Customer(s) Name: Chandler Mexican Restaurant Date: 10/06/2020 LOAN EXTENSION AGREEMENT This Loan Extension Agreement applies to one loan granted by the bank, STATE BANK OF CHANDLER, 4" & Main, P.O. Box 128, Chandler, MN 56122 and should be attached to the back of the loan, The loan is further described as: Loan Number: 3620344 Loan Date: 04/22/2020 (00 Extend Loan Maturity New “EXTENDED” Maturity: 04/22/2025 (X) Extend Loan Payment New “EXTENDED” First Payment Date: 12/22/2021 The bank agrees to extend the Maturity and/or Payment Date described above to the new maturity and/or payment date. ‘The customer agrees to repay the Loan beginning on the New First Payment Date and/or Payment in full on the New Maturity and together with any additional interest accrued because of this extension. No other terms of the loan or security are changed by this agreement except that the above noted payments are extended to the Maturity or Payment Date described above. The bank does not agree to make any additional extensions on this or any other loan. RepresentativePaycheck Protection Program Loan Recipients You will now have a longer time until the first payment is due on your PPP loan, This will give us more time to help you file vour Application for Forgiveness with the SBA. The State Bank of Chandler has elected to extend the deferral period for all Paycheck Protection Program loans by an additional 10 months, At loan origination, payments for these loans were deferred for a 6 month period. In an updated release to the interim final rule by the SBA, changes were made that would allow for an extension to first payment deferrals from a 6 month period to 2.10 month period after the end of the 24 week (6 month} “Covered Period”. This essentially adds another 6 months on top of the extra 4 months on top of the original 6 months. This adds up to a.16 month deferral. As noted above we have elected to extend the payment deferrals on all PPP loans. How will this affect me as a Paycheck Protection Program loan recipient? As mentioned, your first payment date has been extended and will not be due until 16 months after the date of your loan. For example, if your first payment date was October 15, 2020, your first payment date will now be August 15, 2021 instead. Also, if your original maturity was 2 years, the loan is now 5 ‘years to maturity based on changes made by the SBA. Aside from the changes to your first payment date and maturity, all other terms of the Paycheck Protection Program loan remain unchanged, ‘The SBA has released forgiveness forms but legislation has been introduced to simplify them. We have yet to receive guidance from the U.S, Small Business Administration regarding a simplification to the forgiveness process. We hope that congress will pass a resolution soon What do | do now? Please sign and return a copy of the enclosed Allonge. Also, at this time we ask that you begin to gather information necessary to apply for forgiveness of your loan. How did you spend the money? Did at least 60% go to payroll? Did you get it all spent within the 24 week "Covered Period” as required? if not, you probably still have time to get that done. In the coming weeks we will be contacting each of you for a follow up to discuss details of the program and to schedule a review period for your forgiveness application prior to our submission of your application into the forgiveness portal. ‘As always, please contact the State Bank of Chandler at 507-677-2201 for any questions you may have regarding this program. We wish you the best as we all continue to work through the struggles of the COVID-19 pandemic. Thanks, State Bank of ChandlerELIZABETH M HERNANDEZ Soc SEC GROSS INCOME PENSION EXCL CAPITAL GAINS DED TOTAL ADJUSTMENTS NET INCOME FEDERAL REFUND SELF EMPL TAX TOTAL FEDERAL TAX DEDUCTION QUAL BUS INC DED (QBI) DPAD 199A(G) DEDUCTION BALANCE ‘TOTAL DEDUCTIONS TAXABLE INCOME COMPUTED TAX LUMP SUM TAX MINIMUM TAX TOTAL TAX ‘TOT EXEMPT CREDIT NON REFUND EIC ‘TUIT/TEXT CREDIT FE/ENS/RPO CR BALANCE NON/PART RESIDENT OUT/STATE CREDIT OTHER CREDITS BALANCE SURTAXCES) TOTAL TAX FISH/ WILDLIFE FAIRGROUNDS FIREFIGHTERS/ VETERANS CHILD ABUSE FUEL TAX CREDIT CHILD CARE CREDIT REFUNDABLE EITC REFUNDABLE CREDITS TRUST FUND CREDITS JA TAX WITHHELD PAYMENTS ‘TOT CREDITS CREDITS COMBINED OFFICE ADJUSTMENT OVERPAYMENT NET AMOUNT 2210 PENALTY PENALTY INTEREST LATE ACTIVITY REMITTED REFUND CREDIT FORWARD AMOUNT DUE 12/31/2019 2020055503157 TAXPAYER CALCULATION COLUMN B. COLUMN A, 20,118 20,118 2,292 17,826 346 2u0 106 110 ou 1,596 2,435.00 2,435.00 96054 REVENUE CALCULATION COLUMN B. COLUMN A 53,464 53,464 4,090 87,554 2,292 55,262 5,120 50,142, 2,568 2,568 240 2,328 2,328 93 2,421 1,596 1,596.00 1,596.00 825.00 825.00£1040 Srincividuai income'fax rotut [2019 Fling Status] siie [] Marie ingly] Marie ing separately WS) Head ormousstons (Hor) ] Quattyng wiser OM) ‘OMB No, 1546-0578 | 5 Ue On) nat ro estate ms soca. Gheckony, ——ycu achat the MES bx, rae he name of pouHe you checked the HOH or box, onl he cis ramet ho uaiyng parson a Acid but ot your depen. ‘our ft ar are mi i aaron ] Your soca scary wamber ELIZABETH M HERNANDEZ 73317512916 _ "it et, spss Ware nd sal “asa Spout sos ccurty number a) Home acrss faba ard avel Fyoufave a 20, box, soe ins ‘Aono | Presidential Beton Camoaion 503 W 8TH ST TRLR D Lena eek air yer eo hyn pow tb a en 2 con Fane Gp SSS Sas SO Bs pence STORM LAKE, TA 50588 fecranz”[-] You [] Spore ere county name Fes rovhs/atfcouny Foren pei code | more than fw dependants sevineructone rd? a > Standard Someone can claim: [-] Youssa dpandent 1] Your speuse apa depondon Deduction [7] spouse tame ona separate ret or you wie a dua tate aon Aoeiindness You:_[] Werebom before Januay2, 1955 _[] Aretind Spouse: C] was bom betoresruary2, 1905 CT eine Dependents (Se instuctonsy @ Socosiynonbr |G) Rabep was (6 7 tlie erat (rane astra Cotetcoust Oud ae spent ‘ALAN _TALAMNTES — a7a]a3 [0420 [son a oO ETHAN TALAMANTES: 47515119337 [sow a Oo ANDREA 4 SALAZAR 474)35/3185 [pAUGaTER a bs WILLTAN J_TALAMANTES 473)3912714 Isox a bd 1 Wages, sla ip, Atach Fors W2 153,464, 20 Tac exept nteest 2 b Table test ach Sch Bineged | 2b uated cides eS © ordnayavcinds. Araen seh Btrequres | a RA etiasione a |b Text aeuns rs Penson orc ares “ Text arcunt aa Soca secu bent a Texte scant Es canal gan or Qos. tan Sonos Droge, re qed check ere »ofe o: Other income from Schedule 1, fine 9 Ta 39,948. Aktne 1, 2595, barca, Tse your ttl nome > [wt 207118- Aauetessoincoe tm Sete, 22 a Oo ‘Suc nea on no 70 Ths jours gross income > [eof 20,118. ‘Standard deduction or itemized deductions (from Schedule A) 2 18,350, Cana ss come decir tach For 895 or Ferm 8005-4 10 ac toes and 10 sw| 18,350. Taxable income, Sit ra 1 om zr ota ee 9. 1 1168: For Disclosure, Privacy Act, and Paperwork Reduction Act Nollee, see separate Instructions at no 08 Fam 1040 cor0)Fom 7040 2019 ELIZABETH M HERNANDEZ 733-75-2916 Page? ‘2a Tax oooinct) Cuckfaytomfom(: + L] eae 2] 8 L] a 176] 1b Ad Schedule 2, ne. ar ne 12 aera hot > | 10 176. 130 Chie ne erect or crac to othr dependants $98 176, 1b Ae Schedule 3, ine 7, sn ine 1a ad ete he tal > | sap 176. 14 Subtoct Ine 18 tom Ine 12b, Hero ores, erro “ Oo. 15 Othortoxs, nausing cl employmont tax, fem Soha 2, le 10 15 $8 Acne 1 an 15. Thi your total tax > [re 17 Feceral income ex witha rom Forms W-2 ard 1099 7 2,292. LN. erm en ce Ge Ne cctrore ena =| 6,326, aia 1b Aton! ed tx ered. Atach Schedule 8812 ‘tb 2, 643, rama. |_| © Arecanopporuaty ced ren Form 8863, re 8 ‘te Sexe) ¢ omnin ‘se ne =m | 2,969. 49 Add lines 17 are 18s. These are your total payments, > | 19 11,261. Refund 2 tine 19: mocethan no 16, subtract ne 1 om ine 18. This tho aroun you overpald | 11,261. ‘21a Arnount of ne 20 you want etunded to you. Form 8508 attached check ere »O [ew] 11,261. Bena by Aetarember [0[7/ 3/9/2111 41 3/3 Porm Blcnecting C1 Sevngs a Accomtnunber {1/91 0) 0) Bi 615i 7, 8] 5} i iij 22) hematin oa sn 22 ter : imoyt 2 taney we Sir amo Fea on po bane ra Yous Owe) ss coun etpeatesn ieianaas + lel Third Party svete ctr nr oer jr Sa aw th ein] Yu Con Designee no ee, nee rime more See Sore = tess Sign ena utara Sasa ae eases ata ae He an Leeda! signature Date “Your occupation Ifthe IRS sent you an identity secretion went, Pode algal rn (| Sire. Piel enim aa fhe 7 en ae ianianargoam ouge Expo acne cd se hana TID 295-25 79 frais — - Tress Bae AW axe Bae LIAR Taomdes (i sng — 2h 20 oan Preparer" Tmshal F renee Cisatonsond Use Only | ~ nesses © [eens ein (Go wwacre gonFonnT 040 fo ineratons and the tat fara, For 1040 e215) copa2019 1A 1040 lowa Individual Income Tax Return For cal year ogining and ending ey HERNANDEZ ELIZABETH M syste Spa et rane i “or aig sss ant a vo apne wrace ambe FOBDE 503 W 8TH ST TREAD STORM LAKE, IA 50588 Spouee SSW Yours 53-75-2916 ‘ap 2 Filing Status Ma one Do eny ede Wena eae ota preston? ve LT DT ars igs, Tehama ies ay one ng sats 94) foes roerasar rms ow a a ares ig acpi os cored, Spano we urn Fesirceen 20070-Caryho 11 Scheu Oetcno. 6219 Wares fing scurte rene Seo rare ro Tecoma: § [sting owe pede ie Noe 5 strona wi ean pean aang pian rc dada Upscale Ba posovanare rd SEN lw ‘ee aren Inger vea 5 0 ae ano reach me te sn. so pec: Exar fre depen, a Ent novel opondetere SER STATEMENT ‘sop + Repro Scy Soft clea on oe 1 ova ci onary mera ‘wages, sslotes, ps, . “Teale tre income. Kno han $1,500. cme Sch. 8 ‘Ouinary dviend income. mere than $1600, ompato Sh. B. ‘Any sive, ‘Sep Breton 1 Spam Ping Seam 3H Kew 8 xem. 5 xswo= 5 eran § Semmens] cao You ora 53,4640 g 3160, etou $240 [avec | ] B Spacious FYoneron ‘Busine oomalioes). Se nerctons (me gainatosses). See instars, | | 33, 34600 NOTE Use only uso bck inkere penal ‘cred ik “avabie RA deibutons “Tenable pansins and ana zs 5 Capt gsin(oee)- See ineetore = Fam incomalfoss). See sincions " is “2 Unomployrnancopensatlon. S68 nso. 2 +2. Gambling winnings a 8 84 Othrincrne, bonus preitn, ad secon 179 aurtent gg 18 Gress Incas Ad ns 1-14 Bese Payments toan A, Koosh or SEF 6 aymonts to an IA, Koogh or SEP. Petbie 17 Oebetbe par of sateloyment x z wn 1a Heat nsurance peru... 7 + 18 Panay on erty winds of ange ‘8 ee ». 2%. Pensionoementineame excuson 2 22 Ming expense doctor rm odaral frm 380. a a capil in deduct: Iludecoresponding A 100 these. nnn 24 ote agusments 7 cnn 25. Tolalaghsimerts asines 16-25 oa 26 Net come, Subtract ne 25 rom he 15. EET, 2r- Federtrerve tax rundoveraymen coed 21D mnmnemmar, {nues" 23, Satersioyentnousenol enploymentoher federal 92.28 ‘Riinies 29. Adciton for federal taxes, Ade IM08 27 3M 2B enone a - tara on wel in 2°, ocoral otis ox payrente mesa 42019, ano Sader tases ped in 2040 fr 2018 and pir Yoare no 3 32, Ojatted business nar deducson. 250% (25) fdr ‘mou See nsucions . — £9, OPAD 19A%g) deduct. 25.0% (25) of feral amount nnn 38, 2. To fedora and ther usted cautions ines 31,92, and 33. 36 Balance, Subact ine 36 tom in 30, Enter hee and on ne 38, pape 2... Rents, yates, panne, ete, Soo rebUCEONE nn BReESReSeRER ER eee Be eeeeesese oo 4 20,118.00 co 4 20, 118.90 © __ 20,118 0 2,292.0 so 4 17, 626.0 MN 4.901 (110118)2019 IK 1040, page 2 1B. SpouserStaus 3A You or Joint 8. Spouse/Statue 3 A. You or Joint Spt 28 BALANCE Fom se ne 5. z % ‘e 1782600 Teint 2. Dodveion Check tor teze(uaniasohale®) |] samans [x e mt 4 51200 138_TAXABLE INCOME. SUBTRACT line 37 trom line 36. = oe 12,706 00 Be. Taxon bes orator ix. ry uh 346m 5, sa tona ump sum tax. See instruction. 1, ok 0 Bie 4. tow atematve mun ta. A 0251, “ mA 0 Seq, 2 Tekin. ADD inn 39,40, ant : ” 346.0 45. Toa eampten cee aru) rom tp 3, ot - oo 44. Tein ae ek el epee 12 4 owe 0 <2. Voumeer Wenger MSesene peace ta 0 nnn oe © Wh racic. adios 4,44 a. ci — * » 240.0 17. BALANCE SUBTRACT kn 46 for ne 4, tes ha oer 28 ——— ma 106.@ 44. Crestor norrsent or part year resent. I 125 ad fea es. « wa © 49, BALANCE SUBTRACT ine 48 fn 47 lesan 20, et 200 = me 106 5. Ovtofsnataccrac.eA10. cs a ma co 21. BALANCE. SUBTRACT ine 50 fo 49 Hess a 20 err 0 an wa 106.0 £2, Omer nrendbiowacrats nce 18 Tax Cre Sched. ieee oa © 3, BALANCE. SUBTRACT ine 52 ram ne St. ess than sera, ener zero. a m ook 106 00 ‘A. Sco cic stor ENS outa Tek percentage tm ae: dip yn “ nn ae 55, Tol a angle i ADD Ine 36nd en - = a 1i0.@ $8. TOTAL ste alec txt cantina. Contine cis and cn ne 8 an er hare. . 110% ‘57. Contributions wil reduce your refund or add to tha amount you owe. Amounts must be in whole dollars. as Fwnatesra'a Shes A Signo Ste k Chil tenner T@ A __ Enron 7 » 58. TOTAL STATE AND LOCAL TAX. AND GONTRIBLITONS. Adee 58 anna an entrar a8 Td Ee toe ox ce, cae a et a wy © ©. Check One: Oia dependent care cet Ce a 1 Ey chit deveopnent ea a a ©, ts comedic x ced 160% (18) dot eh. ok 2 Otero cts neue Ik 48 Tax rods Sch 2 m4 ©. tovalacone ax we a ok 4. Esimatd and vourer payments mace tax ya 2018.———-9¢ Se 65 TOTAL ADD nee 5 trough andere s ek TOTAL GREDIS, ADD cours Aan ine ar ei ae. = ©. 2,545.00 EEqd er tine nore mane 99 sac he 36 Fo ne 06, Ts the anc you ae 2,435 m0 Aron of ne 67128 REFUNDED. REFNO te a S Roinghimbor 0739-21 4 3 3 th Type Geng K Sams om pcomtnmeer 1 9 0 0 8 6 5 7 8 5 _Ancunl fn 67 be apple your 220 ete ook 2 TE Hine 6 sleet ne 8, sce 63 ne 6, Tis ktbe AUOUNT OF THX VOU OWE wy ~ 7, Penalty for underpayment of satimated tax from IA 2210, 1A 20408, or A 2210F. Check annualized income method isused. a [] 7, 0 72, Pony andieest rx Penaty ” sr. iret 90 AOD. Ener 7, TOTAL AMOUNT DUE. ADD ies 7,7, and 72. Ei eo Tian PAVTMISAMOUNT 7a Om {AA A te undersigned, deco under penales of ayo alse crate, Dot Fave varied Ws relma. he Boo of my krgwledpe ana ele Rie Tum COTES AS oo flee. 3 eS ° wh afeo our Sra ‘Crack Decasad Tale Danh — Preparers Sonate Date a Ld Spouses Sara Das Crack Dacaaned Dae DeaR — Preparers PT FSFE 712-299-2579 Dayle Teephone Nurcer Davie Talophans Naber “This roturn sue Apri oth, 2020 Sign enclose W.2s, and vary SSN MAILING ADDRESS" lows Income Tax Document Processing. PO BOK 187, Dos weinoe 1A 0308-0787 Make check payable fo Treasurer, State of ea HWWK 41-001 irra)WWD DEPARTMENT OF REVENUE 2019 Form M1, Individual Income Tax ca Leave unused boves bank. Oo net wee staples on anything you submit ‘oar Ft ens sa iniime ir SST TSS) Your Dae oT BAT ELIZABETH M HERNANDEZ 733752916 12021980 ian Rta, pes st aT Spouse as Name “Sxl Sc ery Naber Spoass Date oth Garent Home Ars hea ws Bre Felon Riess - 03 W 8TH ST TRLR D {1 ey fare 2iP Case STORM LAKE IA emt 50588 2019 Federal Filing Status (place an X in one box): [a singe eas warring jiney [—] ors tng seperately tai Heed othousshotd []ts} auativing widonter Spouse mame and SSH gee State Elections Campaign Fund you want $5 too top ands for st fens poy campaign expenses ene th ads namter forthe pty of your ch. Thiswillot eas our x ot educe your fund. Pallet Party Code Numbers: epblar—14 Independence—12 ceeen15 eps Dwecac/fameriabor—12_GrasresileizeCmmabs—14 Ubertran—16 General Campaign Fand—99 Yourcode Spouse's Code From Your Federal Return se insirctons) se eee acerca FE Wages, Sais py, ee IR, pense, ad aes © Unemaloyment Fade GBT TE 53464 - 1768 (Aiea Xin os epee 4 Federal adjusted gross income from line 8b of federal Farm 1040 ond 1040-5R) (ifo negative number, plce an Xin the box)... areata u 20118 2 Additions to Minnesota income from line 17 of Schedule MIM (see instructions: enclose Schedule MM). cry 3 Add lines 1 nd 2 (ifa negative number, place an Xin the box)... 3 20118 4 Itemized deductions (jrom Schedule MISA) or your standard deduction (see instructions) ................ 4™____18350 5 Exemptions (determine from instructions)... “ si 17000 {6 State income tax refund from line 1 of federal Schedule 1... eet 7. Other subtractions from Minnesota income from line 46 of Schedule MIM (see instructions; enclose Schedule M1M) a . uaa 27 & Total subtractions. Add lines 4 through 7... Piles pate 8 35350 9 Minnesota taxable income. Subtract line & from line 3. 1f2era or les, leave blank ° 10 Tax from the table in the M1 instructions case ie LL Alternative minimum tax (enclose Schedule MINT) TaGsaRiantoeLARRTEERE IN un 12 Add lines 10 and 11 ae 413. ul.year residents tor tho rmount rom line 12 on line 13, Skip nas 138 and 12, Par: year residents and nonresidents: From Schedule MINR, enter the amount fom line 26.09, line 13, from fine 2 on ie 13, a from ie 23 on ine 13 enclose Schedule MIN) ate oe a val 1.18 (piece an Xin boris negative number) 44 Other taxes such asthe tax on lump sum distributions and recapture amounts fram (check appropriate bos): Schedule iHome [__|schedulews2s [__|schedule mits : sal [es 2012 ala ON 15 Taxbefore credits, Add tines 13 and 14 eee 45 16 Marriage Credit for joint return when both spouses have taxable earned income ‘or taxable retirement Income (enclose Schedule MA1MA) 17 Credit for long-term care insurance premiums paid (enclose Schedule MILTI) 18 Credit for taxes paid to another state (enclose Schedules) MICR and MIRCR) «.....-.0ssescvesceeveeeee BOM 19 Other nonrefundable crests (enclose Schedule MIC) 20 Total nonrefundable credits. Add lines 16 through 19 .....cs.csessseeseeee ee tet ao 21 Subtract line 20 from ine 15 (if result is zero or less, leave blank) ‘i a 22 _Nongame Wildlife Fund contribution (se instructions) This will reduce your refund or increase the amount you owe 23. Add lines 21 and 22, 24 Minnesota income tax withheld. Complete and enclose Schedule MIW to report Minnesota withholding From Forms W-2, 1099, and W.2G (do not send) ......e..e0+e 20m 25. Minnesota estimated tax and extension payments made for 2019 26 Refundable credits from line 9 of Schedule MIREF (see Instructions; enclase Schedule MIREF). 27. ‘Total payments. Add ines 24 through 26 «+... aeagane BF 28 REFUND. I ine 27s more than line 23, subtract line 23 from line 27 (abe instructions). For direct deposit, complete fine 29 : 29. Direct deposit of your relund (you must use on account not essocated with a foreian bank) ant Type Routing Number ‘Account Number ti fara) ais cece verre see eee 20 AMOUNT YOU OWE. If line 23 is more than line 27, subtractine 27 from line 23 (se instructions) 31. Penalty amount from Schedule MIS (see instructions). Also subtract this amount from line 28 or addi to line 30 (enclose Schedule MS) IF YOU PAY ESTIMATED TAX and want part of your refund credited to estimated tax, complete lines 32 and 23, 32 Amount from line 28 you want sent to you EB i sanietnSiandsninhsaninssenio ofp ZO. = sear a Ser HLH ge gu eaneeLenEeeLaenEeELEE cn mn milicoquette@gmail.com i Z Include a copy of your 2019 federal return and schedules. [tata he Minnesota Department of Revenue to dc ths return with y ‘Mail to; Minnesota Individual income Tax ald propaer rhe th pry designe incest on my feral tu. St. Paul, MN 55145-0010 To check onthe status of your refund, vit wuwrevenuestate.mnass — [_] 1 donot wart mld preparer‘ ey tun electronical L 2012 !mm DEPARTMENT OF REVENUE 2019 Schedule M1NR, Nonresidents/Part-Year inianaihia Before you complete thi schedule, reed the instrvtions and complete ines 1 through 11 of Form M3, st Neme and nal test ame social Secu Nambar ELIZABETH M HERNANDEZ 733752916 Spouse's Fist Nome and I last Name ‘Spout Social Security Number “Minnezota Residency (Pace an Xa Ge Bx nd ener other ate of gen) our [E Tratyorsonescent L_Iraeter essen fom to ters of eden TA. i ‘our Spouse: |__Jrut-ear Norresent [paras Reient rom Other tte of Residency: 53464 ‘Wages, salaries tins, ete. from line 1 of federal Form 1040 or 1040-SR) a Terabe interest and ordinary dividend income lines 2b ond 3b of Frm 1040 or 1040-58). 2 Business income or loss from line 3 of federal Schedule 1) 3 Capital gain of loss (from line 6 of Form 1040 or 1040-SR) 4 IRA distributions, pensions, and annuities (from lines 4b and 4d of Form 1040 or 1040-SR). S et income from rents, royalties, partnerships, S corporations, estates, and trusts (fram line 5 of federal Schedule 1). pe eae Farm income or loss (from lin 6 of federal Schedule 1) 00.00.00. scsessvsevesieeees To 8 Other income (add ines 5b of Form 1040 or 1040-SR and Ines 1, 20, 4,7, ond 8 of federal Schedule 1) 9 Interest and dividends from non-Minnesota state or municipal bonds (add lines 1 and 2 of Schedule MIM) 10 Other required adeitions (odd lines 3,4, 6 7 §, 10, and 12 of Schedule 641M) 11 Addlines 1 through 10 for each column... um 20118 g__-33346 If your Minnesota eros income is below $12,200, se intructons. 12. Fducator expenses, certain business expenses, and Armed Forces moving expenses {odd lines 10,11, and 13 of federal Schedule 1). 2 13 Self-employed SEP, SIMPLE, and qualified plans and IRA deduction {add fines 15 and 19 of federol Schedule 1) 2 ee 4 Health savings account and Archer MSA deductions (add line 12 and Archer MSA amount included on line 22 of federal Schedule 1) u 15. One-half of sel employment tax and self-employed health insurance {add fines 14 and 16 of federal Schedule 1) . . 8 16. Deductions for alimony paid and student loan interest {see instructions for ine 25, calumn 8) : 7 asaassaaiaiataniann Sea 17 Penalty on early withdrawal of savings (rom line 27 of federal Schedule 1) .... val. 8 Other required subtractions fal ines 21, 35,35, 39, ond 41 of Schedule MIM) 1. . 19 Net US. bond interest and active military pay received while a nonresident (add nes 18 and 29 of Schedule MIM) 20. Subtraction fr federal section 173 expensing from line 2 of Schedule MIM 21 Addlines 12 through 20 for each column 22. Subiratline 2, column 8, rom ine 11 cclamnB. Enter here and online 13a of Form (Ma. If your Minnesota gross income is below $12,200 or the result is zero or less, enter O .-...2.sesse+s 2 23. Subtract line 24, column A, from line 11, column A Enter the result here and on line 13 of Form M1 23 20118 24 Divide ine 22 byline 23, and enter the resulta a decinal (arr to fue decimal places) Fine 22 ls more than ine 23, enter 1.0. Ifline 22 is zero, enter 0...» 2 0.00000 __ 25. Amount from line 12 of Form M1. 25 eeiea. 26 Multiply line 24 byline 25. Enter the esult here and on ne 13 of Form MIL... 2528 ‘You rust include this schedule with Form MI. Ente the amounts from ines 22 and 23 of ths schedule on Form Mt, lines 13a and 13b. L 2012