2017 Individual Income Tax Return

prepared by:
STRICKLAND & HENDERSON LLC
804 WASHINGTON ST NW
GAINESVILLE, GA 30501-3538

JOSEPH and SARAH KANCLERZ

5742 ALLEE WAY
BRASELTON, GA 30517
 L
AI
M
T
NO

I Detach Here and Mail With Your Payment I

DO

Calendar Year '

Department of the Treasury
Internal Revenue Service Due 04/17/2018 2018 Form 1040-ES Payment Voucher 1
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the 'United States Treasury.' Write
Amount of estimated tax
your social security number and ' 2018 Form 1040-ES' on your check or money order. Do not you are paying by check
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . G 5,222.
REV 11/13/17 PRO 1555
592-60-0414 259-57-5679
JOSEPH KANCLERZ INTERNAL REVENUE SERVICE
SARAH KANCLERZ PO BOX 931100
5742 ALLEE WAY LOUISVILLE KY 40293-1100
BRASELTON GA 30517

592600414 PN KANC 30 0 201812 430

 L
AI
M
T
NO

I Detach Here and Mail With Your Payment I

DO

Calendar Year'
Department of the Treasury
Internal Revenue Service Due 06/15/2018 2018 Form 1040-ES Payment Voucher 2
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the 'United States Treasury.' Write
Amount of estimated tax
your social security number and '2018 Form 1040-ES' on your check or money order. Do not you are paying by check
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . G 5,222.
REV 11/13/17 PRO 1555
592-60-0414 259-57-5679
JOSEPH KANCLERZ INTERNAL REVENUE SERVICE
SARAH KANCLERZ PO BOX 931100
5742 ALLEE WAY LOUISVILLE KY 40293-1100
BRASELTON GA 30517

592600414 PN KANC 30 0 201812 430

 L
AI
M
T
NO

I Detach Here and Mail With Your Payment I

DO

Calendar Year'
Department of the Treasury
Internal Revenue Service Due 09/17/2018 2018 Form 1040-ES Payment Voucher 3
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the 'United States Treasury.' Write
Amount of estimated tax
your social security number and ' 2018 Form 1040-ES' on your check or money order. Do not you are paying by check
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . G 5,222.
REV 11/13/17 PRO 1555
592-60-0414 259-57-5679
JOSEPH KANCLERZ INTERNAL REVENUE SERVICE
SARAH KANCLERZ PO BOX 931100
5742 ALLEE WAY LOUISVILLE KY 40293-1100
BRASELTON GA 30517

592600414 PN KANC 30 0 201812 430

 L
AI
M
T
NO

I Detach Here and Mail With Your Payment I

DO

Calendar Year'
Department of the Treasury
Internal Revenue Service Due 01/15/2019 2018 Form 1040-ES Payment Voucher 4
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the 'United States Treasury.' Write
Amount of estimated tax
your social security number and ' 2018 Form 1040-ES' on your check or money order. Do not you are paying by check
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order . . . . . . . . . G 5,222.
REV 11/13/17 PRO 1555
592-60-0414 259-57-5679
JOSEPH KANCLERZ INTERNAL REVENUE SERVICE
SARAH KANCLERZ PO BOX 931100
5742 ALLEE WAY LOUISVILLE KY 40293-1100
BRASELTON GA 30517

592600414 PN KANC 30 0 201812 430

Form 8879 IRS e-file Signature Authorization
OMB No. 1545-0074

Department of the Treasury

a Return completed Form 8879 to your ERO. (Do not send to IRS.)
2017
Internal Revenue Service a Go to www.irs.gov/Form8879 for the latest information.

F
Submission Identification Number (SID) 674354201809800prpmc
Taxpayer’s name Social security number

JOSEPH KANCLERZ 592-60-0414

Spouse’s name Spouse’s social security number

SARAH KANCLERZ 259-57-5679

L
Part I Tax Return Information — Tax Year Ending December 31, 2017 (Whole dollars only)
1 Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4; Form 1040NR,
line 37) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 184,614.
2 Total tax (Form 1040, line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) . . 2 18,986.

AI
3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040, line 64; Form 1040A, line 40;
Form 1040EZ, line 7; Form 1040NR, line 62a) . . . . . . . . . . . . . . . . . . . 3
4 Refund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 13a; Form 1040-SS, Part I, line 13a;
Form 1040NR, line 73a) . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1,522.
5 Amount you owe (Form 1040, line 78; Form 1040A, line 50; Form 1040EZ, line 14; Form 1040NR, line 75) 5
Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)

M
Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements
for the tax year ending December 31, 2017, and to the best of my knowledge and belief, it is true, correct, and accurately lists all amounts and sources of income
I received during the tax year. I further declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my
intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement
of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I
authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution
account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial
institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the
authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be
T
received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic
payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the
personal identification number (PIN) below is my signature for my electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent.

Taxpayer’s PIN: check one box only

NO
I authorize STRICKLAND & HENDERSON LLC to enter or generate my PIN 0 0 4 1 4
ERO firm name Enter five digits, but
as my signature on my tax year 2017 electronically filed income tax return. don’t enter all zeros

I will enter my PIN as my signature on my tax year 2017 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Your signature a Date a

Spouse’s PIN: check one box only

I authorize STRICKLAND & HENDERSON LLC to enter or generate my PIN 7 5 6 7 9
ERO firm name Enter five digits, but
as my signature on my tax year 2017 electronically filed income tax return. don’t enter all zeros
DO

I will enter my PIN as my signature on my tax year 2017 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.

Spouse’s signature a Date a

Practitioner PIN Method Returns Only—continue below

Part III Certification and Authentication — Practitioner PIN Method Only

ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. 6 7 4 3 5 4 4 2 0 6 0
Don’t enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the tax year 2017 electronically filed income tax return for
the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN
method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
ERO’s signature a Date a

ERO Must Retain This Form — See Instructions

Don’t Submit This Form to the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 11/27/17 PRO Form 8879 (2017)
 Department of the Treasury - Internal Revenue Service
Form 9325 Acknowledgement and General Information for
(January 2017)
Taxpayers Who File Returns Electronically
Thank you for participating in IRS e-file.
592-60-0414
Taxpayer name JOSEPH & SARAH KANCLERZ

Taxpayer address (optional)

L
5742 ALLEE WAY
BRASELTON GA 30517

1. Your federal income tax return for 2017 was filed electronically with the Philadelphia

AI
Submission Processing Center. The electronic filing services were provided by STRICKLAND & HENDERSON LLC .

2. Your return was accepted on 04/08/2018 using a Personal Identification Number (PIN) as your electronic
signature. You entered a PIN or authorized the Electronic Return Originator (ERO) to enter or generate a PIN
for you. The Submission ID assigned to your return is 674354201809800prpmc .

M
3. Your return was accepted on Allow 4 to 6 weeks for the processing of your return.
The Earned Income Credit or a dependent's exemption on your return may be reduced or disallowed due to a
child's name and social security number mismatch.

4. Your electronic funds withdrawal payment request was accepted for processing.
T
5. Your electronic funds withdrawal payment request was not accepted for processing. Refer to the "If You Owe
Tax" section.
NO
6. Your Form 4868, Application for Automatic Extension of Time to File U.S. Individual Income Tax Return, was
accepted on . The Submission ID assigned to your extension
is .

DO NOT SEND A PAPER COPY OF YOUR RETURN TO THE IRS.

IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN.

If You Need to Make a Change to Your Return

DO

If you need to make a change or correct the return you filed electronically, you should send a Form 1040X, Amended U.S.
Individual Income Tax Return, to the IRS Submission Processing Center that processes paper returns for your area. The
address is available at www.irs.gov, or you can call the IRS toll-free at 1-800-829-1040.

If You Need to Ask About Your Refund

The IRS notifies your Electronic Return Originator (ERO) when your return is accepted, usually within 48 hours. If your
return was not accepted, the IRS notifies your ERO of the reasons for rejection. If it has been more than three weeks
since the IRS accepted your return and you have not received your refund, go to www.irs.gov and click on "Where's My
Refund?" to view your refund status. Exception: If box 3 above is checked, allow 4 to 6 weeks for processing of your
return. A notice will be sent to you advising of changes to your return.

Also, you can call the TeleTax line at 1-800-829-4477, for automated refund information. You should have available the
first social security number shown on your return, your filing status, and the exact amount of the refund you expect.
TeleTax gives you the date for mailing or depositing your refund. You should receive your refund check within 30 days of
the date given by TeleTax, or within one week of that date, if you chose direct deposit. If you do not receive it by then, or if
TeleTax does not give your refund information, call the Refund Hotline at 1-800-829-1954.
BAA REV 11/13/17 PRO Form 9325 (Rev. 1-2017)
The IRS uses refunds to cover overdue taxes and notifies you when this occurs. The Fiscal Service offsets refunds
through the Treasury Offset Program to cover past due child support, federal agency non-tax debts such as student loans
and state income tax obligations. Fiscal Service sends you an offset notice if it applies your refund or part of your refund
to non-tax debts. If you have questions about the offset, contact the agency identified in the notice. You may also call the
Treasury Offset Program Call Center at 1-800-304-3107, if you have additional questions.

If You Owe Tax

If your return has a balance due, you must pay the amount you owe by the prescribed due date. If you paid by electronic
funds withdrawal (direct debit) or by credit card, no voucher is needed. The credit card service providers will charge a
convenience fee based on the amount of taxes you are paying. The fees and the type of credit or debit cards accepted

L
may vary between providers. You will be told the amount of the fee during the transaction and you will be given the option
to either continue or end the transaction. For information on paying your taxes electronically, including by credit or debit
card, go to www.irs.gov/e-pay.

AI
If you are not paying electronically you may use Form 1040-V, Payment Voucher, which you can obtain from your
Electronic Return Originator. If the IRS does not receive your payment by the prescribed due date, you will receive a
notice that requests full payment of the tax due, plus penalties and interest. If you can not pay the amount in full, complete
Form 9465, Installment Agreement Request, which you may file electronically. To apply for an installment agreement
online, go to www.irs.gov. You may also order Form 9465 by calling 1-800-TAX-FORM (1-800-829-3676). If approved, the
IRS charges a user fee to set up an installment agreement.

M
If You Need to Inquire About Your Electronic Funds Withdrawal Payment
You may call 1-888-353-4537 to inquire about the status of your electronic funds withdrawal payment. If there is a change
to the bank account information included on your return, you should call this number to cancel a scheduled payment. You
should have available the social security number of the first person listed on the tax return, the payment amount, and the
bank account number. Cancellation requests must be received no later than 11:59 p.m. E.T. two business days prior to
the scheduled payment date.
T
Tax Refund Related Financial Products

Financial institutions offer a variety of financial products to taxpayers based on their refunds. Contracts for financial
NO
products are between you and the financial institution. The IRS is not associated with the contract. If you have questions
about tax refund related products, contact your Electronic Return Originator or the lender.
DO

Catalog Number 12901K BAA www.irs.gov REV 11/13/17 PRO Form 9325 (Rev. 1-2017)
 Form
1040 Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

(99)
2017 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2017, or other tax year beginning , 2017, ending , 20 See separate instructions.
Your first name and initial Last name Your social security number

JOSEPH KANCLERZ 592-60-0414

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

SARAH KANCLERZ 259-57-5679

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above
c
and on line 6c are correct.
5742 ALLEE WAY
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
BRASELTON GA 30517 Check here if you, or your spouse if filing

L
jointly, want $3 to go to this fund. Checking
Foreign country name Foreign province/state/county Foreign postal code
a box below will not change your tax or
refund. You Spouse

1 Single 4 Head of household (with qualifying person). (See instructions.)

Filing Status
2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, enter this

AI
Check only one 3 Married filing separately. Enter spouse’s SSN above child’s name here. a
box. and full name here. a 5 Qualifying widow(er) (see instructions)

Exemptions 6a
b
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
} Boxes checked
on 6a and 6b
No. of children
2
c Dependents: (2) Dependent’s (3) Dependent’s (4)  if child under age 17 on 6c who:
social security number relationship to you qualifying for child tax credit • lived with you 3
(1) First name Last name (see instructions) • did not live with

M
you due to divorce
AIDEN J KANCLERZ 667-34-6309 Son or separation
If more than four JOSEPH R KANCLERZ 670-44-7452 Son (see instructions)
dependents, see Dependents on 6c
instructions and RHETT H KANCLERZ 009-87-3189 Son not entered above
check here a Add numbers on
d Total number of exemptions claimed . . . . . . . . . . . . . . . . . lines above a
5
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7 55,300.
Income
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a

Attach Form(s)
W-2 here. Also
attach Forms
b
9a
b
Tax-exempt interest. Do not include on line 8a .
Ordinary dividends. Attach Schedule B if required
Qualified dividends . . . . . . . . . . . 9b
T .
.
.
.
8b
. . . . . . . .
150.
. 9a 150.

W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10 55.
NO
1099-R if tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here a 13
If you did not 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14
get a W-2,
see instructions. 15a IRA distributions . 15a b Taxable amount . . . 15b
ROLLOVER 16a Pensions and annuities 16a 39,866. b Taxable amount . . . 16b 0.
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 142,823.
18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18
19 Unemployment compensation . . . . . . . . . . . . . . . . . 19
20a Social security benefits 20a b Taxable amount . . . 20b
21 Other income. List type and amount 21
DO

22 Combine the amounts in the far right column for lines 7 through 21. This is your total income a 22 198,328.
23 Educator expenses . . . . . . . . . . . 23
Adjusted 24 Certain business expenses of reservists, performing artists, and
Gross fee-basis government officials. Attach Form 2106 or 2106-EZ 24
Income 25 Health savings account deduction. Attach Form 8889 . 25
26 Moving expenses. Attach Form 3903 . . . . . . 26
27 Deductible part of self-employment tax. Attach Schedule SE . 27
28 Self-employed SEP, SIMPLE, and qualified plans . . 28
29 Self-employed health insurance deduction . . . . 29 13,714.
30 Penalty on early withdrawal of savings . . . . . . 30
31a Alimony paid b Recipient’s SSN a 31a
32 IRA deduction . . . . . . . . . . . . . 32
33 Student loan interest deduction . . . . . . . . 33
34 Tuition and fees. Attach Form 8917 . . . . . . 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 13,714.
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . a 37 184,614.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA REV 02/22/18 PRO Form 1040 (2017)
Form 1040 (2017) Page 2
38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38 184,614.
Tax and
Credits
39a Check
if:
{ You were born before January 2, 1953,
Spouse was born before January 2, 1953,
Blind.
Blind.
} Total boxes
checked a 39a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here a 39b
Standard 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . 40 54,272.
Deduction 130,342.
for— 41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41
• People who 42 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions 42 20,250.
check any
box on line 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43 110,092.
39a or 39b or 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44 18,986.
who can be
claimed as a 45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45
dependent,
see 46 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . 46

L
instructions. 47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . a 47 18,986.
• All others:
48 Foreign tax credit. Attach Form 1116 if required . . . . 48
Single or
Married filing 49 Credit for child and dependent care expenses. Attach Form 2441 49
separately,
$6,350 50 Education credits from Form 8863, line 19 . . . . . 50

AI
Married filing 51 Retirement savings contributions credit. Attach Form 8880 51
jointly or
Qualifying 52 Child tax credit. Attach Schedule 8812, if required . . . 52
widow(er), 53 Residential energy credits. Attach Form 5695 . . . . 53
$12,700
Head of 54 Other credits from Form: a 3800 b 8801 c 54
household, 55 Add lines 48 through 54. These are your total credits . . . . . . . . . . . . 55
$9,350
56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . a 56 18,986.

M
57 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 57
Other 58 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 58
59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 59
Taxes 60a Household employment taxes from Schedule H . . . . . . . . . . . . . . 60a
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . 60b
61 Health care: individual responsibility (see instructions) Full-year coverage . . . . . 61
62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62

Payments
63
64
65
Federal income tax withheld from Forms W-2 and 1099 . .
2017 estimated tax payments and amount applied from 2016 return
64
65
T
Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . a

20,508.
63 18,986.

If you have a
66a Earned income credit (EIC) . . . . . . .No. . . 66a
NO
qualifying
child, attach b Nontaxable combat pay election 66b
Schedule EIC. 67 Additional child tax credit. Attach Schedule 8812 . . . . . 67
68 American opportunity credit from Form 8863, line 8 . . . 68
69 Net premium tax credit. Attach Form 8962 . . . . . . 69
70 Amount paid with request for extension to file . . . . . 70
71 Excess social security and tier 1 RRTA tax withheld 71 . . . .
72 Credit for federal tax on fuels. Attach Form 4136 72 . . . .
73 Credits from Form: a 2439 b Reserved c 8885 d 73
74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . a 74 20,508.
Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75 1,522.
76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . a 76a 1,522.
DO

a
b
Routing number 0 6 1 0 0 0 1 0 4 a c Type: Checking Savings
Direct deposit?
See a d
Account number 8 8 1 5 8 6 4 8 5 8
instructions.
77 Amount of line 75 you want applied to your 2018 estimated tax a 77
Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions a 78
You Owe 79 Estimated tax penalty (see instructions) . . . . . . . 79
Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No
Designee’s Phone Personal identification
Designee name a no. a number (PIN) a
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
Sign accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation Daytime phone number
F

Joint return? See

instructions. MEDICAL
Keep a copy for Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection
your records. PIN, enter it
TEACHER here (see inst.)
Print/Type preparer’s name Preparer’s signature Date PTIN
Paid Check if
William M Strickland 05/03/2018 self-employed P01450266
Preparer
Firm’s name a STRICKLAND & HENDERSON LLC Firm’s EIN a 26-1701034
Use Only
Firm’s address a 804 WASHINGTON ST NW GAINESVILLE GA 30501-3538 Phone no.
Go to www.irs.gov/Form1040 for instructions and the latest information. REV 02/22/18 PRO Form 1040 (2017)
SCHEDULE A Itemized Deductions OMB No. 1545-0074

2017
(Form 1040) a Go to www.irs.gov/ScheduleA for instructions and the latest information.
a Attach to Form 1040.
Department of the Treasury Attachment
Internal Revenue Service (99) Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 28. Sequence No. 07
Name(s) shown on Form 1040 Your social security number
JOSEPH & SARAH KANCLERZ 592-60-0414
Caution: Do not include expenses reimbursed or paid by others.
Medical
and 1 Medical and dental expenses (see instructions) . . . . . 1 4,397.
2 Enter amount from Form 1040, line 38 2 184,614.
Dental
3 Multiply line 2 by 7.5% (0.075). . . . . . . . . . . . 3 13,846.
Expenses
4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . 4 0.

L
Taxes You 5 State and local (check only one box):
Paid a
b
Income taxes, or
General sales taxes } . . . . . . . . . . . 5 6,480.

6 Real estate taxes (see instructions) . . . . . . . . . 6 10,026.

AI
7 Personal property taxes . . . . . . . . . . . . . 7 4,399.
8 Other taxes. List type and amount a
8
9 Add lines 5 through 8 . . . . . . . . . . . . . . . . . . . . . . 9 20,905.
Interest 10 Home mortgage interest and points reported to you on Form 1098 10 18,047.
You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid

M
to the person from whom you bought the home, see instructions
Note: and show that person’s name, identifying no., and address a
Your mortgage
interest
deduction may 11
be limited (see 12 Points not reported to you on Form 1098. See instructions for
instructions). special rules . . . . . . . . . . . . . . . . . 12
13 Mortgage insurance premiums (see instructions) . . . . . 13 0.

Gifts to
T
14 Investment interest. Attach Form 4952 if required. See instructions
15 Add lines 10 through 14 . . . . . . . . . . . . . . . . . . . . .
16 Gifts by cash or check. If you made any gift of $250 or more,
14
15 18,047.

Charity see instructions . . . . . . . . . . . . . . . . 16 15,320.

NO
If you made a 17 Other than by cash or check. If any gift of $250 or more, see
gift and got a instructions. You must attach Form 8283 if over $500 . . . 17
benefit for it, 18 Carryover from prior year . . . . . . . . . . . . 18
see instructions.
19 Add lines 16 through 18 . . . . . . . . . . . . . . . . . . . . . 19 15,320.
Casualty and 20 Casualty or theft loss(es) other than net qualified disaster losses. Attach Form 4684 and
Theft Losses enter the amount from line 18 of that form. See instructions . . . . . . . . . 20
Job Expenses 21 Unreimbursed employee expenses—job travel, union dues,
and Certain job education, etc. Attach Form 2106 or 2106-EZ if required.
Miscellaneous See instructions. a 21
Deductions 22 Tax preparation fees . . . . . . . . . . . . . 22
23 Other expenses—investment, safe deposit box, etc. List type
DO

and amount a
23
24 Add lines 21 through 23 . . . . . . . . . . . . 24
25 Enter amount from Form 1040, line 38 25
26 Multiply line 25 by 2% (0.02) . . . . . . . . . . 26
27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- . . . . . . 27
Other 28 Other—from list in instructions. List type and amount a
Miscellaneous
Deductions 28
Total 29 Is Form 1040, line 38, over $156,900?

}
Itemized No. Your deduction is not limited. Add the amounts in the far right column
Deductions for lines 4 through 28. Also, enter this amount on Form 1040, line 40. . . 29 54,272.
Yes. Your deduction may be limited. See the Itemized Deductions
Worksheet in the instructions to figure the amount to enter.
30 If you elect to itemize deductions even though they are less than your standard
deduction, check here . . . . . . . . . . . . . . . . . . . a
For Paperwork Reduction Act Notice, see the Instructions for Form 1040. REV 02/22/18 PRO Schedule A (Form 1040) 2017
BAA
SCHEDULE E Supplemental Income and Loss OMB No. 1545-0074

2017
(Form 1040) (From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
a Attach to Form 1040, 1040NR, or Form 1041.
Department of the Treasury Attachment
Internal Revenue Service (99) a Go to www.irs.gov/ScheduleE for instructions and the latest information. Sequence No. 13
Name(s) shown on return Your social security number
JOSEPH & SARAH KANCLERZ 592-60-0414
Part I Income or Loss From Rental Real Estate and Royalties Note: If you are in the business of renting personal property, use
Schedule C or C-EZ (see instructions). If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40.
A Did you make any payments in 2017 that would require you to file Form(s) 1099? (see instructions) . . . . . Yes No
B If “Yes,” did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . Yes No
1a Physical address of each property (street, city, state, ZIP code)

L
A 515 TOPSOIL BLVD MIRAMAR BEACH FL 32550
B 1351 LOOWIT FALLS WAY BRASELTON GA 30517
C
1b Type of Property 2 For each rental real estate property listed Fair Rental Personal Use

AI
above, report the number of fair rental and QJV
(from list below) Days Days
personal use days. Check the QJV box
A 1 only if you meet the requirements to file as A 365 0
B 1 a qualified joint venture. See instructions. B 365 0
C C
Type of Property:
1 Single Family Residence 3 Vacation/Short-Term Rental 5 Land 7 Self-Rental

M
2 Multi-Family Residence 4 Commercial 6 Royalties 8 Other (describe)
Income: Properties: A B C
3 Rents received . . . . . . . . . . . . . 3 10,781. 18,000.
4 Royalties received . . . . . . . . . . . . 4
Expenses:
5 Advertising . . . . . . . . . . . . . . 5
6 Auto and travel (see instructions) . . . . . . . 6
7
8
9
Cleaning and maintenance . . . . . . . . .
Commissions. . . . . . . . . . . . . .
Insurance . . . . . . . . . . . . . . .
7
8
9
T 1,985.

864.
10 Legal and other professional fees . . . . . . . 10
NO
11 Management fees . . . . . . . . . . . . 11
12 Mortgage interest paid to banks, etc. (see instructions) 12
13 Other interest. . . . . . . . . . . . . . 13
14 Repairs. . . . . . . . . . . . . . . . 14 1,085.
15 Supplies . . . . . . . . . . . . . . . 15 380.
16 Taxes . . . . . . . . . . . . . . . . 16 2,343.
17 Utilities . . . . . . . . . . . . . . . . 17 692.
18 Depreciation expense or depletion . . . . . . 18 3,000. 8,727.
19 Other (list) a HOA 19 9,633. 500.
20 Total expenses. Add lines 5 through 19 . . . . . 20 19,118. 10,091.
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties). If
DO

result is a (loss), see instructions to find out if you must

file Form 6198 . . . . . . . . . . . . . 21 -8,337. 7,909.
22 Deductible rental real estate loss after limitation, if any,
on Form 8582 (see instructions) . . . . . . . 22 ( 0. ) ( -7,909. ) ( )
23a Total of all amounts reported on line 3 for all rental properties . . . . 23a 28,781.
b Total of all amounts reported on line 4 for all royalty properties . . . . 23b
c Total of all amounts reported on line 12 for all properties . . . . . . 23c
d Total of all amounts reported on line 18 for all properties . . . . . . 23d 11,727.
e Total of all amounts reported on line 20 for all properties . . . . . . 23e 29,209.
24 Income. Add positive amounts shown on line 21. Do not include any losses . . . . . . . 24 7,909.
25 Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here . 25 ( 7,909. )
26 Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result here.
If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter this amount on Form 1040, line
17, or Form 1040NR, line 18. Otherwise, include this amount in the total on line 41 on page 2 . . . 26 0.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 02/13/18 PRO Schedule E (Form 1040) 2017
Schedule E (Form 1040) 2017 Attachment Sequence No. 13 Page 2
Name(s) shown on return. Do not enter name and social security number if shown on other side. Your social security number

JOSEPH & SARAH KANCLERZ 592-60-0414

Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
Part II Income or Loss From Partnerships and S Corporations Note: If you report a loss from an at-risk activity for which
any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See instructions.
27 Are you reporting any loss not allowed in a prior year due to the at-risk, excess farm loss, or basis limitations, a prior year
unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? If
you answered “Yes,” see instructions before completing this section . . . . . . . . . . . . Yes No
(b) Enter P for (c) Check if (d) Employer (e) Check if
28 (a) Name partnership; S foreign identification any amount is
for S corporation partnership number not at risk

L
A SOUTHERN SURGICAL ASSISTANTS LLC S 26-2419950
B
C
D

AI
Passive Income and Loss Nonpassive Income and Loss
(f) Passive loss allowed (g) Passive income (h) Nonpassive loss (i) Section 179 expense (j) Nonpassive income
(attach Form 8582 if required) from Schedule K-1 from Schedule K-1 deduction from Form 4562 from Schedule K-1

A 70,610. 213,433.
B
C

M
D
29a Totals 213,433.
b Totals 70,610.
30 Add columns (g) and (j) of line 29a . . . . . . . . . . . . . . . . . . . . . 30 213,433.
31 Add columns (f), (h), and (i) of line 29b . . . . . . . . . . . . . . . . . . . 31 ( 70,610. )
32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the
result here and include in the total on line 41 below . . . . . . . . . . . . . . . 32 142,823.
Part III
33
Income or Loss From Estates and Trusts
(a) Name
T (b) Employer
identification number

A
NO
B
Passive Income and Loss Nonpassive Income and Loss
(c) Passive deduction or loss allowed (d) Passive income (e) Deduction or loss (f) Other income from
(attach Form 8582 if required) from Schedule K-1 from Schedule K-1 Schedule K-1

A
B
34a Totals
b Totals
35 Add columns (d) and (f) of line 34a . . . . . . . . . . . . . . . . . . . . 35
36 Add columns (c) and (e) of line 34b . . . . . . . . . . . . . . . . . . . . 36 ( )
37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and
DO

include in the total on line 41 below . . . . . . . . . . . . . . . . . . . . 37

Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)—Residual Holder
(b) Employer identification (c) Excess inclusion from (d) Taxable income (net loss) (e) Income from
38 (a) Name number Schedules Q, line 2c from Schedules Q, line 1b Schedules Q, line 3b
(see instructions)

39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below 39
Part V Summary
40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below . . . . . . 40
41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Form 1040, line 17, or Form 1040NR, line 18 a 41 142,823.
42 Reconciliation of farming and fishing income. Enter your gross
farming and fishing income reported on Form 4835, line 7; Schedule K-1
(Form 1065), box 14, code B; Schedule K-1 (Form 1120S), box 17, code
V; and Schedule K-1 (Form 1041), box 14, code F (see instructions) . . 42
43 Reconciliation for real estate professionals. If you were a real estate
professional (see instructions), enter the net income or (loss) you reported
anywhere on Form 1040 or Form 1040NR from all rental real estate activities
in which you materially participated under the passive activity loss rules . . 43
REV 02/13/18 PRO Schedule E (Form 1040) 2017
Form 4562 Depreciation and Amortization
(Including Information on Listed Property)
OMB No. 1545-0172

2017
a Attach
to your tax return.
Department of the Treasury Attachment
Internal Revenue Service (99)
a Go to www.irs.gov/Form4562 for instructions and the latest information. Sequence No. 179
Name(s) shown on return Business or activity to which this form relates Identifying number
JOSEPH & SARAH KANCLERZ Section 179 Summary 592-60-0414
Part I Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
1 Maximum amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 1 510,000.
2 Total cost of section 179 property placed in service (see instructions) . . . . . . . . . . . 2 0.
3 Threshold cost of section 179 property before reduction in limitation (see instructions) . . . . . . 3 2,030,000.

L
4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- . . . . . . . . . . 4 0.
5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . 5 510,000.
6 (a) Description of property (b) Cost (business use only) (c) Elected cost

AI
from Schedule K-1 70,610.

7 Listed property. Enter the amount from line 29 . . . . . . . . . 7

8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 . . . . . . 8 70,610.
9 Tentative deduction. Enter the smaller of line 5 or line 8 . . . . . . . . . . . . . . . . 9 70,610.
10 Carryover of disallowed deduction from line 13 of your 2016 Form 4562 . . . . . . . . . . . 10

M
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11 268,733.
12 Section 179 expense deduction. Add lines 9 and 10, but don’t enter more than line 11 . . . . . . 12 70,610.
13 Carryover of disallowed deduction to 2018. Add lines 9 and 10, less line 12 a 13 0.
Note: Don’t use Part II or Part III below for listed property. Instead, use Part V.
Part II Special Depreciation Allowance and Other Depreciation (Don’t include listed property.) (See instructions.)
14 Special depreciation allowance for qualified property (other than listed property) placed in service
during the tax year (see instructions) . . . . . . . . . . . . . . . . . . . . . . 14

16 Other depreciation (including ACRS) . . . . . . . . . . . . . . . . . . . . . .

Part III MACRS Depreciation (Don’t include listed property.) (See instructions.)
T
15 Property subject to section 168(f)(1) election . . . . . . . . . . . . . . . . . . . . 15
16

Section A
NO
17 MACRS deductions for assets placed in service in tax years beginning before 2017 . . . . . . . 17
18 If you are electing to group any assets placed in service during the tax year into one or more general
asset accounts, check here . . . . . . . . . . . . . . . . . . . . . . a
Section B—Assets Placed in Service During 2017 Tax Year Using the General Depreciation System
(b) Month and year (c) Basis for depreciation
(a) Classification of property placed in (business/investment use (d) Recovery (e) Convention (f) Method (g) Depreciation deduction
service only—see instructions) period

19a 3-year property

b 5-year property
c 7-year property
d 10-year property
e 15-year property
DO

f 20-year property
g 25-year property 25 yrs. S/L
h Residential rental 27.5 yrs. MM S/L
property 27.5 yrs. MM S/L
i Nonresidential real 39 yrs. MM S/L
property MM S/L
Section C—Assets Placed in Service During 2017 Tax Year Using the Alternative Depreciation System
20a Class life S/L
b 12-year 12 yrs. S/L
c 40-year 40 yrs. MM S/L
Part IV Summary (See instructions.)
21 Listed property. Enter amount from line 28 . . . . . . . . . . . . . . . . . . . . 21
22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter
here and on the appropriate lines of your return. Partnerships and S corporations—see instructions . 22
23 For assets shown above and placed in service during the current year, enter the
portion of the basis attributable to section 263A costs . . . . . . . 23
For Paperwork Reduction Act Notice, see separate instructions. REV 02/27/18 PRO Form 4562 (2017)
BAA
Form 8582 Passive Activity Loss Limitations
a See separate instructions.
OMB No. 1545-1008

2017
a Attach
to Form 1040 or Form 1041.
Department of the Treasury Attachment
Internal Revenue Service (99) a Go to www.irs.gov/Form8582 for instructions and the latest information. Sequence No. 88
Name(s) shown on return Identifying number
JOSEPH & SARAH KANCLERZ 592-60-0414
Part I 2017 Passive Activity Loss
Caution: Complete Worksheets 1, 2, and 3 before completing Part I.
Rental Real Estate Activities With Active Participation (For the definition of active participation, see
Special Allowance for Rental Real Estate Activities in the instructions.)
1a Activities with net income (enter the amount from Worksheet 1,

L
column (a)) . . . . . . . . . . . . . . . . . . 1a 7,909.
b Activities with net loss (enter the amount from Worksheet 1, column
(b)) . . . . . . . . . . . . . . . . . . . . . 1b ( 8,337. )
c Prior years' unallowed losses (enter the amount from Worksheet 1,

AI
column (c)) . . . . . . . . . . . . . . . . . . 1c ( 31,075. )
d Combine lines 1a, 1b, and 1c . . . . . . . . . . . . . . . . . . . . . . 1d -31,503.
Commercial Revitalization Deductions From Rental Real Estate Activities
2a Commercial revitalization deductions from Worksheet 2, column (a) . 2a ( )
b Prior year unallowed commercial revitalization deductions from
Worksheet 2, column (b) . . . . . . . . . . . . . . 2b ( )

M
c Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . 2c ( )
All Other Passive Activities
3a Activities with net income (enter the amount from Worksheet 3,
column (a)) . . . . . . . . . . . . . . . . . . 3a
b Activities with net loss (enter the amount from Worksheet 3, column
(b)) . . . . . . . . . . . . . . . . . . . . . 3b ( )
c Prior years' unallowed losses (enter the amount from Worksheet 3,

4
column (c)) . . . . . . . . . . . . . . . . . .
d Combine lines 3a, 3b, and 3c . . . . . . . . . . . . .
T .
3c (
. . .
Combine lines 1d, 2c, and 3d. If this line is zero or more, stop here and include this form with
. . . . .
)
3d

your return; all losses are allowed, including any prior year unallowed losses entered on line 1c,
NO
2b, or 3c. Report the losses on the forms and schedules normally used . . . . . . . . 4 -31,503.
If line 4 is a loss and: • Line 1d is a loss, go to Part II.
• Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III.
• Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III and go to line 15.
Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete
Part II or Part III. Instead, go to line 15.
Part II Special Allowance for Rental Real Estate Activities With Active Participation
Note: Enter all numbers in Part II as positive amounts. See instructions for an example.
5 Enter the smaller of the loss on line 1d or the loss on line 4 . . . . . . . . . . . . 5 31,503.
6 Enter $150,000. If married filing separately, see instructions . . 6 150,000.
7 Enter modified adjusted gross income, but not less than zero (see instructions) 7 184,614.
DO

Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9,

enter -0- on line 10. Otherwise, go to line 8.
8 Subtract line 7 from line 6 . . . . . . . . . . . . . 8
9 Multiply line 8 by 50% (0.50). Do not enter more than $25,000. If married filing separately, see instructions 9
10 Enter the smaller of line 5 or line 9 . . . . . . . . . . . . . . . . . . . . 10 0.
If line 2c is a loss, go to Part III. Otherwise, go to line 15.
Part III Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities
Note: Enter all numbers in Part III as positive amounts. See the example for Part II in the instructions.
11 Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions 11
12 Enter the loss from line 4 . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Reduce line 12 by the amount on line 10 . . . . . . . . . . . . . . . . . . 13
14 Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13 . . . . . . 14
Part IV Total Losses Allowed
15 Add the income, if any, on lines 1a and 3a and enter the total . . . . . . . . . . . . 15 7,909.
16 Total losses allowed from all passive activities for 2017. Add lines 10, 14, and 15. See
instructions to find out how to report the losses on your tax return . . . . . . . . . . . 16 7,909.
For Paperwork Reduction Act Notice, see instructions. BAA REV 02/13/18 PRO Form 8582 (2017)
Form 8582 (2017) Page 2
Caution: The worksheets must be filed with your tax return. Keep a copy for your records.
Worksheet 1—For Form 8582, Lines 1a, 1b, and 1c (See instructions.)
Current year Prior years Overall gain or loss
Name of activity
(a) Net income (b) Net loss (c) Unallowed
(d) Gain (e) Loss
(line 1a) (line 1b) loss (line 1c)
515 TOPSOIL BLVD 0. 8,337. 19,489. 27,826.
1351 LOOWIT FALLS WAY 7,909. 0. 11,586. 3,677.

L
Total. Enter on Form 8582, lines 1a, 1b,
and 1c . . . . . . . . . . . a 7,909. 8,337. 31,075.
Worksheet 2—For Form 8582, Lines 2a and 2b (See instructions.)

AI
(a) Current year (b) Prior year
Name of activity (c) Overall loss
deductions (line 2a) unallowed deductions (line 2b)

M
Total. Enter on Form 8582, lines 2a and
2b . . . . . . . . . . . . a
Worksheet 3—For Form 8582, Lines 3a, 3b, and 3c (See instructions.)
Current year Prior years Overall gain or loss
Name of activity
(a) Net income (b) Net loss (c) Unallowed
(d) Gain (e) Loss
(line 3a) (line 3b) loss (line 3c)
T
NO
Total. Enter on Form 8582, lines 3a, 3b,
and 3c . . . . . . . . . . . a
Worksheet 4—Use this worksheet if an amount is shown on Form 8582, line 10 or 14 (See instructions.)
Form or schedule
(d) Subtract
and line number (c) Special
Name of activity (a) Loss (b) Ratio column (c) from
to be reported on allowance
column (a)
(see instructions)
DO

Total . . . . . . . . . . . . . . . . . a 1.00
Worksheet 5—Allocation of Unallowed Losses (See instructions.)
Form or schedule
and line number
Name of activity (a) Loss (b) Ratio (c) Unallowed loss
to be reported on
(see instructions)
515 TOPSOIL BLVD E Ln 22 27,826. 0.88328096 27,826.
1351 LOOWIT FALLS WAY E Ln 22 3,677. 0.11671904 3,677.

Total . . . . . . . . . . . . . . . . . . . a 31,503. 1.00 31,503.

REV 02/13/18 PRO Form 8582 (2017)
Form 8582 (2017) Page 3
Worksheet 6—Allowed Losses (See instructions.)
Form or schedule
and line number to
Name of activity (a) Loss (b) Unallowed loss (c) Allowed loss
be reported on (see
instructions)
515 TOPSOIL BLVD E Ln 22 27,826. 27,826. 0.
1351 LOOWIT FALLS WAY E Ln 22 11,586. 3,677. 7,909.

L
Total . . . . . . . . . . . . . . .
39,412. . . . .
31,503. a 7,909.
Worksheet 7—Activities With Losses Reported on Two or More Forms or Schedules (See instructions.)
Name of activity: (d) Unallowed

AI
(a) (b) (c) Ratio (e) Allowed loss
loss
Form or schedule and line number
to be reported on (see
instructions):
1a Net loss plus prior year unallowed
loss from form or schedule . a

M
b Net income from form or
schedule . . . . . . . a

c Subtract line 1b from line 1a. If zero or less, enter -0- a

Form or schedule and line number
to be reported on (see
instructions):
1a Net loss plus prior year unallowed
loss from form or schedule . a
b Net income from form or
T
schedule . . . . . . . a
NO
c Subtract line 1b from line 1a. If zero or less, enter -0- a
Form or schedule and line number
to be reported on (see
instructions):
1a Net loss plus prior year unallowed
loss from form or schedule . a
b Net income from form or
schedule . . . . . . . a

c Subtract line 1b from line 1a. If zero or less, enter -0- a

DO

Total . . . . . . . . . . . . . . . . . . a 1.00
REV 02/13/18 PRO Form 8582 (2017)
 Form 1040 State and Local Income Tax Refund Worksheet 2017
Line 10 State and local taxes paid in 2016 or prior years and refunded in 2017

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Part I State and Local Income Tax Refunds from 2016 Tax Returns

1 (a) (b) (c) (d) (e) (f) (g)

State Refund Estimated Extension Total Refund Refund
or Amount Tax Paid Payments Payments Allocated to Allocated to

L
Local After and Column (c) Column (d)
Code 12/31/2016 Withholding

GA 73. 1,638. 6,592. 18.

AI
Totals 73. 1,638. 6,592. 18.

2 Total state and local refunds. Total line 1 column (b). 73.

M
3 Refund allocated to tax paid after 12/31/2016. Total line 1 columns (f) and (g).
(Include net tax paid after 12/31/2016 on Schedule A, line 5.) 18.
4 Net refund. Line 2 less line 3. 55.

Part II Recovery Amount

The recovery amount is the state and local income tax deducted in 2016 refunded in 2017.
5
6 Recovery amount. Lesser of line 4 or line 5.
T
Total state and local income tax deduction from line 5 of your 2016 Schedule A 4,954.
55.

Part III Recovery Exclusion

NO
The recovery exclusion is the part of the recovery amount which did not reduce tax in 2016.
7 Recovery exclusion from standard deduction and/or sales tax deduction:
a Allowable itemized deductions, from 2016 Schedule A, line 29 35,351.
b Allowable itemized deductions, refigured by excluding recovery amount:
(1) Refigured state and local tax deduction:
(a) Refigured state income tax deduction 4,899.
(b) Sales tax deduction 1,589.
(c) Refigured deduction. Larger of (a) or (b) 4,899.
(2) Refigured total itemized deductions before limitation 35,296.
(3) Refigured reduction for limitation on itemized deductions 0.
(4) Refigured allowable itemized deductions. Line 7b(2) less line 7b(3) 35,296.
DO

c 2016 standard deduction based on 2016 filing stat, exemptns, and deductns. 12,600.
d Larger of lines 7b(4) or 7c 35,296.
e Subtract line 7d from line 7a 55.
f Subtract line 7e from line 6 0.
8 Recovery exclusion from negative taxable income. If 2016 taxable income
was negative, enter here as a positive number, else enter zero. 0.
9 Recovery exclusion from alternative minimum tax. If no alternative minimum
tax (AMT) in 2016 enter zero. If did pay AMT in 2016, enter amt from line 24 0.
10 Recovery exclusion from unused tax credits. If no unused credits in 2016,
enter zero. If there were unused credits in 2016, enter amount from line 35. 0.
11 Total recovery exclusion. Add lines 7f, 8, 9, and 10. 0.

Part IV Taxable Refund

The recovery amount less the recovery exclusion is a taxable refund.

12 Taxable refund from 2016. Line 6 less line 11. 55.
13 Total taxable refunds from 2015 or prior tax returns. Total line 36 column (d).
14 Total taxable refunds. Add lines 12 and 13. Enter here and on Form 1040, line 10 55.
 Tax History Report 2017
G Keep for your records

Name(s) Shown on Return

JOSEPH & SARAH KANCLERZ

Five Year Tax History:

2013 2014 2015 2016 2017

Filing status MFJ MFJ MFJ MFJ MFJ

L
Total income 230,132. 226,767. 170,307. 174,041. 198,328.

Adjustments to income 9,001. 4,884. 9,555. 12,311. 13,714.

AI
Adjusted gross income 221,131. 221,883. 160,752. 161,730. 184,614.

Tax expense 14,089. 14,677. 18,843. 13,809. 20,905.

Interest expense 24,183. 12,722. 11,331. 10,244. 18,047.

M
Contributions 5,960. 17,595. 3,320. 11,298. 15,320.

Miscellaneous
deductions

Other Itemized
Deductions 0.

Total itemized/
T
standard deduction 44,232. 44,994. 33,494. 35,351. 54,272.
NO
Exemption amount 15,600. 15,800. 16,000. 16,200. 20,250.

Taxable income 161,299. 161,089. 111,258. 110,179. 110,092.

Tax 32,629. 32,352. 19,389. 19,069. 18,986.

Alternative min tax

Total credits 0. 1,415. 500.

Other taxes
DO

Payments 27,116. 35,892. 36,531. 18,736. 20,508.

Form 2210 penalty

Amount owed 5,513.

Applied to next
year’s estimated tax

Refund 3,540. 18,557. 167. 1,522.

Effective tax rate % 14.76 14.58 10.59 11.48 10.28

**Tax bracket % 28.0 28.0 25.0 25.0 25.0

**Tax bracket % is based on Taxable income.

 IRS e-file Authentication Statement 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

A ' Practitioner PIN Authorization

Note - PIN information is entered in Part IV of the Federal Information Worksheet. This worksheet only serves
as a record of the PIN information transmitted in the electronic return.

L
QuickZoom to the Federal Information Worksheet to enter PIN information

Taxpayer(s) entered PIN(s)

ERO entered Primary Taxpayer’s PIN

AI
ERO entered Secondary Taxpayer’s PIN
ERO entered PIN(s) on behalf of taxpayer(s) X

B ' Signature of Electronic Return Originator

ERO Declaration:

M
I declare that the information contained in this electronic tax return is the information furnished to me by the
taxpayer. If the taxpayer furnished me a completed tax return, I declare that the information contained in
this electronic tax return is identical to that contained in the return provided by the taxpayer. If the furnished
return was signed by a paid preparer, I declare I have entered the paid preparer’s identifying information in
the appropriate portion of this electronic return. If I am the paid preparer, under the penalties of perjury I
declare that I have examined this electronic return, and to the best of my knowledge and belief, it is true,
correct, and complete. This declaration is based on all information of which I have any knowledge.

I am signing this Tax Return by entering my PIN below.

T
ERO’s PIN (EFIN followed by any 5 numbers) EFIN 674354 Self-Select PIN 42060
NO
C ' Signature of Taxpayer/Spouse

Perjury Statement:
Under penalties of perjury, I declare that I have examined this return, including any accompanying
statements and schedules and, to the best of my knowledge and belief, it is true, correct, and complete.

Consent to Disclosure:
I consent to allow my Intermediate Service Provider, transmitter, or Electronic Return Originator (ERO) to
send my return to IRS and to receive the following information from IRS: (1) acknowledgement of receipt or
reason for rejection of transmission; (2) refund offset; (3) reason for any delay in processing or refund; and,
DO

(4) date of any refund.

I am signing this Tax Return and Electronic Funds Withdrawal Consent, if applicable,
with my Self-Select PIN below.
QuickZoom to the Federal Information Worksheet to enter PIN numbers
Taxpayer’s PIN (5 numbers) 00414
Spouse’s PIN (5 numbers) 75679
Date 04/02/2018

D ' Form 1310 Signature and Verification

Completion of this section indicates that I am requesting a refund of taxes overpaid by or on behalf of the
decedent. Under penalties of perjury, I declare that I have examined this Form 1310 claim, and to the best
of my knowledge and belief, it is true, correct, and complete.

Signature of person claiming refund (35 character limit) Date

 Federal Information Worksheet 2017
G Keep for your records

Part I ' Personal Information

Taxpayer: Spouse:
Last name KANCLERZ Last name (if different) KANCLERZ
First name JOSEPH First name SARAH
Middle initial Suffix Middle initial Suffix
Social security no. 592-60-0414 Social security no. 259-57-5679
Occupation MEDICAL Occupation TEACHER
Date of birth 01/26/1978 (mm/dd/yyyy) Date of birth 12/31/1980 (mm/dd/yyyy)
Age as of 1-1-2018 39 Age as of 1-1-2018 37
Date of death Date of death
Legally blind Legally blind

L
E-mail address E-mail address
Work phone Ext Work phone Ext
Cell phone Cell phone
Home phone Note: Work phone is transmitted for electronic funds withdrawal.
Fax number

AI
Best contact phone number
Print phone number on Form 1040 Home Taxpayer work Spouse work

US Address:
Address 5742 ALLEE WAY Apt no.
City BRASELTON State GA ZIP code 30517
Foreign Address: Check this box to use foreign address

M
Address Apt no.
City
Foreign code Foreign country
Foreign province/county Foreign postal code
Foreign phone
APO/FPO/DPO address APO FPO DPO

Part II ' Federal Filing Status

X
1 Single
2 Married filing jointly
T
3 Married filing separately
NO
Taxpayer did not live with spouse at any time during year
Taxpayer eligible to claim spouse’s exemption (see Help)
4 Head of household
If qualifying person is child but not dependent:
Child’s First name MI Last Name Suff
Child’s social security number
5 Qualifying widow(er)
Year spouse died 2015 2016
If the ’qualifying person’ is your child but not your dependent:
Child’s First name MI Last Name Suff
Child’s social security number

Part III ' Dependent/Earned Income Credit/Child and Dependent Care Credit Information
Qualified
DO

child and
Dependent dependent
Identity care expenses
A Protection PIN incurred and
G (see tax help) paid in 2017
Date of birth E Lived Not qual
(mm/dd/yyyy) with Educ for child
Social security E taxpyr Tuition tax credit
First name MI number Date of death I in and Or non
Last name Suff *Relationship (mm/dd/yyyy)** C U.S. Fees Code U.S.***
AIDEN J 667-34-6309 03/16/2007 10
KANCLERZ Son E L
JOSEPH R 670-44-7452 11/09/2009 8
KANCLERZ Son E L
RHETT H 009-87-3189 06/22/2017 0
KANCLERZ Son E L

* Caution: If claiming child other than taxpayer’s see Relationship in Help

** The health care shared responsibility payment calculation does not include individuals after date of death
*** Caution: If this person is NOT a U.S. citizen, U.S. national, or a U.S. resident check this box
 Identity Verification Worksheet 2017
GSee tax help for more information on identity verification

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Driver’s License or State Id Information

Required for electronic filing, either complete the driver’s license or state id detail information below or
select the appropriate box for taxpayer and spouse to indicate why driver’s license or state id information is
not present.

L
Note: Providing identification numbers helps the IRS and states verify taxpayer identity which can prevent
unnecessary delays in tax return processing.

AI
All identity verification information should be entered here and will automatically flow to the
state return.

Taxpayer/Spouse does not have a driver’s license or state id

Taxpayer Note: Alabama does not allow this option
Spouse

M
Taxpayer/Spouse did not provide driver’s license or state id information
X Taxpayer Note: Alabama, New Mexico, New York and Ohio do not allow this option
X Spouse

Check to confirm transferred driver’s license or state id information (which appears in green) is correct
Note: Transfer not available for returns with Alabama, Iowa, or New York state taxes. See tax help for
more information.

Driver’s License Detail

T
Taxpayer: Spouse:
NO
Issuing state Issuing state
License number License number
Issue date Issue date
Expiration date Expiration date
Does not expire Does not expire
NY Document number (first 3 chars)* NY Document number (first 3 chars)*

State Identification Card Detail

Taxpayer: Spouse:
Issuing state Issuing state
DO

Identification number Identification number

Issue date Issue date
Expiration date Expiration date
Does not expire Does not expire
NY Document number (first 3 chars)* NY Document number (first 3 chars)*

* Enter the first 3 characters of the NY document number, which is the 8 or 10 number/letter combination
found at the bottom of the NY license (or NY state ID) or on the back if it was issued after January 28, 2014.

Additional Verification Information

Use these fields to record the client status and method used to verify the taxpayer and spouse identity.

Client Status:
New client
Returning client to same preparer and firm
Returning client to same firm
Identity Verification Method (select one):
In person
Remote via email, phone, or fax
Both in person and remote
Identity not verified

Documents Used to Verify Primary Taxpayer Identity:

Driver’s license (complete detail above)
State issued identification card (complete detail above)
Passport
Account statement from financial institution

L
Utility billing statement
Credit card billing statement

Documents Used to Verify Spouse Identity (If you file joint return):

AI
Driver’s license (complete detail above)
State issued identification card (complete detail above)

fdiv7101.SCR 03/23/18

M
T
NO
DO
 Electronic Filing Information Worksheet 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Payment by Check (Form 1040-V) ' Federal Balance Due

Date Form 1040-V was given to client

Electronic Return Originator Information

The ERO Information below will automatically calculate based on the preparer code entered on the

L
Federal Information Worksheet.

Calculates to the EFIN for the ERO that is responsible for filing this return based on the
preparer code. For returns that are marked as a "Non-Paid Preparer" (XNP) or
"Self-Prepared" (XSP) can be changed but is required. 674354

AI
For returns that are marked as a "Non-Paid Preparer" (XNP) or "Self-Prepared" (XSP)
enter a PIN for the ERO that is responsible for filing return

ERO Name ERO Electronic Filers Identification Number (EFIN)

STRICKLAND & HENDERSON LLC 674354
ERO Address ERO Employer Identification Number
804 WASHINGTON ST NW 26-1701034

M
City State ZIP Code ERO Social Security Number or PTIN
GAINESVILLE GA 30501-3538
Country

Paid Preparer Information

Firm Name
T Social Security Number or PTIN
STRICKLAND & HENDERSON LLC P01450266
Name Employer Identification Number
NO
William M Strickland 26-1701034
Address Phone Number Fax Number
804 WASHINGTON ST NW
City State ZIP Code
GAINESVILLE GA 30501-3538
Country E-mail Address
mstrickland@snhcpa.com

Non Paid Preparer Information

If the return was prepared or reviewed through an IRS tax assistance program, self-prepared by the
taxpayer, or was prepared by another person who was not paid to prepare the return, check one of the
DO

following boxes that applies to this return.

IRS-reviewed
IRS-prepared
Prepared by taxpayer or other non-paid preparer

Amended Returns

File another Amended Form 114 Report of Foreign Bank and Financial Accounts (FBAR) electronically
Check this box to file another state and/or city amended return electronically
* Select the state and/or city amended return(s) to file electronically.

State/City *

New York
Vermont
JOSEPH & SARAH KANCLERZ 592-60-0414 Page 2

Miscellaneous Electronic Filing Items

If the return was rejected for dependent name and SSN mismatch (business rule R0000-504-01) or
Schedule EIC qualifying child name and SSN mismatch (business rule SEIC-F1040-501-01),
check this box to retransmit this return as an imperfect return.

Enter an ’in care of addressee’ if applicable

Name of personal representative for deceased returns

L
If married filing joint and one spouse is deceased, is the surviving spouse also the
personal representative? Yes No

AI
Check this box if your client is in the U.S. Armed Forces with a stateside address

Check the appropriate box if the taxpayer (or spouse) last served in an area designated as a combat zone
or qualified hazardous duty area.
Iraqi Freedom
Kosovo Operation

M
Afghanistan/Enduring Freedom
Desert Storm
Haiti
Former Yugoslavia
UN Operation
Joint Guard
Joint Forge
Northern Watch
Operation Allied Force
Northern Forge
T
Combat Zone Deployment Date
NO
Option of Transmitting the Forms as PDF with the Electronic Submission or Mailing the Forms with
Form 8453: U.S. Individual Income Tax Transmittal for an IRS e-file Return.

Note: To Attach and Send a PDF file with this return, click on the "E-File" drop down menu, and then select "Attach PDF Files".

Check the applicable box(es) on forms to be attached and mail with form 8453 Transmit Print & Mail
PDF with 8453

Form 2848. Power of Attorney and Declaration of Representative

DO

Form 3468, Historic Structure Certificate

Form 4136, Credit for Federal Tax Paid on Fuels
Form 8283, Noncash Charitable Contributions (Declaration of Appraiser)
Form 1098-C, Contributions of Motor Vehicles, Boats and Airplanes
Form 8332, Release of Claim to Exemption for Child by Custodial Parent or Other Doc
Form 8885, Health Coverage Tax Credit
Form 8949. Sales and Other Disp of Capital Assets.(or a stmt w/the same information)
Form 3115, Change in Accounting Method

These forms are not supported in ProSeries. You may print a completed form to Transmit Print & Mail
mail with your Form 8453, please check the applicable box(es) . PDF with 8453
Form 5713, International Boycott Report N/A
Form 8858, Foreign Disregarded Entities N/A
Form 8864, attach the Certificate for Biodiesel N/A
 Form 1040 Forms W-2 & W-2G Summary 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Form W-2 Employer SP Wages Federal Tax State Wages State Tax
SOUTHERN SURGICAL ASSISTANTS LLC 50,000. 50,000.
GWINNETT COUNTY PUBLIC SCHOOLS X 5,300. 5,300.

L
AI
Totals 55,300. 55,300.

Form W-2 Summary

Box No. Description Taxpayer Spouse Total

M
1 Total wages, tips and compensation:
Non-statutory & statutory wages not on Sch C 50,000. 5,300. 55,300.
Statutory wages reported on Schedule C
Foreign wages included in total wages
Unreported tips 0. 0. 0.
2 Total federal tax withheld
3 & 7 Total social security wages/tips 50,000. 50,000.
4
5
6
Total social security tax withheld
Total Medicare wages and tips
Total Medicare tax withheld
T 3,100.
50,000.
725.
6,164.
89.
3,100.
56,164.
814.
8 Total allocated tips
9 Not used
NO
10 a Total dependent care benefits
b Offsite dependent care benefits
c Onsite dependent care benefits
11 Total distributions from nonqualified plans
12 a Total from Box 12 9,503. 9,503.
b Elective deferrals to qualified plans 252. 252.
c Roth contrib. to 401(k), 403(b), 457(b) plans
d Deferrals to government 457 plans
e Deferrals to non-government 457 plans
f Deferrals 409A nonqual deferred comp plan
g Income 409A nonqual deferred comp plan
h Uncollected Medicare tax
DO

i Uncollected social security and RRTA tier 1

j Uncollected RRTA tier 2
k Income from nonstatutory stock options
l Non-taxable combat pay
m QSEHRA benefits
n Total other items from box 12 9,251. 9,251.
14 a Total deductible mandatory state tax
b Total deductible charitable contributions
c Total deductible employee expenses
d Total RR Compensation
e Total RR Tier 1 tax
f Total RR Tier 2 tax
g Total RR Medicare tax
h Total RR Additional Medicare tax
i Total RRTA tips
j Total other items from box 14
16 Total state wages and tips 50,000. 5,300. 55,300.
17 Total state tax withheld
19 Total local tax withheld
 Form 1040 Form W-2 Worksheet 2017
G Keep for your records

Name as shown on return Social Security Number

JOSEPH KANCLERZ 592-60-0414

Employer EIN 26-2419950

Employer Name SOUTHERN SURGICAL ASSISTANTS LLC
Name (cont.)
Street Address or P. O. Box PO BOX 7042
City CHESTNUT MOUNTAIN State GA ZIP 30502
Foreign Province/County

L
Foreign Postal Code
Foreign Country

Spouse’s W-2 Do not transfer this W-2 to next year

AI
X Automatically calculate lines 3 through 6 and line 16.
Caution: Box 12 entries for deferred compensation will change lines 3 through 6 automatically.

1 Wages, tips, other comp 50,000. 2 Federal tax withheld

3 Social security wages 50,000. 4 Social sec tax withheld 3,100.
5 Medicare wages and tips 50,000. 6 Medicare tax withheld 725.
7 Social security tips 8 Allocated tips

M
13 b Retirement plan
Foreign source income eligible for exclusion on Form 2555
Active duty military pay

Box 12 Box 12 If Box 12 code is:

Code Amount A: Enter amount attributable to RRTA Tier 2 tax
M: Enter amount attributable to RRTA Tier 2 tax
P: Double click to link to Form 3903, line 4
T
R: Enter MSA contribution for

W: Enter HSA contribution for

Taxpayer
Spouse
Taxpayer
Spouse
NO
G: Employer is not a state or local government

Box 15 Box 16 Box 17

State Employer’s state I.D. no. State wages, tips, etc. State income tax
GA 3094530lk 50,000.

I confirm that the state withholding identification number(s) are accurate X

Box 20 Box 18 Box 19 Associated

Locality name Local wages, tips, etc. Local income tax State
DO

9 Verification Code 9
10 Dependent care benefits (Check if employer furnished care at work) 10
Dependent care benefits - Amount forfeited from flexible spending account
11 Distributions from Section 457 and other nonqualified plans (See help,
if EIC, Child Care, Child Tax Credit, or IRAs.) 11

Box 14 ProSeries Identification of Description or Code

Description or Code (Identify this item by selecting the identification from
on Actual Form W-2 Amount the drop down list. If not on the list, select Other).
 Form 1040 Form W-2 Worksheet Additional Information 2017
G Keep for your records
JOSEPH KANCLERZ 592-60-0414 Page 2

Employer Name SOUTHERN SURGICAL ASSISTANTS LLC

Part I Statutory employees

A Box 13a. Statutory employee

B Deducting expenses in connection with this income
C If deducting expenses, double click to link to Schedule C C

Part II Clergy, church employees, members of recognized religious sects

L
Clergy only:
D Designated housing or parsonage allowance D
E Smallest of (a) the designated housing or parsonage allowance,
(b) amount spent on qualifying housing expenses, or (c) fair rental value E

AI
F If no FICA was withheld, check the applicable box below
1 Pay self-employment tax on housing or parsonage allowance only
2 Pay self-employment tax on W-2 income only
3 Pay self-employment tax on W-2 income and housing allowance
4 Exempt from self-employment tax and has approved Form 4361
Non-Clergy only:
G If no FICA was withheld, check the applicable box below
1 Pay self-employment tax on this W-2 income

M
2 Exempt from self-employment tax and has approved Form 4029

Part III Unreported Tip Income

H1 Tips $20 or more in a month which were not reported to employer H1

2 Tips less than $20 in a month which were not required to be reported H2
3 Value of non-cash tips, such as tickets or passes, not reported H3
4 Actual amount of allocated tips if different than the amount in box 8 H4
5 Tips paid out through a tip-sharing arrangement H5
6
T
Employer is a federal, state, or local government and tips are
only subject to Medicare tax

Part IV Substitute Form W-2

NO
I a If substitute Form W-2 needed, double-click to link this W-2 to a Form 4852
b Enter Form 4852, Line 9 information. "How did you determine amounts on line 7 of Form 4852?"

c Form 4852, Line 10 information. "Explain your efforts to obtain Form W-2?"

d QuickZoom to completed Form 4852 for reference

Part V Inmate In a Penal Institution

DO

J a Pay from work performed while an inmate in a penal institution

Part VI Additional Information for Electronic Filing and Certain States (See Help)

13 c Third-party sick pay

Non-standard W-2 (handwritten, typewritten, or altered in any way)
Corrected W-2
Income from Paid Family Leave
Control number (optional)

Employee information: Correct to match employee information on W-2

Employee’s SSN. 592-60-0414
First name M.I. Last name Suff.
JOSEPH KANCLERZ
Address City St ZIP code
5742 ALLEE WAY BRASELTON GA 30517
Foreign Province/County Foreign Postal Code

Foreign Country
 Form 1040 Form W-2 Worksheet 2017
G Keep for your records

Name as shown on return Social Security Number

SARAH KANCLERZ 259-57-5679

Employer EIN 58-6000254

Employer Name GWINNETT COUNTY PUBLIC SCHOOLS
Name (cont.)
Street Address or P. O. Box 437 OLD PEACHTREE ROAD
City SUWANEE State GA ZIP 30024
Foreign Province/County

L
Foreign Postal Code
Foreign Country

X Spouse’s W-2 Do not transfer this W-2 to next year

AI
Automatically calculate lines 3 through 6 and line 16.
Caution: Box 12 entries for deferred compensation will change lines 3 through 6 automatically.

1 Wages, tips, other comp 5,300. 2 Federal tax withheld

3 Social security wages 4 Social sec tax withheld
5 Medicare wages and tips 6,164. 6 Medicare tax withheld 89.
7 Social security tips 8 Allocated tips

M
13 b X Retirement plan
Foreign source income eligible for exclusion on Form 2555
Active duty military pay

Box 12 Box 12 If Box 12 code is:

Code Amount A: Enter amount attributable to RRTA Tier 2 tax
E 252. M: Enter amount attributable to RRTA Tier 2 tax
DD 9,251. P: Double click to link to Form 3903, line 4
T
R: Enter MSA contribution for

W: Enter HSA contribution for

Taxpayer
Spouse
Taxpayer
Spouse
NO
G: Employer is not a state or local government

Box 15 Box 16 Box 17

State Employer’s state I.D. no. State wages, tips, etc. State income tax
GA 4693072xn 5,300.

I confirm that the state withholding identification number(s) are accurate X

Box 20 Box 18 Box 19 Associated

Locality name Local wages, tips, etc. Local income tax State
DO

9 Verification Code 9
10 Dependent care benefits (Check if employer furnished care at work) 10
Dependent care benefits - Amount forfeited from flexible spending account
11 Distributions from Section 457 and other nonqualified plans (See help,
if EIC, Child Care, Child Tax Credit, or IRAs.) 11

Box 14 ProSeries Identification of Description or Code

Description or Code (Identify this item by selecting the identification from
on Actual Form W-2 Amount the drop down list. If not on the list, select Other).
 Form 1040 Form W-2 Worksheet Additional Information 2017
G Keep for your records
SARAH KANCLERZ 259-57-5679 Page 2

Employer Name GWINNETT COUNTY PUBLIC SCHOOLS

Part I Statutory employees

A Box 13a. Statutory employee

B Deducting expenses in connection with this income
C If deducting expenses, double click to link to Schedule C C

Part II Clergy, church employees, members of recognized religious sects

L
Clergy only:
D Designated housing or parsonage allowance D
E Smallest of (a) the designated housing or parsonage allowance,
(b) amount spent on qualifying housing expenses, or (c) fair rental value E

AI
F If no FICA was withheld, check the applicable box below
1 Pay self-employment tax on housing or parsonage allowance only
2 Pay self-employment tax on W-2 income only
3 Pay self-employment tax on W-2 income and housing allowance
4 Exempt from self-employment tax and has approved Form 4361
Non-Clergy only:
G If no FICA was withheld, check the applicable box below
1 Pay self-employment tax on this W-2 income

M
2 Exempt from self-employment tax and has approved Form 4029

Part III Unreported Tip Income

H1 Tips $20 or more in a month which were not reported to employer H1

2 Tips less than $20 in a month which were not required to be reported H2
3 Value of non-cash tips, such as tickets or passes, not reported H3
4 Actual amount of allocated tips if different than the amount in box 8 H4
5 Tips paid out through a tip-sharing arrangement H5
6
T
Employer is a federal, state, or local government and tips are
only subject to Medicare tax

Part IV Substitute Form W-2

NO
I a If substitute Form W-2 needed, double-click to link this W-2 to a Form 4852
b Enter Form 4852, Line 9 information. "How did you determine amounts on line 7 of Form 4852?"

c Form 4852, Line 10 information. "Explain your efforts to obtain Form W-2?"

d QuickZoom to completed Form 4852 for reference

Part V Inmate In a Penal Institution

DO

J a Pay from work performed while an inmate in a penal institution

Part VI Additional Information for Electronic Filing and Certain States (See Help)

13 c Third-party sick pay

Non-standard W-2 (handwritten, typewritten, or altered in any way)
Corrected W-2
Income from Paid Family Leave
Control number (optional)

Employee information: Correct to match employee information on W-2

Employee’s SSN. 259-57-5679
First name M.I. Last name Suff.
SARAH KANCLERZ
Address City St ZIP code
5742 ALLEE WAY BRASELTON GA 30517
Foreign Province/County Foreign Postal Code

Foreign Country
 Healthcare Entry Sheet 2017
G Keep for your records

The forms associated with healthcare (8965, 8962, 1095-A, 1095-B, 1095-C, and this Healthcare Entry Sheet) all interact with
information from the information worksheet. Be sure to enter all personal information including dependents listed on the return
before using this sheet to track health insurance coverage.

Yes No/Partial
X Everyone on the tax return was covered by health insurance all year.
If everyone on the return was covered and there was no Market Place coverage (Form 1095-A) then check the YES box
above - no other action is required. The 1095-B or 1095-C can be used to verify coverage but you do not need to enter

L
the information if everyone on the return was covered.

Health Insurance Coverage for Individuals: Use this form to report healthcare coverage for individuals for months:
? not reported on 1095-A, 1095-B or 1095-C

AI
? not covered by employer
? months not covered by an exemption

Note: The 1095-A information must be entered on Form 1095-A in order to correctly calculate any Premium Tax Credit. The 1095-B
or the 1095-C months can be entered directly in the table below.

M
If applicable enter information on form 1095-A, Health Insurance Marketplace Statement

Note: The IRS is not requiring the 1095-B or 1095-C be filed with the returns. To track the months covered you can either enter
on the 1095-B and/or 1095-C or check the boxes below

If applicable enter information on form 1095-B, Health Coverage

T
If applicable enter information on form 1095-C, Employer-Provided Health Insurance Offer and Coverage

If applicable enter Market Place exemptions (ECNs) or Request exemptions on form 8965
NO
Check this box to populate the Name, SSN, and DOB for everyone listed on the return below.
Note: Checking this box again will repopulate the information below and overwrite existing entries.

Covered Individual (only complete the table below if not entering on 1095-A, 1095-B or 1095-C):

Short Gap
Eligible*
Yes No
a. Name of covered individual(s) Covered all
b. SSN c. DOB 12 months Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
DO

1 Short gap: Yes No

2 Short gap: Yes No

3 Short gap: Yes No

4 Short gap: Yes No

5 Short gap: Yes No

6 Short gap: Yes No

* See help for explanation of short gap Yes/No box function. It affects the calculation of short gap coverage for January and
February based on answer, which indicates whether coverage at end of prior year qualify months for short gap eligibility.

To review the detail of each person listed on the return (covered, not covered, exempt) and to see any penalty calculation go to the
Health Care Individual Responsibility Smart Worksheet on Form 8965
 Interest and Dividends Summary 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Interest Summary Total Interest Tax-Exempt U.S. Government Priv Actvy Bond

1 Seller-financed mortgage
2 From Schedule B, Part I
3 From Schedule B, Part II

L
4 From K-1 Worksheets
5 Exempt-int.divs (net of adj.)
6 From Forms 6252
7 From Forms 8814

AI
8 Subtotal
Less Adjustments:
9 U.S. savings bond interest
previously reported
10 Nominee distribution
11 OID adjustment
12 ABP adjustment

M
13 Accrued interest
14 Other adjustment
15 Series EE & I bond exclusion
16 Total Adjustments
17 Total to Schedule B, line 2
18 Total to Form 1040, line 8b
19 Total U.S. govt. interest
20 Total to Form 6251, line 12
T
Dividends Summary Ordinary Qualified Capital Gains Nontaxable
NO
1 From Schedule B 150. 150.
2 From K-1 Worksheets
Subtotal 150. 150.
3 Less Adjustments:
4 Nominee distribution
5 Other adjustment
6 Total Adjustments
7 Total to Schedule B, line 6 150.
8 Total qualified dividends 150.
9 Total capital gains
10 Total nontaxable dividends
DO

Capital Gains Summary 28% rate Sec. 1250 Sec. 1202 50% Sec. 1202 60%

1 From Schedule B
Less Adjustments:
2 Nominee distribution
3 Other adjustment
4 Total Adjustments
5 Total to Schedule D

Capital Gains Summary Sec. 1202 75% Sec. 1202 100%

1 From Schedule B
Less Adjustments:
2 Nominee distribution
3 Other adjustment
4 Total Adjustments
5 Total to Schedule D
 Form 1040 Form 1099-G Worksheet 2017
Certain Government Payments
G Keep for your records

Name(s) Shown on Return Social Security No.

JOSEPH & SARAH KANCLERZ 592-60-0414

Worksheet Description COPY 1

L
Box Description Payer 1 Payer 2 Payer 3

Ownership (defaults to taxpayer):

Check if Taxpayer X

AI
Check if Spouse
Check if Joint
Payer’s Federal ID number
Enter the abbreviation of State
or Locality issuing this payment:
10 a State abbreviation GA

M
Locality abbreviation
Payer’s name State of GA
1 Unemployment compensation
a Amount repaid
2 State or local income tax refunds,
credits, or offsets 73.
3 Box 2 amount is for tax year 2016
4
5
6
Federal income tax withheld
RTAA payments
Taxable grants
T
7 Agriculture payments
NO
(Double-click) to:
a Link to Schedule F Line 4a, 39a
b Link to Schedule F Line 6a, 41
c Link to Form 4835 Line 3a
d Link to Form 4835 Line 5a
8 Check if the amount in box 2
applies to income from
a trade or business
(Double-click) to:
a Link to Schedule C line 6
b Link to Schedule F line 8b, 43b
DO

Enter the taxable portion of the

amount in box 2 to be reported
on Schedule C or F
9 Market gain
a Link to Schedule F Line 4a, 39a
b Link to Form 4835 Line 3a
10 b State identification no
11 State income tax withheld
12 a Locality name
13 Local Income Tax Withheld
 Form 1099-R Summary 2017
G Keep for your records
Name(s) Shown on Return Social Security No.
JOSEPH & SARAH KANCLERZ 592-60-0414
Payer SP Gross Taxable Federal Tax State Tax IRA
BRANCH BANKING AND TRUST COMPANY 28,247.
SE2 AS ADMINISTRATOR FOR AFLIAC 11,619.

L
Traditional IRA Distributions Taxpayer Spouse

Gross 1 Total gross distributions from box 1 of Form 1099-R

a Less: Amounts rolled over

AI
b Less: Inherited and treat as own
c Less: Other inherited IRA amount
d Less: Return of contributions
e Less: Qualified charitable distributions
f Less: HSA funding distributions
2 Balance of gross traditional IRA distributions
a Gross distribution transferred to Form 8915A/B, 2(a)
b Qualified disaster distributions

M
c Less: Amount rolled over
d Gross distribution transferred to Form 8915A/B, 2(b)
e Qualified disaster home repayment distribution
f Less: Amount rolled over
g Gross distribution transferred to Form 8915B, line 21
3 Amount of line 2 converted to a Roth IRA
a Less: Amount recharacterized
4 Net amount of line 2 converted to a Roth IRA
5 Amount of line 2 not converted to a Roth IRA

Taxable 6
7
8
T
Earnings on return of contributions
Taxable amount of inherited IRAs on line 1c
Taxable amount not converted to Roth IRA
9 Taxable amount of Roth IRA conversions
NO
10 Taxable amount included on Form 1040, line 15b
11 If checked, taxable amount calculated on Form 8606

Roth IRA Distributions

Gross 12 Total gross distributions from box 1 of Form 1099-R
a Less: Rollover to another Roth IRA
b Less: Inherited and treat as own
c Less: Other inherited Roth IRA amount
d Less: Return of contributions
e Less: Qualified home repayment distribution
f Qualified disaster distribution
13 Roth IRA distributions subject to distribution rules
DO

Qualified 14 Total gross qualified distributions

a Less: Rollover to another Roth IRA
b Less: Inherited and treat as own
c Less: Other inherited Roth IRA amount
15 Qualified distributions subject to distribution rules

Taxable 16 Net nonqualified distributions for Form 8606

17 Earnings on return of contributions
18 Taxable amount of inherited Roth IRAs on line 12c
19 Taxable earnings on nonqualified distributions
20 Taxable amount included on Form 1040, line 15b

IRA Qualified Disaster Distributions From Form 8915A and 8915B

Taxable 20 a Qualified distributions on Form 1040, line 15b
b Home repayment distributions on Form 1040, line 15b

Recharacterizations (See Help)

Gross 21 a 2017 form code N (included on Form 1040, line 15a)
21 b 2018 form code R (not included on 1040, line 15a)
Forms 1099-R Summary 2017 Page 2
JOSEPH & SARAH KANCLERZ 592-60-0414
Pensions and Annuities Taxpayer Spouse

Gross 22 Total gross distributions from box 1 of Form 1099-R 39,866.

a Less: Lump sum transferred to Form 4972
b Less: Amount not reported on Form 1040, line 16
c Designated Roth distribution allocated to an IRR
23 Amount of line 22 converted to a Roth IRA
a Less: Amount recharacterized
b Net amount of line 23 converted to a Roth IRA
24 Distributions from Canada RRP Wks, line 7a
25 Gross distribution transferred to Form 1040, line 16a 39,866.
a Less: Amount rolled over 39,866.

L
b Amount attributable to an in-plan Roth rollover
c Gross distribution transferred to Form 8915A/B, 1(a)
d Qualified disaster distribution
e Less: Amount rolled over

AI
f Gross distribution transferred to Form 8915A/B, 1(b)
g Qualified disaster home repayment distribution
h Less: Amount rolled over
i Gross distribution transferred to Form 8915B

Taxable 26 Taxable amount in box 2a, Form 1099-R 39,866.

a Taxable amount rolled over 39,866.
b Non-taxable amount rolled over
c Designated Roth contribution basis rolled to Roth IRA

M
d Insurance premiums for retired public safety officers
e Qualified disaster amount to Form 8915A/B
f Qualified disaster home repayment distribution
27 Lump sum amount transferred to Form 4972
28 Amount transferred to Form 1040, line 7
a Disability before minimum retirement age
b Return of contributions
c Insurance premiums for retired public safety officers
29 Nontaxable amount from Simplified Method
30
a
b
T
Capital gains from charitable gift annuities
Capital gain subject to the 28% rate
Unrecaptured section 1250 gain
31 Taxable amount of Roth IRA conversions
a Taxable amount of in-plan Roth rollovers
NO
32 a Taxable amount of distributions 0.
b Taxable distributions from Canada RRP Wks, line 7b
c Taxable disaster distributions from Form 8915A/B
d Taxable disaster home repayments from Form 8915B
e Taxable amount transferred to Form 1040, line 16b 0.
Section 1035 Tax-free Exchange
Pensions 33 Total gross distributions from box 1 of Form 1099-R
IRAs 34 Total gross distributions from box 1 of Form 1099-R

Distributions on 2017 1099-Rs Not Reported on the 2017 Return

Code P 35 Distribution reported on 2016 tax return
DO

Code R 36 Recharacterizations of prior year contributions or

conversions. Need not be reported on tax return.

Tax Withholding
Box 4 37 Total federal tax withheld
Box 10 38 Total state tax withheld
Box 13 39 Total local tax withheld

Nontaxable Distributions for Sales Tax Deduction

40 Nontaxable IRA distributions
41 Nontaxable pension distributions 0.
Health Insurance Premiums
42 Health insurance deductible on Schedule A

Taxable Distributions included in Net Investment Income

43 Annuity payments and other distributions that
may be subject to the net investment income tax
 Form 1040 Form 1099-R Worksheet 2017
G Keep for your records
Name Social Security Number
JOSEPH KANCLERZ 592-60-0414

Check Applicable Box : 1099-R X CSA-1099-R CSF-1099-R RRB-1099-R

Payer Federal ID 56-1368984 Corrected

Payer Name BRANCH BANKING AND TRUST COMPANY
Name (cont.) NE GEORGIA HEALTH SYSTEMS INC Non standard
Street Address or P. O. Box P O BOX 29542
City RALEIGH State NC ZIP 27626-0542
Foreign:
Province/County Postal Code

L
Country

If Spouse's 1099-R, check this box Do not transfer this 1099-R to next year
This section is for RRB-1099-R use only

AI
1 Gross distribution 28,247. 2a Taxable amount (See Help)
2b Taxable amount not determined A Total distribution A
3 Capital gain 4 Federal tax withheld
5 Contributns/Desig Roth/Insur 6 Net unrealized appreciation
A IRA/SEP/SIMPLE A A

M
7 Distribution code(s) G G Roth IRA
12 -1 State tax withheld 13 -1 State Payer’s state No.
14 -1 State distribution State use code (See Help)
A I confirm that the state withholding identification number(s) are accurate
15 -1 Local tax withheld 16 -1 Name of locality
17 -1 Local distribution

A Check if NOT from a qualified retirement plan or IRA (see Help)

T
A If box 7 code is J or T, check if a qualified Roth IRA distribution (see Help)
A If box 7 code is J, enter amount used for first time home purchase
A Rollovers Enter rollovers, conversions and recharacterizations on lines B and C on page 2.
A Inherited IRA If this distribution is from an inherited IRA, indicate the distribution is from the IRA of
NO
A Treat as recipient’s own (this is treated as a rollover)
A Recipient, but was originally inherited from a spouse (treated as recipient’s IRA)
A Spouse and not treat as recipient’s own (taxable amount must be in box 2a)
A Someone other than a spouse (taxable amount must be in box 2a)
A Insurance A Amount of insurance premiums deductible on Schedule A
A Amount of health savings account (HSA) funding distributions
A Amount of qualified insurance premiums paid subtracted from
an eligible retired public safety officer’s distribution
A Qualified Charitable Distribution Enter IRA distributions made directly by the trustee
to a qualified charitable organization

A RMD If this is a Required Minimum Distribution (RMD) (See Help),

Entire gross is RMD or the amount of gross distbn that is RMD
DO

8 Other %
9a Percentage of total distribution 9b Total employee contributions
10 Amount allocable to IRR within 5 years
11 1st year of desig. Roth contrib.
Account number
FATCA filing requirement
12 -2 State tax withheld 13 -2 State Payer’s state No.
14 -2 State distribution State use code (See Help)
15 -2 Local tax withheld 16 -2 Name of locality
17 -2 Local distribution

Recipient information: Correct to match recipient information on Form 1099-R

Recipient’s name Recipient’s federal ID.
JOSEPH KANCLERZ 592-60-0414
Address City St ZIP code
5742 ALLEE WAY BRASELTON GA 30517
Foreign:
Province/County Postal Code
Foreign Country
 Form 1040 Form 1099-R Worksheet 2017
G Keep for your records
Name
JOSEPH KANCLERZ 592-60-0414 Page 2

Payer’s Name BRANCH BANKING AND TRUST COMPANY

Additional Distribution Information
See Help for important information about Roth conversions and recharacterizations.

Verify Box 7 Distribution Codes (See Help)

L
A1 Early distribution except Roth or SIMPLE (first 2 years), but no code 1
A2 Early distribution from Roth but no code J
A3 Early SIMPLE distribution in first 2 years, but no code S

AI
A4 Return of excess contribution before return due date, but no code 8
A5 Code P or R on a 2018 Form 1099-R

Rollovers, Roth Conversions, Roth Rollovers, and Recharacterizations

Rollover: Enter traditional IRA or pension distribution that was rolled over to a pension or

M
traditional IRA. Enter Roth IRA rollover or conversion on lines B5 or B6 below.
B1 Entire distribution rolled over X
B2 or amount of partial rollover B2
B3 If box 7 code is B or H, check if rolled over into a Roth IRA
Roth IRA Rollover or Conversion:
B4 Amount of this distribution that may be rolled or converted to a Roth IRA B4
B5 Full amount of line B4 rolled or converted to Roth IRA
B6
B7
B8
Amount of partial Roth conversion of line B4
T
If box 7 code is G, check if in-plan Roth rollover to a designated Roth
Previously taxed contributions, if different than box 5, for rollover from a qualified
B6
B7

retirement plan to Roth IRA or an in-plan Roth rollover to a designated Roth B8

NO
Recharacterization:
Complete line C2 or C3 only for amount of this distribution indicated on
line C1. Disregard earnings and losses.
C 1 Amount of this distribution that can be recharacterized C1
C 2 Full amount on line C1 recharacterized
C 3 If partial recharacterization, enter the amount that was not recharacterized C3

Pensions and Annuities

Lump-Sum Distribution Averaging:

DO

D 1 Check this box if you wish to use 10-year averaging (or make the
capital gain election) on Form 4972 for this distribution
D 2 If averaging elected, federal estate taxes paid (see Help) D2
D 3 If averaging elected, death benefit exclusion (see Help) D3
If multiple recipients, see Help.

Disability Payments:
E If code 3 in box 7 (disability), check if the recipient is under the minimum
retirement age

Charitable Gift Annuities:

If code F in box 7
F 1 Enter amount of box 3 that is taxed at maximum 28% rate F1
F 2 Enter amount of box 3 that is unrecaptured section 1250 gain F2
 Form 1040 Form 1099-R Worksheet 2017
G Keep for your records
Name Social Security Number
JOSEPH KANCLERZ 592-60-0414

Check Applicable Box : 1099-R X CSA-1099-R CSF-1099-R RRB-1099-R

Payer Federal ID 20-4536242 Corrected

Payer Name SE2 AS ADMINISTRATOR FOR AFLIAC
Name (cont.) FBO ZURICH Non standard
Street Address or P. O. Box PO BOX 758557
City TOPEKA State KS ZIP 66675
Foreign:
Province/County Postal Code

L
Country

If Spouse's 1099-R, check this box Do not transfer this 1099-R to next year
This section is for RRB-1099-R use only

AI
1 Gross distribution 11,619. 2a Taxable amount (See Help)
2b Taxable amount not determined A Total distribution A
3 Capital gain 4 Federal tax withheld
5 Contributns/Desig Roth/Insur 6 Net unrealized appreciation
A IRA/SEP/SIMPLE A A

M
7 Distribution code(s) G G Roth IRA
12 -1 State tax withheld 13 -1 State Payer’s state No.
14 -1 State distribution State use code (See Help)
A I confirm that the state withholding identification number(s) are accurate
15 -1 Local tax withheld 16 -1 Name of locality
17 -1 Local distribution

A Check if NOT from a qualified retirement plan or IRA (see Help)

T
A If box 7 code is J or T, check if a qualified Roth IRA distribution (see Help)
A If box 7 code is J, enter amount used for first time home purchase
A Rollovers Enter rollovers, conversions and recharacterizations on lines B and C on page 2.
A Inherited IRA If this distribution is from an inherited IRA, indicate the distribution is from the IRA of
NO
A Treat as recipient’s own (this is treated as a rollover)
A Recipient, but was originally inherited from a spouse (treated as recipient’s IRA)
A Spouse and not treat as recipient’s own (taxable amount must be in box 2a)
A Someone other than a spouse (taxable amount must be in box 2a)
A Insurance A Amount of insurance premiums deductible on Schedule A
A Amount of health savings account (HSA) funding distributions
A Amount of qualified insurance premiums paid subtracted from
an eligible retired public safety officer’s distribution
A Qualified Charitable Distribution Enter IRA distributions made directly by the trustee
to a qualified charitable organization

A RMD If this is a Required Minimum Distribution (RMD) (See Help),

Entire gross is RMD or the amount of gross distbn that is RMD
DO

8 Other %
9a Percentage of total distribution 9b Total employee contributions
10 Amount allocable to IRR within 5 years
11 1st year of desig. Roth contrib.
Account number
FATCA filing requirement
12 -2 State tax withheld 13 -2 State Payer’s state No.
14 -2 State distribution State use code (See Help)
15 -2 Local tax withheld 16 -2 Name of locality
17 -2 Local distribution

Recipient information: Correct to match recipient information on Form 1099-R

Recipient’s name Recipient’s federal ID.
JOSEPH KANCLERZ 592-60-0414
Address City St ZIP code
5742 ALLEE WAY BRASELTON GA 30517
Foreign:
Province/County Postal Code
Foreign Country
 Form 1040 Form 1099-R Worksheet 2017
G Keep for your records
Name
JOSEPH KANCLERZ 592-60-0414 Page 2

Payer’s Name SE2 AS ADMINISTRATOR FOR AFLIAC

Additional Distribution Information
See Help for important information about Roth conversions and recharacterizations.

Verify Box 7 Distribution Codes (See Help)

L
A1 Early distribution except Roth or SIMPLE (first 2 years), but no code 1
A2 Early distribution from Roth but no code J
A3 Early SIMPLE distribution in first 2 years, but no code S

AI
A4 Return of excess contribution before return due date, but no code 8
A5 Code P or R on a 2018 Form 1099-R

Rollovers, Roth Conversions, Roth Rollovers, and Recharacterizations

Rollover: Enter traditional IRA or pension distribution that was rolled over to a pension or

M
traditional IRA. Enter Roth IRA rollover or conversion on lines B5 or B6 below.
B1 Entire distribution rolled over X
B2 or amount of partial rollover B2
B3 If box 7 code is B or H, check if rolled over into a Roth IRA
Roth IRA Rollover or Conversion:
B4 Amount of this distribution that may be rolled or converted to a Roth IRA B4
B5 Full amount of line B4 rolled or converted to Roth IRA
B6
B7
B8
Amount of partial Roth conversion of line B4
T
If box 7 code is G, check if in-plan Roth rollover to a designated Roth
Previously taxed contributions, if different than box 5, for rollover from a qualified
B6
B7

retirement plan to Roth IRA or an in-plan Roth rollover to a designated Roth B8

NO
Recharacterization:
Complete line C2 or C3 only for amount of this distribution indicated on
line C1. Disregard earnings and losses.
C 1 Amount of this distribution that can be recharacterized C1
C 2 Full amount on line C1 recharacterized
C 3 If partial recharacterization, enter the amount that was not recharacterized C3

Pensions and Annuities

Lump-Sum Distribution Averaging:

DO

D 1 Check this box if you wish to use 10-year averaging (or make the
capital gain election) on Form 4972 for this distribution
D 2 If averaging elected, federal estate taxes paid (see Help) D2
D 3 If averaging elected, death benefit exclusion (see Help) D3
If multiple recipients, see Help.

Disability Payments:
E If code 3 in box 7 (disability), check if the recipient is under the minimum
retirement age

Charitable Gift Annuities:

If code F in box 7
F 1 Enter amount of box 3 that is taxed at maximum 28% rate F1
F 2 Enter amount of box 3 that is unrecaptured section 1250 gain F2
 Form 1040 Qualified Dividends and Capital Gain Tax Worksheet 2017
Line 44 G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

1 Enter the amount from Form 1040, line 43 1 110,092.

2 Enter the amount from Form
1040, line 9b 2 150.
3 Are you filing Schedule D?

L
Yes. Enter the smaller of line 15
or 16 of Schedule D. If
either line 15 or 16 is blank
or loss, enter -0- 3

AI
X No. Enter the amount from Form
1040, line 13.
4 Add lines 2 and 3 4 150.
5 If filing Form 4952 (used to figure
investment interest expense
deduction), enter any amount from line

M
4g of that form. Otherwise, enter -0-. 5 0.
6 Subtract line 5 from line 4. If zero or less, enter -0- 6 150.
7 Subtract line 6 from line 1. If zero or less, enter -0- 7 109,942.
8 Enter:
$37,950 if single or married filing separately,
$75,900 if married filing jointly or qualifying widow(er), 8 75,900.
$50,800 if head of household.
9
10
11
Enter the smaller of line 1 or line 8
Enter the smaller of line 7 or line 9
T
Subtract line 10 from line 9 (this amount taxed at 0%)
10
11
9 75,900.
75,900.
0.
12 Enter the smaller of line 1 or line 6 12 150.
NO
13 Enter the amount from line 11 13 0.
14 Subtract line 13 from line 12. 14 150.
15 Enter:
$418,400 if single,
$235,350 if married filing separately, 15 470,700.
$470,700 if married filing jointly or qualifying widow(er),
$444,550 if head of household.
16 Enter the smaller of line 1 or line 15 16 110,092.
17 Add lines 7 and 11 17 109,942.
18 Subtract line 17 from line 16. If zero or less, enter -0- 18 150.
19 Enter the smaller of line 14 or line 18 19 150.
DO

20 Multiply line 19 by 15% (.15) 20 23.

21 Add lines 11 and 19 21 150.
22 Subtract line 21 from line 12 22 0.
23 Multiply line 22 by 20% (.20) 23 0.
24 Figure the tax on the amount on line 7. If the amount on line 7 is less than
$100,000, use the Tax Table to figure the tax. If the amount on line 7 is
$100,000 or more, use the Tax Computation Worksheet 24 18,963.
25 Add lines 20, 23, and 24 25 18,986.
26 Figure the tax on the amount on line 1. If the amount on line 1 is less than
$100,000, use the Tax Table to figure this tax. If the amount on line 1 is
$100,000 or more, use the Tax Computation Worksheet 26 19,001.
27 Tax on all taxable income. Enter the smaller of line 25 or line 26 here and on
Form 1040, line 44. 27 18,986.
 Tax Payments Worksheet 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Estimated Tax Payments for 2017 (If more than 4 payments for any state or locality, see Tax Help)

Federal State Local

Date Amount Date Amount ID Date Amount ID

L
1 04/18/17 5,127. 04/18/17 1,620. GA 04/18/17

2 06/15/17 5,127. 06/15/17 1,620. GA 06/15/17

AI
3 09/15/17 5,127. 09/15/17 1,620. GA 09/15/17

4 01/16/18 5,127. 01/16/18 1,620. GA 01/16/18

M
Tot Estimated
Payments 20,508. 6,480.

Tax Payments Other Than Withholding Federal State ID Local ID

(If multiple states, see Tax Help)
T
6 Overpayments applied to 2017
NO
7 Credited by estates and trusts
8 Totals Lines 1 through 7 20,508. 6,480.
9 2017 extensions

Taxes Withheld From: Federal State Local

10 Forms W-2
11 Forms W-2G
12 Forms 1099-R
13 Forms 1099-MISC, 1099-K and 1099-G
14 Schedules K-1
15 Forms 1099-INT, DIV and OID
DO

16 Social Security and Railroad Benefits

17 Form 1099-B St Loc
18 a Other withholding St Loc
b Other withholding St Loc
c Other withholding St Loc
d Additional Medicare Tax
19 Total Withholding Lines 10 through 18d

20 Total Tax Payments for 2017 20,508. 6,480.

Prior Year Taxes Paid In 2017 State ID Local ID

(If multiple states or localities, see Tax Help)

21 Tax paid with 2016 extensions

22 2016 estimated tax paid after 12/31/2016 1,638. GA
23 Balance due paid with 2016 return
24 Other (amended returns, installment payments, etc)
 Schedule A State and Local Tax Deduction Worksheet 2017
Line 5 G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

State and Local Income Taxes

State income taxes:

1 State income tax withheld 1

L
2 2017 state estimated taxes paid in 2017 2 4,860.
3 2016 state estimated taxes paid in 2017 3 1,638.
4 Amount paid with 2016 state application for extension 4
5 Amount paid with 2016 state income tax return 5

AI
6 Overpayment on 2016 state income tax return applied to 2017 tax 6
7 Other amounts paid in 2017 (amended returns, installment payments, etc.) 7
8 State estimated tax from Schedule(s) K-1 (Form 1041) 8
Local income taxes:
9 Local income tax withheld 9
10 2017 local estimated taxes paid in 2017 10

M
11 2016 local estimated taxes paid in 2017 11
12 Amount paid with 2016 local application for extension 12
13 Amount paid with 2016 local income tax return 13
14 Overpayment on 2016 local income tax return applied to 2017 tax 14
15 Other amounts paid in 2017 (amended returns, installment payments, etc.) 15
16 Local estimated tax from Schedule(s) K-1 (Form 1041) 16
Other:
17
18
19
Total Add lines 1 through 17
State and local refund allocated to 2017
T 17
18
19
6,498.
18.
20 Nondeductible state income tax from line 28 20
NO
21 Total reductions Add lines 19 and 20. 21 18.
22 Total state and local income tax deduction Line 18 less line 21 22 6,480.

Nondeductible State Income Tax (Hawaii Only)

23 Nontaxable federal employee cost of living allowance 23

24 Adjusted gross income 24
25 Add lines 23 and 24 25
26 Nondeductible percent. Line 23 divided by line 25 26 %
27 Hawaii state income tax included in line 18 27
28 Nondeductible Hawaii state income tax. Multiply line 26 by line 27. 28
DO
 Charitable Contributions Summary 2017
G Keep for your records
Name(s) Shown on Return Social Security Number
JOSEPH & SARAH KANCLERZ 592-60-0414
Part I Cash Contributions Summary
(a) (b) (c) (d)
Name of Charitable Organization Total 50% 30% 100%
Limit Limit Limit

PRINCE OF PEACE 14,820. 14,820.

L
VARIOUS CONTRIBUTIONS 500. 500.

AI
Totals: 15,320. 15,320.
Part II Non-Cash Contributions Summary

M
Total Other Property Capital Gain Property

(a) (b) (c) (d) (e)

Name of Charitable Organization Total 50% 30% 30% 20%
Limit Limit Limit Limit
T
NO

Totals:

Part III Contribution Carryovers to 2018

Total Cash and Other Capital Gain
Non-Capital Gain Property Property

(a) (b) (c) (d) (e) (f)

Total 100% 50% 30% 30% 20%
Limit Limit Limit Limit Limit
DO

1 2017 contributions 15,320. 15,320.

2 2017 contributions
allowed 15,320. 0. 15,320. 0. 0. 0.
3 Carryovers from:
a 2016 tax year
b 2015 tax year
c 2014 tax year
d 2013 tax year
e 2012 tax year
4 Carryovers
allowed in 2017 0. 0. 0. 0. 0.
5 Carryovers
disallowed in 2017 0. 0. 0. 0. 0.
6 Carryovers to 2018:
a From 2017 0. 0. 0. 0. 0.
b From 2016
c From 2015
d From 2014
e From 2013
f From 2012
 Earned Income Worksheet 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Part I ' Earned Income Credit Wks Computation Taxpayer Spouse Total

1 If filing Schedule SE:

a
Net self-employment income
b
Optional Method and Church Employee income

L
c
Add lines 1a and 1b
d
One-half of self-employment tax
e
Subtract line 1d from line 1c
2 If not required to file Schedule SE:

AI
a Net farm profit or (loss)
b Net nonfarm profit or (loss)
c Add lines 2a and 2b
3 If filing Schedule C or C-EZ as a statutory
employee, enter the amount from line 1
of that Schedule C or C-EZ

M
4 Add lines 1e, 2c and 3. To EIC Wks, line 5

Part II ' Form 2441 and Standard Deduction Worksheet Computations

5 Net self-employment earnings (line 4 above)

6 Wages, salaries, and tips less distributions
from nonqualified or section 457 plans, etc 50,000. 5,300. 55,300.
7a

8
b
Taxable employer-provided adoption benefits
Foreign earned income exclusion
Add lines 5 through 7b. To Form 2441, lines 19
T
and 20 50,000. 5,300. 55,300.
NO
9a Taxable dependent care benefits
b Nontaxable combat pay
10 Add lines 8, 9a & 9b . To Form 2441, lines
4 and 5 50,000. 5,300. 55,300.
11 Scholarship or fellowship income not on W-2
12 SE exempt earnings less nontaxable income
13 Distributions from nonqualified/Sec. 457 plans
14 Add lines 5, 6, 7a, 9a and 11 through 13.
To Standard Deduction Worksheet 50,000. 5,300. 55,300.

Part III ' IRA Deduction Worksheet Computation

DO

15 Net self-employment income or (loss)

16 Wages, salaries, tips, etc 50,000. 5,300. 55,300.
17 Net self-employment loss
18 Alimony received
19 Nontaxable combat pay
20 Foreign earned income exclusion
21 Keogh, SEP or SIMPLE deduction
22 Combine lines 15 through 21. To IRA Wks, ln 2 50,000. 5,300. 55,300.

Part IV ' Schedule 8812 and Child Tax Credit Line 11 Worksheet Computations

23 Self-employed, church and statutory employees

24 Wages, salaries, tips, etc 50,000. 5,300. 55,300.
25 Nontaxable combat pay
26 Combine lines 23 through 25. To Schedule
8812, line 4a & Line 11 Wks, line 2 50,000. 5,300. 55,300.
 Schedule E Schedule E Worksheet 2017
G Keep for your records

Name(s) shown on return Social Security No.

JOSEPH & SARAH KANCLERZ 592-60-0414

General Information:
Property description CONDO
Property type 1 Single Family Residence If type is other, enter a description
Location (street address) 515 TOPSOIL BLVD

L
City MIRAMAR BEACH State FL ZIP code 32550
If a foreign address: Foreign province or state
Foreign postal code Foreign country

AI
Complete For All Properties:
Did you make any payments that would require you to file Form(s) 1099? Yes No X
If yes, did you or will you file all required Form(s) 1099? Yes No

Complete For All Rental Properties:

Days rented at fair rental value 365 Days of personal use 0

M
Check All That Apply:
A Owned by spouse B Owned jointly
C Active participation X D Material participation X
E Qualified joint venture F Some investment is not at risk
G Other passive exceptions H Complete taxable disposition - See Help
Trade or business not subject to net investment income tax

J
I
T
Treat all MACRS assets for this activity as qualified Indian reservation property?
Treat all assets acquired after August 27, 2005 as
qualified GO Zone property? Regular
Yes

Extension
No

No
X

X
K Treat all assets acquired after May 4, 2007 as
NO
qualified Kansas Disaster Zone property? Yes No X
L Was this activity located in a Qualified Disaster Area? Yes No X
M Check this box if filing this Schedule E as an LLC in CA

Ownership Percentage:
N Check to allocate income and expenses using ownership percentage
O Enter ownership percentage %

Owner-Occupied Rentals:
P Check to allocate personal use items to Schedule A
Q Percentage of rental use %
DO

Vacation Home or Property with Personal Use Days:

R Check to allocate interest and taxes using the Tax Court Method
S Number of days property owned if less than the entire year
Property Location Page 2
515 TOPSOIL BLVD, MIRAMAR BEACH, FL 32550
Income % if Different Total
3 Enter rental income (not reported elsewhere) 10,781.
Rental income from Form 1099-MISC
Rental income from Form 1099-K
Rental Income from Cancellation of Debt Wks
Total rents received 10,781. 100.000000 10,781.
4 Enter royalties received (not reported elsewhere)
Royalty income from Form 1099-MISC

L
Royalty income from Form 1099-K
Royalty Income from Cancellation of Debt Wks
Royalty Income from Schedule K-1
Total royalties received

AI
(a) (b) (c) (d) (e)
Expenses Total Enter % Reported On Vacation Allocated to
if not Schedule E Home Loss Personal
100.00 Limitation use
5 Advertising

M
6a Auto
b Travel
7 Cleaning and maint 1,985. 1,985.
8 Commissions
9a Mort insur qualified
From Form 1098 import
Total mort insur qual

10
11
b Other Insurance
Legal & other prof fees
Management fees
T
12 a Mortgage int qualified
NO
From Form 1098 import
Total mort int qualified
b Mort int other
From Form 1098 import
Total mort int other
13 Other interest
14 Repairs 1,085. 1,085.
15 Supplies 380. 380.
16 a Real estate taxes
From Form 1098 import
Total real estate taxes
DO

b Other taxes 2,343. 2,343.

17 Utilities 692. 692.
18 a Depreciation 3,000. 3,000.
b Depletion
c Depreciation carryover
19 Other expenses
a HOA 9,633. 9,633.
b
c
d
e Indirect operating exp
f Operating exp carryover
g Vehicle rental
h Amortization
20 Add lines 5 through 19 19,118. 19,118.
21 Income or (loss) -8,337.
22 Deductible rental real estate loss 0.
 Schedule E Schedule E Worksheet 2017
G Keep for your records

Name(s) shown on return Social Security No.

JOSEPH & SARAH KANCLERZ 592-60-0414

General Information:
Property description 1351 LOOWIT FALLS WAY
Property type 1 Single Family Residence If type is other, enter a description
Location (street address) 1351 LOOWIT FALLS WAY

L
City BRASELTON State GA ZIP code 30517
If a foreign address: Foreign province or state
Foreign postal code Foreign country

AI
Complete For All Properties:
Did you make any payments that would require you to file Form(s) 1099? Yes No X
If yes, did you or will you file all required Form(s) 1099? Yes No

Complete For All Rental Properties:

Days rented at fair rental value 365 Days of personal use 0

M
Check All That Apply:
A Owned by spouse B Owned jointly
C Active participation X D Material participation X
E Qualified joint venture F Some investment is not at risk
G Other passive exceptions X H Complete taxable disposition - See Help
Trade or business not subject to net investment income tax

J
I
T
Treat all MACRS assets for this activity as qualified Indian reservation property?
Treat all assets acquired after August 27, 2005 as
qualified GO Zone property? Regular
Yes

Extension
No

No
X

X
K Treat all assets acquired after May 4, 2007 as
NO
qualified Kansas Disaster Zone property? Yes No X
L Was this activity located in a Qualified Disaster Area? Yes No X
M Check this box if filing this Schedule E as an LLC in CA

Ownership Percentage:
N Check to allocate income and expenses using ownership percentage
O Enter ownership percentage %

Owner-Occupied Rentals:
P Check to allocate personal use items to Schedule A
Q Percentage of rental use %
DO

Vacation Home or Property with Personal Use Days:

R Check to allocate interest and taxes using the Tax Court Method
S Number of days property owned if less than the entire year
Property Location Page 2
1351 LOOWIT FALLS WAY, BRASELTON, GA 30517
Income % if Different Total
3 Enter rental income (not reported elsewhere) 18,000.
Rental income from Form 1099-MISC
Rental income from Form 1099-K
Rental Income from Cancellation of Debt Wks
Total rents received 18,000. 100.000000 18,000.
4 Enter royalties received (not reported elsewhere)
Royalty income from Form 1099-MISC

L
Royalty income from Form 1099-K
Royalty Income from Cancellation of Debt Wks
Royalty Income from Schedule K-1
Total royalties received

AI
(a) (b) (c) (d) (e)
Expenses Total Enter % Reported On Vacation Allocated to
if not Schedule E Home Loss Personal
100.00 Limitation use
5 Advertising

M
6a Auto
b Travel
7 Cleaning and maint
8 Commissions
9a Mort insur qualified
From Form 1098 import
Total mort insur qual

10
11
b Other Insurance
Legal & other prof fees
Management fees
864.
T 864.

12 a Mortgage int qualified

NO
From Form 1098 import
Total mort int qualified
b Mort int other
From Form 1098 import
Total mort int other
13 Other interest
14 Repairs
15 Supplies
16 a Real estate taxes
From Form 1098 import
Total real estate taxes
DO

b Other taxes
17 Utilities
18 a Depreciation 8,727. 8,727.
b Depletion
c Depreciation carryover
19 Other expenses
a HOA 500. 500.
b
c
d
e Indirect operating exp
f Operating exp carryover
g Vehicle rental
h Amortization
20 Add lines 5 through 19 10,091. 10,091.
21 Income or (loss) 7,909.
22 Deductible rental real estate loss -7,909.
 Schedule K-1 Shareholder’s Share of Income, Credits, 2017
(Form 1120S) Deductions, etc.
G Keep for your records

Shareholder’s Name Social Security Number

JOSEPH KANCLERZ 592-60-0414

Part I Information About the Corporation

A Corporation’s Employer Identification Number 26-2419950

L
B Corporation’s
Name SOUTHERN SURGICAL ASSISTANTS LLC
Address
City

AI
State
ZIP Code

Part II Information About the Shareholder

Shareholder is Taxpayer X Spouse Joint

M
At-Risk Status (check one):
All investment in corporation is at-risk X
Some investment in corporation not at-risk

Final / Amended Final K-1 and Amended K-1 Checkboxes

Final K-1 Amended K-1

Part III
T
Shareholder’s Share of Current Year Income, Deductions, Credits, Other Items

1 Ordinary business income (loss) 213,433.

NO
Check if "materially" participated in the business activities X
2 Net rental real estate income (loss)
Check if "materially" participated in rental real estate activities
Check if "actively" participated in rental real estate activities
Check if rental of property is a type subject to recharacterization rules
Check if rental real estate activity is a trade or business.
3 Other net rental income (loss)
Check if rental of property is a type subject to recharacterization rules
Check if rental activity is a trade or business
4 Interest income
Interest income from U.S. obligations included in box 4
DO

5 a Ordinary dividends
5 b Qualified dividends
Interest income from U.S. obligations included in box 5
6 Royalties
Double-click to link royalties to Schedule E Worksheet
JOSEPH KANCLERZ 592-60-0414 Page 2
Corporation Name: SOUTHERN SURGICAL ASSISTANTS LLC

Part III Shareholder’s Share of Current Year Income, Deductions, Other Items (continued)

7 Net short-term capital gain (loss)

8 a Net long-term capital gain (loss)
8 b Collectibles (28%) gain (loss)
8 c Unrecaptured section 1250 gain
9 Net section 1231 gain (loss)
10 Other income (loss)

L
Code Description Amount

AI
11 Section 179 deduction 70,610.
12 Other deductions
Code Description Amount

M
13 Credits & credit recapture
Code Description Amount
T
NO
14 Foreign transactions
A Name of country or U.S. possession
Code Description Amount

15 Alternative minimum tax (AMT) items

Code Description Amount
DO

16 Items affecting shareholder basis

Code Description Amount

17 Other information
Code Description Amount
JOSEPH KANCLERZ 592-60-0414 Page 5
Corporation Name SOUTHERN SURGICAL ASSISTANTS LLC

Section C Income and Loss Reported on Schedule E, Supplemental Income or Loss

Passive Income and Loss Nonpassive Income and Loss

# Description (f) (g) (h) (i) (j)

Loss K-1 Income K-1 Loss K-1 Section 179 Income K-1

L
1 A SOUTHERN SURGICAL ASSISTANTS LLC 70,610. 213,433.

AI
M
T
NO
DO
 Form 1040 Self-Employed Health and Long-Term Care 2017
Line 29 Insurance Deduction Worksheet
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH KANCLERZ 592-60-0414

Name of the trade or business this worksheet is attached to SOUTHERN SURGICAL ASSISTANTS LLC

A Health insurance and long-term care insurance premiums:

L
1 Enter total amount paid during 2017 for health insurance coverage for 2017
for you, your spouse, and your dependents (for this trade or business only).
@ Do not include any amounts already entered on Form 1095-A.
@ Do not include any amounts included on Form 8885, line 4.

AI
@ Do not include any advance monthly payments shown on Form 1099-H
@ Do not include any premiums paid for months you received the benefits
of advance payments for the Health Coverage Tax Credit (Form 8885)
Also enter amounts paid for health insurance for any child of yours who
was under age 27 at the end of 2017, even if the child was not your
dependent. See Help A1 13,714.

M
Enter the total premiums paid during the year for each person covered
under a qualified long-term care insurance contract:
2 Taxpayer’s gross long-term care premiums 2
3 Taxpayer’s allowable long-term care premiums 3
4 Spouse’s gross long-term care premiums 4
5 Spouse’s allowable long-term care premiums 5
6 Dep or child under 27 gross LT care premiums 6
T
7 Dep or child under 27 allowable LT care (see Help) 7
8 Total allowable long-term care premiums, sum of lines A3, A5, and A7
9 Total self-employed health and allowed long-term care insurance
A8

premiums, sum of lines A1 and A8 A9 13,714.

NO
B Enter Medicare wages (Form W-2, box 5) from a S corporation in which you are
a more-than-2% shareholder and in which the insurance plan is established B 50,000.
C Total from Form 2555, line 45 for the owner of this trade or business.
(Foreign Income)
Enter the amount, if any, attributable to this trade or business C

1 Total payments made during 2017 1 13,714.

2 Enter the Medicare wages from the S corporation for a more-than-2%

shareholder in which the health insurance plan is established 2 50,000.
DO

3 Enter the amount from Form 2555, line 45, attributable to the amount
entered on line 2 3

4 Subtract the amount on line 3, if any, from the amount on line 2 4 50,000.

5 Compare the amounts on lines 1 and 4 above. Enter the smaller of the two
amounts here and on Form 1040, line 29 (1040NR, line 29) 5 13,714.

Allocation of SE Health and Long-Term Care Premiums on Line 5

SE health insurance premium allowed as adjustment 13,714.

SE long-term care premium allowed as adjustment - Taxpayer 0.
SE long-term care premium allowed as adjustment - Spouse 0.
SE long-term care premium allowed as adjustment - Dep or child under 27 0.
 Federal Carryover Worksheet 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

2016 State and Local Income Tax Information

(a) (b) (c) (d) (e) (f) (g)

State or Paid With Estimates Pd Total With- Paid With Total Over- Applied
Local ID Extension After 12/31 held/Pmts Return payment Amount

L
GA 1,638. 6,592. 73.

AI
Totals 1,638. 6,592. 73.

2016 State Extension Information 2016 Locality Extension Information

(a) (b) (a) (b)

M
State Paid With Extension Locality Paid With Extension

2016 State Estimates Information T 2016 Locality Estimates Information

(a) (c) (a) (c)

State Estimates Paid After 12/31 Locality Estimates Paid After 12/31
GA 1,638.
NO
2016 State Taxes Due Information 2016 Locality Taxes Due Information

(a) (e) (a) (e)

State Paid With Return Locality Paid With Return

2016 State Refund Applied Information 2016 Locality Refund Applied Information
DO

(a) (g) (a) (g)

State Applied Amount Locality Applied Amount

2016 State Tax Refund Information 2016 Locality Tax Refund Information

(a) (d) (f) (a) (d) (f)

Total Total Total Total
State Withheld/Pmts Overpayment Locality Withheld/Pmts Overpayment
GA 6,592. 73.
Federal Carryover Worksheet page 2 2017

JOSEPH & SARAH KANCLERZ 592-60-0414

Other Tax and Income Information 2016 2017

1 Filing status 1 2 MFJ 2 MFJ

2 Number of exemptions for blind or over 65 (0 - 4) 2
3 Itemized deductions 3 35,351. 54,272.
4 Check box if required to itemize deductions 4

L
5 Adjusted gross income 5 161,730. 184,614.
6 Tax liability for Form 2210 or Form 2210-F 6 18,569. 18,986.
7 Alternative minimum tax 7
8 Federal overpayment applied to next year estimated tax 8

AI
QuickZoom to the IRA Information Worksheet for IRA information

Excess Contributions 2016 2017

9a Taxpayer’s excess Archer MSA contributions as of 12/31 9a

M
b Spouse’s excess Archer MSA contributions as of 12/31 b
10 a Taxpayer’s excess Coverdell ESA contributions as of 12/31 10 a
b Spouse’s excess Coverdell ESA contributions as of 12/31 b
11 a Taxpayer’s excess HSA contributions as of 12/31 11 a
b Spouse’s excess HSA contributions as of 12/31 b

Loss and Expense Carryovers 2016 2017

Note: Enter all entries as a positive amount

12 a Short-term capital loss

T 12 a
b AMT Short-term capital loss b
NO
13 a Long-term capital loss 13 a
b AMT Long-term capital loss b
14 a Net operating loss available to carry forward 14 a
b AMT Net operating loss available to carry forward b
15 a Investment interest expense disallowed 15 a
b AMT Investment interest expense disallowed b
16 Nonrecaptured net Section 1231 losses from: a 2017 16 a
b 2016 b
c 2015 c
d 2014 d
e 2013 e
DO

f 2012 f
17 AMT Nonrecap’d net Sec 1231 losses from: a 2017 17 a
b 2016 b
c 2015 c
d 2014 d
e 2013 e
f 2012 f
Federal Carryover Worksheet page 3 2017

JOSEPH & SARAH KANCLERZ 592-60-0414

Credit Carryovers 2016 2017

18 General business credit 18

19 Adoption credit from: a 2017 19 a
b 2016 b
c 2015 c
d 2014 d

L
e 2013 e
f 2012 f
20 Mortgage interest credit from: a 2017 20 a
b 2016 b

AI
c 2015 c
d 2014 d
21 Credit for prior year minimum tax 21
22 District of Columbia first-time homebuyer credit 22
23 Residential energy efficient property credit 23

M
Other Carryovers 2016 2017

24 Section 179 expense deduction disallowed 24 0.

25 Excess a Taxpayer (Form 2555, line 46) 25 a
foreign b Taxpayer (Form 2555, line 48) b
housing c Spouse (Form 2555, line 46) c
deduction: d Spouse (Form 2555, line 48) d

Charitable Contribution Carryovers

T
26 2016 Carryover of Other Property Capital Gain
NO
charitable contributions
from: (a) 50% (b) 30% (c) 30% (d) 20%

a 2016
b 2015
c 2014
d 2013
e 2012

27 2017 Carryover of Other Property Capital Gain

charitable contributions
DO

from: (a) 50% (b) 30% (c) 30% (d) 20%

a 2017
b 2016
c 2015
d 2014
e 2013
 Form 8582 Modified Adjusted Gross Income Worksheet 2017
Line 7 G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Description Amount

Income

L
Wages 55,300.
Interest income before Series EE bond exclusion
Dividend income 150.
Tax refund 55.

AI
Alimony received
Nonpassive business income or loss
Royalty and nonpassive rental activities income or loss
Nonpassive partnership income or loss
Nonpassive S corporation income or loss 142,823.
Nonpassive farm rental income or loss

M
Nonpassive farm income or loss
Nonpassive estate and trust income or loss
Real estate mortgage investment conduits
Business gains and losses from nonpassive activities
Capital gains and losses
Taxable IRA distributions
Taxable pension distributions
Unemployment compensation
Other income
T
Total income 198,328.
NO
Adjustments

Educator expenses
Certain business expenses of reservists, performing artists, and government officials
Health savings account deduction
Moving expenses
Self-employed SEP, SIMPLE, and qualified plans
Self-employed health insurance deduction 13,714.
Penalty on early withdrawals of savings
Alimony paid
DO

Other adjustments

Total adjustments 13,714.

Modified adjusted gross income 184,614.

 AI
Form 4562 Depreciation and Amortization Report 2017
Tax Year 2017
G Keep for your records
JOSEPH & SARAH KANCLERZ
Sch E - 515 TOPSOIL BLVD 592-60-0414
Asset Description * Code Date Cost Land Bus Section Special Depreciable Method/ Prior Current

M
In Service (Net of Use % 179 Depreciation Basis Life Convention Depreciation Depreciation
Land) Allowance
DEPRECIATION
CONDO FL 03/01/11 82,500 5,000 100.00 82,500 27.5 SL/MM 17,375 3,000
SUBTOTAL PRIOR YEAR 82,500 5,000 0 0 82,500 17,375 3,000

TOTALS 82,500 5,000 0 0 82,500 17,375 3,000

T
NO
DO

* Code: S = Sold, A = Auto, L = Listed, V = Vine with SDA in Year Planted/Grafted, X = Non-depreciated asset, H = Home Office

Page 1 of 1
 AI
Form 4562 Depreciation and Amortization Report 2017
Tax Year 2017
G Keep for your records
JOSEPH & SARAH KANCLERZ
Sch E - 1351 LOOWIT FALLS WAY 592-60-0414
Asset Description * Code Date Cost Land Bus Section Special Depreciable Method/ Prior Current

M
In Service (Net of Use % 179 Depreciation Basis Life Convention Depreciation Depreciation
Land) Allowance
DEPRECIATION
1351 LOOWIT FALLS WAY 10/01/12 240,000 10,000 100.00 240,000 27.5 SL/MM 36,726 8,727
SUBTOTAL PRIOR YEAR 240,000 10,000 0 0 240,000 36,726 8,727

TOTALS 240,000 10,000 0 0 240,000 36,726 8,727

T
NO
DO

* Code: S = Sold, A = Auto, L = Listed, V = Vine with SDA in Year Planted/Grafted, X = Non-depreciated asset, H = Home Office

Page 1 of 1
 AI
Form 4562 Alternative Minimum Tax Depreciation Report 2017
Tax Year 2017
G Keep for your records
JOSEPH & SARAH KANCLERZ
Sch E - 515 TOPSOIL BLVD 592-60-0414
Asset Description * Code Date Cost Land Bus Section Special Depreciable Method/ Prior Current Adjustments

M
In Service (Net of Use % 179 Depreciation Basis Life Convention Depreciation Depreciation Preferences
Land) Allowance
DEPRECIATION
CONDO FL 03/01/11 82,500 5,000 100.00 82,500 27.5 SL/MM 17,375 3,000 0.
SUBTOTAL PRIOR YEAR 82,500 5,000 0 0 82,500 17,375 3,000 0.

TOTALS 82,500 5,000 0 0 82,500 17,375 3,000 0.

T
NO
DO

* Code: S = Sold, A = Auto, L = Listed, V = Vine with SDA in Year Planted/Grafted, X = Non-depreciated asset H = Home Office

Page 1 of 1
 AI
Form 4562 Alternative Minimum Tax Depreciation Report 2017
Tax Year 2017
G Keep for your records
JOSEPH & SARAH KANCLERZ
Sch E - 1351 LOOWIT FALLS WAY 592-60-0414
Asset Description * Code Date Cost Land Bus Section Special Depreciable Method/ Prior Current Adjustments

M
In Service (Net of Use % 179 Depreciation Basis Life Convention Depreciation Depreciation Preferences
Land) Allowance
DEPRECIATION
1351 LOOWIT FALLS WAY 10/01/12 240,000 10,000 100.00 240,000 27.5 SL/MM 36,726 8,727 0.
SUBTOTAL PRIOR YEAR 240,000 10,000 0 0 240,000 36,726 8,727 0.

TOTALS 240,000 10,000 0 0 240,000 36,726 8,727 0.

T
NO
DO

* Code: S = Sold, A = Auto, L = Listed, V = Vine with SDA in Year Planted/Grafted, X = Non-depreciated asset H = Home Office

Page 1 of 1
 Section 179 Expense Report 2017
G Keep for your records PAGE 1

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Description Business Use Elected

Activity of Cost/Basis Section 179
Property Expense

L
AI
M
T
NO
DO

From K-1(s): Current year 70,610.

Prior year carryover

Totals: Current year 70,610.

Prior year carryover

 Two-Year Comparison 2017

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ

Income 2016 2017 Difference %

Wages, salaries, tips, etc 59,122. 55,300. -3,822. -6.46

Interest and dividend income 186. 150. -36. -19.35
State tax refund 3,002. 55. -2,947. -98.17
Business income (loss)

L
Capital and other gains (losses)
IRA distributions
Pensions and annuities 0. 0.
Rents and royalties -13,821. 0. 13,821. 100.00

AI
Partnerships, S Corps, etc 125,552. 142,823. 17,271. 13.76
Farm income (loss)
Social security benefits
Income other than the above
Total Income 174,041. 198,328. 24,287. 13.95
Adjustments to Income 12,311. 13,714. 1,403. 11.40

M
Adjusted Gross Income 161,730. 184,614. 22,884. 14.15

Itemized Deductions
Medical and dental 0. 0. 0.
Income or sales tax 4,954. 6,480. 1,526. 30.80
Real estate taxes 6,350. 10,026. 3,676. 57.89
Personal property and other taxes 2,505. 4,399. 1,894. 75.61
Interest paid
Gifts to charity
Casualty and theft losses
T
10,244.
11,298.
18,047.
15,320.
7,803.
4,022.
76.17
35.60

Miscellaneous
NO
Phaseout of itemized deductions
Total Itemized Deductions 35,351. 54,272. 18,921. 53.52
Standard or Itemized Deduction 35,351. 54,272. 18,921. 53.52
Exemption Amount 16,200. 20,250. 4,050. 25.00

Taxable Income 110,179. 110,092. -87. -0.08

Income tax 19,069. 18,986. -83. -0.44

Additional income taxes
Alternative minimum tax
Total Income Taxes 19,069. 18,986. -83. -0.44
DO

Nonbusiness credits 500. -500. -100.00

Business credits
Total Credits 500. -500. -100.00
Self-employment tax
Other taxes
Total Tax After Credits 18,569. 18,986. 417. 2.25
Withholding
Estimated and extension payments 18,736. 20,508. 1,772. 9.46
Earned income credit
Additional child tax credit
Other payments
Total Payments 18,736. 20,508. 1,772. 9.46
Form 2210 penalty
Applied to next year’s estimated tax
Refund 167. 1,522. 1,355. 811.38
Balance Due

Current year effective tax rate 10.28 %

 Schedule E Two-Year Comparison 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Property Location
515 TOPSOIL BLVD, MIRAMAR BEACH, FL 32550
Note: Transferred data will not be displayed in the prior year column unless you have entered
current year data on the Schedule E Worksheet.

L
2016 2016 2017 2017 2016 to 2017
Percent Percent Comparison
of of X as amount

AI
Income* Income* as percent
Income:
1 Rental income 784. 100.00 10,781. 100.00 9997.00
2 Royalty income
Expenses:
3 Advertising

M
4 Auto 2,122. 270.66 -2122.00
5 Travel
6 Cleaning & maintenance 1,985. 18.41 1985.00
7 Commissions
8 Insurance:
a Mortgage Insur qualified
b Other insurance 851. 108.55 -851.00
9
10
11
Legal & professional
Management fees
Mortgage interest:
T
a Qualified 738. 94.13 -738.00
NO
b Other
12 Other interest
13 Repairs 1,085. 10.06 1085.00
14 Supplies 380. 3.52 380.00
15 a Real estate taxes 994. 126.79 -994.00
b Other taxes 2,343. 21.73 2343.00
16 Utilities 692. 6.42 692.00
17 a Depreciation 3,000. 382.65 3,000. 27.83 0.00
b Depletion
c Depreciation carryover
18 a Other expenses 500. 63.78 9,633. 89.35 9133.00
DO

b Indirect operating exp

c Operating exp carryover
d Vehicle rental
e Amortization
19 Total expenses 8,205. 999.00 19,118. 177.33 10913.00
20 Income or (loss) -7,421. -946.56 -8,337. -77.33 -916.00
21 Deductible rental loss -7,421. 0. 7421.00

Passive suspended losses:

Schedule E -19,489. -27,826. -8337.00
Form 4797
Schedule D

*Lines 1 through 20 as a percentage of income.

 Schedule E Two-Year Comparison 2017
G Keep for your records

Name(s) Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Property Location
1351 LOOWIT FALLS WAY, BRASELTON, GA 30517
Note: Transferred data will not be displayed in the prior year column unless you have entered
current year data on the Schedule E Worksheet.

L
2016 2016 2017 2017 2016 to 2017
Percent Percent Comparison
of of X as amount

AI
Income* Income* as percent
Income:
1 Rental income 19,800. 100.00 18,000. 100.00 -1800.00
2 Royalty income
Expenses:
3 Advertising

M
4 Auto 933. 4.71 -933.00
5 Travel
6 Cleaning & maintenance
7 Commissions
8 Insurance:
a Mortgage Insur qualified
b Other insurance 786. 3.97 864. 4.80 78.00
9
10
11
Legal & professional
Management fees
Mortgage interest:
T
a Qualified 9,563. 48.30 -9563.00
NO
b Other 1,035. 5.23 -1035.00
12 Other interest
13 Repairs 1,750. 8.84 -1750.00
14 Supplies
15 a Real estate taxes 2,806. 14.17 -2806.00
b Other taxes
16 Utilities
17 a Depreciation 8,727. 44.08 8,727. 48.48 0.00
b Depletion
c Depreciation carryover
18 a Other expenses 600. 3.03 500. 2.78 -100.00
DO

b Indirect operating exp

c Operating exp carryover
d Vehicle rental
e Amortization
19 Total expenses 26,200. 132.32 10,091. 56.06 -16109.00
20 Income or (loss) -6,400. -32.32 7,909. 43.94 14309.00
21 Deductible rental loss -6,400. -7,909. -1509.00

Passive suspended losses:

Schedule E -11,586. -3,677. 7909.00
Form 4797
Schedule D

*Lines 1 through 20 as a percentage of income.

 Tax Summary Report 2017
Name(s) Shown on Return
JOSEPH & SARAH KANCLERZ

Filing status Married Filing Jointly Number of exemptions 5

Gross Income
Wages and salaries 55,300.
Interest and dividend income 150.
Business income (loss)
Capital gains (losses)
Pensions and annuities 0.

L
Rents, royalties, partnerships, etc 142,823.
Farm income (loss)
Social security benefits
Other income 55.

AI
Total Gross Income 198,328.

Adjustments to Income 13,714.

Adjusted Gross Income (Last year’s AGI) 161,730. 184,614.

Itemized/Standard Deductions

M
Medical and dental 0.
Taxes 20,905.
Interest 18,047.
Contributions 15,320.
Casualty or theft loss(es)
Miscellaneous
Phaseout of itemized deductions
Total Itemized Deductions 54,272.
Standard deduction
Exemption amount
T 20,250.

Taxable Income 110,092.

NO
Income tax 18,986.
Alternative minimum tax
Total Taxes before Credits 18,986.
Nonbusiness credits
Business credits
Total Credits
Self-employment tax
Other taxes

Total Tax 18,986.

DO

Withholding
Estimated tax payments 20,508.
Other payments
Total Payments 20,508.
Estimated tax penalty
Refund applied to next year’s estimated tax

Amount Overpaid 1,522.

Refund 1,522.

Amount Applied to Estimate

Amount Due 0.

Tax bracket 25.0 %

Effective tax rate 10.28 %
Form 1040-ES Estimated Tax Worksheet 2018
G Keep for your records

Name(s) Shown on Return Your Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Part I 2018 Estimated Tax Amount Options

1 Select One of Six Ways to Calculate the Required Annual Payment for 2018 Estimates:
a 100% (110%) of 2017 taxes (default, see Tax Help) X 20,885.
b 100% of tax on 2018 estimated taxable income 20,544.

L
c 90% of tax on 2018 estimated taxable income 18,490.
d 66-2/3% of tax on 2018 estimated taxable income (farmers and fishermen) 13,696.
e Equal to 100% of overpayment (no vouchers) 1,522.
f Enter total amount you want to use for estimates and check box

AI
2 Selected estimated tax amount:
a 2018 Required Annual Payment based on your choice above 20,885.
b Estimated amount of 2018 federal income tax withholding 0.
c Total of estimated tax payments required for 2018 (line 2a less line 2b) 20,885.
3 Select Estimated Tax Payment option:
a Calculate estimates if $1,000 or more (default) X

M
b Calculate estimates if (specify amount) or more
c Calculate estimates regardless of amount
d Do not calculate estimates

Part II Overpayment Application Options

1 Amount of overpayment available (Form 1040, line 75) 1,522.

2
a
b
Select Overpayment Application Amount Option:
Apply none (refund entire overpayment)
Apply all (increase estimate if required)
T X

c Apply to extent of total estimated tax and refund excess 20,888.

NO
d Apply to extent of first quarter amount and refund excess 5,222.
e Enter amount you want to apply
f Amount applied to 2018 estimated tax 0.
g Overpayment to be refunded (line 1 less line 2f) 1,522.
3 Select Overpayment Application Sequence:
a X H Consecutively b H Evenly

Part III Rounding and Printing Options (see Tax Help for printing ES amounts on Client Letter)

1 Select Rounding Option:

aX H Round up to b H Round up to c H Round up to d H Round to
DO

next $1 next $10 next $100 nearest $1

2 Select Voucher Printing Option:
a X H Print (per Part I, lines 3a - c) b H Print only name, etc. c H Do not print vouchers
JOSEPH & SARAH KANCLERZ 592-60-0414 Page 2

Part IV Estimated Tax Payment Summary

1 2 3 4 Total
Apr 17, 2018 Jun 15, 2018 Sep 17, 2018 Jan 15, 2019

1 If the client has already

made payments,
enter amounts
2 Indicate which payment is

L
due next. (e.g. if it is now
April 25, 2018, check col. 2) X

3 Required Payment 5,222. 5,222. 5,222. 5,222. 20,888.

AI
4 Overpayment applied 0. 0. 0. 0. 0.
5 Net payment due 5,222. 5,222. 5,222. 5,222. 20,888.

6 Voucher amounts 5,222. 5,222. 5,222. 5,222. 20,888.

M
Part V Changes to Income, Deductions and Withholding for 2018

2017 income and deductions are shown in the ’2017 Actual’ column below.
*Caution: For each line in the ’2018 Estimated’ column, enter the estimated 2018 amount if different from
2017. Otherwise, the ’2017 Actual’ amount will be used for that line. If zero, you must enter zero.
T 2017 Actual 2018 Estimated
1 a Adjusted gross income 184,614.
b Foreign income or housing exclusions (info only)
2 Net capital gains (losses) included in AGI (info only)
NO
3 a Self-employment profit included in AGI for Taxpayer
b Self-employment profit included in AGI for Spouse
c Taxpayer’s wages subject to Social Security tax included in AGI
Medicare wages for taxpayer (W-2 box 5) included in AGI 50,000.
Add’l 0.9% Medicare tax withheld on taxpayer wages
d Spouse’s wages subject to Social Security tax included in AGI
Medicare wages for spouse (W-2 box 5) included in AGI 6,164.
Add’l 0.9% Medicare tax withheld on spouse wages
4 a Total itemized deductions (after limits) 54,272.
b Net qualified disaster loss included on line 4a above (after limits)
5 Federal income tax withholding 0.
DO

6 Deduction for qualified business income

JOSEPH & SARAH KANCLERZ 592-60-0414 Page 3

Part VI Filing Status and Personal Exemptions for 2018

1 Choose 2018 filing status:

Single X Married filing jointly
Married filing separately Head of Household Qualifying widow(er)
2 Check if required to itemize in 2018
3 Check the boxes that will apply in 2018:
Taxpayer: 65 or Over Blind

L
Spouse: 65 or Over Blind
4 a Check if dependent of another in 2018
b Enter 2018 expected earned income if dependent of another
5 Enter the number of personal exemptions in 2018 5

AI
Part VII 2018 Estimated Taxable Income and Tax

1 Estimated 2018 adjusted gross income 1 184,614.

2 Larger of itemized or standard deduction 2 54,272.
3 Line 1 less line 2 3 130,342.

M
4 Deduction for qualified business income 4
5 Line 3 less line 4 5 130,342.
6 Income tax 6 20,544.
7 Enter additional taxes 7
8 Line 6 plus line 7 8 20,544.
9 Enter nonrefundable credits 9
10 Line 8 less line 9 (but not less than zero) 10 20,544.
11
12
13
T
Self-employment tax and additional 0.9% Medicare tax
Other taxes (not including taxes on lines 6, 7 or 11)
Enter refundable credits (not withholding)
11
12
13
0.

14 Sum of lines 10 - 12, less line 13. This is your 2018 tax based on your
NO
estimate of 2018 income 14 20,544.
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 1

Smart Worksheets from your 2017 Federal Tax Return

SMART WORKSHEET FOR: Form 1040: Individual Tax Return

Tax Smart Worksheet

A Tax 18,986.

L
Check if from:
1 Tax table
2 Tax Computation Worksheet (see instructions)
3 Schedule D Tax Worksheet

AI
4 Qualified Dividends and Capital Gain Tax Worksheet X
5 Schedule J
6 Form 8615
7 Foreign Earned Income Tax Worksheet
B Additional tax from Form 8814
C Additional tax from Form 4972

M
D Tax from additional Form(s) 4972
E Recapture tax from Form 8863
F IRC Section 197(f)(9)(B)(ii) election for an additional tax
G Health Coverage Tax Credit Recovery, Form 8885, Line 5, if negative
H Tax. Add lines A through G. Enter the result here and on line 44 18,986.
T
NO
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 2

SMART WORKSHEET FOR: Schedule A: Itemized Deductions

State and Local Taxes Smart Worksheet

Enter sales tax information below. The greater of sales taxes from line I plus line J, or income taxes
on line K, will flow to line 5. See Help.

A Income from Form 1040, line 38 184,614.

B Nontaxable income entered elsewhere on return 0.

L
C Available income: 2016 refundable credits in excess of tax 0.
D Enter any additional nontaxable income
E Total available income for sales taxes 184,614.

AI
F Sales tax table information:
Enter total (combined) state and local sales tax rate in column (d) for each state listed in column (a).
If AZ, CO, LA, MS, NY or SC column (a):
QuickZoom to Misc Global Options to enter default locality
or Double-click in column (d) to select your locality for each state entered.

(a) (b) (c) (d) (e) (f) (g) (h) (i)

M
ST Lived in Lived in Enter State Local State Local Prorated
State State Total Tax Tax Table Sales or Total
From To Tax Rate Rate (%) Rate (%) Amount Taxes Amount
GA 01/01/17 12/31/17 7.0000 4.0000 3.0000 960. 870. 1,830.

Total general sales taxes from table

T 1,830.
H Enter additions to table amount (motor vehicle, boat)
I Total sales taxes from table plus additions to table amount 1,830.
NO
J Enter actual sales taxes paid (in lieu of table amount)
K Total income taxes paid 6,480.
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 3

SMART WORKSHEET FOR: Schedule A: Itemized Deductions

Mortgage Interest and Points Smart Worksheet

A Enter a description and an amount for fully deductible mortgage interest and points. Check the
box if the mortgage was sold to another lender, or the mortgage has been paid off; the
lender’s name will not transfer to next year’s return.
Check the box if the mortgage interest and/or points are not reported on Form 1098.
Note: When the points must be deducted over the life of the loan, enter this information on

L
the Other Points Smart Worksheet.
If the interest deduction may be limited, enter all information on the Deductible Home Mortgage
Interest Worksheet instead.

AI
QuickZoom to Deductible Home Mortgage Interest Worksheet

Lender’s Name/Description Deductible Fully Paid Not

Mortgage Deductible Off on
Interest Points Form
1098

M
SUNTRUST 8,715.
See Mortgage Interest and Points 9,332.

T
SMART WORKSHEET FOR: Schedule A: Itemized Deductions
NO
A Adjust Home mortgage interest and points reported on Form 1098:
1 Total home mortgage interest and points from 1098’s from detail. 18,047.
2 Enter amount to deduct on Line 10 if different.
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 4

SMART WORKSHEET FOR: Schedule A: Itemized Deductions

Qualified Mortgage Insurance Premiums Smart Worksheet

A Qualified Mortgage Insurance Premiums
1 Principal Residence - Enter the premiums paid in 2017 for qualified mortgage
insurance for a contract entered into after 2006 not from Form 1098 import 1,010.
2 Qualified mortgage insurance premiums from Form 1098 import
3 From office in the home
4 Qualified mortgage insurance premiums from Schedule E Worksheet

L
5 Total qualified mortgage insurance premiums 1,010.
B Amount from Form 1040, line 38 184,614.
C $100,000 ($50,000 if married filing separately) 100,000.

AI
D Is the amount on Line B more than the amount on line C?
No. The deduction is not limited. The amount from
line A above goes on Schedule A, line 13.
X Yes. Line C subtracted from line B. If the result is not a
multiple of $1,000 ($500 if married filing separately),
it is increased to the next multiple of $1,000
($500 if married filing separately). 85,000.

M
E Line D divided by $10,000 ($5,000 if married filing separately). The result
is a decimal. If the result is 1.0 or more then 1.0. 1.0
F Line A multiplied by line E 1,010.
G Qualified mortgage insurance premiums deduction. Line F subtracted
from line A. The result goes on Schedule A, line 13. 0.

SMART WORKSHEET FOR: Schedule A: Itemized Deductions

T
Cash Contributions Smart Worksheet
NO
A Miles driven for charitable purposes:
1 All miles for:
a To perform charitable service
b To deliver noncash contributions
c Total. Add lines a and b
B Cash contributions, enter name of charity, type of charity, and amount:
Caution: Do not enter Hurricane Harvey, Irma or Maria disaster contributions in this smart
worksheet. Instead, use the Hurricane Disaster Areas Smart Worksheet directly
below this smart worksheet.

Name of charity Type Amount

DO

PRINCE OF PEACE 14,820.

VARIOUS CONTRIBUTIONS 500.

JOSEPH & SARAH KANCLERZ 592-60-0414 5

SMART WORKSHEET FOR: State and Local Income Tax Refund Worksheet

2016 Federal Form 1040 Information Smart Worksheet

Use this worksheet to compute taxable refund amount? X Yes No

If no, skip this Smart Worksheet. Total refunds from Line 1 column (b) will be reported as income.

A Did you itemize deductions in 2016? X Yes No

If no, none of your refund from 2016 is reportable as income. Do not complete the

L
remainder of this worksheet.
B Enter the amount from your 2016 Schedule A, line 5, State and local tax 4,954.
If none, enter zero, and do not complete the remainder of this worksheet.

AI
C Which type of taxes were deducted on your 2016 Schedule A, line 5?
1 Income taxes (2016 Schedule A, box 5a, was checked) X
2 General sales taxes (2016 Schedule A, box 5b, was checked)
3 Not applicable
If general sales taxes were deducted, none of the refund from 2016 is reportable
as income. Do not complete the remainder of this worksheet.
D Enter the deduction for general sales taxes that could have been taken in 2016

M
if you know that amount 1,589.
E What was your filing status for 2016?
Single
X Married filing jointly
Married filing separately
Married filing separately and your spouse itemized deductions
Head of household
Qualifying widow(er)
T
F Could be claimed as a dependent by someone else in 2016? Yes X No
G If yes, enter your earned income for 2016
Enter the following amounts from your 2016 Form 1040:
NO
H Line 38, Adjusted gross income 161,730.
I Line 39a, Total number of boxes checked
J Line 40, Itemized deductions or standard deduction 35,351.
K Line 41, Adjusted gross income less itemized or standard deduction 126,379.
L Line 42, Deduction for exemptions 16,200.
M Line 43, Taxable income. Line K less line L (if less than zero, enter as negative) 110,179.
N Line 44, Tax 19,069.
O Line 45, Alternative minimum tax
P Line 46, Excess advance premium tax credit repayment
Q Line 47, Total tax before credits 19,069.
R Line 56, Total tax after credits 18,569.
DO

If your adjusted gross income was greater than $313,800 if filing status was married
filing joint or qualifying widow(er), $287,650 if filing status was head of household,
$261,500 if filing status was single, or $156,900 if filing status was married filing
separately, then also complete the below.
Enter the following amounts from your 2016 Schedule A, Itemized Deductions:
S Line 4, Medical and dental expenses 0.
T Line 9, Taxes 13,809.
U Line 14, Investment interest expense
V Line 15, Interest 10,244.
W Line 19, Charity 11,298.
X Line 20, Casualty and theft losses
Y Line 27, Job expenses and other deductions
Z Line 28, Other miscellaneous deductions
1 Any gambling losses included in line 28
2 Any casualty or theft losses included in line 28
JOSEPH & SARAH KANCLERZ 592-60-0414 6

SMART WORKSHEET FOR: Form 1099-G Worksheet (COPY 1)

Form 1099-G Electronic Filing Information Smart Worksheet

Complete only if filing electronically -See Tax Help for additional info.

Payer 1 Recipient 1
If CORRECTED check here

Payer Information: Recipient Information:

L
State Identification Number Identification Number 592-60-0414
Federal Identification Number 58-6002015 Name
Name, street address, city, state, ZIP code and JOSEPH KANCLERZ

AI
telephone number. Street address Apartment No.
State of GA 5742 ALLEE WAY
PO BOX 105499 City State Zip code
BRASELTON GA 30517
ATLANTA GA 30348 Account No. (optional)
Telephone number Ext:

M
Payer 2 Recipient 2
If CORRECTED check here

Payer Information: Recipient Information:

State Identification Number Identification Number
Federal Identification Number Name
Name, street address, city, state, ZIP code and
telephone number.
T Street address Apartment No.

City State Zip code

NO
Account No. (optional)
Telephone number Ext:

Payer 3 Recipient 3
If CORRECTED check here

Payer Information: Recipient Information:

State Identification Number Identification Number
Federal Identification Number Name
DO

Name, street address, city, state, ZIP code and

telephone number. Street address Apartment No.

City State Zip code

Account No. (optional)

Telephone number Ext:

SMART WORKSHEET FOR: Schedule E Worksheet (515 TOPSOIL BLVD)

This copy of the Worksheet will be on Schedule E, Page 1, Copy 1, Property A
JOSEPH & SARAH KANCLERZ 592-60-0414 7

SMART WORKSHEET FOR: Schedule E Worksheet (515 TOPSOIL BLVD)

Carryovers to 2017 Smart Worksheet

Regular AMT

L
A Section 179 carryover (Enter as a positive number)
At-Risk Losses Carryover
Enter carryover losses as negative numbers.

AI
B Schedule E suspended loss
C Schedule D short-term suspended loss
D Schedule D long-term suspended loss
E Form 4797 ordinary suspended loss
F Form 4797 long-term suspended loss
Passive Losses Carryover
Enter carryover losses as negative numbers.

M
G Schedule E suspended loss -19,489. -19,489.
H Schedule D short-term suspended loss
I Schedule D long-term suspended loss
J Form 4797 ordinary suspended loss
K Form 4797 long-term suspended loss
Vacation Home Carryover
Enter carryover expenses as positive numbers.
L
M
Vacation home operating expenses
Vacation home depreciation
T
NO
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 8

SMART WORKSHEET FOR: Schedule E Worksheet (515 TOPSOIL BLVD)

Activity Summary Smart Worksheet

Supporting information provided by program. NO ENTRIES ARE NEEDED.

A Ownership Taxpayer

L
B At-risk status All
C Passive status Active RE

AI
Regular AMT

Schedule E
D Tentative profit (loss) -8,337. -8,337.
E Other adjustments and preferences
F At-risk disallowed loss

M
G Passive carryover loss -19,489. -19,489.
H Passive disallowed loss -27,826. -27,826.
I Net profit (loss) allowed 0. 0.
Related Disposition
J Tentative profit (loss)
K At-risk disallowed loss
L Passive carryover loss
M
N
Passive disallowed loss
Net profit (loss) allowed
T
NO
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 9

SMART WORKSHEET FOR: Schedule E Worksheet (515 TOPSOIL BLVD)

Carryforward to 2018 Smart Worksheet

Supporting information provided by program. NO ENTRIES ARE NEEDED.

Regular AMT

L
A Section 179 carryover
At-Risk Losses Carryover

AI
B Schedule E suspended loss
C Schedule D short-term suspended loss
D Schedule D long-term suspended loss
E Form 4797 ordinary suspended loss
F Form 4797 long-term suspended loss
Passive Losses Carryover
G Schedule E suspended loss -27,826. -27,826.

M
H Schedule D short-term suspended loss
I Schedule D long-term suspended loss
J Form 4797 ordinary suspended loss
K Form 4797 long-term suspended loss
L Vacation home operating expenses
M Vacation home depreciation T
SMART WORKSHEET FOR: Schedule E Worksheet (1351 LOOWIT FALLS WAY)
NO
This copy of the Worksheet will be on Schedule E, Page 1, Copy 1, Property B
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 10

SMART WORKSHEET FOR: Schedule E Worksheet (1351 LOOWIT FALLS WAY)

Carryovers to 2017 Smart Worksheet

Regular AMT

L
A Section 179 carryover (Enter as a positive number)
At-Risk Losses Carryover
Enter carryover losses as negative numbers.

AI
B Schedule E suspended loss
C Schedule D short-term suspended loss
D Schedule D long-term suspended loss
E Form 4797 ordinary suspended loss
F Form 4797 long-term suspended loss
Passive Losses Carryover
Enter carryover losses as negative numbers.

M
G Schedule E suspended loss -11,586. -11,586.
H Schedule D short-term suspended loss
I Schedule D long-term suspended loss
J Form 4797 ordinary suspended loss
K Form 4797 long-term suspended loss
Vacation Home Carryover
Enter carryover expenses as positive numbers.
L
M
Vacation home operating expenses
Vacation home depreciation
T
NO
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 11

SMART WORKSHEET FOR: Schedule E Worksheet (1351 LOOWIT FALLS WAY)

Activity Summary Smart Worksheet

Supporting information provided by program. NO ENTRIES ARE NEEDED.

A Ownership Taxpayer

L
B At-risk status All
C Passive status Former

AI
Regular AMT

Schedule E
D Tentative profit (loss) 7,909. 7,909.
E Other adjustments and preferences
F At-risk disallowed loss

M
G Passive carryover loss -11,586. -11,586.
H Passive disallowed loss -3,677. -3,677.
I Net profit (loss) allowed 0. 0.
Related Disposition
J Tentative profit (loss)
K At-risk disallowed loss
L Passive carryover loss
M
N
Passive disallowed loss
Net profit (loss) allowed
T
NO
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 12

SMART WORKSHEET FOR: Schedule E Worksheet (1351 LOOWIT FALLS WAY)

Carryforward to 2018 Smart Worksheet

Supporting information provided by program. NO ENTRIES ARE NEEDED.

Regular AMT

L
A Section 179 carryover
At-Risk Losses Carryover

AI
B Schedule E suspended loss
C Schedule D short-term suspended loss
D Schedule D long-term suspended loss
E Form 4797 ordinary suspended loss
F Form 4797 long-term suspended loss
Passive Losses Carryover
G Schedule E suspended loss -3,677. -3,677.

M
H Schedule D short-term suspended loss
I Schedule D long-term suspended loss
J Form 4797 ordinary suspended loss
K Form 4797 long-term suspended loss
L Vacation home operating expenses
M Vacation home depreciation T
SMART WORKSHEET FOR: Sch K-1 Wks-S Corporations (SOUTHERN SURGICAL ASSISTANTS LLC)
NO
Form 4562, Line 12 Smart Worksheet
(Only applies if Summary Form 4562 used)
A Total Section 179 before limitation
B Section 179 allowable, if different -70,610.

SMART WORKSHEET FOR: Estimated Tax Worksheet

Electronic Funds Withdrawal of Estimated Tax Smart Worksheet (Electronic Filing Only)
DO

If the client would like to pay one or more installments of estimated tax by electronic funds
withdrawal, check a box in the first column of the following table and enter bank information on the
Federal Information Worksheet.

X Installment Number Amount Date

1 5,222. April 17, 2018
2 5,222. June 15, 2018
3 5,222. September 17, 2018
4 5,222. January 15, 2019

QuickZoom to the Federal Information Worksheet to enter bank information

JOSEPH & SARAH KANCLERZ 592-60-0414 13

SMART WORKSHEET FOR: Estimated Tax Worksheet

Maximum Capital Gains Rate Tax Information Smart Worksheet

Enter qualified dividends and capital gains (losses) that are included in adjusted gross income.
Enter net losses as negative numbers.
A Dividends qualifying for lower tax rate included in AGI 150.
B Net short-term gains (losses)
C Net long-term gains (losses)
Net 28% rate gains included in net long-term

L
Unrecaptured Section 1250 gains included in net long-term
D Investment income election 0.

AI
M
T
NO
DO
JOSEPH & SARAH KANCLERZ 592-60-0414 1

Additional information from your 2017 Federal Tax Return

SMART WORKSHEET FOR: Schedule A: Itemized Deductions

L
Mortgage Interest and Points Continuation Statement
Lender’s Name/Description Deductible Fully Paid Not
Mortgage Deductible Off on

AI
Interest Points Form
1098

M&T 9,332.
BANK OF AMERICA

M
SIDUS
GE X
Total 9,332.

T
NO
DO
 INSTRUCTIONS FOR INDIVIDUAL AND FIDUCIARIES ESTIMATED TAX (500ES)
WHO MUST FILE ESTIMATED TAX. Each individual or fiduciary subject WHEN AND WHERE TO FILE. Estimated tax required from persons not
to Georgia income tax who reasonably expects to have gross income regarded as farmers or fishermen shall be filed on or before April 15 of
during the year which exceeds (1) personal exemption, plus (2) credit for the taxable year, except if the above requirements are first met on or after
dependents, plus (3) estimated deductions, plus (4) $1,000 o f income April 1 and before June 1, estimated tax must be filed by June 15; on or
not subject to withholding. after June 1 but before September 1, by September 15; and on or after
September 1, by January 15 of the following year. Individuals filing on a
EXCEPTION. Estimated tax is not required if, under an agreement fiscal year basis ending after December 31 must file on corresponding
between the employer and the employee, additional tax is withheld to dates.
cover income that normally would require estimated tax to be filed.
Individuals whose gross income from farming or fishing is at least Make check or money order payable to:
two thirds of the total gross income from all sources may: (a) file
as other taxpayers or (b) file their return by March 1 and pay the “Georgia Department of Revenue”
full amount of tax due by that date. Fiduciaries shall not be

L
required to pay estimated tax with respect to any taxable year ending Payment should be mailed to:
before the date two years after the date of the decedent’s death in the Processing Center
case of: Georgia Department of Revenue
1. The estate of such decedent; or PO Box 740319
Atlanta, Georgia 30374-0319

AI
2. A testamentary trust as defined in IRC Section 6654(l)(2)(B).
PURPOSE OF ESTIMATED TAX. The purpose is to enable taxpayers You may also pay estimated tax with a credit card. Visit our website
having income not subject to withholding to currently pay their income at dor.georgia.gov for more information.
tax. Taxpayers are also required to file an annual return claiming credit
thereon for amounts paid or credited to their estimated tax. HOW TO COMPLETE FORM 500 ES.
PAYMENT OF ESTIMATED TAX. Payment in full of your estimated tax Complete the name and address field located on the upper right side of
may be made with the first required installment or in equal installments coupon. Calculate your estimated tax using the schedule in the tax

M
during this year on or before April 15, June 15, September 15, and the booklet . Line 15 is your estimated tax for the year. Divide Line 15 by the
following January 15. Fiscal year filers should adjust the dates number of quarters of liability (see “When and Where to File” above) to
accordingly. lf the due date falls on a weekend or holiday, the tax compute the amount to be submitted quarterly. Enter this amount on
shall be due on the next day that is not a weekend or holiday. Please Form 500 ES and submit to the Georgia Department of Revenue.
include your Social Security number or FEIN on your check.
HOW TO ESTIMATE YOUR TAX. A schedule for computing your EXEMPTION AMOUNT FOR TAX YEAR 2018
estimated tax and the tax rate schedules are listed in the Tax Booklet. Personal Exemption for self and spouse if married (each)..........$3,700
Personal Exemption for self if not married....................................$2,700
PENALTIES. Failure to comply with the provisions of this law relative to
underpayment of installments may result in the assessment of additional
charges as a penalty. Willful failure to pay estimated tax will constitute a
misdemeanor.
T Dependent Exemption..................................................................$3,000

Maximum Retirement Income Exclusion:

If age 62-64 or less than 62 and permanently disabled..............$35,000
STANDARD DEDUCTION.
If age 65 or older.........................................................................$65,000
NO
Single and head of household ........................................... $2,300
Married filing jointly .............................................................. $3,000 For additional information concerning Individual forms please
Married filing separately .......................................................$1,500 call: 1-877-423-6711.
Additional Deduction:
Age 65 or older .................................. $1,300 Georgia Public Revenue Code Section 48-2-31 stipulates that
Blind ......................................................$1,300 taxes shall be paid in lawful money of the United States, free of
These additional deductions are for you and your spouse only if the any expense to the State of Georgia.
standard deduction is used. These amounts are standard regardless
of income. PLEASE DO NOT STAPLE. PLEASE REMOVE ALL ATTACHED CHECK STUBS.
Cut along dotted line

500 ES (Rev. 06/22/17) Individual or Fiduciary Name and Address:

DO

Individual and Fiduciary Estimated Tax

Payment Voucher J KANCLERZ & S KANCLERZ
5742 ALLEE WAY
1850011515
Calendar Year 2018 BRASELTON GA 30517
or Fiscal Year Ending TYPE OF RETURN: Individual Fiduciary
Taxpayer’s SSN or Fiduciary FEIN Spouse’s SSN Tax Year Quarter Due Date Vendor Code
592-60-0414 259-57-5679 2018 1 04/15/2018 115
PLEASE DO NOT STAPLE. REMOVE ALL CHECK STUBS. If your name and address is incorrect,
mark the change of address box and make
the change in the box below. Address Change

PROCESSING CENTER
GEORGIA DEPARTMENT OF REVENUE
PO BOX 740319
ATLANTA GA 30374-0319 Amount Paid $ 1645.00

50000592600414104151818109200000000011500001645009 REV 11/13/17 PRO

 INSTRUCTIONS FOR INDIVIDUAL AND FIDUCIARIES ESTIMATED TAX (500ES)
WHO MUST FILE ESTIMATED TAX. Each individual or fiduciary subject WHEN AND WHERE TO FILE. Estimated tax required from persons not
to Georgia income tax who reasonably expects to have gross income regarded as farmers or fishermen shall be filed on or before April 15 of
during the year which exceeds (1) personal exemption, plus (2) credit for the taxable year, except if the above requirements are first met on or after
dependents, plus (3) estimated deductions, plus (4) $1,000 o f income April 1 and before June 1, estimated tax must be filed by June 15; on or
not subject to withholding. after June 1 but before September 1, by September 15; and on or after
September 1, by January 15 of the following year. Individuals filing on a
EXCEPTION. Estimated tax is not required if, under an agreement fiscal year basis ending after December 31 must file on corresponding
between the employer and the employee, additional tax is withheld to dates.
cover income that normally would require estimated tax to be filed.
Individuals whose gross income from farming or fishing is at least Make check or money order payable to:
two thirds of the total gross income from all sources may: (a) file
as other taxpayers or (b) file their return by March 1 and pay the “Georgia Department of Revenue”
full amount of tax due by that date. Fiduciaries shall not be

L
required to pay estimated tax with respect to any taxable year ending Payment should be mailed to:
before the date two years after the date of the decedent’s death in the Processing Center
case of: Georgia Department of Revenue
1. The estate of such decedent; or PO Box 740319
Atlanta, Georgia 30374-0319

AI
2. A testamentary trust as defined in IRC Section 6654(l)(2)(B).
PURPOSE OF ESTIMATED TAX. The purpose is to enable taxpayers You may also pay estimated tax with a credit card. Visit our website
having income not subject to withholding to currently pay their income at dor.georgia.gov for more information.
tax. Taxpayers are also required to file an annual return claiming credit
thereon for amounts paid or credited to their estimated tax. HOW TO COMPLETE FORM 500 ES.
PAYMENT OF ESTIMATED TAX. Payment in full of your estimated tax Complete the name and address field located on the upper right side of
may be made with the first required installment or in equal installments coupon. Calculate your estimated tax using the schedule in the tax

M
during this year on or before April 15, June 15, September 15, and the booklet . Line 15 is your estimated tax for the year. Divide Line 15 by the
following January 15. Fiscal year filers should adjust the dates number of quarters of liability (see “When and Where to File” above) to
accordingly. lf the due date falls on a weekend or holiday, the tax compute the amount to be submitted quarterly. Enter this amount on
shall be due on the next day that is not a weekend or holiday. Please Form 500 ES and submit to the Georgia Department of Revenue.
include your Social Security number or FEIN on your check.
HOW TO ESTIMATE YOUR TAX. A schedule for computing your EXEMPTION AMOUNT FOR TAX YEAR 2018
estimated tax and the tax rate schedules are listed in the Tax Booklet. Personal Exemption for self and spouse if married (each)..........$3,700
Personal Exemption for self if not married....................................$2,700
PENALTIES. Failure to comply with the provisions of this law relative to
underpayment of installments may result in the assessment of additional
charges as a penalty. Willful failure to pay estimated tax will constitute a
misdemeanor.
T Dependent Exemption..................................................................$3,000

Maximum Retirement Income Exclusion:

If age 62-64 or less than 62 and permanently disabled..............$35,000
STANDARD DEDUCTION.
If age 65 or older.........................................................................$65,000
NO
Single and head of household ........................................... $2,300
Married filing jointly .............................................................. $3,000 For additional information concerning Individual forms please
Married filing separately .......................................................$1,500 call: 1-877-423-6711.
Additional Deduction:
Age 65 or older .................................. $1,300 Georgia Public Revenue Code Section 48-2-31 stipulates that
Blind ......................................................$1,300 taxes shall be paid in lawful money of the United States, free of
These additional deductions are for you and your spouse only if the any expense to the State of Georgia.
standard deduction is used. These amounts are standard regardless
of income. PLEASE DO NOT STAPLE. PLEASE REMOVE ALL ATTACHED CHECK STUBS.
Cut along dotted line

500 ES (Rev. 06/22/17) Individual or Fiduciary Name and Address:

DO

Individual and Fiduciary Estimated Tax

Payment Voucher J KANCLERZ & S KANCLERZ
5742 ALLEE WAY
1850011515
Calendar Year 2018 BRASELTON GA 30517
or Fiscal Year Ending TYPE OF RETURN: Individual Fiduciary
Taxpayer’s SSN or Fiduciary FEIN Spouse’s SSN Tax Year Quarter Due Date Vendor Code
592-60-0414 259-57-5679 2018 2 06/15/2018 115
PLEASE DO NOT STAPLE. REMOVE ALL CHECK STUBS. If your name and address is incorrect,
mark the change of address box and make
the change in the box below. Address Change

PROCESSING CENTER
GEORGIA DEPARTMENT OF REVENUE
PO BOX 740319
ATLANTA GA 30374-0319 Amount Paid $ 1645.00

50000592600414106151818209200000000011500001645005 REV 11/13/17 PRO

 INSTRUCTIONS FOR INDIVIDUAL AND FIDUCIARIES ESTIMATED TAX (500ES)
WHO MUST FILE ESTIMATED TAX. Each individual or fiduciary subject WHEN AND WHERE TO FILE. Estimated tax required from persons not
to Georgia income tax who reasonably expects to have gross income regarded as farmers or fishermen shall be filed on or before April 15 of
during the year which exceeds (1) personal exemption, plus (2) credit for the taxable year, except if the above requirements are first met on or after
dependents, plus (3) estimated deductions, plus (4) $1,000 o f income April 1 and before June 1, estimated tax must be filed by June 15; on or
not subject to withholding. after June 1 but before September 1, by September 15; and on or after
September 1, by January 15 of the following year. Individuals filing on a
EXCEPTION. Estimated tax is not required if, under an agreement fiscal year basis ending after December 31 must file on corresponding
between the employer and the employee, additional tax is withheld to dates.
cover income that normally would require estimated tax to be filed.
Individuals whose gross income from farming or fishing is at least Make check or money order payable to:
two thirds of the total gross income from all sources may: (a) file
as other taxpayers or (b) file their return by March 1 and pay the “Georgia Department of Revenue”
full amount of tax due by that date. Fiduciaries shall not be

L
required to pay estimated tax with respect to any taxable year ending Payment should be mailed to:
before the date two years after the date of the decedent’s death in the Processing Center
case of: Georgia Department of Revenue
1. The estate of such decedent; or PO Box 740319
Atlanta, Georgia 30374-0319

AI
2. A testamentary trust as defined in IRC Section 6654(l)(2)(B).
PURPOSE OF ESTIMATED TAX. The purpose is to enable taxpayers You may also pay estimated tax with a credit card. Visit our website
having income not subject to withholding to currently pay their income at dor.georgia.gov for more information.
tax. Taxpayers are also required to file an annual return claiming credit
thereon for amounts paid or credited to their estimated tax. HOW TO COMPLETE FORM 500 ES.
PAYMENT OF ESTIMATED TAX. Payment in full of your estimated tax Complete the name and address field located on the upper right side of
may be made with the first required installment or in equal installments coupon. Calculate your estimated tax using the schedule in the tax

M
during this year on or before April 15, June 15, September 15, and the booklet . Line 15 is your estimated tax for the year. Divide Line 15 by the
following January 15. Fiscal year filers should adjust the dates number of quarters of liability (see “When and Where to File” above) to
accordingly. lf the due date falls on a weekend or holiday, the tax compute the amount to be submitted quarterly. Enter this amount on
shall be due on the next day that is not a weekend or holiday. Please Form 500 ES and submit to the Georgia Department of Revenue.
include your Social Security number or FEIN on your check.
HOW TO ESTIMATE YOUR TAX. A schedule for computing your EXEMPTION AMOUNT FOR TAX YEAR 2018
estimated tax and the tax rate schedules are listed in the Tax Booklet. Personal Exemption for self and spouse if married (each)..........$3,700
Personal Exemption for self if not married....................................$2,700
PENALTIES. Failure to comply with the provisions of this law relative to
underpayment of installments may result in the assessment of additional
charges as a penalty. Willful failure to pay estimated tax will constitute a
misdemeanor.
T Dependent Exemption..................................................................$3,000

Maximum Retirement Income Exclusion:

If age 62-64 or less than 62 and permanently disabled..............$35,000
STANDARD DEDUCTION.
If age 65 or older.........................................................................$65,000
NO
Single and head of household ........................................... $2,300
Married filing jointly .............................................................. $3,000 For additional information concerning Individual forms please
Married filing separately .......................................................$1,500 call: 1-877-423-6711.
Additional Deduction:
Age 65 or older .................................. $1,300 Georgia Public Revenue Code Section 48-2-31 stipulates that
Blind ......................................................$1,300 taxes shall be paid in lawful money of the United States, free of
These additional deductions are for you and your spouse only if the any expense to the State of Georgia.
standard deduction is used. These amounts are standard regardless
of income. PLEASE DO NOT STAPLE. PLEASE REMOVE ALL ATTACHED CHECK STUBS.
Cut along dotted line

500 ES (Rev. 06/22/17) Individual or Fiduciary Name and Address:

DO

Individual and Fiduciary Estimated Tax

Payment Voucher J KANCLERZ & S KANCLERZ
5742 ALLEE WAY
1850011515
Calendar Year 2018 BRASELTON GA 30517
or Fiscal Year Ending TYPE OF RETURN: Individual Fiduciary
Taxpayer’s SSN or Fiduciary FEIN Spouse’s SSN Tax Year Quarter Due Date Vendor Code
592-60-0414 259-57-5679 2018 3 09/15/2018 115
PLEASE DO NOT STAPLE. REMOVE ALL CHECK STUBS. If your name and address is incorrect,
mark the change of address box and make
the change in the box below. Address Change

PROCESSING CENTER
GEORGIA DEPARTMENT OF REVENUE
PO BOX 740319
ATLANTA GA 30374-0319 Amount Paid $ 1645.00

50000592600414109151818309200000000011500001645000 REV 11/13/17 PRO

 INSTRUCTIONS FOR INDIVIDUAL AND FIDUCIARIES ESTIMATED TAX (500ES)
WHO MUST FILE ESTIMATED TAX. Each individual or fiduciary subject WHEN AND WHERE TO FILE. Estimated tax required from persons not
to Georgia income tax who reasonably expects to have gross income regarded as farmers or fishermen shall be filed on or before April 15 of
during the year which exceeds (1) personal exemption, plus (2) credit for the taxable year, except if the above requirements are first met on or after
dependents, plus (3) estimated deductions, plus (4) $1,000 o f income April 1 and before June 1, estimated tax must be filed by June 15; on or
not subject to withholding. after June 1 but before September 1, by September 15; and on or after
September 1, by January 15 of the following year. Individuals filing on a
EXCEPTION. Estimated tax is not required if, under an agreement fiscal year basis ending after December 31 must file on corresponding
between the employer and the employee, additional tax is withheld to dates.
cover income that normally would require estimated tax to be filed.
Individuals whose gross income from farming or fishing is at least Make check or money order payable to:
two thirds of the total gross income from all sources may: (a) file
as other taxpayers or (b) file their return by March 1 and pay the “Georgia Department of Revenue”
full amount of tax due by that date. Fiduciaries shall not be

L
required to pay estimated tax with respect to any taxable year ending Payment should be mailed to:
before the date two years after the date of the decedent’s death in the Processing Center
case of: Georgia Department of Revenue
1. The estate of such decedent; or PO Box 740319
Atlanta, Georgia 30374-0319

AI
2. A testamentary trust as defined in IRC Section 6654(l)(2)(B).
PURPOSE OF ESTIMATED TAX. The purpose is to enable taxpayers You may also pay estimated tax with a credit card. Visit our website
having income not subject to withholding to currently pay their income at dor.georgia.gov for more information.
tax. Taxpayers are also required to file an annual return claiming credit
thereon for amounts paid or credited to their estimated tax. HOW TO COMPLETE FORM 500 ES.
PAYMENT OF ESTIMATED TAX. Payment in full of your estimated tax Complete the name and address field located on the upper right side of
may be made with the first required installment or in equal installments coupon. Calculate your estimated tax using the schedule in the tax

M
during this year on or before April 15, June 15, September 15, and the booklet . Line 15 is your estimated tax for the year. Divide Line 15 by the
following January 15. Fiscal year filers should adjust the dates number of quarters of liability (see “When and Where to File” above) to
accordingly. lf the due date falls on a weekend or holiday, the tax compute the amount to be submitted quarterly. Enter this amount on
shall be due on the next day that is not a weekend or holiday. Please Form 500 ES and submit to the Georgia Department of Revenue.
include your Social Security number or FEIN on your check.
HOW TO ESTIMATE YOUR TAX. A schedule for computing your EXEMPTION AMOUNT FOR TAX YEAR 2018
estimated tax and the tax rate schedules are listed in the Tax Booklet. Personal Exemption for self and spouse if married (each)..........$3,700
Personal Exemption for self if not married....................................$2,700
PENALTIES. Failure to comply with the provisions of this law relative to
underpayment of installments may result in the assessment of additional
charges as a penalty. Willful failure to pay estimated tax will constitute a
misdemeanor.
T Dependent Exemption..................................................................$3,000

Maximum Retirement Income Exclusion:

If age 62-64 or less than 62 and permanently disabled..............$35,000
STANDARD DEDUCTION.
If age 65 or older.........................................................................$65,000
NO
Single and head of household ........................................... $2,300
Married filing jointly .............................................................. $3,000 For additional information concerning Individual forms please
Married filing separately .......................................................$1,500 call: 1-877-423-6711.
Additional Deduction:
Age 65 or older .................................. $1,300 Georgia Public Revenue Code Section 48-2-31 stipulates that
Blind ......................................................$1,300 taxes shall be paid in lawful money of the United States, free of
These additional deductions are for you and your spouse only if the any expense to the State of Georgia.
standard deduction is used. These amounts are standard regardless
of income. PLEASE DO NOT STAPLE. PLEASE REMOVE ALL ATTACHED CHECK STUBS.
Cut along dotted line

500 ES (Rev. 06/22/17) Individual or Fiduciary Name and Address:

DO

Individual and Fiduciary Estimated Tax

Payment Voucher J KANCLERZ & S KANCLERZ
5742 ALLEE WAY
1850011515
Calendar Year 2018 BRASELTON GA 30517
or Fiscal Year Ending TYPE OF RETURN: Individual Fiduciary
Taxpayer’s SSN or Fiduciary FEIN Spouse’s SSN Tax Year Quarter Due Date Vendor Code
592-60-0414 259-57-5679 2018 4 01/15/2019 115
PLEASE DO NOT STAPLE. REMOVE ALL CHECK STUBS. If your name and address is incorrect,
mark the change of address box and make
the change in the box below. Address Change

PROCESSING CENTER
GEORGIA DEPARTMENT OF REVENUE
PO BOX 740319
ATLANTA GA 30374-0319 Amount Paid $ 1645.00

50000592600414101151918409200000000011500001645005 REV 11/13/17 PRO

 Instructions for the Individual/Fiduciary (525-TV) Payment Voucher

For faster and more accurate posting to your account, use a payment voucher with a valid scanline
from the Georgia Department of Revenue’s website dor.georgia.gov or one produced by an
approved software company listed at dor.georgia.gov/approved-software-vendors.

Only complete this voucher if you owe taxes.

L
Complete the name and address field located on the upper right side of the voucher.

Please write your SSN or FEIN on your check or money order.

AI
Remove your check stub to keep with your records.
If the due date falls on a weekend or holiday, the tax shall be due on the next day that is not a
weekend or holiday.
If you are filing electronically, mail only your voucher and payment to:

M
Processing Center
Georgia Department of Revenue
P O Box 740323
Atlanta, Georgia 30374-0323
T
If you are filing a paper return; mail your return, 525-TV payment voucher and your payment to
the address that appears on the return.
NO
Georgia Public Revenue Code Section 48-2-31 stipulates that taxes shall be paid in lawful money of the United
States, free of any expense to the State of Georgia.

PLEASE DO NOT mail this entire page. Please cut along dotted line and mail only your voucher and payment.
PLEASE DO NOT STAPLE. PLEASE REMOVE ALL ATTACHED CHECK STUBS.
Cut along dotted line

525-TV (Rev. 06/22/17) Individual or Fiduciary Name and Address:

DO

Individual and Fiduciary Payment Voucher JOSEPH KANCLERZ SARAH KANCLE

5742 ALLEE WAY
2017 1852511516
BRASELTON GA 30517
Amended Return Paper Return Electronically Filed TYPE OF RETURN: Individual Fiduciary
Taxpayer’s SSN or Fiduciary FEIN Spouse’s SSN (if joint or combined return) Tax Year Daytime Telephone Number Vendor Code
592-60-0414 259-57-5679 2017 115
PLEASE DO NOT STAPLE. REMOVE ALL CHECK STUBS.

PROCESSING CENTER
GEORGIA DEPARTMENT OF REVENUE
PO BOX 740323 Amount Paid $ 97 .00
ATLANTA GA 30374-0323

REV 11/13/17 PRO

52500592600414117092120000000000000011500000097002
 DO NOT ERO MUST RETAIN THIS FORM.
E
PLEAS DO NOT SUBMIT THIS FORM TO

MA
GEORGIA DEPARTMENT OF REVENUE

IL!
UNLESS REQUESTED TO DO SO.
IRS DCN OR SUBMISSION ID GA-8453
2017

GEORGIA INDIVIDUAL INCOME TAX DECLARATION FOR ELECTRONIC FILING

SUMMARY OF AGREEMENT BETWEEN TAXPAYER AND ERO OR PAID PREPARER

L
First Name and Initial Last Name Social Security Number

JOSEPH KANCLERZ 592-60-0414

If Joint Return, Spouse’s First Name and Initial Spouse’s Last Name Spouse’s Social Security Number

AI
SARAH KANCLERZ 259-57-5679
Home Address (number and street) Apt Number Daytime Telephone Number

5742 ALLEE WAY

City, Town or Post Office State Zip Code
BRASELTON GA 30517
PART I TAX RETURN INFORMATION

M
1. FederalAdjustedGrossIncome(Form500RU)RUP;,Line8;Form500EZ,Line1).................. 1. 184614
2. GeorgiaTaxableIncome(Form500RU)RUP;,Line15;Form500EZ,Line3).......................... 2. 113942
3. NetGeorgiaTax(Form500RU)RUP;,Line22;Form500EZ,Line6)........................................ 3. 6577
4. %DODQFH'XH )RUP/LQH)RUP;/LQH)RUP(=/LQH  4. 97
5. 5HIXQG )RUP/LQH)RUP;/LQH)RUP(=/LQH  5.
T
PART II DECLARATION OF TAXPAYER(S)
Under penalties of perjury, I declare that the information I have provided to my Electronic Return Originator (ERO) and/or Online Service
Provider and/or Transmitter and the amounts shown in Part I agree with the amounts shown on the corresponding lines of the electronic
portion of my 2017 Georgia Income Tax Return. I declare that I have examined my tax return, including accompanying schedules and
NO
statements, and to the best of my knowledge and belief, my return is true, correct and complete. I consent that the electronic portion of my
return may be sent by my ERO/Online Service Provider/Transmitter.
SIGN
HERE TAXPAYER’S SIGNATURE Date SPOUSE’S SIGNATURE (if joint return, both must sign) Date

PRINT NAME EMAIL ADDRESS

PART III DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER

I DECLARE THAT I HAVE REVIEWED THE ABOVE TAXPAYER’S RETURN AND THAT THE ENTRIES ON THE GA-8453 ARE COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE.
ERO’s Signature _____________________________________________________________ 05/03/2018
Date ______________________
DO

ERO’s
Firm’s Name STRICKLAND & HENDERSON LLC
_______________________________________________________________ Check also if paid preparer
Use
Only Address 804 WASHINGTON ST NW
_______________________________________________________________ FEIN/PTIN 26-1701034
GAINESVILLE GA 305013538
City, State, & Zip Code_________________________________________________________ SSN/TIN
IFPREPAREDBYANYPERSONOTHERTHANTHETAXPAYER,THISDECLARATIONISBASEDON ALLINFORMATIONOF WHICH
THE35(3$5(RHAS ANY KNOWLEDGE.
Paid Preparer’s Signature _____________________________________________________ 05/03/2018
Date ______________________
Paid 26-1701034
Firm’s Name STRICKLAND & HENDERSON LLC
_______________________________________________________________ FID/TIN
Preparer’s P01450266
Use Only Address 804 WASHINGTON ST NW
_______________________________________________________________ SSN/TIN
GAINESVILLE GA 305013538
City, State, & Zip Code_________________________________________________________
GA-8453 (REV 0//17)
KEEP A COPY WITH YOUR RECORDS

REV 12/15/17 PRO

INTUIT 01 115 2017
 1800411518

Georgia Form 500

(Rev. 06/22/17) Page 1 .
Individual Income Tax Return
Georgia Department of Revenue
2017 (Approved software version)

L
Fiscal Year
Beginning

AI
version)
Fiscal Year
Ending YOUR DRIVER’S LICENSE/STATE ID STATE ISSUED

YOUR FIRST NAME MI YOUR SOCIAL SECURITY NUMBER

M
1. JOSEPH 592-60-0414
LAST NAME SUFFIX
KANCLERZ
SPOUSE’S FIRST NAME MI SPOUSE’S SOCIAL SECURITY NUMBER
SARAH 259-57-5679 DEPARTMENT USE ONLY

LAST NAME
KANCLERZ
T SUFFIX
NO
ADDRESS (NUMBER AND STREET or P.O. BOX) (Use 2nd address line for Apt, Suite or Building Number) CHECK IF ADDRESS HAS CHANGED
2. 5742 ALLEE WAY

CITY (Please insert a space if the city has multiple names) STATE ZIP CODE
3. BRASELTON GA 30517

(COUNTRY IF FOREIGN)
DO

Residency Status
4. Enter your Residency Status with the appropriate number................................................................................................................. 4. 1
1. FULL- YEAR RESIDENT 2. PART- YEAR RESIDENT TO 3. NONRESIDENT

Part-Year Residents and Nonresidents must omit Lines 9 thru 14 and use Form 500 Schedule 3.
Filing Status
5. Enter Filing Status with appropriate letter (See I T - 5 1 1 Tax Booklet)...................................................................................
.... .... 5. B
A. Single B.Married filing joint C.Married filing separate(Spouse’s social security number must be entered above) D. Head of Household or Qualifying Widow(er)

6. Number of exemptions (Check appropriate box(es) and enter total in 6c.) 6a. Yourself 6b. Spouse 6c. 2

Pages (1-5) are Required for Processing

REV 11/13/17 PRO
Georgia Form 500 Page 2
Individual Income Tax Return
Georgia Department of Revenue 1800411528 YOUR SOCIAL SECURITY NUMBER
2017 592-60-0414

7a. Number of Dependents (Enter details on Line 7c., and DO NOT include yourself or your spouse)..................................... 7a. 3
7b. Enter the total number of exemptions and dependents (Add Lines 6c and 7a) ............................................................................ 7b. 5

L
7c. Dependents (If you have more than 5 dependents, attach a list of additional dependents)
First Name, MI. Last Name
AIDEN J KANCLERZ

AI
Social Security Number Relationship to You
667-34-6309 SON

First Name, MI. Last Name

M
JOSEPH R KANCLERZ

Social Security Number Relationship to You

670-44-7452 SON

First Name, MI. Last Name

RHETT H
Social Security Number
T
KANCLERZ
Relationship to You
009-87-3189 SON
NO
First Name, MI. Last Name

Social Security Number Relationship to You

First Name, MI. Last Name

DO

Social Security Number Relationship to You

INCOME COMPUTATIONS

If amount on line 8, 9, 10, 13 or 15 is negative, use the minus sign (-). Example -3,456.
8. Federal adjusted gross income (From Federal Form 1040,1040A or 1040 EZ)................................................................ 8. 184614
(Do not use FEDERAL TAXABLE INCOME) If the amount on Line 8 is $40,000 or more, or your gross income is less than your
W-2s you must include a copy of your Federal Form 1040 Pages 1 and 2.
9. Adjustments from Form 500 Schedule 1 (See IT-511 Tax Booklet )............................................................... 9.

10. Georgia adjusted gross income (Net total of Line 8 and Line 9)...................................................................... 10. 184614

Pages (1-5) are Required for Processing REV 11/13/17 PRO

Georgia Form 500 Page 3
Individual Income Tax Return
Georgia Department of Revenue 1800411538 YOUR SOCIAL SECURITY NUMBER
2017 592-60-0414

11. Standard Deduction (Do not use FEDERAL STANDARD DEDUCTION) ...... 11a.
(See IT-511 Tax Booklet)

L
b. Self: 65 or over? Blind?
Total x 1,300=......... 11b.
Spouse: 65 or over? Blind?

AI
c. Total Standard Deduction (Line 11a + Line 11b)................................. 11c.
Use EITHER Line 11c OR Line 12c (Do not write on both lines)
12. Total Itemized Deductions used in computing Federal Taxable Income. If you use itemized deductions, you must include Federal Schedule A

a. Federal Itemized Deductions (Schedule A-Form 1040) ..................... 12a. 54272

M
b. Less adjustments: (See IT-511 Tax Booklet) ................................... 12b. 0
c. Georgia Total Itemized Deductions...................................................... 12c. 54272
13. Subtract either Line 11c or Line 12c from Line 10; enter balance.............. 13. 130342
14a. Enter the number from Line 6c. 2 Multiply by $2,700 for filing status A 14a. 7400
or D OR multiply by $3,700 for filing status B or C
14b. Enter the number from Line 7a. 3
T
Multiply by $3,000............................ 14b. 9000
14c. Add Lines 14a. and 14b. Enter total...................................................... 14c. 16400
NO
15. Georgia taxable income (Line 13 less Line 14c or Schedule 3, Line 14) 15. 113942

16. Tax (Use Tax Table in the IT-511 Tax Booklet).......................................... 16. 6577

17. Low Income Credit 17a. 17b. ........................ 17c.

18. Other State(s) Tax Credit (Include a copy of the other state(s) return)........ 18.

19. Credits used from IND-CR Summary Worksheet ....................................... 19.

DO

20. Total Credits Used from Schedule 2 Georgia Tax Credits .............................. 20.

21. Total Credits Used (sum of Lines 17-20) cannot exceed Line 16 ........................ 21. 0
22. Balance (Line 16 less Line 21) if zero or less than zero, enter zero ...... 22. 6577
23. Georgia Income Tax Withheld on Wages and 1099s ..................... 23.
(Enter Tax Withheld Only and include W-2s and/or 1099s)

24. Other Georgia Income Tax Withheld................................................ 24.

(Must include G2-A, G2-FL, G2-LP and/or G2-RP)

PLEASE COMPLETE INCOME STATEMENT DETAILS ON PAGE 4. REV 11/13/17 PRO

Pages (1-5) are Required for Processing

INTUIT 02 1555 115 2017 GA 004 T1 17
Georgia Form 500 Page 4
Individual Income Tax Return
Georgia Department of Revenue 1800411548 YOUR SOCIAL SECURITY NUMBER
2017 592-60-0414

INCOME STATEMENT DETAILS Only enter income on which Georgia Tax was withheld. Enter W-2s, 1099s, and G2-As on Line 4 GA Wages/Income. For
other income statements complete Line 4 using the income reported from Form G2-RP Line 12 or 13; Form G2-LP Line 11, or for Form G2-FL enter zero.

L
(INCOME STATEMENT A) (INCOME STATEMENT B) (INCOME STATEMENT C)
1. WITHHOLDING TYPE: 1. WITHHOLDING TYPE: 1. WITHHOLDING TYPE:
W-2s G2-A G2-LP W-2s G2-A G2-LP W-2s G2-A G2-LP
1099s G2-FL G2-RP 1099s G2-FL G2-RP 1099s G2-FL G2-RP

AI
2. EMPLOYER/PAYER FEDERAL 2. EMPLOYER/PAYER FEDERAL 2. EMPLOYER/PAYER FEDERAL
ID NUMBER (FEIN) SSN ID NUMBER (FEIN) SSN ID NUMBER (FEIN) SSN

3. EMPLOYER/PAYER STATE WITHHOLDING ID 3. EMPLOYER/PAYER STATE WITHHOLDING ID 3. EMPLOYER/PAYER STATE WITHHOLDING ID

M
4. GA WAGES / INCOME 4. GA WAGES / INCOME 4. GA WAGES / INCOME

5. GA TAX WITHHELD 5. GA TAX WITHHELD 5. GA TAX WITHHELD

1.
(INCOME STATEMENT D)
WITHHOLDING TYPE:
W-2s G2-A G2-LP
1. WITHHOLDING TYPE:
W-2s
T
(INCOME STATEMENT E)

G2-A G2-LP
1.
(INCOME STATEMENT F)
WITHHOLDING TYPE:
W-2s G2-A G2-LP
1099s G2-FL G2-RP 1099s G2-FL G2-RP 1099s G2-FL G2-RP
NO
2. EMPLOYER/PAYER FEDERAL 2. EMPLOYER/PAYER FEDERAL 2. EMPLOYER/PAYER FEDERAL
ID NUMBER (FEIN) SSN ID NUMBER (FEIN) SSN ID NUMBER (FEIN) SSN

3. EMPLOYER/PAYER STATE WITHHOLDING ID 3. EMPLOYER/PAYER STATE WITHHOLDING ID 3. EMPLOYER/PAYER STATE WITHHOLDING ID

4. GA WAGES / INCOME 4. GA WAGES / INCOME 4. GA WAGES / INCOME

5. GA TAX WITHHELD 5. GA TAX WITHHELD 5. GA TAX WITHHELD

DO

Please complete the Supplemental W-2 Income Statement if additional space is needed.
25. Estimated Tax paid for 2017 and Form IT-560 ....................................... 25. 6480
26. Total prepayment credits (Add Lines 23, 24 and 25)................................. 26. 6480
27. If Line 22 exceeds Line 26, subtract Line 26 from Line 22 and enter
balance due............................................................................................... 27. 97
28. If Line 26 exceeds Line 22, subtract Line 22 from Line 26 and enter
overpayment ............................................................................................. 28.

29. Amount to be credited to 2018 ESTIMATED TAX ................................. 29.

Pages (1-5) are Required for Processing

Georgia Form 500 Page 5
Individual Income Tax Return
Georgia Department of Revenue 1800411558 YOUR SOCIAL SECURITY NUMBER
2017 592-60-0414

30. Georgia Wildlife Conservation Fund (No gift of less than $1.00)............. 30.

31. Georgia Fund for Children and Elderly (No gift of less than $1.00)........ 31.

L
32. Georgia Cancer Research Fund (No gift of less than $1.00) ................. 32.

33. Georgia Land Conservation Program (No gift of less than $1.00)........... 33.

AI
34. Georgia National Guard Foundation (No gift of less than $1.00) ............. 34.

35. Dog & Cat Sterilization Fund (No gift of less than $1.00) ....................... 35.

36. Saving the Cure Fund (No gift of less than $1.00)................................. 36.

M
37. Realizing Educational Achievement Can Happen (REACH) Program ............. 37.
(No gift of less than $1.00)
38. Public Safety Memorial Grant (No gift of less than $1.00)....................... 38.

39. Form 500 UET (Estimated tax penalty) 500 UET exception attached.... 39.
40. (If you owe) Add Lines 27, 30 thru 39
MAKE CHECK PAYABLE TO GEORGIA DEPARTMENT OF REVENUE.. 40. 97
41. (If you are due a refund) Subtract the sum of Lines 29 thru 39 from Line 28
T
THIS IS YOUR REFUND......................................................................... 41.

Routing
41a. Direct Deposit (For U.S. Accounts Only) Type: Checking Savings Number
NO
Account
Number
If you do not enter Direct Deposit information or if PROCESSING CENTER PROCESSING CENTER
(PAYMENT) GEORGIA DEPARTMENT OF REVENUE (REFUND and NO GEORGIA DEPARTMENT OF REVENUE
you are a first time filer a paper check will be issued.
PO BOX 740399 BALANCE DUE) PO BOX 740380
ATLANTA, GA 30374-0399 ATLANTA, GA 30374-0380

INCLUDE ALL ITEMS IN ENVELOPE, DO NOT STAPLE YOUR CHECK, W-2s, OTHER WITHHOLDING DOCUMENTS, OR TAX RETURN
I/We declare under the penalties of perjury that I/we have examined this return (including accompanying schedules and statements) and to the best of my/our knowledge
and belief, it is true, correct, and complete. If prepared by a person other than the taxpayer(s), this declaration is based on all information of which the preparer has knowledge.
Georgia Public Revenue Code Section 48-2-31 stipulates that taxes shall be paid in lawful money of the United States, free of any expense to the State of Georgia.
DO

Taxpayer’s Signature (Check box if deceased) Spouse’s Signature (Check box if deceased)

Date Date

Taxpayer’s Phone Number REV 11/13/17 PRO

I authorize DOR to discuss this return with the named preparer.

Preparer’s Phone Number

Signature of Preparer
Name of Preparer Other Than Taxpayer Preparer’s FEIN
WILLIAM M STRICKLAND 26-1701034
Preparer’s Firm Name Preparer’s SSN/PTIN/SIDN
STRICKLAND & HENDERSON LL P01450266
Pages (1-5) are Required for Processing
 Georgia Information Worksheet 2017
G Keep for your records

Part I ' Personal Information

Taxpayer: Spouse:
First Name JOSEPH First Name SARAH
Middle Initial Suffix Middle Initial Suffix
Last Name KANCLERZ Last Name KANCLERZ
Social Security No. 592-60-0414 Social Security No. 259-57-5679
Occupation MEDICAL Occupation TEACHER
Date of Birth 01/26/1978 Date of Birth 12/31/1980
Date of Death Date of Death

L
Daytime Phone Daytime Phone
Home Phone
Print phone number on Form 500 Home Taxpayer work Spouse work

Street Address 5742 ALLEE WAY Apartment No.

AI
City BRASELTON State GA ZIP Code 30517
Country, if foreign
Taxpayer email address

Part II ' Main Form

X Form 500: Resident Tax Return (Long form)

M
Form 500: Nonresident Tax Return
Form 500: Part-Year Resident Tax Return From To
Schedule 3: Enter Nonresident and Part-year resident allocations

Part III ' Filing Status

Single
X Married filing joint return
Married filing separate return
Head of household
Qualifying widow(er)
T
Part IV ' Other Information
NO
The address above is different than last year
Taxpayer authorizes the Georgia Department of Revenue to electronically notify them by the
e-mail address above regarding any updates to their account(s).
Taxpayer authorizes the Georgia Department of Revenue to discuss return with preparer

Form 500UET calculations (Underpayment of Estimated Tax Penalty):

You want the GA Dept of Revenue to figure the underpayment penalty Form 500 UET
At least 2/3 of your total gross income is from fishing or farming
Last year’s Georgia return did not cover a twelve month period or show a tax liability

Part V ' Electronic Filing Information

DO

New! State e-file disclosure consent:

By using a computer system and software to prepare and transmit my client’s return electronically, I
consent to the disclosure of all information pertaining to my use of the system and software to create
my client’s return and to the electronic transmission of my client’s return to the Georgia Department of
Revenue, as applicable by law.

X Filed the Georgia return electronically

Electronic PDF Attachments

PDF’s that you have selected to attach to your state e-file return are listed below.
Description Filename

EF Status Dates:
Enter the date return was EFiled 04/08/2018
Enter the date return was accepted by the state 04/08/2018
Enter the date Form 525-TV was given to client
QuickZoom to Form GA-8453: Additional Information Smart Worksheet
JOSEPH & SARAH KANCLERZ 592-60-0414 Page 2

Part VI ' Direct Deposit Information or Electronic Funds Withdrawal Information

**Note: Georgia does not allow direct deposit of refunds for first time filers or taxpayers who have not
filed a Georgia tax return within the last five years.

Yes No
X Is this your first time filing a Georgia income tax return?
** Check "Yes" if you have not filed a Georgia tax return within the last five years.

L
Yes No
X Elect direct deposit of state tax refund
Use electronic funds withdrawal for state tax payments (EF Only)

AI
If you selected direct deposit or electronic funds withdrawal, fill out the information below:
Name of Financial Institution (optional) SUNTRUST
Account type Checking X Savings
Routing number 061000104
Account number 8815864858
Payment date to withdraw from the account above

M
State balance-due amount from this return

International ACH Transactions

Yes No
Will the funds for this refund (or payment) go to (or come from) an account outside the U.S.?

Note: If, for any reason, the scanning equipment at the Georgia Department of Revenue fails to read your
T
direct deposit information (from the barcode on Form 500), you will receive a paper check instead.
For refund information see https://dor.georgia.gov/wheres-my-refund.

Part VII ' Paid Preparer Information

NO
Enter Preparer Code from Firm/Preparer Info 1
QuickZoom to Firm/Preparer Info

Part VIII ' Extension Status

Yes No
X Tax return due date extended?
Extended due date

QuickZoom to Form IT-303: Application for Extension of Time for Filing

DO

QuickZoom to Form IT-560: Extension Payment Voucher

QuickZoom to Form 500: Income Tax Return (Long form)

gaiw0203.SCR 01/25/18
 Income and Retirement Worksheets 2017
G Keep for your records

Name Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Georgia Amounts Other State Amounts

Column A Column B Column C Column D

L
Income Taxpayer Spouse Taxpayer Spouse

1 Wages 50,000. 5,300. 0. 0.

2 Federal Interest

AI
- Georgia Adjustments to
federal taxable Interest
3 Dividends 150.
- Georgia Adjustments to
federal taxable Dividends
4 Capital/other gains

M
or (losses)
5 Income from federal
Schedules C and F
6a Rental/K-1 etc. income 142,823.
b - income above subject to
FICA or S.E. tax, or S corp
income in which you

7a
materially participated
Pension/Annuity and
IRA/SEP distributions
T
b Lump-sum distributions
NO
c RRB-1099-R
d Other Subtraction #2, withdrawals
with GA/Fed tax difference
e Other Subtraction #7, income
exempt from state tax
f Other Subtraction # 8, teachers
retirement contributions already
taxed by Georgia
8 Alimony received
9 Social security
10 a State income tax refund 55. 0.
DO

b Unemployment
compensation
11 Other income
- Gambling winnings
- Home mortgage debt
forgiveness relief
- NOL Carryover
- Other
Federal Form 8814 income
included in other income
Adjustments
12 IRA deductions
13 Educator expenses
14 Tuition and fees deduction
15 Other federal adjustments 13,714.
 Section 179 Worksheet 2017

Name as Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Section 179 Limitation

This worksheet calculates the allowable state Section 179 deduction. If the deduction is limited then the
allowable Section 179 (Line 7) must be allocated back to the individual activities using the State
Allowed columns below. The Section 179 amounts for Schedules C, E, F, K-1 Partnership,
K-1 S Corporation, and Form 4835 are on the Activity Worksheet(s).

L
1 Federal taxable income computed for the Section 179 limitation 1 268,733.
State adjustments:
2 Depreciation adjustment (without Section 179) 2

AI
3 Section 1231 gain adjustment 3
4 Other additions or subtractions to taxable income 4
5 State taxable income for the Section 179 limitation (line 1 plus lines 2 - 4) 5 268,733.
6 Total Section 179 before limitation 6 70,610.
7 Section 179 allowable, if different 7
8 Federal Section 179 allowed 8 70,610.

M
9 State Section 179 adjustment 9 0.
10 Carryover to next year 10

QuickZoom to Activity Worksheet O

Form 2106 P/Y (A) (B) (C) (D) (E)

Copy Fed Total Federal Net State State State Total
# Section 179
Before
Limitation
TSection 179
After
Limitation
Current
Year
Expense
Carryover
From Prior
Year
Section 179
Before
Limitation
NO

Form 2106 Section 179 Carryovers (F) (G) (H)

State Total State Carryover
Section 179 Section 179
Before Allowed
Limitation
DO

Total Form 2106 Section 179 Adjustment (Column B minus Column G)

Schedule A

(A) (B) (C) (C) (D) (E) (F)

Federal Total Federal Net State State State Total State State
Section 179 Section 179 Current Carryover Section 179 Section 179 Section 179
Before After Year From Prior Before Allowed Carryover To
Limitation Limitation Expense Year Limitation Next Year

Total Schedule A Section 179 Adjustment (Column B minus Column E)

 Activity Worksheet 2017

Name as Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Activity Description 515 TOPSOIL BLVD

Form or Worksheet Type Sch E Copy number 1

A If this activity was operated by spouse, check this box

B If this activity was operated jointly by taxpayer and spouse, check this box
C Check this box if you completely disposed of the property in the current year
D Check this box if all investment is at risk (Not for K-1 Estates and Trusts)

L
E Check this box if some of the investment is not at risk (Not for K-1 Estates and Trusts)
F Did you materially participate in this activity? (Not for K-1’s) Yes X No
G Check this box if you actively participate in the operation of this activity (Not for Schedule C or
Schedule F) X

AI
H Check this box if rental property is subject to recharacterization rules (Sch E/Sch K-1 Ptrshp)
I Check if rental real estate (or other rental) activity is a trade or business (Not for Schedule C
or Schedule F)

If this is a Schedule E, check the appropriate boxes:

M
J Rental property X L Commercial property
K Royalty property M Other passive exceptions

If this is a K-1, check the appropriate boxes:

N This is a K-1 with ordinary income with material participation

O This is a K-1 with rental real estate with material participation
P This is a publicly traded partnership
Q
R
T
If this is a K-1 Estates and Trusts, check the box if this is a final K-1
Check if "working interest" in oil or gas well (Schedule K-1 Partnership)
NO
S At-risk status All
T Passive status Active RE

Part I - Section 179 Adjustments

(A) (B) (C) (D) (E) (F) (G)

Federal Total Federal Net State State State Total State State
Section 179 Section 179 Current Year Carryover Section 179 Section 179 Section 179
Before After Expense From Prior Before Allowed Carryover To
Limitation Limitation Year Limitation Next Year
DO

Part II - Regular Income/Loss Income/Loss

1 Federal income/loss -8,337.

2 Adjustments:
a 30%/50% Special Depreciation Allowance (Bonus Depreciation)
b Other depreciation adjustment(s)
c Section 179 adjustment
d Other adjustments
3 Total -8,337.
4 At-Risk adjustment a Adjust amount b
5 Total -8,337.
6 Passive carryover loss -19,489.
7 Passive disallowed loss (carryover to next year) -27,826.
8 Net profit or (loss) allowed 0.
9 Net federal profit or (loss) allowed 0.
10 Federal/State adjustment 0.
JOSEPH & SARAH KANCLERZ 592-60-0414 Page 2
Activity Description 515 TOPSOIL BLVD

Part III - Schedule K-1 Partnership and S Section 179 Misc Income Commercial
Corporations Expense Revitalization

1 Federal income/loss
2 Adjustments
3 Total
4a At-Risk adjustment amount
b At-Risk adjustment

L
5 Total
6 Passive carryover loss
7 Passive disallowed loss (carryover to next year)
8 Net profit or (loss) allowed

AI
9 Net federal profit or (loss) allowed
10 Federal/State adjustment

Schedule D Schedule D Form 4797 Form 4797

Part IV - Dispositions Short-Term Long-Term Short-Term Long-Term

M
1 Federal income/loss
2 Adjustments:
a Adjustments transferred from the
federal return
b Other adjustments
c Total adjustments
3 Total
4a

5
b
At-Risk adjustment amount
At-Risk adjustment
Total
T
6 Passive carryover loss
NO
7 Passive disallowed loss
8 Net profit or (loss) allowed
9 Net federal profit or (loss) allowed
10 Federal/State adjustment
DO
 Activity Worksheet 2017

Name as Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Activity Description 1351 LOOWIT FALLS WAY

Form or Worksheet Type Sch E Copy number 2

A If this activity was operated by spouse, check this box

B If this activity was operated jointly by taxpayer and spouse, check this box
C Check this box if you completely disposed of the property in the current year
D Check this box if all investment is at risk (Not for K-1 Estates and Trusts)

L
E Check this box if some of the investment is not at risk (Not for K-1 Estates and Trusts)
F Did you materially participate in this activity? (Not for K-1’s) Yes X No
G Check this box if you actively participate in the operation of this activity (Not for Schedule C or
Schedule F) X

AI
H Check this box if rental property is subject to recharacterization rules (Sch E/Sch K-1 Ptrshp)
I Check if rental real estate (or other rental) activity is a trade or business (Not for Schedule C
or Schedule F)

If this is a Schedule E, check the appropriate boxes:

M
J Rental property X L Commercial property
K Royalty property M Other passive exceptions X

If this is a K-1, check the appropriate boxes:

N This is a K-1 with ordinary income with material participation

O This is a K-1 with rental real estate with material participation
P This is a publicly traded partnership
Q
R
T
If this is a K-1 Estates and Trusts, check the box if this is a final K-1
Check if "working interest" in oil or gas well (Schedule K-1 Partnership)
NO
S At-risk status All
T Passive status Former

Part I - Section 179 Adjustments

(A) (B) (C) (D) (E) (F) (G)

Federal Total Federal Net State State State Total State State
Section 179 Section 179 Current Year Carryover Section 179 Section 179 Section 179
Before After Expense From Prior Before Allowed Carryover To
Limitation Limitation Year Limitation Next Year
DO

Part II - Regular Income/Loss Income/Loss

1 Federal income/loss 7,909.

2 Adjustments:
a 30%/50% Special Depreciation Allowance (Bonus Depreciation)
b Other depreciation adjustment(s)
c Section 179 adjustment
d Other adjustments
3 Total 7,909.
4 At-Risk adjustment a Adjust amount b
5 Total 7,909.
6 Passive carryover loss -11,586.
7 Passive disallowed loss (carryover to next year) -3,677.
8 Net profit or (loss) allowed 0.
9 Net federal profit or (loss) allowed 0.
10 Federal/State adjustment 0.
JOSEPH & SARAH KANCLERZ 592-60-0414 Page 2
Activity Description 1351 LOOWIT FALLS WAY

Part III - Schedule K-1 Partnership and S Section 179 Misc Income Commercial
Corporations Expense Revitalization

1 Federal income/loss
2 Adjustments
3 Total
4a At-Risk adjustment amount
b At-Risk adjustment

L
5 Total
6 Passive carryover loss
7 Passive disallowed loss (carryover to next year)
8 Net profit or (loss) allowed

AI
9 Net federal profit or (loss) allowed
10 Federal/State adjustment

Schedule D Schedule D Form 4797 Form 4797

Part IV - Dispositions Short-Term Long-Term Short-Term Long-Term

M
1 Federal income/loss
2 Adjustments:
a Adjustments transferred from the
federal return
b Other adjustments
c Total adjustments
3 Total
4a

5
b
At-Risk adjustment amount
At-Risk adjustment
Total
T
6 Passive carryover loss
NO
7 Passive disallowed loss
8 Net profit or (loss) allowed
9 Net federal profit or (loss) allowed
10 Federal/State adjustment
DO
 Activity Worksheet 2017

Name as Shown on Return Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Activity Description SOUTHERN SURGICAL ASSISTANTS LLC

Form or Worksheet Type K-1S Copy number 1

A If this activity was operated by spouse, check this box

B If this activity was operated jointly by taxpayer and spouse, check this box
C Check this box if you completely disposed of the property in the current year
D Check this box if all investment is at risk (Not for K-1 Estates and Trusts) X

L
E Check this box if some of the investment is not at risk (Not for K-1 Estates and Trusts)
F Did you materially participate in this activity? (Not for K-1’s) Yes No
G Check this box if you actively participate in the operation of this activity (Not for Schedule C or
Schedule F)

AI
H Check this box if rental property is subject to recharacterization rules (Sch E/Sch K-1 Ptrshp)
I Check if rental real estate (or other rental) activity is a trade or business (Not for Schedule C
or Schedule F)

If this is a Schedule E, check the appropriate boxes:

M
J Rental property L Commercial property
K Royalty property M Other passive exceptions

If this is a K-1, check the appropriate boxes:

N This is a K-1 with ordinary income with material participation X

O This is a K-1 with rental real estate with material participation
P This is a publicly traded partnership
Q
R
T
If this is a K-1 Estates and Trusts, check the box if this is a final K-1
Check if "working interest" in oil or gas well (Schedule K-1 Partnership)
NO
S At-risk status All At-Risk
T Passive status Nonpassive

Part I - Section 179 Adjustments

(A) (B) (C) (D) (E) (F) (G)

Federal Total Federal Net State State State Total State State
Section 179 Section 179 Current Year Carryover Section 179 Section 179 Section 179
Before After Expense From Prior Before Allowed Carryover To
Limitation Limitation Year Limitation Next Year

70,610. 70,610. 70,610. 70,610. 70,610. 0.

DO

Part II - Regular Income/Loss Income/Loss

1 Federal income/loss 213,433.

2 Adjustments:
a 30%/50% Special Depreciation Allowance (Bonus Depreciation)
b Other depreciation adjustment(s)
c Section 179 adjustment
d Other adjustments
3 Total 213,433.
4 At-Risk adjustment a Adjust amount b
5 Total 213,433.
6 Passive carryover loss
7 Passive disallowed loss (carryover to next year)
8 Net profit or (loss) allowed 213,433.
9 Net federal profit or (loss) allowed 213,433.
10 Federal/State adjustment 0.
JOSEPH & SARAH KANCLERZ 592-60-0414 Page 2
Activity Description SOUTHERN SURGICAL ASSISTANTS LLC

Part III - Schedule K-1 Partnership and S Section 179 Misc Income Commercial
Corporations Expense Revitalization

1 Federal income/loss -70,610.

2 Adjustments 0.
3 Total -70,610.
4a At-Risk adjustment amount
b At-Risk adjustment

L
5 Total -70,610.
6 Passive carryover loss
7 Passive disallowed loss (carryover to next year)
8 Net profit or (loss) allowed -70,610.

AI
9 Net federal profit or (loss) allowed -70,610.
10 Federal/State adjustment 0.

Schedule D Schedule D Form 4797 Form 4797

Part IV - Dispositions Short-Term Long-Term Short-Term Long-Term

M
1 Federal income/loss
2 Adjustments:
a Adjustments transferred from the
federal return
b Other adjustments
c Total adjustments
3 Total
4a

5
b
At-Risk adjustment amount
At-Risk adjustment
Total
T
6 Passive carryover loss
NO
7 Passive disallowed loss
8 Net profit or (loss) allowed
9 Net federal profit or (loss) allowed
10 Federal/State adjustment
DO
Form 500 ES Estimated Tax Worksheet 2018
G Keep for your records

Name(s) Shown on Return Your Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Part I 2018 Estimated Tax Amount Options

1 Select One of Six Ways to Calculate the Required Annual Payment for 2018 Estimates:
a 100% of 2017 taxes (default, see Tax Help) X 6,577.
b 100% of tax on 2018 estimated taxable income 6,577.
c 90% of tax on 2018 estimated taxable income 5,920.
d 66-2/3% of tax on 2018 estimated taxable income (farmers and fishermen) 4,385.

L
e Equal to 100% of overpayment (no vouchers) 0.
f Enter total amount you want to use for estimates and check box
2 Selected estimated tax amount:
a 2018 Required Annual Payment based on your choice above 6,577.

AI
b Estimated amount of 2018 state income tax withholding
c Total of estimated tax payments required for 2018 (line 2a less line 2b) 6,577.
3 Select Estimated Tax Payment option:
a Calculate estimates if $500 or more (default) X
b Calculate estimates if (specify amount) or more
c Calculate estimates regardless of amount
d Do not calculate estimates

M
Part II Overpayment Application Options

1 Amount of overpayment available (Form 500, line 24 less lines 26-34) 0.

2 Select Overpayment Application Amount Option:
a Apply none (refund entire overpayment) X
b Apply all (increase estimate if required)
c
d
e
T
Apply to extent of total estimated tax and refund excess
Apply to extent of first quarter amount and refund excess
Enter amount you want to apply
6,580.
1,645.

f Amount applied to 2018 estimated tax 0.

NO
g Overpayment to be refunded (line 1 less line 2f) 0.
3 Select Overpayment Application Sequence:
a X H Consecutively b H Evenly

Part III Rounding and Printing Options

1 Select Rounding Option:

aX H Round up to b H Round up to c H Round up to d H Round to
next $1 next $10 next $100 nearest $1
2 Select Voucher Printing Option:
a X H Print (per Part I, lines 3a - c) b H Print only name, etc. c H Do not print vouchers
DO

Part IV Estimated Tax Payment Summary

1 2 3 4 Total
4/17/2018 6/15/2018 9/17/2018 1/15/2019

1 If you have already

made payments,
enter amounts
2 Indicate which payment is
due next. (e.g. if it is now
April 25, 2018, check col. 2) X

3 Required Payment 1,645. 1,645. 1,645. 1,645. 6,580.

4 Overpayment applied 0. 0. 0. 0. 0.
5 Net payment due 1,645. 1,645. 1,645. 1,645. 6,580.

6 Voucher amounts 1,645. 1,645. 1,645. 1,645. 6,580.

JOSEPH & SARAH KANCLERZ 592-60-0414 Page 2

Part V Changes to Income, Deductions and Withholding for 2018

2017 income and deductions are shown in the ’2017 Actual’ column below.
*Caution: For each line in the ’2018 Estimated’ column, enter the estimated 2018 amount if different
from 2017. Otherwise, the ’2017 Actual’ amount will be used. If zero, you must enter zero.

2017 Actual *2018 Estimated

1 Adjusted gross income 184,614.

L
2 Adjustments and Deductions 54,272.
3 Applicable retirement exclusion (See Tax Help)
4 Georgia tax withholding
5 Other credits

AI
Part VI Filing Status and Personal Exemptions for 2018

1 Choose 2018 filing status: (Default = last year’s filing status)

Single X Married filing jointly
Married filing separately Head of household Qualifying Widow(er)

M
2 Enter the number of exemptions in 2018 2
3 Enter the number of dependents in 2018 3

Part VII 2018 Estimated Taxable Income and Tax

1 Adjusted gross income expected during the current year 1 184,614.

2 Less: Adjustments and Deductions 2 54,272.
3
4
5
Balance (line 1 less line 2)
Less: Deduction for exemptions/dependents
Balance (line 3 less line 4)
T 3
4
5
130,342.
16,400.
113,942.
6 Applicable retirement exclusion (see worksheet) 6
NO
7 Taxable income (line 5 less line 6) 7 113,942.
8 Tax on amount on line 7 (see tax rate schedule) 8 6,577.
9 Less: Credits 9
10 Line 8 less line 9. This is your 2018 tax based on your
estimate of 2018 income 10 6,577.

GAIW0812.SCR 11/09/17
DO
 Tax Payments Worksheet 2017
G Keep for your records

Name Social Security Number

JOSEPH & SARAH KANCLERZ 592-60-0414

Tax Payments for the Current Year

State

L
Date Payment

1 First Payment 04/18/17 1,620.

2 Second Payment 06/15/17 1,620.

AI
3 Third Payment 09/15/17 1,620.
4 Fourth Payment 01/16/18 1,620.

Additional Payments
5 Payment
Payment

M
Payment
Payment
Payment

6 Overpayment from previous year applied to current year 6

7 Amount paid with current year extension T 7

8 Total tax payments 8 6,480.

Income Taxes Withheld for the Current Year

NO
9 State withholding on Forms W-2 9
10 State withholding on Forms W-2G 10
11 State withholding on Forms 1099-R 11
12 a State withholding on Forms 1099-MISC 12 a
b State withholding on Forms 1099-G b
c State withholding on Forms 1099-K c
13 Other state tax withholding 13

14 Total income tax withheld 14

DO

15 Date return will be filed and balance paid 15

OTHV0301.SCR 11/28/16
JOSEPH & SARAH KANCLERZ 592-60-0414 1

Smart Worksheets from your 2017 Georgia Tax Return

SMART WORKSHEET FOR: Form 8453: Declaration for Electronic Filing

Additional Information Smart Worksheet

A Date return was E-Filed 04/08/2018

L
B Date return was accepted by the state 04/08/2018
C Documents to attach to the FRONT of Form GA-8453:
Form W-2 (Georgia Copy)

AI
D Documents to attach to the BACK of Form GA-8453:

M
E Retain Form GA-8453 and all attachments for a period of three years
DO NOT MAIL TO STATE AUTHORITIES

SMART WORKSHEET FOR: Form 500: Individual Income Tax Return (Copy 1)
T
Georgia Itemized Deduction Smart Worksheet

The following are Georgia adjustments to Federal Itemized Deduction:

NO
Income taxes from states other than Georgia 0
Investment interest for the production of income
exempt from Georgia income tax
Other adjustments
DO