amount fom line 37 Othewis, add lines 3 and 3 and ntth sa of tat eslt o th amount fom line 10 of th SchdlD aWoksht (as figd fo the AMT if necssay)f yo a fing Fom 2555o 2555EZ se nstuctions fo th amont to ent

3

3

40 Ent th sma of ln 3 o in 3

36

40

41 btact n 40 from lin 3

'4 f lin 4 is $175000 o less ($,500 o less if maed iling sepaatly) mltply lne 41 by 2% (2)Othewise multiply line 41 by 2% (2) and sbtct $3,500 ($1 50 if maed filin9 sepaately) fm

the sult . 42 Ente:

$000 f maed fillng jointy o qualifyng widow(e $35350 f sinl o maid filing sepately o $430 f hd of hos_hold

Ent th am ount fom ln 7 of the uaifiedDivideds and Capital GanT Wokseet in the instctions fo Fo m 1040 line 44 or the amount fomin 4 of te hedl D Tx Woksht in th instctons fo chedule D(Fom 040) wihe applies (as fgued fo th gla ta) If you dd notcompete the oshet fo the egla tax entr D

45 bact line fom lin . If zo o ss en 0-

4 Ente th sm a of n 3 o ine 37

4 Et the sm al of ine 45 or ine 4

4 Sbtact 47 fom line 4

4 utiply n 4 by 15% (15)

45

46

47

.

f ne 38 s o o blank skip nes 50 ad51 ad g t e 52. thwis go to e 5

50 Subtactlin 46 from ne 40.

. . I5oOc . _-51 Multiply ine 50 by 25% (25)

5 Add ins 42 4 and 51

If ln 3 is $1 500 0 or ess ($87 500 o lss if maied flng sepa atly multiply line 3 by 2% ( 2)

Otse mtply li 3 by 2% {2) ad sbtact $3500 ($1 50 f ma ed filing s paatly) fomth eslt

54 Ent th sm of ln 52 or ne 53 he and on ln 3 If yo ae flng Fom 2555 o 2555E do not entethis amount on lne 31 Instad nte t on line 4 of the oksht in th Instctons fo lin 3

21952-

4

51

5

5Fom (2012)


17/38

Depatnt of he TrsuyIntrnl Rvene Sric ()

ALTENATVE MNMUM TAX

Foreign Tax Crdt(lndvduai,-Estate orTst

Attach to Fom 104 1040NR 104 o 990.' abou Fom 116 nd t ;,

OMS No 54-2

-0l2AttcmenSqne o. 1

Name Identifying nubera ow 1pge o yor x en

BARACK H & MCHELLE L OBMUse a separae Frm 1116 for eac h catey f icoe lise elw. See Caterie coe the sructs heck o oe x o each Frm 1116. Reo aams US. dollas excet where secifed i Pa ew.

a assive cate come Seci901D icome e Lm-sm dstiis [ Geeral caey cme eai ce resrced y treay

esidet of (ame f t) UNTE STATESte:If you paid taxes to onl oe foreig co or U.S, possess/on use colum A P n ieA II o p axes tooe h oefog cot or S poe sio use serte colu n le for ech out or possessol Part I l axabe Incoe o Loss rom Souces Outsde te Unted States {fo Categoy ecked Aoe)

ore n Countryo S Possesson otaA B c (Ad cos A , adG.)

g nter te name of te oegn contry or .S

possesson .. .

aGross icome frm soces whi cuy show aove

ad f he ye checke aoe

b heck if ie 1a'is cmesai fo esal seices as

a emee o otal cmesai from all srces is$250, or mre ad yo used a aerae asis todeterie is source (see structis) D

Dedctons and !sses (to: See ston)

3

b

cd

e

f

g

4

a

b

5

Exeses eiite re at e the come o ie 1a(aach saeme) r ra shae of oher dedcts nt einite elae

ea temized deducs o sadad deduc .Other dedctis {aach sateme

. .

dd es 3a ad 3 . .

Grss rei sorce icme Gross i coe fm all surces Diie ie d lie e ..Mlly ie c lie 3f .... .o aa share iterest exese

.

.

.

Home mrae iees use wrkshee for

Home Morae terest i he istucis) .ther ieres exese ...osses from ei srces

Add ies 4a 4 ad5

.

OTHERrQUNTRIES

39,875

7,702

39,85680,78

058581

2,39

10341 Sract e 6om lie a Eer he resul here ad o lie 15, pae ....I Prt Foreign axs Paid r ccu

1a

6

. .. ... .. 7

Crei aie d oegn taxes ad o accredfr taxes

u ust

feck e

0 ( '" (I) D Aedu UaA

B

fore crey

axes whhe at source

{k} idn (l} Yi:a { Inere(n Oher

foreiaes pai r

accre

8 Ad ine A tug C cln {s te te tal here and line9 ae2LH o Paewok educton Act otce see nstctons.

223

S. dola

axes wihhe a source o:(r Otherei

taxes pai r

( Dividens \J ;n: q} nt accre3,402

. 18

39,875

10,34129,534

() Tal freiaxes aid or

accrued (add cls(hrh ()

3,402

3,402m 1 012


18/38

ALTRNATIV MINIM Tfom 6 (202) BAK H & MIHLL L OMAJ'rU_ ._Eiguringhd - -- - -

9

10

11

12

13

14

15

16

17

18

1

2

2

Ent h amount om in 8. Ths ar you total oign taxs paid o accud

o th cato o Incom chckd abov a .

Caback o caov (a tach dtaid computation)

Add ins 9 and 10

Rduction In orin tas ..

as cassiid un d hih t a ickout ..

....'

.

Combin ins , 2 and 3 his s th o amount o oin taxs avaiab o cdi

nt h amount om in 7 his s you axab incom o ( oss om soucs outsid th

Unid Stats (bo adjustmnts) to h caoy o incom chckd abov a 1

Adustmnts to i 5.....

. . .. ... . .

...

Combin th amounts on ins 5 and 6 his is you n oign souc taxab ncom

(I th su is zo o ss you hav no oin tax cdit o th catoy o incom

you chckd abov at I kp ins 8 thouh 22 Howe i you a iin mo thanon Fom 16, you mus compt in 20) . vs nt th amount om Fom 040n 4 or Fom 040NR !in 39

Esates an uss nt you ab inom ihout th dducon o you

mption ... . . . . . . . . . . ...... . . . . . . .

3,402.

1

1 3,402

12

1

.

15 29,534

1

29,534

1 413,531

Caution: Iyou fgured you tax using the lowe rates on quaed dvidends o capit! gns, see nstcons.

Divid i 7 by in lB. in is mo than in , nt "" . .. . .. ... .Individuals: n th amount om om 040 in 44you a a nonsidn an nt h amount om Fom 00NR

42 Esaes and us: nt th amount om Fom 04, chdu G, in a, o th tota o Fom 90-

ins 36 and 37 . . . . . . ... ..

you e cometng ne 20 o septe categoe up-su dsbuions) see nsctons

MuiY in 20 by n 9 (maimum amount o cdit). ..

n th m o n 4 o in 2 this is ony Fom 6 you a iing, sip ins 23 thouh 27 and n this

.

amount on 28 Othis compt th appopiat in in a t IV . . . ,I Par lV Smmay of Cedis Fom Sepaate as Ill2324

25

2

2

28

2 9

30

Cdit o as on passiv cagoy incom

Cdit o tas on gna cato incom . .

,. ..

.. .

Cdit o tas on cain incom soucd by a Cdit o tas on umpsum distibutions . .

. .. 2

. 2

2

2

Add ins 23 thouh 26 . .. nt h a o in 20 o in 27

. .

Rduction o cdi o intaiona boycot opations .

.

utact in 29 om in 2 his is you freg ta crei. nt h and on Fom 040, in 47;.

.

Fom 040NR, in 4 Fom 04 Schdu in a o Fom 990 in 40a . . . .

2150-03

1

1

2

21

22

2

2

29

..

Pag 2 -

3,402

07149

18,686.

7 '762

3 '402

3 '402

3,402 om 11 (202)


19/38

Form 16 US and oreig rce Iom mary

NAME

BCK H & MCHELLE L OBA

INCME YP

Compensaion

Dividends/Disribuionsnerest

Capil Gains

Bsness/ roess ion

RenVRoyay

Se/oa Refnds

anershipS Corporaion

TrsVsate

er ncome

Gross ncome

Less:

Secion 9 xcsion

Capia LossesCapa Gains Tax Adjsmen

T oancome - Form

Dedctions:

siness/oesson Expenses

enRoyay xpenses

anersiS Corporaion osses

Trssae Losses

Capia Losses

Noncapia Losses

ndiidua Reiremen Accon

Moing xpenses

Se-empoymen Tax Dedcion

Sefmpoymen H.a nsrance

Keo Conriions

Aimony

oreied neres

orein Hoing Dedcion

Oer Adsmens

ai! Gains Tax Adjsmen

Toa Dedcions

Ase Gross ncome

ess emize ecins

Speciicay Aocaed

ome Moage nteres

er neres

aaly AocaedToa Adjsmens o Adjused Goss ncom

Taxae ncome Beore xempions

27305-

TOTAL

394840.

2.11,462.

635.

273,739.

680,678.

3635.

677043.

14967.

3465.

50000.

68432.

608611

150034

45,046.

63305.258,385.

350226

u.s394840.

211462

635

273739

-39,875.

640803

3,635.

637168.

14967

3465

50,000

-7702

60730

76,438

150034

42407

59,597.

252,038

324,400

REGN

GENER

39875.39875

39,875

702.

,702. 32173.

2639.

308

6,347.

25826.


20/38

NAME

BCK H & MICELLE L OA

To

temied

eductions

axe

63305.

teret Not ncd nvetment

teet . . 45046.

Contibtion

.. 150,034.

Miceaneou eductioSject to 2% . ......

Other Mceaneo eductio Not cudin Gambin oe

oein Adtmet .

o temed edction

Suect to Sec . .. ... 58385.

Add temied edction

Not Sect to Sec :

MedcVeta

netment nteret . ..

aaty Loe .....

amin oe .

Forein Adutment .

Tota temied edction 58385

ota Aowed o Scedue A

2278"0501-

Itemized Dedctions

Afte Sec. 68

Reducton

Speccay us

42407

150034.

192' 441

Form 111

Specificay Foreign Ratable

63,305.

639

2' 639. 63,305


21/38

Form Foeign Tax Cedt Caryovr Statmt (Pge of )

NAME

ARCK H & MICHELLE L OAM

Foeign Incme Cate

Reular1 e tx pd/ed

2 bk t01

f eded ets

Redtn llted t

exlded e

4 e x vlble

Mx edt llwble

Used en tax ( +)

exess lt { ) .

7. e x bk

B en x ywd

9 Less tey djstet

1 e x exess

lt en

2 28

Tl en txes J vble yes t e ed t nex e

2

,

PENERAL LMTATION INCOME29 21 211 212

3,402

3,4026,450

'47839 -3,048.

47,839. 3,048. . . .. .

23 4 25 6

e x pd/ed

2 bk t01

eded etns

.t- Redtn llted t

exlded e

4 e x vilble

Mx edt llwbe

Used e tx ( +)

exess lt - )

e tx k

, e tx ywd .

ess tet djset

1 en tx exess

lten


22/38

Form oreign Tax Credit Carryver Stteet Pge of

NAME

AK H & MHELL OMA

Foreign come Cateoy

AMT 2 2B1 Foegn ax pad/accued2 C cayback to 2012

fo ameded ens3 Reducton aocaed to

excuded ncome4 Foegn tax avaable Maximum cre aowabe Unused oegn _tax +

o excess of m ) .. Foegn ax caybac B Foegn ax caowad9 Less eaty ajsen

Foegn ax o excssm emanngToa foegn taxes fom a I aaabe yeas o be caed o nex ea .

Foegn ax pad/accued2 FC caybac o

fo amended etuns3 Reducon aocae o

excuded ncome oegn ax aaabe. Maxmum cre aoabe Unsed oegn ax { +

o excess of m (

7 Foreg ax caybac . Foegn ax caryowad .. es eat adustent

Foegn ax o excessm emang

27916051

22

@ENERL LMTAN NM29 21 2 22

3,402.

34027' 762

51 -4360

- 5 , 4 4360.... . .... ' . .

23 2 2 26


23/38

BARACK H. & MICHELLE L OBM

FORM 1040 WAGES RECEIVED D TXES WITHHELD

T

S EMPLOYERS NME

T DFAS-CIVPAYDIRECTOTE

TOTALS

AMONT

PAID

394,840.

394,840

FEDERL STATETAX TAX

WITHHELD WITHHELD

9954 8,942.

9954. 8,942

SCHEDULE A STATE D LOCAL INCOME TAXES

DESCRIPTION

DFASCIVPAY DIRECTOTEILLINOIS 2 QTR ESTIMTE PAMENTSILLINOIS 3RD QTR ESTIMTE PAMENTSILLINOIS 4TH QTR ESTIMTE PAMENTSILLINOIS PRIOR YEAR ESTIMTE PAMENTSILLINOIS PRIOR YE BALNCE DUE ND EXTENSION PAMENTS

TOTAL TO SCHEDULE A, LINE 5

SCHEDULE A CASH CONTRIBUTIONS

CITYSDI

TX W/H

DESCRIPTIONMONT

50% LIMIT

MERIC CNCER SOCIETYMERICN RED CROSSBOYS & GIRLS CLUBCALVARY WOMENS SHELTERCARECENTRAL ILLINOIS FOOD BNKCHILDRENS NATIONAL MEDICAL CENTERCITIZENS NITED FOR RESEARCH IN EPILEPSYFISHER HOUSE FODATIONHABITAT FOR HNITY

ILLINOIS HEAD STRT ASSOCIATIONILINOIS READING CONCILJUVENILE DIABETES RESEARCH FONDATIONLEKEMIA LMPHOM SOCIETY

0030002000.,000,000.,0002,063.2,000.

0387.2,000

000.000,000000

STATEMENT

FICA MEDICRE

TX TX

4 624. 5725

4' 624 5,725.

STATEMET 2

MOUNT

8,942.300030005,000.6,000

62

36554

STATEMENT

MONT30% LIMIT

3

TATEMENT(S) , 2 3


24/38

BARCK H MICHELLE L OBMA

.. IF. PIECES TO MSERIEESMIDTON EDUCATIONAL FOUDATIONMIRIM'S ITCHEN MOSAIC YOUTH THEATRE OF DETROIT

MJERES LATINAS EN ACCIONNATIONAL AIDS FUN

NATIONAL COALITION FOR HOMELESS VETENSNATIONAL CONGRESS OF BLAC WOMEN

NATIONAL MS SOCIETYNATIONAL OVARIAN CNCER COALITION

PALM BEACH COUNTY LAW ENFORCEMENT FNDTN

ROCHELLE LEE FUND I BOUNDLESS READERSST JOHNS CHURCHST LEO'S RESIDENCE FOR VETERS

SIDWELL FRIENDS SCHOOLTHE CRISTOPHER HOUSETHE RMONY PROJECT

UNITED NEGRO COLLEGE FUNDIVERSITY OF HAWAII FOUNDATION

SUBTOTALS

TOTAL TO SCHEDULE A, LINE 16

SCHEDULE C

DESCRIPTION

DYSTEL & GODERICH

ROM HOUSECOPYRIGHT CLEARNCE CENTER

TOTAL TO SCHEDULE C, LINE 6

OTHER INCOME

1,000 .1' 0001,000.10001,0001,000

1,0001 000.1,0001,000.5, 000.1 000.1,0001,000.5,0001,000.1,0002 000.1,000

150,034

150,034

STATEMENT 4

ONT

110,41162,789

489.

23,739

STATEMENT ( S ) 3, 4


25/38

BARACK H. & MICHELLE L. OBMA

SCHEDULE D CAPITAL LOSS CARRYOVER STATEMENT 5

1. ENTER THE MOUNT FROM FORM 040, LINE 41 ,2 ENTER THE OSS FROM SCHEDLE D, LINE 21, AS A POSITVE

3 COMBINE LINES 1 AD 2. IF ZERO OR LESS ENTER -04 ENTER THE SMALLER OF LINE 2 OR LINE 3 . . .

MOUT

5 ENTER THE L OSS FROM SCHEDLE D, LINE 7, AS A POSITIVE MONT6 ENTER THE GAIN, IF FROM SCHEDULE D,

LINE 15 . . . . . . . . .7 ADD LINES 4 A 6 . . . . .8 SHORTTERM CAPITAL LOSS CRRYOVER TO NEXT YER.

10

11

2 13.

SBTRACT LI NE 7 FROM LINE 5. IF ZERO OR LESS ENTER 0

ENTER THE LOS 'FROM SCHEDLE D, LINE 15, AS A POSITIVE MONT.ENTER THE AN, IF FROM SCHEDLE D,LINE 7 .SUBTRACT LINE 5 FROM LINE 4. IF ZERO OR LESS,

ENTER 0ADD LINES 10 D 11 LONTERM CAPITAL LOSS CRRYOVER TO NEXT YEAR.

3,000.

SBTRACT LINE 12 FROM LINE 9. IF ZERO OR LESS, ENTER 0 ,

350,226.3,000

33,2263' 000.

115,516.

3,000.

112,516

SCHEDULE SE NONFRM INCOME STATEMENT 6

DESCRIPTION MOT

ATH OR 258,772

TOTAL TO SCHEDLE SE, LINE 2 258,772.

FO 1116 EXPENSES DIRECTLY LOCABLE TO FOREIN INCOME STATEMENT 7

DESCRIPTION CONTRY MONT

OTHER EXPENSES DIRECTLY ALLOCATED OTHER COUTRIES 7,702

TOTAL TO FOM 1116, PRT I, LINE 2 7702

STATEMENT(S) 5, 6, 7


26/38

BACK H & MICHELLE L. OBMA

FOM 6251 EXEMPTION WORKSHEET

1 ENTER: $50,600 IF SINGLE OR HEAD OF HOUSEHOLD; $78,750 IFMARIED FILING JOINTLY OR QUALIFYING WIOW(ER) $39,375

IF MARRIED FILING SEPATELY .2 ENTER YOUR ALTERNATIVE MINIMUM TAXABLE INCOME

(AMTI) FORM 6251, LINE 28 . . . . . 413,531.3 ENTER $112,500 IF SINGLE OR HEAD OF HOUSEHOLD

$150,000 IF MARRIED FILING OINTLY ORQUALIFYING WIDOW(ER) $75,000 IF MARRIEDFILING SEPTELY . . . . 150,000.

4 SUBTRACT LINE 3 FROM LINE 2 IF ZERO OR LESSENTER -0 . . . . . . . 263,531.

5 MULTIPLY INE 4 BY 25% (.25) . . 6 SUBTRACT LINE 5 FROM LINE 1. IF ZERO OR LESS ENTER 0. I

AN OF THE THREE CONDITIONS NDER CERTAIN CHILDREN UNDERAGE 24 APPLY TO YOU COMPLETE LINES 7 THROUGH 10.

OTHERWISE, STOP HERE A ENTER HIS MONT ON FOM 6251,LINE 29, A GO TO FOM 6251 LINE 30 . . .

MINIMUM EXEMPTION MONT FOR CERTAIN CHILDREN UNDER AGE 24. ENTER YOUR EARNED INCOME IF A.9 AD LINES 7 A 8 . . . . . .

10 ENTER THE SMALLER OF LINE 6 OR LINE 9 HERE ND ON FORM 6251,LINE 29, AND GO TO FORM 6251 LINE 30 . ,

STATEMENT 8

78,750

65,883.

12,867.

STATENT(S) 8


27/38

c

c

t

A

"0r

d

,

T

llnois Depament of Revenue

-wbFile_ 212FormIL-1040

lndividua Income Tax Reu or fo fsca year endg

taxi in ois gov

Sep Personal Iomaon

BARACK H. OBMMIHELE OBAM1600 PESYVIA AVEUE NWASHINGT, D 20500

C Fin status (see nstuctions) Sne or ead fhouseold I Mared ln jontly Mae n separately

D Ceck same-sex cl unon reu (see nstuctons

Sep 2 Fedea adusted ross income om your US. 1040, Line ; US D0A ne 21; or

Iome US 1040 ne -2 ederaly taxexempt interest a nd ddend ncome om you S 1040 o 1 040A ne Bb

or US 100Z 2 Oter addtions Atah Scedule M 4 Tota comeAdd ne s 1 tou . 4

Sep 3: 5 Socia Secuy benefts and cean retrement pan incomeBase receed ncluded in Line Aa Pae o ederal retum 5 00ome 6 nos Income oepayment Included n S 1040 Line 10 6 00

ter subtactons Aac Scedule M 11' 418 00Ceck Lne 7 incudes any amount om Scedule 199

8 Add Lines 5 6, and 7 s s te total o you subtactons 8'

9 9Illios base ome. Subtact Lne 8 om ne 4

Sep 0 a Number o exemptions rom your edeal tu 4 X $050 a 8,200 Eemptios b Isomeon ca claim yu s a pnnt, s isrctos X $050 b

Ceck 65 o ode You+ [ Spouse = X $1,000 c d Ceck ealy bnd: D ou D Spouse = X $1,000 d 00

xemtion allowaeAdd Lnes a tou d 0

Step Residens: Net come Subtact ne 10 rom Lne 9. Skp ne . Net 2 Norsidts ad pa-yar sdnsIome Ceck te ox tat aples to you dun 201 Nonresdent D ayear sident and

rite te lnos as Iom rom Sc NR Aah Sc N 2 00

Sep 6 Resdes Mutpy Lne 11 by 5% (05)a Nnresdes d p esides Wre he tax rom Scedule NR.

Recapure o nestment tax credts Aah Scedue 455

15 nome ax Add nes 1 and 14 Cannot be ess tan zero

Sep 6 Income tax p ald to anote state ie an lnos esdentax e a Scedule C 6 00No ropey tax and K educaton expense cedit amount omudabl Scedue !R Aah Scedule I CR 00Ceds 8 Cedit amount rom Scedue 199C Aah Scedule 1299C 8 00

9 Add ines 16 17 and 18 is is te to ta o yo u creditsCannot exceed te tax amount on ne 15 9

20 x afte oeudabl dts Subtract Lne 19rom ne 15 20

IL-1040 pge (R-2/12)Tis fo Is ahrzed s ulne ud Ios comTa A. Dsc o

2491ID: BX Oi-31 hs r Is qr. FUB de nt cod esu I ey.

o o Wrte a ve t !S ne.

Widowed

(Woe dolas ony)

608611 00

00

00

608,61o

11,418 00597,193 00

8,200 00

588,99 00

29 450 0000

29 450 00

00

29,450o


28/38

21 ax ae nonrefundabe creds from Pe 1 Une 20. 21 29 450

Step 8: -Huseho!d-mpoment tx S nstctions- -Othe Txe e x on nee, mal orde, o othe outotate puhes from

UT Workshee o b In the ncions. Do not leave bank. 0 .DO24 T Add nes 21, 22, and 23 24 29,450 DO

St9 25 linois ncome x whhed W2 ad fons 25 18942.Payments 26 Estmaed ayment from oms l10ES and ,ad Includng overpayment appied fom 2011 eurn 26 000 Rfundl 27 Passthough entty tax payment ta Schedule K1 o KT 2 .DCrdit 28 Ead ncome Cedi fom Schedule IQR. t Schedue R. 28 D

29 Topymen nd reundl dt Add nes 25 through 28 29 29942 Step 10 30 Ovepment f n 29 geer han Un24 subtct U ne 4 frm Un 29. 30 492 Resut 31 Undrpamet. If ne 24 s greaer than ne 2, subrc n 29 fom Une 2. 31

Sp 11: 32 atepayment penalty fo undeayment of etimated ta. 32 ndeymet Chec a least twothirds of your feea gros icome s from fming 0of mated b hec you o you spoue e or ole ad pe>nen!yT en living in a nring home ad Do a ons Chec your income was ot received eveny dung he year and you

Stp 12

Refund oAmount You

Owe

Step 13

n ndae

d sgnee

Fom 9G

ormao

annulized yo income on Fo L22. ta om l220 ]d hec you were not quied o le an llnois Indivdual ncome

ret n the pevious tax year 33 Volunta chartble donatons a Shdue G 33 DO34 o penty ad dnos Add ne 32 and33 34 D O35 )f you have an oveayment on ne 3 ad this amoun I greate than

n , ubract n3fom U n3 his s your emning vmen 492 .036 Amoun from Un3 you wnt ended to y f you wan o depos you refund drectly

nto you cheking o avngs account, complete he direct depos nomaon on ne 37 36 0 .3 Complete to diect deoit your eund

Rong numbe 0 Checking orD SavngAccount numer

3 Subtract 36 fom U n3 hs mount w! be id o yo 1 esmatd . 3 492 39 If you have an undepayment on Un 31, add Unes 31 d or

f you have an oveayment on n 3 and thi amount Is ess tan ne ubtract U3 om U ne hi the mount you oe 39 ,

:;u tate that I have examined this etu, and, o the best of my nowledge, i true oret ad comlete.g[zol - L/13vo;W:::_LD,t;=C "m Your spu' !gnat1 Det. 4 'ls "",;------Pld repa.'s te Dt r'G he mb Piaes FEIN S orPl[ heck nd compee be ow to alow anohe peon o dicus thi retu wh the inois Dpament of Revenue.

:' tJ MICHAEL S SOLHEIMDsiPh mb-

e no onger atomaicaly ma099G form ntead we ak that you gt thi nation from ou wtehec the box you stll wan us to ma you a pape orm 9G x year"Jif n py ecsed

_ IliN ERTMENT F REVENUE'--- P BX If yt encsed mail t:

= IlINI EPARTMENT F REVENUERNGEL 7

40

2BX

L0 pe (/)

GERG

DR_ AP_ RR DC


29/38

Illnos Depament o Revenue

2012SchdulM- OhrAddiins and Subcis f IndividuasAach o your Fo rm IL1040 Atachmen N 5

ead hi informatn rstComp ete tis scedule if you are required to add ceain income on Fo 100, Une 3, or if you are entitled t o take subtractions onFom -1040 ne 7.I Note f you are reuired to complete Scedule 1299C Scedule F, or Fom -562, you must do so before you compee tis sceduleStep 1: Poe te lowng normaton

H & MHELE L OYour name as sown on orm I100.

Step 2: Fgure you aons or Fom IL-1040, ne 3Wrte te amoun of

1 Your cid's federaly taxexemp nterest nd dividend income as repoed on S Fon 81

2 Distbutive sare of additions you received from a patnersip, S corporation tst or etateAach llinois Scedule K-P or Scedule K1T

3 loyds plan of operations loss, f repoed on your bealf on Fo 1023-C and incuded inyour adjusted gros ncome

Eaings distibuted rom IRC Secion 29 colege savings and ttion programs if ot incuded in youradused gross Income (o not include distributions fro Bt Sta, Brigt irections," or Colege

linois programs or programs tat meet cetain dsclosure requirements see instctions5 llinois specia depreciation addition mount from Form 62, Sep 2, ine AachForm -562

6 Business expense recapture (nonresidents only7 Recapture of deductions for contribtions to linois coege savings plans ransfeed o an outofsate plan8 Credit taen on Scedule 1299C for studenass istance contbutions you made as an employer9 Recapre of deducions for contribions to college savings pans witdrawn for nonquaifed epenses

or refunded10 Oter income dentiy eac item11 otal Addiions dd nes 1 troug 10 Write e amount here and on Form 100 ine 3

Step 3 gue your subractons or Form I-100 ne 7Write te amount of12 Contribution s made to te folowing college savings plans:

a Brigt Sta College Savings Poob College inois Prepaid uition PogramC Bgt irections College Savings Poo

13 istibuive sare of subtracions from a patneip S coporation tst or estate o notincude any amounts contained in nes 20 or 22 of tis scedule Aach llinois SceduleKP orKT identifying you as te patner sareolder or benefcay and lising yorSocial Secuity number

1 Restoration of amounts eld under caim of rgt under nteal Revenue Code, Section 13115 Conribuio ns t o a ob training proec16 xpenses elated o federl credits or federally tax-eempt income7 Interest eaed on investmens troug te Home wnersip Made asy Program18 Illin ois special depreciation subtraction amount from For 6 2, Step 3 ine 10

Aach Form -562

Wte e folowing ony I inci;ded in Form -100, ines 1, 2 or 3

19 Mili pay eaed Atach miliay W220 S reasuy bond s, bils, noes savi ngs bonds and S agency nerest from S 100 o r 100

Aach a copy of S 100 or 100 Scedule B, if reuired federaly SEE AEME21 ugst 1, 1969 valuation limation amount from your Scedule F, ine 17 Aach Scedule F and

reuired federal fos22 Enterprise or rver edge redeelopment zone and !g mpact business dividend subtraction amount

from your Scedule 1299C, Step 2 ine 10 Atach Scedule 129923 dd ines 12a toug 22 and write e amount ere and on Page 2 ine 2

IL-04 Schedule M pag 1 (R)

496 s3 ID: 2BX

3

our Soci Secuty numbe

Woe doas only)1.002.003

4.DO

5 006 _oo7 .8

9 0010 0011 00

12aD12b_oo12cDO

13 .DO14 0015 16 0017 00

18 00

19 DO

20 11,418 DO

21 00

22 0023 11418 00


30/38

Step 3: Coniued

24 We the amount from Page 1, ine 23.25 Recove of items previously deducted on US 040 Schedue A (including refunds of any state ad

oca income tes other tha Iinois) Aach a copy of U.S 100 Page 1, and required federa forms

26 Rdesharing money and other benefits27 Payment of life insuance endowmet, or anuiy benefs eceived

28 loyds pla o operations Income f repoed o your behalf on Fo L1 023C29 ncome earned by ceai trst accounts estabshed uder the ios Pre-Need Cemetey Sales Act30 Educatio oa repaymets made for pimay care physicians who agree to

practice In designated shoage areas under the Famiy Practice Residency Act

31 Reparations or oer amounts received as a victim of persecution by Nazi Genany32 terest o the foowig taxexempt obligations of Iinois sate and oca govement Do ot

icude nterest you received indirectly through ownig shares in a mutua fund

a inois Housing Deveopmet Authoity bonds ad notes {except housingeated commecia

facities bonds ad notes

b Expo Deveopmet Act of 18 bonds

c Iinois Deveopment inance Auhoity onds notes and other ob!gatons vere fud nd

infrstctue onds only

d Quad Ciies Regional Economic Deveopment Authoriy bonds ad otes if decared to be

exempt from tation by the Authoty)

e Coege Savigs bods

linois Spos Facilities Authoty bonds

g Higher Education Student Assistance Act bods

iois Deveopment inance Authority onds issued under the linois eveopmet inance

Authory Act Sections 780 through 787

Rura Bond Bank Act bods and notes

Iinois Deve opmet inace Authoity bods issued uder the Asbestos Abatemet inance Act

k Quad Cities nterstate Metropolitan Ahory bonds

I Southweste Iiois Deveopment Athoriy bods

m liois iace Authority bonds Issued ud e the inois inance Authoiy Act Secions 820.60 and

8555 or the Asbestos Abatemet inace Act

n iois Power Agecy bonds Issued by the Ilinois iace Authoi

o etra Ilinois Economic Deveopment Authoity bods

p Easte Ilinois Ecoomic Deveopment Authory bonds Southeaste iois Economic Deveopment Authoity bods

r Southe inois Economic Deveopment Authority bonds

s liois ban Deveopmet Authoity bonds

Downstate Iiois Spos acilities Authot onds

u Weste lnos coomic Deveopment Ahoty bonds

v pper inos River Vaey Deveopment Athority Ac bonds

WiKanakee Regioal Deveopment Author bonds

33 Interest on the foowig nonS govemet bondsa Bods Issued by the govement of Guam

b Bods issued by the gove_mment of Pueo Rico

c Bonds issued by the govemet of the igin Islands

d Bonds issued by the govemet of American Samoa

e Bonds issued by the govemet of the ohern Mariana sads

f Mutua mogage Insurace fund bonds34 Amout of your hid's interest fom S Treasu and U.S agency obigations or

rom sources in ine 0 32 or 33 as repored o US orm 881

35 Rairoad sic pay and uempoyment icome Aach om 109G ad a copy of your federa retur36 just impisonmet copensatio warded by Iinois Cout of Caims37 Dstbutos from "Brght Sta Coege Ilinois, ad Bright Directions colege savings pans if icuded

in ie because you caimed a ederal American Opporuny or ifetime eaing Cred38 ota Subractions. Addines through 37 Write the amount here and on om I100, ine 7

!L-1040 SchadUI6 M pg 2 (R12)

IS om u e s o me n e 1o!s co c . 1c o e ohi fmati I rqir. Filre t pvie Ifri r I pey

24 ' 00

25. 00

26 0027 00

28 0029 00

30 003 00

32a 0032b 00

32c 00

32 0032 0032 032g ,

32h 0032 0032j 32k 32

32m 32 .0032 00

32p 0032q 32r 32s 32t 0032 32v .032w 00

33a 00

33b 0033c 0033 33e 00

331 00

34 0035 36

37 0038


31/38

Illinos Depamet of Reveue

201L- Computation of Penalties for IndividualsAah o you Fom JL104 Aachen No 19

Readthis information first We ecouge you o le us ie or pe aie nd ed you bi ited of comeig hi fom youeWe wil ive he e ymet et fo udeymen of eimed x 1 you mey d he Jee of 10 ee of he io ye' ta iii o 90 een of heue ye ibiy If you ee o comee Fom J-2210 h fom eflec h ie

o ol eurs o. Do no ue hi fom If you e fii om JL1040X Amended Idiidu Inome T Reu, e he eended due de f he eun.Step 1: roide tefolowinQ informationBCK H & MICHELLE L OBAYor ae as sow o Fo 14 Yo Soal Se b

oe: f yo po ya x e was fed sg a dff Soa Seiy a e aov we a e

Step Figure you required instaments

1 W ao of yo oa Io ax fo a ax . See sos2 W ao of ds fo a x e Se isos3 Sa e 2 fo L 1

4a We oa ao of s yea's Iois wod fo yo W-2 fos4b We e oa ao of ay passog ey pays ade o yo af4c dd s 4a ad ad wi s e.

5 Sa e fo in .

6 Mpy Co L 3, y % ()

f n 5 $5 o ess o iyo ae o qid o ak saed ax pays

w "0" ad go o Sp 3. ews, we e ss of Co e 6,

o Co , e 8 Dvide ao wte o e 7 y fo Tis s ao ea eqied

sa I f yo se e aazed o sa o see sos

Qaer115h da of h

oh of ax yea

Qae 215h a of

monh of ax a

123

4a

4b4c

5

6

8

9a Wi e isae d da fo aa S sos 06/15/12

9b We e eed saeSe sos1 Oa W ay ed aed fowad fo

e po ya

Ob We e ao of ax whed1 Oc ie he mou of hough yment1 Od Add Ln 10 houh 1 n ech oumn.

11 Sa Lie 1Od fo feao egave s aes

12 f e ao o e 3 of pevios a s egave we

a ao as a posiiv e

ws, we "

13 Sa Le 2 fo e 11 f e

ao Is gave, se

4,584 7,436.

p this in f Qa 24,736. 4,7364,736. 4,736

2,700.

Skp J f Qa 1. 152

2,548.

AThs yea

29450

29,45018,942

18,94210,508.26,505

26505.

6,626.

Qater31 ay o h

moh of ax ya

09/1712

6,484.

S!p i in f Qa 3

4,736

4,736.

1,748

0.

1,748

BLat yea

38,553

38,553.

Qae 45h a of 1s o

ae e of a yea

0115/13

8001

ip n f Qr 4.

4,734.

4734.

3,267.

0.

3267.

oni wh 3 on Pa 2

490 0- IL(R) ID: 2BXThi f J a lind nr i n x At. Dicoure i nman I qd. Faie pvid Inan n a pny

Pag o 4


32/38

. -!ep 3: fiue Y(r unctax

Wrt th amout from Colum A, Ue 35 Wrte the amot of houshod mploymt ta rom n 22. Wrie th amot of use tax fom l- i 237 Add ines through i 6Wt th tota amout hr

8 Wrie th tota amout of all paymets mad o or bfore the oga due date of your tax t Iclud ay crdtcarred foard from the pior yar yor total stimatd paymts made this year Fom paymets thepass-throh tty payments mad o your bhalf ad your wiholdig as show o yourW-2 fos Comparthat total t o th total of 9b Quars throgh ad wrte the grat amout hre

Sbtract e fm i f th amot s positv1 wrt that amount Wite Wok Ln 23, Column C and contnu t Step . zero or atie wrte that amot her ad if egat, s brackts

Ste 4 Figue you lateayment enalts PaltyWorsheet to figur you latpaymt pealty for udeaymet o estmatd taxse PaltyWorkst 2 to igr yo latpaymt paty for upaid ta!Note Yo mst folow the stctos ordr to proprly compet th pal wokshts20 Wrt th amout ad th date of eac paymet yo mad istructios

57

8

Amount ate paid Amount ate paid Amoua 000. 06/5/2 eb 000. 097/12 f- - j

29,50.

2950.

2992.

ate pad

c 5000. 8/12 9_- k__ __d h Penaty ratesI Numr of days a Paty ra- ... . 031 ormore .......0 IPenalty Worksheet 1 Latepayment pealty for undepayment o estmated tax

I Note f yo paid th reqred amout from U 3 by the paymet du dat for each uaer; o ot' compete his worksheet Wrt th paid amouts fom 3 Qars throh o the rst le o th appropriate aes Coum C eow

A B C F G HD Una Paymnt Balan du Paymt Nmbr Pnal at

o at amont appl (CL l D) at of das lat ( abov)Otr 1

Ot 06/5/2 2' 58. 258. 06/5/2258. 000. 52. 0615/12

O 3 09/7/2 78. 78. 09/7/278. 52. 296. 0917/121,296. 000. -70. 0917/12

4 0/5/ ' 26. 267. 0/5/267. 70. 56. Oi15/131'56. 5000. . 115/13

22 Add Colm !, Qars through This is you atpaym ay f drpym of smat ax

Pnat

Wt th total amot here ad o your orm ne32 (rod to who dollars 22__0I Not Yo may apply ay remag orpaymet rom Quar Colum E aboto ay udrpaymt wh gigealtyWorkshet 2, oy f te paymt dat i Colum s ar the ogia d dat o

f the rt.

J? Pag 2 D: X L R)


33/38

Penalty Worksheet 2 -Latepayme penaly for paid ax

23 Wre any positve amount rom ne 19 on the frst lne o Column C below.

A

Rn

8Duedate

cUnpaidamon

DPaymeappld

4 Add Column 1. Ths s your fae-payment enal or unpaid tax.Wte the tota amount here and on Lne 33

EBalanc d

(Col. C Col. D)

FPamen

dae

GNumber ofdas ae

Step 5: Figue your late-flng penalty and the amount you owe

INote j Fgre yo laeling peal ol i you ae flng your tax return after your exteded due date, and your ta was not pad on or beore your oignal due date

igue yo lailg pealy.

HPeal a(S aove)

4

eal

5 Wre the amount rom Form IL040 Lne 5 5-6 Wre the amount o househod empoyment tax rom Form -040, ne 22 67 Wre the amount o use tax rom orm 040 ne23 2 Add ines 25 throuh 27 Wre the tota amount here 29 Wrte the tota amount o credts nd payments made on or beoe your ogna due date 930 Subtact ine 2 rom Un 28 30-31 Multpy the amount on ne 30 by 2% (02 3-3 Wte the esse o ne 3 or $250 hs is your laelng penalt 3Fgue he amou yo owe.33 Wrte any laepamen pena o upai tax rom Ue 24 3334 Wrte any laeiig eay om ne 32 335 Jyou have an overpayment on Form I040 Lne 35, wte that amount as a

f you hae an amount due on Form L040 ne 39, write tha amount as a posve number 35-36 Add nes 33 trouh 3

Ifthe esut ls a neatve nmbe ths s the amout you are oepaid (beoe any amountapped o next year's estmated ta) the result Is a posve number thls s the amount you owe See Fon I040,

n 39, nstuctons or your payment optons

0: BX 4S --3

36

Coie o Sep 6 o Page 4, f analzig you icome.

{R) Pageof4


34/38

Step 6: Complete the annuaization worksheet for Step 2 Line 9b . - ' . . . . . . - 1

Coplete ths woksheet oly f your Incoe as ot eceved eely thouhout the yea ad yo choose to aualzeyou co_e. opet Ls 37 thogh 5 of oe colum bfor gog to the ext, begg wth Col A

3 We you lllo !s ase coeo each pe od See stctos

38 uallzato factos39 Mltply e y U 38 s s

yoauazed coe40 Eeptos See stctos4 Sutact e 4-o Le is

s you os et coe4 Muply e y 5% (5) o each peod e the

aot you ote oSep 2 e 2 o .

Sutat e o e 245 pplcale pecetae

4 Mutpy e 4 y e 45Ts s yo aualzednstaet

4 dd the aots o Le 53 o eachothe pe ced cols ad rethe total h ee

48 Sutact e 4 o e 46. lesstha zeo wte "'

49 We the aount you would haeeteed Step 2 e 9 you weeo aualg

0 We e aou o Le 52 o thepeced colu

dd es ad 5

5 s eate tha e 8sutact e 48 fo e 5

Ohese wte Wte the lesse o e 48 o ie 5

hee ad o Step 2 ne s Isyou eqe stalet

:BX2490 0B3Pag

37

38

340

44

45

4

47

49

0

B Fst 3 oths Fst oths Fst 8 oths

103,927. 226,008. 370,990.

4 24 5

45,708. 542,419. 556,485.8,200. 8,200. 8,200.

407,508. 534,29. 548,28520,375. 26, 711. 27,414.

20,375. 26' 711 27,414

225% {225 45% !.45 65% (67)

4,584. 12,020. 18,504

SKip this i!B for Cumn . 4,584. 2,020.

4,584 7,436. 6,484.

6,626 6' 626. 6,626.

Skip ts ine l Cun A 2' 042. 1,232.

6,626. 8,668. 7,858.

2,042 1,232. 1,374.

4,584. 7,436. 6,484

D12 moths

597,193.

597,193.

8,200.

588,993.29,450.

29,450.

% 1,900

26,505.

18,504.

8 001.

6,627.

,374.

8 001.

Si ts ne O n D.

8001

IL-22 {R-)


35/38

BARACK H. & MICHELLE L OBMA

IL-SCHEDULE M US GOVERNMENT OBLIGATIONS

DESRIPTION

BOND PREMIUM MORTIZATIONNORTHEN TRUST SECURITIES US GOVT INTERESTNORTHERN TRUST SECRITIES US GOVT INTEREST AID

TOT AL TO FORM IL-SHEDULE M INE 20

STTEMENT 3

MONT

-3,5080164804220

,480

STATENT(S) 3


36/38

SCHEDUL B

Form.1040A o_10)Interest and Odinary Dividends

OMS N. 1545-07

Oepamnt of h TrsuInl Av


37/38

8949_Sales and Other Dispositions of Capita Assets

om

OMB No 57

Depent of he TreasuryInernal Revenue Sevice (9)

Inoato abo Fo 8949 and ts sepa ate sctios i s at wwwirgov/fo894.F e wt yor SchedueD st yo tanatio o ine 1 2 3 8 9, n 10 Scele D.

201

aes) sho o et

BK H & ICHELLE L A

Soial serity nbe taxpaye tato no

Mos bokes Isse hei o wn susue semen Insd of sn g F 1098 ey ao ay roe bss omon us y os o you on he seen een Hi Is no ep ed o he IBefor you hc ox A , oC eow ene heher yo reve ny saeans an t so e nsaons loh ass ws eoed o he I oers requ o repo bss o he o os so you bouh In 2011 o .

You mst hk Bo A, B, o belo Chek ony one box oe tha oe o apples o yo sho-e tasactos, oplee a sepaae 99, pae 1 o eah apJcae o yo ha e oe shote tasacos tha ll t o hs ae o oe o oe o the oes, olete as

fos th th sae o cheked as yo eedU (A) Shotte tasatos eoted on os} 199 sho ass a s epoed to he RS0 (B) Sho-te tasactos epoed o os) 99- sho ass as ot epoed o he RSD fC} Shote ansatos ot reoredto vou o o 99

1 {a {b {c {d {e Ajtment if ny to gin o hDesciptio of popey Date aqed ae sold o Poceeds os o ohe o. you enter an mun Gai or (oss.in clumn (, ener de in

Eaple: 1 sh XZ o) M day y dsposed (sales pce ass See the um ee isi. Subtc umn e)

(Mo day, y) oe elo ad (f) (g) rm cumn d) ndsee ol (e) cobine he euhe stucos ode(s Ao o wih cumn (g)adjste

us TREASURY E 04/07/04/02/2 992000 99200 0

2 Toas Add the aots cos d e) ) ad h) saeate aots) Ee eah oal hee ad lde o yoShedle ln 1 Box Aaoe s cheked, l ne 2 Bo Baoe s heked. o lne 3 (i Bo aoe s checked) 992000 992000 o.

oe If yo ?hecked o A aoe t he ass eoted to the RS as noet, ee o e) e ass as epoed to the RS ad ete anadjustmet co (to oet the ass See Column (g inthe separae scos o ho o igurethe aot o he adusment301 OH2-13 LHA Fo Paewok Redtio Act Ntic, see sepaate sutos. o 4 (1)


38/38

Fom_B949 212 A tachmet Se uenceo.12 _ Pa eName{s) shown on rer Name ad SN or tapayer idetfcatO no ot eqred f shon o other se) ocial eci ber or

taxpaer detiicatio oRK H. & MIHELLE . OMos brokes issue ei own sbstie staeent Inedusig Fm 1099-B. T also y povie bis nfo!o {saly yo cost) o you o e teent eHi I no e o he RSoe yo ek Box A, B o C beo eemne hehe yo eee y steens n s he nsons o wh bss s eoe o he I Boes e eqe t o ep bsis o the o os soc yo but in 201 o le

Pa II Long-Term. Trsacons ivo!vn ca t assets ou held more than oe ea ae o tem. For shot-te tnsactons, see a e 1Yo mus ceck Bx A, , orC eow Cec oly oe o If more tha one o apples fo you ong-tem trasactos compete a searate om899 page 2 fo each applcae o f yo have moe lontm transactons than H fr on ths page for one or more of the oes compete asmany forms wth the same o checed as yo eedD {A) Loge trasactos repoted on Form(s) 099 shong asis was reported to the R0 {B) Logtem transactos repoted on o(s) 099 shon ass as ot repoted to the IRSD C) Lo-te trasactons not reoed to vo o Fo 99-

3 a b c d (e)Descpto of poperty ate acred ate sod o Proceeds ost or other

Eample: 0 sh 'Z o) Mo day yr) dsposed saes pce) ass See theote elow ado day y) see Column e nthe instuctons

us TRESURY NOTE 09/02/1008/3/2 ,06,000 ,05,6

4 Tol A dd the amouts n coumns (d e) ) ad (h) (sutctneatve amouts) Enter each tota here and ncude o yoSchede lie 8 (f oA aove s checed) e Box aove is checked\, or ie if o C aove s checked) . 06000. 0,6

Adjusment, If ay to i f y tr c g r d Ic (f. See ss

( (g)Code(s) Ad

ountofad stment)

Gai or loss)btct cl {)rm cmi th t

with cm g

635

63

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