8453 U.S. Individual Income Tax Transmittal for an IRS 2019 · Form 2848, Power of Attorney and Declaration of Representative (or POA that states the agent is granted authority to

OMB No. 1545-0074

Form 8453 U.S. Individual Income Tax Transmittal for an IRS e-file Return

For the year January 1'December 31, 2019 2019G See instructions.

Department of the TreasuryG Go to www.irs.gov/Form8453 for the latest information.Internal Revenue Service

Your first name and initial Last name Your social security numberP

R

If a joint return, spouse's first name and initial Last name Spouse's social security numberI

N

THome address (number and street). If you have a P.O. box, see instructions. Apt. no.Please Important!print or C J J

type. L You must enterCity, town or post office, state, and ZIP code (If a foreign address, also complete spaces below.)E your SSN(s) above.

A

R

Foreign country name Foreign province/state/county Foreign postal codeL

Y

FILE THIS FORM ONLY IF YOU ARE ATTACHING ONE OR MOREOF THE FOLLOWING FORMS OR SUPPORTING DOCUMENTS.

Check the applicable box(es) to identify the attachments.

Form 1098-C, Contributions of Motor Vehicles, Boats, and Airplanes (or equivalent contemporaneous written acknowledgement)

Form 2848, Power of Attorney and Declaration of Representative (or POA that states the agent is granted authority to sign the return)

Form 3115, Application for Change in Accounting Method

Form 3468 - attach a copy of the first page of NPS Form 10-168, Historic Preservation Certification Application (Part 2 ' Description ofRehabilitation), with an indication that it was received by the Department of the Interior or the State Historic Preservation Officer, togetherwith proof that the building is a certified historic structure (or that such status has been requested)

Form 4136 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the provideridentifying the product as renewable diesel and, if applicable, a statement from the reseller

Form 5713, International Boycott Report

Form 8283, Noncash Charitable Contributions, Section A (if any statement or qualified appraisal is required), or Section B, DonatedProperty, and any related attachments (including any qualified appraisal or partnership Form 8283)

Form 8332, Release/Revocation of Release of Claim to Exemption for Child by Custodial Parent (or certain pages from a divorce decreeor separation agreement that went into effect after 1984 and before 2009) (see instructions)

Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities (FDEs) and Foreign Branches (FBs)

Form 8864 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the provideridentifying the product as renewable diesel and, if applicable, a statement from the reseller

Form 8885, Health Coverage Tax Credit, and all required attachments

Form 8949, Sales and Other Dispositions of Capital Assets (or a statement with the same information), if you elect not to report yourtransactions electronically on Form 8949

DON'T SIGN THIS FORM.

BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see your tax return instructions. Form 8453 (2019)

FDIA5901L 01/08/20

SARA J. JACOBS ***-**-****

2604 FIFTH AVE. #403

SAN DIEGO CA 92103

X

MAIL FORM 8453 AND ATTACHMENTS TO:INTERNAL REVENUE SERVICEATTN: SHIPPING AND RECEIVING, 0254RECEIPT AND CONTROL BRANCHAUSTIN, TX 73344-0254

I DETACH HERE I1030

FDIA4601L 08/13/19Application for Automatic Extension of TimeForm 4868

To File U.S. Individual Income Tax ReturnDepartment of the Treasury 2019(99) For calendar year 2019, or other tax year beginning , 2019, ending , .Internal Revenue Service

Identification Individual Income TaxPart I Part II$4 Estimate of total tax liability for 2019. . .

5 Total 2019 payments. . . . . . . . . . . . . . . . . .

6 Balance due. Subtract line 5 from line 4(see instructions) . . . . . . . . . . . . . . . . . . . . .

7 Amount you are payingG(see instructions) . . . . . . . . . . . . . . . . . . . . .

8 Check here if you are 'out of the country' and a U.S.2 3 Gcitizen or resident (see instructions). . . . . . . . . . . . . . . . . . .

9 Check here if you file Form 1040NR or 1040NR-EZ anddid not receive wages as an employee subject to U.S.

Gincome tax withholding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MAKE YOUR CHECK PAYABLE TO THE "UNITED STATES TREASURY"INCLUDE YOUR SSN, DAYTIME PHONE # AND "2019 FORM 4868"MAIL YOUR PAYMENT TO:

INTERNAL REVENUE SERVICEP.O. BOX 7122SAN FRANCISCO, CA 94120-7122

1,809,113.534,113.

1,275,000.1,275,000.

1

SARA J. JACOBS

***-**-****

*********************************

(99)Department of the Treasury ' Internal Revenue Service

Form 1040 2019 IRS Use Only ' Do not write or staple in this space.U.S. Individual Income Tax Return OMB No. 1545-0074

Filing Status Head of household (HOH) Qualifying widow(er) (QW)Single Married filing jointly Married filing separately (MFS)

Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child's name if the qualifying person isone box.

a child but not your dependent. G

Your first name and middle initial Last name Your social security number

If joint return, spouse's first name and middle initial Last name Spouse's social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign

Check here if you, or your spouse if filing

jointly, want $3 to go to this fund.

Checking a box below will not change yourCity, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).tax or refund.

You Spouse

Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,

see instructions and b here G

Standard Someone can claim: You as a dependent Your spouse as a dependent

DeductionSpouse itemizes on a separate return or you were a dual-status alien

You:Age/Blindness Were born before January 2, 1955 Are blind Spouse: Was born before January 2, 1955 Is blind

(2) Social security (3) Relationship to you (4) b if qualifies for (see instructions):Dependents (see instructions):number

Last name Child tax credit Credit for other dependents(1) First name

Wages, salaries, tips, etc. Attach Form(s) W-2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1

Taxable int. Att. Sch. B if reqd. . . . . . . . Tax-exempt interest. . . . . . . . . . . . . . 2a 2a b 2b

3a 3a b 3bOrdinary div. Att. Sch. B if reqd. . . . . . . Qualified dividends . . . . . . . . . . . . . .

IRA distributions. . . . . . . . . . . . . 4a 4a Taxable amount . . . . . . . . . . . . . . . b 4b

c 4cPensions and annuities . . . . . . Taxable amount . . . . . . . . . . . . . . . 4dd

5a 5a Taxable amount . . . . . . . . . . . . . . . b 5bSocial security benefits . . . . . . . . . . .

Standard 6 6Capital gain or (loss). Attach Schedule D if required. If not required, check here. . . . . . . . . . . . . . . . . . . . . . . GDeduction for '

7a7a Other income from Schedule 1, line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? Single or

Married filingAdd lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income. . . . . . . . . . . . . . . . . . . . G 7bbseparately, $12,200

? Married filing 8a Adjustments to income from Schedule 1, line 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8ajointly or Qualifying

widow(er), $24,400 Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . . . . . . . . . . . Gb 8b? Head of household, $18,350 Standard deduction or itemized deductions (from Schedule A). . . . . . . . . . . . 9 9? If you checked any 1010 Qualified business income deduction. Attach Form 8995 or Form 8995-A. . . . . . . . box under StandardDeduction, see

11a 11aAdd lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . instructions.

Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0-. . . . . . . . . . . . . . . . . b 11b

BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)

FDIA0112L 10/07/19

7,186,320.

1,077,758.

6,108,562.

14,564.

57,611.9,154.

806,428.800,684.

7,186,391.



X

SAN DIEGO, CA 92103

1,077,758.

71.

1,001.

6,306,787.

ST 3

ST 4

Form 1040 (2019) Page 2

Tax (see inst.) Check if any from Form(s): 8814112a

2 3 12a4972

12bb Add Schedule 2, line 3, and line 12a and enter the total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

13a13a Child tax credit or credit for other dependents . . . . . . . . . . . . . . . . . .

13bAdd Schedule 3, line 7, and line 13a and enter the total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b G

Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 14

Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . . . . . . . . .15 15

1616 Add lines 14 and 15. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

17 17Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18 Other payments and refundable credits:? If you have aqualifying child, Earned income credit (EIC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18aaattach Sch. EIC.

18bb Additional child tax credit. Attach Schedule 8812 . . . . . . . . . . . . . .? If you have

nontaxable combat 18cc American opportunity credit from Form 8863, line 8. . . . . . . . . . . .pay, see instructions. d 18dSchedule 3, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add lines 18a through 18d. These are your total other payments e18eand refundable credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

Add lines 17 and 18e. These are your total payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 19G

20 20If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . . . . . . . . . . .RefundG21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here. . 21a

b cG GRouting number . . . . . . . . Type: Checking SavingsDirect deposit?See instructions. dG Account number. . . . . . . .

G22 Amount of line 20 you want applied to your 2020 estimated tax. . . . . . . . 22

23 23Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions. . . . . . . . . . . . . . . . . GAmountYou Owe 24 24Estimated tax penalty (see instructions). . . . . . . . . . . . . . . . . . . .

Yes. Complete below.Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS ? See instructions.Third PartyDesignee No

(Other than Designee's Phone Personal identificationG G Gname no. number (PIN)paid preparer)

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, theySignare true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

HereYour signature Date Your occupation If the IRS sent you an Identity Protection

PIN, enter itJoint return?here (see inst.)

See instructions. A Date Spouse's occupation If the IRS sent your spouse an IdentitySpouse's signature. If a joint return, both must sign.Keep a copy for Protection PIN, enteryour records. it here (see inst.)

Phone no. Email address

Date Check if:Preparer's name Preparer's signature PTIN

3rd Party DesigneePaidPreparer Self-employedGFirm's name Phone no.Use Only

G GFirm's address Firm's EIN

Form 1040 (2019)Go to www.irs.gov/Form1040 for instructions and the latest information.

FDIA0112L 02/21/20


1,194,078.

1,196,132.

4,566.

1,191,566.

265,621.

1,457,187.

849.

1,808,264.

1,808,264.

1,809,113.

351,926.0.

351,833.

93.

X

POLITICIAN

X

X

OMB No. 1545-0074SCHEDULE 1Additional Income and Adjustments to Income(Form 1040 or 1040-SR)

2019A Attach to Form 1040 or 1040-SR.

Department of the Treasury AttachmentA Go to www.irs.gov/Form1040 for instructions and the latest information.Internal Revenue Service 01Sequence No.

Name(s) shown on Form 1040 or 1040-SR Your social security number

At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtualcurrency?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part I Additional Income1Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a2ab Date of original divorce or separation agreement (see instructions) G

3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Other gains or (losses). Attach Form 4797. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. . . . . . 5 5

6Farm income or (loss). Attach Schedule F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 7Unemployment compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GOther income. List type and amount8

8

9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a . . . . . . . . . . . . . . . . 9

Part II Adjustments to Income10 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Certain business expenses of reservists, performing artists, and fee-basis government officials.

11Attach Form 2106. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health savings account deduction. Attach Form 8889. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 12

Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . . . . . . . . . . . . . . 13 13

Deductible part of self-employment tax. Attach Schedule SE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1414

15Self-employed SEP, SIMPLE, and qualified plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Self-employed health insurance deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1616

17 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

18a18a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Recipient's SSN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

c Date of original divorce or separation agreement (see instructions) G

19 19IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Student loan interest deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 20

21 Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2122 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040

or 1040-SR, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

BAA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040 or 1040-SR) 2019

FDIA0103L 12/26/19


71.

71.

0.

1.

1,000.

1,001.

X

PACIFIC VIEW CHARTER-1099

STATEMENT 5

OMB No. 1545-0074SCHEDULE 2Additional Taxes(Form 1040 or 1040-SR)

2019A Attach to Form 1040 or 1040-SR.


Name(s) shown on Form 1040 or 1040-SR Your social security number

Part I Tax

1 Alternative minimum tax. Attach Form 6251. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

33 Add lines 1 and 2. Enter here and include on Form 1040 or 1040-SR, line 12b. . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II Other Taxes44 Self-employment tax. Attach Schedule SE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . . . . . . . . . . . . . . . . . . . . . .

6 Additional tax on IRAs, other qualified retirement plans, and other tax-favored accounts. Attach Form

65329 if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7a7a Household employment taxes. Attach Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7bRepayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required . . . . . . . . . . . . . . . . b

Taxes from: a Form 8959 b Form 89608

8c Instructions; enter code(s)

99 Section 965 net tax liability installment from Form 965-A. . . . . . . . . . . . . . . . . . . . .

10 Add lines 4 through 8. These are your total other taxes. Enter here and on Form 1040 or 1040-SR,

line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


FDIA0104L 09/30/19

2,054.

2,054.

***-**-****SARA J. JACOBS

141.

265,621.

X

265,480.

OMB No. 1545-0074SCHEDULE 3Additional Credits and Payments(Form 1040 or 1040-SR)

2019A Attach to Form 1040 or 1040-SR.Department of the Treasury Attachment

A Go to www.irs.gov/Form1040 for instructions and the latest information.Internal Revenue Service 03Sequence No.

Your social security numberName(s) shown on Form 1040 or 1040-SR

Nonrefundable CreditsPart I1 Foreign tax credit. Attach Form 1116 if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Credit for child and dependent care expenses. Attach Form 2441. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Education credits from Form 8863, line 19. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Retirement savings contributions credit. Attach Form 8880. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Other credits from Form: a 3800 b 8801 c 6

7 Add lines 1 through 6. Enter here and include on Form 1040 or 1040-SR, line 13b. . . . . . . . . . . . . . . . . . . . . . . . 7

Other Payments and Refundable CreditsPart II8 2019 estimated tax payments and amount applied from 2018 return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Net premium tax credit. Attach Form 8962. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9

Amount paid with request for extension to file (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10

Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 11

Credit for federal tax on fuels. Attach Form 4136. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 12

13 Credits from Form: 13a 2439 b Reserved c 8885 d

14 Add lines 8 through 13. Enter here and on Form 1040 or 1040-SR, line 18d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14


FDIA0105L 12/26/19

4,566.

4,566.


533,264.

1,275,000.

1,808,264.

OMB No. 1545-0074SCHEDULE A Itemized Deductions(Form 1040 or 1040-SR)

G Go to www.irs.gov/ScheduleA for instructions and the latest information.(Rev. January 2020) 2019

G Attach to Form 1040 or 1040-SR.Department of the Treasury AttachmentInternal Revenue Service Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 16.(99) Sequence No. 07

Your social security numberName(s) shown on Form 1040 or 1040-SR

Caution: Do not include expenses reimbursed or paid by others.Medical1 Medical and dental expenses (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . 1and

Dental 2 Enter amount from Form 1040 orExpenses

1040-SR, line 8b. . . . . . . . . . . . . . . . . . 2

3 Multiply line 2 by 7.5% (0.075) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Taxes You 5 State and local taxes.Paid a State and local income taxes or general sales taxes. You may

include either income taxes or general sales taxes on line 5a,

but not both. If you elect to include general sales taxes instead

of income taxes, check this box.. . . . . . . . . . . . . . . . . . . . . . . 5aG

b 5bState and local real estate taxes (see instructions) . . . . . . . . . . . . . . . . . . . . . . .

c State and local personal property taxes. . . . . . . . . . . . . . . . . . . . . . . 5c

d Add lines 5a through 5c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5d

e Enter the smaller of line 5d or $10,000 ($5,000 if married filingseparately). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5e

6 Other taxes. List type and amount G

6

7 7Add lines 5e and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 Home mortgage interest and points. If you didn't use all of yourInterest YouPaid home mortgage loan(s) to buy, build, or improve your home,Caution: Your see instructions and check this box. . . . . . . . . . . . . . . . . . . . Gmortgage interest

a Home mortgage interest and points reported to you ondeduction may

Form 1098. See instructions if limited. . . . . . . . . . . . . . . . . . . . . . . . . 8abe limited (see

instructions). b Home mortgage interest not reported to you on Form 1098. See

instructions if limited. If paid to the person from whom you

bought the home, see instructions and show that person's name,

identifying no., and address G

8b

8cc Points not reported to you on Form 1098. See instructions for special rules. . . . .

d Mortage insurance premiums (see instructions). . . . . . . . . . . . . . . . 8d

e Add lines 8a through 8d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8e

9 Investment interest. Attach Form 4952 if required. See

9instructions.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Add lines 8e and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Gifts by cash or check. If you made any gift of $250 or more,Gifts toCharity see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Other than by cash or check. If you made any gift of $250 orCaution: If you more, see instructions. You must attach Form 8283 ifmade a gift and

over $500. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12got a benefit for it,

see instructions. 13 Carryover from prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14 Add lines 11 through 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Casualty and theft loss(es) from a federally declared disaster (other than net qualified disasterCasualty andTheft Losses losses). Attach Form 4684 and enter the amount from line 18 of that form. See instructions. 15

16 Other'from list in instructions. List type and amount GOtherItemizedDeductions

16

Add the amounts in the far right column for lines 4 through 16. Also, enter this amount on17TotalItemized Form 1040 or 1040-SR, line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Deductions

18 If you elect to itemize deductions even though they are less than your standard

deduction, check this box. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

FDIA0301L 01/15/20

BAA For Paperwork Reduction Act Notice, see the Instructions for Forms 1040 and 1040-SR. Schedule A (Form 1040 or 1040-SR) 2019


0.

737,759.

10,000.

27,387.

27,387.

6,386.

1,033,985.

1,040,371.

0.

0.

1,077,758.

10,000.

737,759.

STATEMENT 7

STMT 6

OMB No. 1545-0074SCHEDULE B Interest and Ordinary Dividends(Form 1040 or 1040-SR) 2019

G Go to www.irs.gov/ScheduleB for instructions and the latest information.Department of the Treasury AttachmentG Attach to Form 1040 or 1040-SR.(99)Internal Revenue Service 08Sequence No.

Name(s) shown on return Your social security number

AmountList name of payer. If any interest is from a seller-financed mortgage and the buyer used1Part Ithe property as a personal residence, see the instructions and list this interest first. Also,show that buyer's social security number and address GInterest

(See instructionsand theinstructions forForms 1040 and1040-SR, line 2b.)

Note: If you

received a Form 11099-INT, Form

1099-OID, or

substitute statement

from a brokerage

firm, list the firm's

name as the payer

and enter the total

interest shown on

that form.

2 2Add the amounts on line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach33Form 8815 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 4Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b. . . G

Note: If line 4 is over $1,500, you must complete Part III. Amount

List name of payer G5Part II

OrdinaryDividends

(See instructionsand theinstructions forForms 1040 and1040-SR, line 3b.)

Note: If you 5received a Form

1099-DIV or

substitute statement

from a brokerage

firm, list the firm's

name as the payer

and enter the

ordinary dividends

shown on that form.

6 6Add the amounts on line 5. Enter the total here and on Form 1040 or 1040-SR, line 3b. . . . G

Note: If line 6 is over $1,500, you must complete Part III.

Part III You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had aYes Noforeign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.

Foreign 7a At any time during 2019, did you have a financial interest in or signature authority over a financialAccounts account (such as a bank account, securities account, or brokerage account) located in a foreign country?

See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . and TrustsIf 'Yes,' are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR), toreport that financial interest or signature authority? See FinCEN Form 114 and its instructions for filingCaution: If required,requirements and exceptions to those requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . failure to file FinCEN

Form 114 may b If you are required to file FinCEN Form 114, enter the name of the foreign country where the financialresult in

account is located Gsubstantial

penalties. See 8 During 2019, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? Ifinstructions. 'Yes,' you may have to file Form 3520. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FDIA0401L 08/21/19BAA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule B (Form 1040 or 1040-SR) 2019


57,611.

57,611.

806,428.

X

X

BELDORE CAPITAL FUND LLC 1,445.BELGARDE CAPITAL FUND LLC 199.CLEARFORK CAPITAL FUND LLC 969.MERRILL LYNCH - 12754 1,498.MERRILL LYNCH - 846 203.MERRILL LYNCH -841 37,291.MERRILL LYNCH-14414 822.OID-STATE OF ISRAEL BOND 50.SJJ CHARITABLE REMAINDER UNITRUST 15,134.

BELDORE CAPITAL FUND LLC 67,682.BELGARDE CAPITAL FUND LLC 9,275.CLEARFORK CAPITAL FUND LLC 46,316.MERRILL LYNCH-12841 609,531.MERRILL LYNCH-12846 43,959.MERRILL LYNCH-14414 277.SJJ CHARITABLE REMAINDER UNITRUST 29,388.

OMB No. 1545-0074SCHEDULE D(Form 1040 or 1040-SR) Capital Gains and Losses

G Attach to Form 1040, 1040-SR, or 1040-NR. 2019G Go to www.irs.gov/ScheduleD for instructions and the latest information.Department of the Treasury

Attachment(99)Internal Revenue Service G Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10. 12Sequence No.


Yes NoDid you dispose of any investment(s) in a qualified opportunity fund during the tax year?

If "Yes," attach Form 8949 and see its instructions for additional requirements for reporting your gain or loss.

Part I Short-Term Capital Gains and Losses ' Generally Assets Held One Year or Less (see instructions)

(g) (h) Gain or (loss)See instructions for how to figure the amounts toAdjustmentsenter on the lines below. Subtract column (e)(d) (e)

to gain or loss from from column (d) andProceeds CostThis form may be easier to complete if you round Form(s) 8949, Part I, combine the result(sales price) (or other basis)off cents to whole dollars. line 2, column (g) with column (g)

Totals for all short-term transactions reported1aon Form 1099-B for which basis was reportedto the IRS and for which you have noadjustments (see instructions).However, if you choose to report all thesetransactions on Form 8949, leave this lineblank and go to line 1b . . . . . . . . . . . . . . . . . . . . .

Totals for all transactions reported on1bForm(s) 8949 with Box A checked . . . . . . . . . . .

Totals for all transactions reported on2Form(s) 8949 with Box B checked . . . . . . . . . . .

Totals for all transactions reported on3Form(s) 8949 with Box C checked . . . . . . . . . . .

4 4Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . . . . . . . . . . . .

5 5Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1. . . .

6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss CarryoverWorksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any long-term7capital gains or losses, go to Part II below. Otherwise, go to Part III on the back. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II Long-Term Capital Gains and Losses ' Generally Assets Held More Than One Year (see instructions)


to gain or loss from from column (d) andProceeds CostThis form may be easier to complete if you round Form(s) 8949, Part II, combine the result(sales price) (or other basis)off cents to whole dollars. line 2, column (g) with column (g)

Totals for all long-term transactions reported8aon Form 1099-B for which basis was reportedto the IRS and for which you have noadjustments (see instructions). However,if you choose to report all these transactionson Form 8949, leave this line blank and goto line 8b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Totals for all transactions reported on8bForm(s) 8949 with Box D checked. . . . . . . . . . .

Totals for all transactions reported on9Form(s) 8949 with Box E checked. . . . . . . . . . .

Totals for all transactions reported on10Form(s) 8949 with Box F checked. . . . . . . . . . .

Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from1111Forms 4684, 6781, and 8824. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 12Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 . . . .

13Capital gain distributions. See the instrs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss CarryoverWorksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on15the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BAA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule D (Form 1040 or 1040-SR) 2019FDIA0612L 09/04/19


X

931,859. 901,753. 30,106.

104,038.

134,144.

324,259. 214,521. 109,738.

5,997,768. 5,997,768.

64,872.

265.

6,172,643.

SEE ST 8

Page 2Schedule D (Form 1040 or 1040-SR) 2019

Part III Summary

16 16Combine lines 7 and 15 and enter the result. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

? If line 16 is a gain, enter the amount from line 16 on Form 1040 or 1040-SR, line 6; or Form 1040-NR,line 14. Then go to line 17 below.If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22.?

? If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040 or 1040-SR, line 6; orForm 1040-NR, line 14. Then go to line 22.

17 Are lines 15 and 16 both gains?

Yes. Go to line 18.

No. Skip lines 18 through 21, and go to line 22.

If you are required to complete the 28% Rate Gain Worksheet (see instructions), enter the18amount, if any, from line 7 of that worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18G

19 If you are required to complete the Unrecaptured Section 1250 Gain Worksheet (see19Ginstructions), enter the amount, if any, from line 18 of that worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20 Are lines 18 and 19 both zero or blank?

Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Forms 1040 and 1040-SR, line 12a (or in the instructions for Form 1040-NR, line 42). Don'tcomplete lines 21 and 22 below.

No. Complete the Schedule D Tax Worksheet in the instructions. Don't complete lines 21 and 22 below.

21 If line 16 is a loss, enter here and on Form 1040 or 1040-SR, line 6; or Form 1040-NR, line 14,the smaller of:

? The loss on line 16; or21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

? ($3,000), or if married filing separately, ($1,500)

Note: When figuring which amount is smaller, treat both amounts as positive numbers.

22 Do you have qualified dividends on Form 1040 or 1040-SR, line 3a; or Form 1040-NR, line 10b?

Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Forms 1040 and 1040-SR, line 12a (or in the instructions for Form 1040-NR, line 42).

No. Complete the rest of Form 1040, 1040-SR, or 1040-NR.

Schedule D (Form 1040 or 1040-SR) 2019

FDIA0612L 09/04/19


6,306,787.

X

0.

31.

X

OMB No. 1545-0074

Form 8949 Sales and Other Dispositions of Capital Assets 2019G Go to www.irs.gov/Form8949 for instructions and the latest information.Department of the Treasury AttachmentInternal Revenue Service 12AG File with your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D. Sequence No.

Name(s) shown on return SSN or taxpayer identification number

Before you check Box A, B, or C below, see whether you received any Form(s) 1099-B or substitute statement(s) from your broker. A substitutestatement will have the same information as Form 1099-B. Either will show whether your basis (usually your cost) was reported to the IRS by yourbroker and may even tell you which box to check.

Short-Term. Transactions involving capital assets you held 1 year or less are generally short-term (seePart Iinstructions). For long-term transactions, see page 2.

Note: You may aggregate all short-term transactions reported on Form(s) 1099-B showing basis wasreported to the IRS and for which no adjustments or codes are required. Enter the totals directly onSchedule D, line 1a; you aren't required to report these transactions on Form 8949 (see instructions).

You must check Box A, B, or C below. Check only one box. If more than one box applies for your short-term transactions, complete a separateForm 8949, page 1, for each applicable box. If you have more short-term transactions than will fit on this page for one or more of the boxes,complete as many forms with the same box checked as you need.

(A) Short-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see Note above)

(B) Short-term transactions reported on Form(s) 1099-B showing basis wasn't reported to the IRS

(C) Short-term transactions not reported to you on Form 1099-B

Adjustment, if any, to gain or loss. (h)1 (a) (b) (e)(c) If you enter an amount in column (g),(d)enter a code in column (f).Date acquired Cost or other basis.Date sold or ProceedsDescription of property Gain or (loss).

See the separate instructions.(Example: 100 shares XYZ Co.) disposed of Subtract column (e)(Mo., day, yr.) See the Note below(sales price)(Mo., day, yr.) and see Column (e) from column (d) and(see instructions) (f) (g)in the separate combine the result

Code(s) from Amount ofinstructions with column (g)instructions adjustment

2 Totals. Add the amounts in columns (d), (e), (g), and (h)(subtract negative amounts). Enter each total here andinclude on your Schedule D, line 1b (if Box A above ischecked), line 2 (if Box B above is checked), or line 3 (ifBox C above is checked) . . . . . . . . . . . . . . . . . . . . . . . . . . . G

Note: If you checked Box A above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enteran adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment.

FDIA9212L 07/31/19BAA For Paperwork Reduction Act Notice, see your tax return instructions. Form 8949 (2019)

0.931,859.

X


901,753. 30,106.

SEE ATTACHED MERRILL LYNCH-12846 - SEE ATTACHED STATEMENT931,859. 901,753. M 30,106.

Form 8949 (2019) Attachment Sequence No. 12A Page 2Name(s) shown on return. Name and SSN or taxpayer identification no. not required if shown on other side SSN or taxpayer identification number

Before you check Box D, E, or F below, see whether you received any Form(s) 1099-B or substitute statement(s) from your broker. A substitutestatement will have the same information as Form 1099-B. Either will show whether your basis (usually your cost) was reported to the IRS by yourbroker and may even tell you which box to check.

Long-Term. Transactions involving capital assets you held more than 1 year are generally long-term Part II(see instructions). For short-term transactions, see page 1.

Note: You may aggregate all long-term transactions reported on Form(s) 1099-B showing basis wasreported to the IRS and for which no adjustments or codes are required. Enter the totals directly onSchedule D, line 8a; you aren't required to report these transactions on Form 8949 (see instructions).

You must check Box D, E, or F below. Check only one box. If more than one box applies for your long-term transactions, complete a separateForm 8949, page 2, for each applicable box. If you have more long-term transactions than will fit on this page for one or more of the boxes,complete as many forms with the same box checked as you need.

(D) Long-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see Note above)

(E) Long-term transactions reported on Form(s) 1099-B showing basis wasn't reported to the IRS

(F) Long-term transactions not reported to you on Form 1099-B


See the separate instructions.(Example: 100 shares XYZ Co.) disposed of Subtract column (e)(Mo., day, yr.) See the Note below(sales price)(Mo., day, yr.) and see Column (e) from column (d) and(see instructions) (f) (g)in the separate combine the resultCode(s) from Amount ofinstructions with column (g)instructions adjustment

2 Totals. Add the amounts in columns (d), (e), (g), and (h)(subtract negative amounts). Enter each total here andinclude on your Schedule D, line 8b (if Box D above ischecked), line 9 (if Box E above is checked), or line 10 (if

GBox F above is checked). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Note: If you checked Box D above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, andenter an adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amountof the adjustment.

FDIA9212L 07/31/19 Form 8949 (2019)

0.324,259.

X


214,521. 109,738.

SEE ATTACHED MERRILL LYNCH-12846 - SEE ATTACHED STATEMENT324,259. 214,521. M 109,738.











2 Totals. Add the amounts in columns (d), (e), (g), and (h)(subtract negative amounts). Enter each total here andinclude on your Schedule D, line 8b (if Box D above ischecked), line 9 (if Box E above is checked), or line 10 (if



FDIA9212L 07/31/19 Form 8949 (2019)

0.5,997,768.

X


0. 5,997,768.

15150 QUALCOMM VARIOUS 4/16/19 1,009,782. 0. 1,009,782.

6445 QUALCOMM VARIOUS 4/16/19 450,883. 0. 450,883.





OMB No. 1545-0074Supplemental Income and LossSCHEDULE E(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)(Form 1040 or 1040-SR) 2019

G Attach to Form 1040, 1040-SR, 1040-NR, or 1041.Department of the Treasury Attachment

(99) G Go to www.irs.gov/ScheduleE for instructions and the latest information. 13Internal Revenue Service Sequence No.


Income or Loss From Rental Real Estate and Royalties Note: If you are in the business of renting personal property, usePart ISchedule C (see instructions). If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40.

Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions). . . . . . . . . . . . . . . . . . . A Yes No

If "Yes," did you or will you file required Forms 1099?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B Yes No

Physical address of each property (street, city, state, ZIP code)1 a

A

B

CType of Property1 b 2 For each rental real estate property listed Fair Rental Days Personal Use Days QJV(from list below) above, report the number of fair rental and

personal use days. Check the QJV box onlyA Aif you meet the requirements to file as a

B Bqualified joint venture. See instructions.C C

Type of Property:1 Single Family Residence 3 Vacation/Short-Term Rental 5 Land 7 Self-Rental

2 Multi-Family Residence 4 Commercial 6 Royalties 8 Other (describe)

Income: Properties: A B C

3 3Rents received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4Royalties received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Expenses:5 5Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 6Auto and travel (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 7Cleaning and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 8Commissions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 9Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 10Legal and other professional fees. . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 11Management fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 12Mortgage interest paid to banks, etc. (see instructions) . . . . . . . . . . . . . . . . . . .

13 13Other interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 14Repairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 15Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16 16Taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17 17Utilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18 18Depreciation expense or depletion . . . . . . . . . . . . . . . . . . . . . . . . . . .

19 19Other (list) G

2020 Total expenses. Add lines 5 through 19. . . . . . . . . . . . . . . . . . . . . . .

21 Subtract line 20 from line 3 (rents) and/or 4 (royalties). If result is a (loss), seeinstructions to find out if you must fileForm 6198. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Deductible rental real estate loss after limitation, if any, on22Form 8582 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

a23 a 23Total of all amounts reported on line 3 for all rental properties. . . . . . . . . . . . . . . . . . . . . . .

b 23bTotal of all amounts reported on line 4 for all royalty properties . . . . . . . . . . . . . . . . . . . . . .

c 23cTotal of all amounts reported on line 12 for all properties. . . . . . . . . . . . . . . . . . . . . . . . . . . .

d 23dTotal of all amounts reported on line 18 for all properties. . . . . . . . . . . . . . . . . . . . . . . . . . . .

e 23eTotal of all amounts reported on line 20 for all properties. . . . . . . . . . . . . . . . . . . . . . . . . . . .

24 Income. Add positive amounts shown on line 21. Do not include any losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here. . . 25 25Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the26result here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter thisamount on Schedule 1 (Form 1040 or 1040-SR), line 5, or Form 1040-NR, line 18. Otherwise,include this amount in the total on line 41 on page 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Schedule E (Form 1040 or 1040-SR) 2019BAA For Paperwork Reduction Act Notice, see the separate instructions.

FDIZ2301L 08/12/19


2029 CONNECTICUT AVE NW #41, WASHINGTON, DC 20008-614299 JANE ST APT 6L, NEW YORK, NY 10014

13,740. 8,478.

3,000. 22,991.22,871.

22,871.

10,130.38.

33,629. 17,822.493.

366,704.

115,252. 45,450.

160,702.

255,404. 111,300.

-195,939. -36,021.

-22,932. -14,814.

-37,746.

-37,746.

56,251. 16,559.

134,744.

75,279.59,465.

11

X

X

SEE STM 9 SEE STM 10

Schedule E (Form 1040 or 1040-SR) 2019 Attachment Sequence No. 13 Page 2Name(s) shown on return. Do not enter name and social security number if shown on Page 1. Your social security number

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 CorporationsNote: If you report a loss, receive a distribution, dispose of stock, or receive a loan repayment from an S corporation, you must check the box in column (e) on line 28and attach the required basis computation. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box incolumn (f) 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 or basis limitations, a prior yearunallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership

Yes Noexpenses? If you answered "Yes," see instructions before completing this section. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(e) Check if(b) Enter P for (c) Check if (d) Employer (f) Check ifbasispartnership; S28 (a) Name foreign identification any amountcomputationfor S partnership number is not at riskis requiredcorporation

A

B

C

D

Passive Income and Loss Nonpassive Income and Loss

(j) Section 179 (k) Nonpassive(g) Passive loss allowed (h) Passive income (i) Nonpassive loss allowed expense deduction income from(attach Form 8582 if required) from Schedule K-1 (see Schedule K-1) from Form 4562 Schedule K-1

A

B

C

D

29 a Totals. . . . . . . . . . . . . . . .

b Totals. . . . . . . . . . . . . . . .

30 30Add columns (h) and (k) of line 29a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3131 Add columns (g), (i), and (j) of line 29b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3232 Total partnership and S corporation income or (loss). Combine lines 30 and 31 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part III Income or Loss From Estates and Trusts33 (a) Name (b) Employer ID no.

A

B


(c) Passive deduction or loss allowed (d) Passive income (e) Deduction or loss (f) Other income(attach Form 8582 if required) from Schedule K-1 from Schedule K-1 from Schedule K-1

A

B

34 a Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35 35Add columns (d) and (f) of line 34a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36 36Add columns (c) and (e) of line 34b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

37 37Total estate and trust income or (loss). Combine lines 35 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs) ' Residual Holder(c) Excess inclusion from (d) Taxable income(b) Employer (e) Income from38 (a) Name Schedules Q, line 2c (net loss) fromidentification number Schedules Q, line 3b(see instructions) Schedules Q, line 1b

39 39Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below. . . . . . . . . . .

Part V Summary40 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 Schedule 141G(Form 1040 or 1040-SR), line 5, or Form 1040-NR, line 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42 Reconciliation of farming and fishing income. Enter your gross farmingand fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065),box 14, code B; Schedule K-1 (Form 1120-S), box 17, code AC; and

42Schedule K-1 (Form 1041), box 14, code F (see instructions) . . . . . . . . . . . . . . . . . .

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, Form 1040-SR, or Form 1040-NRfrom all rental real estate activities in which you materially participated under the passive activity

43loss rules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FDIZ2302L 08/12/19BAA Schedule E (Form 1040 or 1040-SR) 2019


72,573.34,826.

72,573.-34,826.

37,747.

1.

X

SARA JOSEPHINE JACOBS IRREV TRUST 33-6266230SJJ CHARITABLE REMAINDER UNITRUST 30-6633603

SEE STATEMENT 11

SCHEDULE SE OMB No. 1545-0074

(Form 1040 or 1040-SR) Self-Employment Tax2019G Go to www.irs.gov/ScheduleSE for instructions and the latest information.

Department of the Treasury AttachmentG Attach to Form 1040, 1040-SR, or 1040-NR.Internal Revenue Service (99) 17Sequence No.

Name of person with self-employment income (as shown on Form 1040, 1040-SR, or 1040-NR)Social security number of personwith self-employment income G

Before you begin: To determine if you must file Schedule SE, see the instructions.

May I Use Short Schedule SE or Must I Use Long Schedule SE?

Note: Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions.

Did you receive wages or tips in 2019?

No Yes

I I IAre you a minister, member of a religious order, or Yes Yes

Was the total of your wages and tips subject to socialChristian Science practitioner who received IRS approval G security or railroad retirement (tier 1) tax plus your netnot to be taxed on earnings from these sources, but you Gearnings from self-employment more than $132,900?owe self-employment tax on other earnings?

No No

I IYes YesAre you using one of the optional methods to figure your Did you receive tips subject to social security or Medicare

net earnings (see instructions)? tax that you didn't report to your employer?G GNo No

I IYes No YesDid you receive church employee income (see instruc- Did you report any wages on Form 8919, Uncollected

tions) reported on Form W-2 of $108.28 or more? Social Security and Medicare Tax on Wages? GHGNo

I IYou may use Short Schedule SE below You must use Long Schedule SE on page 2G

Section A ' Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE.

1 a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065),1 abox 14, code A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If you received social security retirement or disability benefits, enter the amount of Conservation ReservebProgram payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20,code AH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 b

Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other than2farming). Ministers and members of religious orders, see instructions for types of income to report

2on this line. See instructions for other income to report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 3Combine lines 1a, 1b, and 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Multiply line 3 by 92.35% (0.9235). If less than $400, you don't owe self-employment tax; don't file this4schedule unless you have an amount on line 1b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

Note: If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions.

5 Self-employment tax. If the amount on line 4 is:

?$132,900 or less, multiply line 4 by 15.3% (0.153). Enter the result here and on Schedule 2 (Form 1040or 1040-SR), line 4, or Form 1040-NR, line 55.

?More than $132,900, multiply line 4 by 2.9% (0.029). Then, add $16,479.60 to the result.

Enter the total here and on Schedule 2 (Form 1040 or 1040-SR), line 4, or Form 1040-NR, line 55. . . . . . . . . . . 5

6 Deduction for one-half of self-employment tax.

Multiply line 5 by 50% (0.50). Enter the result here and on Schedule 1

(Form 1040 or 1040-SR), line 14, or Form 1040-NR, line 27 . . . . . . . . . . . . . . . . . . . . 6

BAA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule SE (Form 1040 or 1040-SR) 2019

FDIA1101L 10/14/19


1,000.

1,000.

924.

141.

71.

OMB No. 1545-0121Form 1116 Foreign Tax Credit

(Individual, Estate, or Trust) 2019G Attach to Form 1040, 1040-SR, 1040-NR, 1041, or 990-T.Department of the Treasury Attachment(99) G Go to www.irs.gov/Form1116 for instructions and the latest information.Internal Revenue Service 19Sequence No.

Name ID no. as shown on page 1 of your tax return

Use a separate Form 1116 for each category of income listed below. See Categories of Income in the instructions. Check only one box on eachForm 1116. Report all amounts in U.S. dollars except where specified in Part II below.

Passive category income Section 901(j) income Lump-sum distributionsc e gSection 951A category incomea

General category income Certain income re-sourced by treatyd fForeign branch category incomeb

GResident of (name of country)h

Note: If you paid taxes to only one foreign country or U.S. possession, use column A in Part I and line A in Part II. If you paid taxes to morethan one foreign country or U.S. possession, use a separate column and line for each country or possession.

Part I Taxable Income or Loss From Sources Outside the United States (for category checked above)Foreign Country or U.S. Possession Total

(Add columns A, B, and C.)A B C

i Enter the name of the foreign country orGU.S. possession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 a Gross income from sources within countryshown above and of the type checked above(see instructions):

1 a

Check if line 1a is compensation for personal services asban employee, your total compensation from all sources is$250,000 or more, and you used an alternative basis to

Gdetermine its source (see instructions). . . . . . . . . . . . . . . .

Deductions and losses (Caution: See instructions.):

2 Expenses definitely related to the income on line 1a(attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Pro rata share of other deductionsnot definitely related:

a Certain itemized deductions or standard deduction(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other deductions (attach statement). . . . . . . . . . . . . . . . . . . . . . . b

c Add lines 3a and 3b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Gross foreign source income (see instructions). . . . . . . . . . . . . . .

Gross income from all sources (see instructions). . . . . . . . . . . . . . e

Divide line 3d by line 3e (see instructions). . . . . . . . . . f

Multiply line 3c by line 3f. . . . . . . . . . . . . . . . . . . . . . . . . . g

Pro rata share of interest expense (see instructions):4

a Home mortgage interest (use the Worksheet forHome Mortgage Interest in the instructions) . . . . . . . .

Other interest expense. . . . . . . . . . . . . . . . . . . . . . . . . . . . b

Losses from foreign sources. . . . . . . . . . . . . . . . . . . . . . . 5

Add lines 2, 3g, 4a, 4b, and 5 . . . . . . . . . . . . . . . . . . . . . 6 6

7 GSubtract line 6 from line 1a. Enter the result here and on line 15, page 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Part II Foreign Taxes Paid or Accrued (see instructions)

C Credit is claimed Foreign taxes paid or accruedO for taxes (youU In foreign currency In U.S. dollarsmust check one)NT Paid(j) (u) Total foreign(p) Other (t) OtherR Taxes withheld at source on: Taxes withheld at source on: taxes paid or accruedforeign foreignY Accrued(k) (add columns (q)

taxes paid taxes paid through (t))or accrued or accrued(l) Date paid (m) (n) Rents & (o) (q) (r) Rents & (s)

or accrued Dividends royalties Interest Dividends royalties Interest

A

B

C

G8 Add lines A through C, column (u). Enter the total here and on line 9, page 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

FDIZ2612L 09/30/19BAA For Paperwork Reduction Act Notice, see instructions. Form 1116 (2019)


90,472. 90,472.

2,026.

90,472.7,398,780.0.012228

29,413.61,059.

X

4,566.

X

29,413.

27,387.

VARIOUS

4,566. 4,566.

SEE ST 13

SEE STATEMENT 12

PageForm 1116 (2019) 2

Part III Figuring the Credit

9 Enter the amount from line 8. These are your total foreign taxes paid or accrued9for the category of income checked above Part I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Carryback or carryover (attach detailed computation). . . . . . . . . . . . . . . . . . . . . . . . . . . . 10(If your income was section 951A category income (box a above Part I), leaveline 10 blank.)

11 Add lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Reduction in foreign taxes (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Taxes reclassified under high tax kickout (see instructions). . . . . . . . . . . . . . . . . . . . . . 13 13

Combine lines 11, 12, and 13. This is the total amount of foreign taxes available for credit. . . . . . . . . . . . . . . . . . . . 14 14

Enter the amount from line 7. This is your taxable income or (loss) from sources15outside the United States (before adjustments) for the category of income

15checked above Part I (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adjustments to line 15 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 16

Combine the amounts on lines 15 and 16. This is your net foreign source taxable17income. (If the result is zero or less, you have no foreign tax credit for thecategory of income you checked above Part I. Skip lines 18 through 22. However,

17if you are filing more than one Form 1116, you must complete line 20.) . . . . . . . . . .

18 Individuals: Enter the amount from Form 1040 or 1040-SR, line 11b; or Form 1040-NR, line 41. Estates and trusts: Enter your taxable incomewithout the deduction for your exemption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Caution: If you figured your tax using the lower rates on qualified dividends or capital gains, see instructions.

19 Divide line 17 by line 18. If line 17 is more than line 18, enter "1" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20 Individuals: Enter the total of Form 1040 or 1040-SR, line 12a, and Schedule 2 (Form 1040 or 1040-SR), line 2. If you are a nonresident alien, enter the total of Form 1040-NR, lines 42 and 44. Estates and trusts:Enter the amount from Form 1041, Schedule G, line 1a; or the total of Form 990-T, lines 41, 42, and 44.

20Foreign estates and trusts should enter the amount from Form 1040-NR, line 42. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caution: If you are completing line 20 for separate category g (lump-sum distributions), see instructions.

21 Multiply line 20 by line 19 (maximum amount of credit). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

22 Enter the smaller of line 14 or line 21. If this is the only Form 1116 you are filing, skiplines 23 through 30 and enter this amount on line 31. Otherwise, complete the appropriate

G 22line in Part IV (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Summary of Credits From Separate Parts III (see instructions)Part IV

Credit for taxes on section 951A category income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 23

Credit for taxes on foreign branch category income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 24

Credit for taxes on passive category income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 25

Credit for taxes on general category income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 26

Credit for taxes on section 901(j) income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 27

Credit for taxes on certain income re-sourced by treaty. . . . . . . . . . . . . . . . . . . . . . . . . . 28 28

Credit for taxes on lump-sum distributions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 29

Add lines 23 through 29. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 30

31 Enter the smaller of line 20 or line 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Reduction of credit for international boycott operations. See instructions for line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . 32 32

33 Subtract line 32 from line 31. This is your foreign tax credit. Enter here and on Schedule 3 (Form 1040 or33G1040-SR), line 1; Form 1040-NR, line 46; Form 1041, Schedule G, line 2a; or Form 990-T, line 46a. . . . . . . . . . . .

Form 1116 (2019)

FDIZ2612L 09/30/19


4,566.

4,566.

4,566.

61,059.

61,059.

6,108,562.

0.009995642

1,194,078.

11,936.

4,566.

4,566.

4,566.


(Individual, Estate, or Trust) 2019G Attach to Form 1040, 1040-SR, 1040-NR, 1041, or 990-T.Department of the Treasury Attachment(99) G Go to www.irs.gov/Form1116 for instructions and the latest information.Internal Revenue Service 19Sequence No.



Passive category income Section 901(j) income Lump-sum distributionsc e gSection 951A category incomea

General category income Certain income re-sourced by treatyd fForeign branch category incomeb







1 a








c Add lines 3a and 3b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .









Add lines 2, 3g, 4a, 4b, and 5 . . . . . . . . . . . . . . . . . . . . . 6 6






A

B

C



ALTERNATIVE MINIMUM TAX


90,472. 90,472.

2,026.

90,472.7,398,780.0.012228

29,413.61,059.

X

4,566.

X

29,413.

27,387.

VARIOUS

4,566. 4,566.

SEE ST 15

SEE STATEMENT 14

PageForm 1116 (2019) 2



10 Carryback or carryover (attach detailed computation). . . . . . . . . . . . . . . . . . . . . . . . . . . . 10(If your income was section 951A category income (box a above Part I), leaveline 10 blank.)

11 Add lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11









18 Individuals: Enter the amount from Form 1040 or 1040-SR, line 11b; or Form 1040-NR, line 41. Estates and trusts: Enter your taxable incomewithout the deduction for your exemption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18



20 Individuals: Enter the total of Form 1040 or 1040-SR, line 12a, and Schedule 2 (Form 1040 or 1040-SR), line 2. If you are a nonresident alien, enter the total of Form 1040-NR, lines 42 and 44. Estates and trusts:Enter the amount from Form 1041, Schedule G, line 1a; or the total of Form 990-T, lines 41, 42, and 44.

20Foreign estates and trusts should enter the amount from Form 1040-NR, line 42. . . . . . . . . . . . . . . . . . . . . . . . . . . . .






Credit for taxes on section 951A category income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 23

Credit for taxes on foreign branch category income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 24









33 Subtract line 32 from line 31. This is your foreign tax credit. Enter here and on Schedule 3 (Form 1040 or33G1040-SR), line 1; Form 1040-NR, line 46; Form 1041, Schedule G, line 2a; or Form 990-T, line 46a. . . . . . . . . . . .

Form 1116 (2019)

FDIZ2612L 09/30/19

ALTERNATIVE MINIMUM TAXSARA J. JACOBS ***-**-****

4,566.

4,566.

4,566.

61,059.

61,059.

6,118,832.

0.009978865

1,196,132.

11,936.

4,566.

4,566.

4,566.

OMB No. 1545-0074

Form 6251 Alternative Minimum Tax ' Individuals 2019Go to www.irs.gov/Form6251 for instructions and the latest information.G

Department of the Treasury AttachmentInternal Revenue Service (99) 32Attach to Form 1040, 1040-SR, or 1040-NR. Sequence No.GName(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number

Alternative Minimum Taxable Income (See instructions for how to complete each line.)Part I

Enter the amount from Form 1040 or 1040-SR, line 11b, if more than zero. If Form 1040 or 1040-SR, line111b, is zero, subtract lines 9 and 10 of Form 1040 or 1040-SR from line 8b of Form 1040 or 1040-SR andenter the result here. (If less than zero, enter as a negative amount.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

If filing Schedule A (Form 1040 or 1040-SR), enter the taxes from Schedule A, line 7; otherwise, enter the2a2aamount from Form 1040 or 1040-SR, line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tax refund from Sched 1 (Form 1040 or 1040-SR), ln 1 or ln 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b 2b

Investment interest expense (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c 2c

Depletion (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d 2d

Net operating loss deduction from Schedule 1 (Form 1040 or 1040-SR), line 8. Enter as a positive amount. . . e 2e

Alternative tax net operating loss deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f 2f

Interest from specified private activity bonds exempt from the regular tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g 2g

Qualified small business stock, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h 2h

Exercise of incentive stock options (excess of AMT income over regular tax income) . . . . . . . . . . . . . . . . . . . . . . . i 2i

Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j 2j

Disposition of property (difference between AMT and regular tax gain or loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k 2k

Depreciation on assets placed in service after 1986 (difference between regular tax and AMT) . . . . . . . . . . . . . . l 2l

Passive activities (difference between AMT and regular tax income or loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m 2m

Loss limitations (difference between AMT and regular tax income or loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n 2n

Circulation costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o 2o

Long-term contracts (difference between AMT and regular tax income). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p 2p

Mining costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q 2q

Research and experimental costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r 2r

Income from certain installment sales before January 1, 1987. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s 2s

Intangible drilling costs preference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t 2t

3 3Other adjustments, including income-based related adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Alternative minimum taxable income. Combine lines 1 through 3. (If married filingseparately and line 4 is more than $733,700, see instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Part II Alternative Minimum Tax (AMT)5 Exemption. (If you were under age 24 at the end of 2019, see instructions.)

THEN enter on line 5. . . . . . IF your filing status is. . . . AND line 4 is not over. . . .

Single or head of household. . . . . . . . . . . . . . 510,300. . . . . . . . . . . . . . . 71,700$$1,020,600. . . . . . . . . . . . . . . 111,700Married filing jointly or qualifying widow(er)

Married filing separately. . . . . . . . . . . . . . . . . . . 510,300 . . . . . . . . . . . . . . . 55,850. . . . . . 5If line 4 is over the amount shown above for your filing status, see instructions.

Subtract line 5 from line 4. If more than zero, go to line 7. If zero or less,66enter -0- here and on lines 7, 9, and 11, and go to line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 ? If you are filing Form 2555, see instructions for the amount to enter.? If you reported capital gain distributions directly on Form 1040 or 1040-SR, line 6; you reported qualified dividends on

Form 1040 or 1040-SR, line 3a; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040 or 1040-SR) (asrefigured for the AMT, if necessary), complete Part III on the back and enter the amount from line 40 here. 7. . . . . . . All others: If line 6 is $194,800 or less ($97,400 or less if married filing separately),?multiply line 6 by 26% (0.26). Otherwise, multiply line 6 by 28% (0.28) and subtract $3,896($1,948 if married filing separately) from the result.

8 Alternative minimum tax foreign tax credit (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Tentative minimum tax. Subtract line 8 from line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9

Add Form 1040 or 1040-SR, line 12a (minus any tax from Form 4972), and Schedule 2 (Form 1040 or 1040-SR), line 2. Subtract from10the result any foreign tax credit from Schedule 3 (Form 1040 or 1040-SR), line 1. If you used Schedule J to figure your tax on Form 1040

10or 1040-SR, line 12a, refigure that tax without using Schedule J before completing this line (see instructions). . . . . . . . . . . . . . . . . . . . . . .

11 11AMT. Subtract line 10 from line 9. If zero or less, enter -0-. Enter here and on Schedule 2 (Form 1040 or 1040-SR), line 1 . . . . . . . . . . . .

BAA For Paperwork Reduction Act Notice, see your tax return instructions. Form 6251 (2019)

FDIA5312L 08/26/19


6,108,562.

10,000.

270.

6,118,832.

6,118,832.

1,196,132.

4,566.

1,191,566.

1,189,512.

2,054.

Form 6251 (2019) Page 2

Part III Tax Computation Using Maximum Capital Gains RatesComplete Part III only if you are required to do so by line 7 or by the Foreign Earned Income Tax Worksheet in the instructions.

Enter the amount from Form 6251, line 6. If you are filing Form 2555, enter the amount from line 3 of the12worksheet in the instructions for line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax Worksheet in the Instructions13for Forms 1040 and 1040-SR or the amount from line 13 of the Schedule D Tax Worksheet in the Instructionsfor Schedule D (Form 1040 or 1040-SR), whichever applies (as refigured for the AMT, if necessary) (see

13instructions). If you are filing Form 2555, see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the amount from Schedule D (Form 1040 or 1040-SR), line 19 (as refigured for the AMT, if necessary)1414(see instructions). If you are filing Form 2555, see instructions for the amount to enter . . . . . . . . . . . . . . . . . . . . .

If you did not complete a Schedule D Tax Worksheet for the regular tax or the AMT, enter the amount15from line 13. Otherwise, add lines 13 and 14, and enter the smaller of that result or the amount from line10 of the Schedule D Tax Worksheet (as refigured for the AMT, if necessary). If you are filing Form 2555,

15see instructions for the amount to enter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16 Enter the smaller of line 12 or line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Subtract line 16 from line 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 17

If line 17 is $194,800 or less ($97,400 or less if married filing separately), multiply line 17 by 26% (0.26).18Otherwise, multiply line 17 by 28% (0.28) and subtract $3,896 ($1,948 if married filing separately) from

Gthe result. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Enter:19

? $78,750 if married filing jointly or qualifying widow(er),

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? $39,375 if single or married filing separately, or 19

? $52,750 if head of household.

20 Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet or the amount fromline 14 of the Schedule D Tax Worksheet, whichever applies (as figured for the regular tax). If you did notcomplete either worksheet for the regular tax, enter the amount from Form 1040 or 1040-SR, line 11b; if

20zero or less, enter -0-. If you are filing Form 2555, see instructions for the amount to enter. . . . . . . . . . . . . . . . .

Subtract line 20 from line 19. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 21


23 Enter the smaller of line 21 or line 22. This amount is taxed at 0%. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23


25 Enter:

? $434,550 if single

? $244,425 if married filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

? $488,850 if married filing jointly or qualifying widow(er)

? $461,700 if head of household

26 Enter the amount from line 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet or the amount from27line 21 of the Schedule D Tax Worksheet, whichever applies (as figured for the regular tax). If you did notcomplete either worksheet for the regular tax, enter the amount from Form 1040 or 1040-SR, line 11b; ifzero or less, enter -0-. If you are filing Form 2555, see instructions for the amount to enter. . . . . . . . . . . . . . . . . 27

28 Add line 26 and line 27. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28


Enter the smaller of line 24 or line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 30

GMultiply line 30 by 15% (0.15). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 31

Add lines 23 and 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 32

If lines 32 and 12 are the same, skip lines 33 through 37 and go to line 38. Otherwise, go to line 33.

33 33Subtract line 32 from line 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multiply line 33 by 20% (0.20). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G34 34If line 14 is zero or blank, skip lines 35 through 37 and go to line 38. Otherwise, go to line 35.

Add lines 17, 32, and 33. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 35


37 GMultiply line 36 by 25% (0.25). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Add lines 18, 31, 34, and 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 38

If line 12 is $194,800 or less ($97,400 or less if married filing separately), multiply line 12 by 26% (0.26).39Otherwise, multiply line 12 by 28% (0.28) and subtract $3,896 ($1,948 if married filing separately) fromthe result. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

40 Enter the smaller of line 38 or line 39 here and on line 7. If you are filing Form 2555, do not enter this40amount on line 7. Instead, enter it on line 4 of the worksheet in the instructions for line 7. . . . . . . . . . . . . . . . . . .

Form 6251 (2019)

FDIA5312L 08/26/19


6,118,832.

6,973,296.

31.

6,973,327.

6,118,832.

39,375.

0.

39,375.

6,118,832.

39,375.

6,079,457.

434,550.

39,375.

0.

39,375.395,175.

395,175.

59,276.

434,550.

5,684,282.

1,136,856.

6,118,832.

1,196,132.

1,709,377.

1,196,132.

OMB No. 1545-0123Qualified Business Income DeductionForm 8995-A2019 G Attach to your tax return.

Department of the Treasury AttachmentInternal Revenue Service G Go to www.irs.gov/Form8995A for instructions and the latest information. Sequence No. 55AName(s) shown on return Your taxpayer identification number

Trade, Business, or Aggregation InformationPart IComplete Schedules A, B, and/or C (Form 8995-A), as applicable, before starting Part I. Attach additional worksheets when needed.See instructions.

(e) Check if(c) Check if (d) Taxpayer (b) Check if (a) Trade, business, or aggregation name1 specified service patronaggregation identification number

A

B

C

Part II Determine Your Adjusted Qualified Business Income

BA C

Qualified business income from the trade, business, or22aggregation. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multiply line 2 by 20% (0.20). If your taxable income is3$160,700 or less ($160,725 if married filing separately;

$321,400 if married filing jointly), skip lines 4 through 12 and

enter the amount from line 3 on line 13. . . . . . . . . . . . . . . . . . . . . . . 3

Allocable share of W-2 wages from the trade, business, or4aggregation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Multiply line 4 by 50% (0.50). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5

Multiply line 4 by 25% (0.25). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6

Allocable share of the unadjusted basis immediately after7

acquisition (UBIA) of all qualified property . . . . . . . . . . . . . . . . . . . . 7

Multiply line 7 by 2.5% (0.025). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 8

Add lines 6 and 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9

Enter the greater of line 5 or line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . 1010

W-2 wage and qualified property limitation. Enter the smaller11of line 3 or line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Phased-in reduction. Enter the amount from line 26, if any.12

See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Qualified business income deduction before patron reduction.13

Enter the greater of line 11 or line 12 . . . . . . . . . . . . . . . . . . . . . . . . 13

Patron reduction. Enter the amount from Schedule D14(Form 8995-A), line 6, if any. See instructions . . . . . . . . . . . . . . . . 14

15Qualified business income component. Subtract line 14 from line 13. . . . . . . . . . 15

Total qualified business income component. Add all amounts16Greported on line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

BAA For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Form 8995-A (2019)

FDIA9923L 12/26/19


MASS PATHWAYS TO ECON ADVANCEMENT 32-0500335

72,573.

14,515.

Form 8995-A (2019) Page 2

Part III Phased-in ReductionComplete Part III only if your taxable income is more than $160,700 but not $210,700 ($160,725 and $210,725 if married filingseparately; $321,400 and $421,400 if married filing jointly) and line 10 is less than line 3. Otherwise, skip Part III.

BA C

Enter the amounts from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1717

Enter the amounts from line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 18

19Subtract line 18 from line 17. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Taxable income before qualified2020business income deduction. . . . . .

21 Threshold. Enter $160,700 ($160,725

if married filing separately; $321,400

if married filing jointly) . . . . . . . . . . . . . . 21

22 Subtract line 21 from line 20. . . . . 22

Phase-in range. Enter $50,000 ($100,000 if23

married filing jointly). . . . . . . . . . . . . . . . 23

24 %Phase-in percentage. Divide ln 22 by ln 23 24

25Total phase-in reduction. Multiply line 19 by line 24 . . . . . . . . . . . 25

Qualified business income after phase-in reduction. Subtract26line 25 from line 17. Enter this amount here and on line 12,for the corresponding trade or business . . . . . . . . . . . . . . . . . . . . . . 26

Part IV Determine Your Qualified Business Income Deduction

Total qualified business income component from all qualified trades,2727businesses, or aggregations. Enter the amount from line 16 . . . . . . . . . . . . . . . . . . .

Qualified REIT dividends and publicly traded partnership (PTP)28income or (loss). See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

29Qualified REIT dividends and PTP (loss) carryforward from prior years . . . . . . . . . 29

30 Total qualified REIT dividends and PTP income. Combine lines 28 and 29. Ifless than zero, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

REIT and PTP component. Multiply line 30 by 20% (0.20). . . . . . . . . . . . . . . . . . . . . . 31 31

Qualified business income deduction before the income limitation. Add lines 27 and 31. . . . . . . . . . . . . . . . . . G 3232

33Taxable income before qualified business income deduction. . . . . . . . . . . . . . . . . . . 33

Net capital gain. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3434

35Subtract line 34 from line 33. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

36Income limitation. Multiply line 35 by 20% (0.20). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

37 Qualified business income deduction before the domestic production activities deduction (DPAD) under37section 199A(g). Enter the smaller of line 32 or line 36. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

DPAD under section 199A(g) allocated from an agricultural or horticultural cooperative. Don't enter more38than line 33 minus line 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

39 Total qualified business income deduction. Add lines 37 and 38. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 39

Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 28 and 29. If zero or greater,40enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Form 8995-A (2019)

FDIA9923L 12/26/19


2,544.

2,544.509.

509.6,108,562.6,973,327.

OMB No. 1545-2227Net Investment Income Tax 'Form 8960 Individuals, Estates, and Trusts 2019Department of the Treasury Attach to your tax return.D AttachmentInternal Revenue Service (99) 72Sequence No.Go to www.irs.gov/Form8960 for instructions and the latest information.D

Your social security number or EINName(s) shown on your tax return

Part I Investment Income Section 6013(g) election (see instructions)

Section 6013(h) election (see instructions)

Regulations section 1.1411-10(g) election (see instructions)

Taxable interest (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Ordinary dividends (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Annuities (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Rental real estate, royalties, partnerships, S corporations, trusts,4 a

etc. (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a

Adjustment for net income or loss derived in the ordinary course ofb

4ba non-section 1411 trade or business (see instructions). . . . . . . . . . . . . . . . . . . .

Combine lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c 4c

5 a Net gain or loss from disposition of property (see instructions) . . . . . . . . . . . . . 5a

Net gain or loss from disposition of property that is not subject tob

net investment income tax (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b

Adjustment from disposition of partnership interest or S corporationc

stock (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5c

Combine lines 5a through 5c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5dd

Adjustments to investment income for certain CFCs and PFICs (see instructions). . . . . . . . . . . . . . . . . . . . . . . . 66

Other modifications to investment income (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Total investment income. Combine lines 1, 2, 3, 4c, 5d, 6, and 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 8

Part II Investment Expenses Allocable to Investment Income and Modifications9aInvestment interest expenses (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 a

b State, local, and foreign income tax (see instructions) . . . . . . . . . . . . . . . . . . . . . 9b

Miscellaneous investment expenses (see instructions). . . . . . . . . . . . . . . . . . . . . c 9c

9dAdd lines 9a, 9b, and 9c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . dAdditional modifications (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10

Total deductions and modifications. Add lines 9d and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 11

Part III Tax Computation12 Net investment income. Subtract Part II, line 11, from Part I, line 8. Individuals, complete lines 13-17.

Estates and trusts, complete lines 18a-21. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Individuals:Modified adjusted gross income (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . 13 13

Threshold based on filing status (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . 14 14

Subtract line 14 from line 13. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . 15 15

Enter the smaller of line 12 or line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1616

Net investment income tax for individuals. Multiply line 16 by 3.8% (0.038). Enter here and17

include on your tax return (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Estates and Trusts:Net investment income (line 12 above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 a 18a

Deductions for distributions of net investment income andb

deductions under section 642(c) (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . 18b

c Undistributed net investment income. Subtract line 18b from 18a18c(see instructions). If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adjusted gross income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 a 19a

b Highest tax bracket for estates and trusts for the year

(see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19b

Subtract line 19b from line 19a. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . c 19c

Enter the smaller of line 18c or line 19c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2020

Net investment income tax for estates and trusts. Multiply line 20 by 3.8% (0.038). Enter here21

and include on your tax return (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21


FDIA6801L 08/14/19

SARA J. JACOBS ***********

57,611.

806,428.

1.

1.

6,306,787.

6,306,787.

7,170,827.

27,387.

10,000.

37,387.

37,387.

7,133,440.

7,186,320.200,000.

6,986,320.6,986,320.

265,480.

OMB No. 1545-1073Credit for Prior Year Minimum Tax 'Form 8801 Individuals, Estates, and Trusts 2019

G Go to www.irs.gov/Form8801 for instructions and the latest information.Department of the Treasury AttachmentG Attach to Form 1040, 1040-SR, 1040-NR, or 1041.Internal Revenue Service (99) 74Sequence No.

Name(s) shown on return Identifying number

Net Minimum Tax on Exclusion ItemsPart I

1 1Combine lines 1 and 2e of your 2018 Form 6251. Estates and trusts, see instructions . . . . . . . . . . . . . . . . . . . . . .

2 2Enter adjustments and preferences treated as exclusion items (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . .

3 3Minimum tax credit net operating loss deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Combine lines 1, 2, and 3. If zero or less, enter -0- here and on line 15 and go to Part II. If more than4$718,800 and you were married filing separately for 2018, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Enter: $109,400 if married filing jointly or qualifying widow(er) for 2018; $70,300 if single or head of5household, for 2018; or $54,700 if married filing separately for 2018. Estates and trusts, enter $24,600. . . . . .

Enter: $1,000,000 if married filing jointly or qualifying widow(er) for 2018; $500,000 if single, head of6household, or married filing separately for 2018. Estates and trusts, enter $81,900. . . . . . . . . . . . . . . . . . . . . . . . . 6

7 7Subtract line 6 from line 4. If zero or less, enter -0- here and on line 8 and go to line 9. . . . . . . . . . . . . . . . . . . . .

8 8Multiply line 7 by 25% (0.25). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 8 from line 5. If zero or less, enter -0-. If under age 24 at the end of 2018, see instructions . . . . 9 9

10 Subtract line 9 from line 4. If zero or less, enter -0- here and on line 15 and go to10Part II. Form 1040-NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 ? If for 2018 you filed Form 2555 or 2555-EZ, see instructions for the amount to enter.

? If for 2018 you reported capital gain distributions directly on Schedule 1 (Form 1040), line 13; youreported qualified dividends on Form 1040, line 3a (Form 1041, line 2b(2)); or you had a gain on bothlines 15 and 16 of Schedule D (Form 1040) (lines 18a and 19, column (2), of Schedule D (Form 1041)),complete Part III of Form 8801 and enter the amount from line 55 here. Form 1040-NR filers,see instructions. 11? All others: If line 10 is $191,100 or less ($95,550 or less if married filing separately for 2018),multiply line 10 by 26% (0.26). Otherwise, multiply line 10 by 28% (0.28) and subtract $3,822 ($1,911if married filing separately for 2018) from the result. Form 1040-NR filers, see instructions.

12 12Minimum tax foreign tax credit on exclusion items (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13 13Tentative minimum tax on exclusion items. Subtract line 12 from line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 14Enter the amount from your 2018 Form 6251, line 10, or 2018 Form 1041, Schedule I, line 55. . . . . . . . . . . . . . .

15 Net minimum tax on exclusion items. Subtract line 14 from line 13. If zero or less, enter -0-. . . . . . . . . . . . . . . . 15

BAA For Paperwork Reduction Act Notice, see instructions. Form 8801 (2019)

FDIZ2413L 11/21/19


2,088,665.

10,000.

2,098,665.

70,300.

500,000.

1,598,665.

399,666.

0.

2,098,665.

392,653.

1,582.

391,071.

389,071.

2,000.

Form 8801 (2019) Page 2

Part II Minimum Tax Credit and Carryforward to 2020


17 17Enter the amount from line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18 18Subtract line 17 from line 16. If less than zero, enter as a negative amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19 2018 credit carryforward. Enter the amount from your 2018 Form 8801, line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20 20Enter your 2018 unallowed qualified electric vehicle credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Combine lines 18 through 20. If zero or less, stop here and see the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 21

Enter your 2019 regular income tax liability minus allowable credits (see instructions) . . . . . . . . . . . . . . . . . . . . . . 22 22

Enter the amount from your 2019 Form 6251, line 9, or 2019 Form 1041, Schedule I, line 52. . . . . . . . . . . . . . . . 23 23


25 Minimum tax credit. Enter the smaller of line 21 or line 24. Also enter this amount on your 2019 Schedule 3(Form 1040 or 1040-SR), line 6 (check box b); Form 1040-NR, line 51 (check box b); or Form 1041,Schedule G, line 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

26 Credit carryforward to 2020. Subtract line 25 from line 21. Keep a record of this amount because youmay use it in future years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Form 8801 (2019)

FDIZ2413L 11/21/19


2,000.

2,000.

133.

133.

1,189,512.

1,191,566.

0.

133.

Form 8801 (2019) Page 3

Tax Computation Using Maximum Capital Gains RatesPart IIIComplete Part III only if you are required to do so by line 11 or by the Foreign Earned Income Tax Worksheet in the instructions.

Caution: If you didn't complete the 2018 Qualified Dividends and Capital Gain Tax Worksheet, the 2018Schedule D Tax Worksheet, or Part V of the 2018 Schedule D (Form 1041), see the instructions beforecompleting this part.*

Enter the amount from Form 8801, line 10. If you filed Form 2555 or 2555-EZ for 2018, enter the27amount from line 3 of the Foreign Earned Income Tax Worksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . 27

Caution: If for 2018 you filed Form 1040-NR, 1041, 2555, or 2555-EZ, see the instructions beforecompleting lines 28, 29, and 30.

Enter the amount from line 6 of your 2018 Qualified Dividends and Capital Gain Tax Worksheet, the amount28from line 13 of your 2018 Schedule D Tax Worksheet, or the amount from line 26 of the 2018 Schedule D(Form 1041), whichever applies*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

If you figured your 2018 tax using the 2018 Qualified Dividends and Capital Gain Tax Worksheet, skipline 29 and enter the amount from line 28 on line 30. Otherwise, go to line 29.

Enter the amount from line 19 of your 2018 Schedule D (Form 1040), or line 18b, column (2), of the 201829Schedule D (Form 1041). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

30 Add lines 28 and 29, and enter the smaller of that result or the amount from line 10 of your 2018Schedule D Tax Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30



If line 32 is $191,100 or less ($95,550 or less if married filing separately for 2018), multiply line 32 by 26%33(0.26). Otherwise, multiply line 32 by 28% (0.28) and subtract $3,822 ($1,911 if married filing separately for

G2018) from the result. Form 1040-NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Enter:34

?$77,200 if married filing jointly or qualifying widow(er) for 2018,

?$38,600 if single or married filing separately for 2018,

?$51,700 if head of household for 2018, or34. . . . . . . . . . . . . . . . . . . . . .

?$2,600 for an estate or trust.

Form 1040-NR filers, see instructions.

Enter the amount from line 7 of your 2018 Qualified Dividends and Capital Gain Tax Worksheet, the amount35from line 14 of your 2018 Schedule D Tax Worksheet, or the amount from line 27 of the 2018 Schedule D(Form 1041), whichever applies. If you didn't complete either worksheet or Part V of the 2018 Schedule D(Form 1041), enter the amount from your 2018 Form 1040, line 10, or 2018 Form 1041, line 22, whichever

35applies; if zero or less, enter -0-. Form 1040-NR filers, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 35 from line 34. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 36

37 Enter the smaller of line 27 or line 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

38 Enter the smaller of line 36 or line 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Subtract line 38 from line 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 39

Enter:40

?$425,800 if single for 2018,

?$239,500 if married filing separately for 2018,

?$479,000 if married filing jointly or qualifying widow(er) for 2018,40. . . . . . . . . . . . . . . . . . . . . .

?$452,400 if head of household for 2018, or


Form 1040-NR filers, see instructions.

Enter the amount from line 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 41

42 Form 1040 filers, enter the amount from line 7 of your 2018 Qualified Dividends and Capital Gain TaxWorksheet or the amount from line 19 of your 2018 Schedule D Tax Worksheet, whichever applies. If youdidn't complete either worksheet, see instructions. Form 1041 filers, enter the amount from line 27 of your2018 Schedule D (Form 1041) or line 18 of your 2018 Schedule D Tax Worksheet, whichever applies. If youdidn't complete either the worksheet or Part V of the 2018 Schedule D (Form 1041), enter the amount from

42your 2018 Form 1041, line 22; if zero or less, enter -0-. Form 1040-NR filers, see instructions. . . . . . . . . . . . . . . .

* The 2018 Qualified Dividends and Capital Gain Tax Worksheet is in the 2018 Instructions for Form 1040. The 2018 Schedule D Tax Worksheet is in the 2018 Instructions for Schedule D (Form 1040) (or the 2018 Instructions for Schedule D (Form 1041)).

Form 8801 (2019)

FDIZ2413L 11/21/19


2,098,665.

2,104,691.

2,104,691.2,098,665.

0.

38,600.

0.38,600.

2,098,665.38,600.

2,060,065.

425,800.

38,600.

Form 8801 (2019) Page 4

Part III Tax Computation Using Maximum Capital Gains Rates (continued)

Add lines 41 and 42. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 43


Enter the smaller of line 39 or line 44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 45


Add lines 38 and 45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 47




If line 29 is zero or blank, skip lines 50 through 52 and go to line 53. Otherwise, go to line 50.

Add lines 32, 47, and 48. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 50


GMultiply line 51 by 25% (0.25). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 52

Add lines 33, 46, 49, and 52. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 53

If line 27 is $191,100 or less ($95,550 or less if married filing separately for 2018), multiply line 27 by 26%54(0.26). Otherwise, multiply line 27 by 28% (0.28) and subtract $3,822 ($1,911 if married filing separately for2018) from the result. Form 1040-NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

55 Enter the smaller of line 53 or line 54 here and on line 11. If you filed Form 2555 or 2555-EZ for 2018,don't enter this amount on line 11. Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet

55in the instructions for line 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 8801 (2019)

FDIZ2413L 11/21/19


38,600.387,200.387,200.58,080.

425,800.

1,672,865.334,573.

392,653.

583,804.

392,653.

OMB No. 1545-1008Passive Activity Loss LimitationsForm 8582

2019G See separate instructions.Department of the Treasury G Attach to Form 1040, Form 1040-SR, or Form 1041.(99) AttachmentInternal Revenue Service

G Go to www.irs.gov/Form8582 for instructions and the latest information. Sequence No. 88Name(s) shown on return Identifying number

Part I 2019 Passive Activity LossCaution: Complete Worksheets 1, 2, and 3 before completing Part I.

Rental Real Estate Activities With Active Participation (For the definition of active participation, seeSpecial Allowance for Rental Real Estate Activities in the instructions.)

Activities with net income (enter the amount from Worksheet 1, column (a)) . . . . 1 a 1 a

1 bb Activities with net loss (enter the amount from Worksheet 1, column (b)) . . . . . . .

1 cc Prior years' unallowed losses (enter the amount from Worksheet 1, column (c)).

1 dd Combine lines 1a, 1b, and 1c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Commercial Revitalization Deductions From Rental Real Estate Activities

Commercial revitalization deductions from Worksheet 2, column (a). . . . . . . . . . . . 2 a 2 a

b Prior year unallowed commercial revitalization deductions from Worksheet 2,column (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 b

c Add lines 2a and 2b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 c

All Other Passive Activities





4 Combine lines 1d, 2c, and 3d. If this line is zero or more, stop here and include this form with your return; alllosses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Report the losseson the forms and schedules normally used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

?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 completePart II or Part III. Instead, go to line 15.

Part II Special Allowance for Rental Real Estate Activities With Active ParticipationNote: 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

Enter $150,000. If married filing separately, see instructions. . . . . . . . . . . . . . . . . . . 6 6

Enter modified adjusted gross income, but not less than zero. See instructions. . . . . 7 7

Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9, enter -0- online 10. Otherwise, go to line 8.

Subtract line 7 from line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 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

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 ActivitiesNote: Enter all numbers in Part III as positive amounts. See the example for Part II in the instructions.

Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions . . . . . . . 1111

Enter the loss from line 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1212

Reduce line 12 by the amount on line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1313

Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1414

Part IV Total Losses AllowedAdd the income, if any, on lines 1a and 3a and enter the total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1515

Total losses allowed from all passive activities for 2019. Add lines 10, 14, and 15. See instructions to16find out how to report the losses on your tax return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16


FDIZ1901L 07/25/19


-231,960.

-512,215.-744,175.

72,573.

-23.

-34,828.37,722.

-706,453.

706,453.150,000.

7,186,390.

0.

72,573.

72,573.

Form 8582 (2019) 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)

Total. Enter on Form 8582, lines 1a, 1b,Gand 1c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worksheet 2 ' For Form 8582, Lines 2a and 2b (see instructions)

(a) Current year (b) Prior year(c) Overall lossName of activity deductions (line 2a) unallowed

deductions (line 2b)

GTotal. Enter on Form 8582, lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . . .





Worksheet 4 ' Use This Worksheet if an Amount Is Shown on Form 8582, Line 10 or 14. See instructions.

Form or schedule (d) Subtract(c) Specialand line number column (c) from(a) Loss (b) RatioName of activity allowanceto be reported on column (a)(see instructions)

GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00Worksheet 5 ' Allocation of Unallowed Losses (see instructions)

Form or scheduleand line number (a) Loss (b) Ratio (c) Unallowed lossName of activityto be reported on(see instructions)

GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

FDIZ1902L 07/25/19BAA Form 8582 (2019)


706,453.744,200.

34,828.23.72,573.

512,215.231,960.

RESIDENTIAL RENTAL-DC 195,939. 256,170. 452,109.RESIDENTIAL RENTAL-NY 36,021. 256,045. 292,066.

BELDORE CAPITAL FUND LLC 20. 20.CLEARFORK CAPITAL FUND LLC 1. 2. 3.MASS PATHWAYS TO ECON ADVANCE 72,573. 34,826. 37,747.BELGARDE CAPITAL FUND LLC 2. 2.

RESIDENTIAL RENTAL-DC SCH E LN 22 452,109. 0.607510 429,177.RESIDENTIAL RENTAL-NY SCH E LN 22 292,066. 0.392456 277,252.BELDORE CAPITAL FUND LLC SCH E LN 28 20. 0.000027 19.CLEARFORK CAPITAL FUND LLC SCH E LN 28 3. 0.000004 3.BELGARDE CAPITAL FUND LLC SCH E LN 28 2. 0.000003 2.

Form 8582 (2019) Page 3

Worksheet 6 ' Allowed Losses (see instructions)

Form or scheduleand line number (a) Loss (b) Unallowed loss (c) Allowed lossName of activityto be reported on(see instructions)

GTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worksheet 7 ' Activities With Losses Reported on Two or More Forms or Schedules (see instructions)

(a) (b) (d) Unallowed(c) Ratio (e) Allowed lossloss

Name of activity:

Form or schedule and line number to be reported on(see instructions):

Net loss plus prior year unallowed loss1 aGfrom form or schedule. . . . . . . . . . . . . . . . .

GNet income from form or schedule . . . . . b

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













Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 1.00Name of activity:

















Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 1.00FDIZ1903L 07/25/19BAA Form 8582 (2019)

37,746.706,429.744,175.


RESIDENTIAL RENTAL-DC SCH E LN 22 452,109. 429,177. 22,932.RESIDENTIAL RENTAL-NY SCH E LN 22 292,066. 277,252. 14,814.

SEE STATEMENT 16









































FDIZ1901L 07/25/19



-237,399.

-488,131.-725,530.

72,573.

-23.

-34,828.37,722.

-687,808.

687,808.150,000.

7,186,390.

0.

72,573.

72,573.

Form 8582 (2019) Page 2


















GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

FDIZ1902L 07/25/19BAA Form 8582 (2019)

***-**-****SARA J. JACOBSALTERNATIVE MINIMUM TAX

687,808.725,555.

34,828.23.72,573.

488,131.237,399.




Form 8582 (2019) Page 3



GTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Name of activity:




































37,746.687,784.725,530.



SEE STATEMENT 17

Noncash Charitable Contributions OMB No. 1545-0908Form 8283G Attach one or more Forms 8283 to your tax return if you claimed a total deduction(Rev. November 2019)

Attachmentof over $500 for all contributed property.Department of the Treasury 155Sequence No.Internal Revenue Service G Go to www.irs.gov/Form8283 for instructions and the latest information.Name(s) shown on your income tax return Identifying number

Note: Figure the amount of your contribution deduction before completing this form. See your tax return instructions.

Section A. Donated Property of $5,000 or Less and Publicly Traded Securities ' List in this section only an item(or groups of similar items) for which you claimed a deduction of $5,000 or less. Also list publicly traded securitiesand certain other property even if the deduction is more than $5,000 (see instructions).

Part I Information on Donated Property ' If you need more space, attach a statement.

(b) If donated property is a vehicle (see (c) Description and condition of donated property(a) Name and address of the1 instructions), check the box. Also enter the vehicle (For a vehicle, enter the year, make, model, anddonee organizationmileage. For securities,and other property,identification number (unless Form 1098-C is attached).

see instructions.)

A

B

C

D

E

Note: If the amount you claimed as a deduction for an item is $500 or less, you do not have to complete columns (e), (f), and (g).

(d) Date of the (e) Date acquired (f) How acquired (g) Donor's cost (h) Fair market value (i) Method used to determinecontribution by donor (mo., yr.) by donor or adjusted basis (see instructions) the fair market value

A

B

C

D

E

Partial Interests and Restricted Use Property ' Complete lines 2a through 2e if you gave less than an entire interest inPart IIa property listed in Part I. Complete lines 3a through 3c if conditions were placed on a contribution listed in Part I; also attach therequired statement (see instructions).

2 a GEnter the letter from Part I that identifies the property for which you gave less than an entire interest . . . . . . . . . .

If Part II applies to more than one property, attach a separate statement.

b GTotal amount claimed as a deduction for the property listed in Part I: For this tax year . . . . . . . . . . . . . . . . . . . (1)

GFor any prior tax years . . . . . . . . . . . . . (2)

c Name and address of each organization to which any such contribution was made in a prior year (complete only if different from thedonee organization above):Name of charitable organization (donee)

Address (number, street, and room or suite no.)

City or town, state, and ZIP code

GFor tangible property, enter the place where the property is located or keptd

e Name of any person, other than the donee organization, having actual possession of the property G

Yes No

3 a Is there a restriction, either temporary or permanent, on the donee's right to use or dispose of the donated property?. . . . . . . . .

Did you give to anyone (other than the donee organization or another organization participating with the donee organizationbin cooperative fundraising) the right to the income from the donated property or to the possession of the property, includingthe right to vote donated securities, to acquire the property by purchase or otherwise, or to designate the person having suchincome, possession, or right to acquire?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Is there a restriction limiting the donated property for a particular use?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c

FDIZ1812L 12/06/19BAA For Paperwork Reduction Act Notice, see separate instructions. Form 8283 (Rev. 11-2019)


JEWISH COMMUNITY FOUNDATION-S.D.4950 MURPHY CANYON RD.SAN DIEGO, CA 92123 6090 SHARES QUALCOMM

10/29/19 9/91 GIFT 500,263. COMPARABLE SALES

Form 8283 (Rev. 11-2019) Page 2Name(s) shown on your income tax return Identifying number

Section B. Donated Property Over $5,000 (Except Publicly Traded Securities, Vehicles, Intellectual Property or Inventory ReportableComplete this section for one item (or a group of similar items) for which you claimed a deduction of more than $5,000 per item or groupin Section A) '

(except contributions reportable in Section A). Provide a separate form for each item donated unless it is part of a group of similar items. A qualified appraisal isgenerally required for items reportable in Section B. See instructions.

Part I Information on Donated PropertyCheck the box that describes the type of property donated.4

a d g jArt* (contribution of $20,000 or more) Collectibles** OtherArt* (contribution of less than $20,000)

b e hQualified Conservation Contribution Other Real Estate Intellectual Property

c f iEquipment Securities Vehicles

*Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antiques, decorative arts, textiles, carpets, silver, rare manuscripts, historical memorabilia, and other similar objects.

**Collectibles include coins, stamps, books, gems, jewelry, sports memorabilia, dolls, etc., but not art as defined above.

Note: In certain cases, you must attach a qualified appraisal of the property. See instructions.

(a) Description of donated property (if you need (b) If any tangible personal property or real property was donated, give a brief (c) Appraised fair5summary of the overall physical condition of the property at the time of the gift market valuemore space, attach a separate statement)

A

B

C

D

See instructions

(d) Date acquired (f) Donor's cost or (g) For bargain sales, (h) Amount claimed as (i) Date of contribution(e) How acquired by donorby donor (mo., yr.) adjusted basis enter amount received a deduction

A

B

C

D

Part II Taxpayer (Donor) Statement ' List each item included in Part I above that the appraisal identifies as having a value of $500 or less. See instructions.

I declare that the following item(s) included in Part I above has to the best of my knowledge and belief an appraised value of not more than $500 (per item).

GEnter identifying letter from Part I and describe the specific item. See instructions.

Signature of taxpayer (donor) G Date G

Part III Declaration of Appraiser

I declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any of the foregoing persons, or married toany person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or party to the transaction, I performed the majority of my appraisals during mytax year for other persons.

Also, I declare that I perform appraisals on a regular basis; and that because of my qualifications as described in the appraisal, I am qualified to make appraisals of the type ofproperty being valued. I certify that the appraisal fees were not based on a percentage of the appraised property value. Furthermore, I understand that a false or fraudulentoverstatement of the property value as described in the qualified appraisal or this Form 8283 may subject me to the penalty under section 6701(a) (aiding and abetting theunderstatement of tax liability). I understand that my appraisal will be used in connection with a return or claim for refund. I also understand that, if there is a substantial or grossvaluation misstatement of the value of the property claimed on the return or claim for refund that is based on my appraisal, I may be subject to a penalty under section 6695A of theInternal Revenue Code, as well as other applicable penalties. I affirm that I have not been at any time in the three-year period ending on the date of the appraisal barred frompresenting evidence or testimony before the Department of the Treasury or the Internal Revenue Service pursuant to 31 U.S.C. 330(c).

SignHere Signature G Title G Date GBusiness address (including room or suite no.) Identifying number


Part IV Donee Acknowledgment ' To be completed by the charitable organization.

This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property

as described in Section B, Part I, above on the following date G

Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section B, Part I(or any portion thereof) within 3 years after the date of receipt, it will file Form 8282, Donee Information Return, with the IRS and give the donora copy of that form. This acknowledgment does not represent agreement with the claimed fair market value.

GDoes the organization intend to use the property for an unrelated use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes NoName of charitable organization (donee) Employer identification number

Address (number, street, and room or suite no.) City or town, state, and ZIP code

Authorized signature Title Date

FDIZ1812L 12/06/19 Form 8283 (Rev. 11-2019)


29194 SHARES QUALCOMM 1,529,766.

9/91 GIFT 1/23/19

,

1/23/19

X

SJJ CHARITABLE REMAINDER CRUT 30-6633603

C/O 114 W 47TH ST NY8-114-07-07 NEW YORK, NY 10036-1510

X












A

B

C

D

See instructions


A

B

C

D

















FDIZ1812L 12/06/19 Form 8283 (Rev. 11-2019)


23,351 SHARES QUALCOMM 1,999,196.

9/91 GIFT 4/23/19

,

4/23/19

X



X












A

B

C

D

See instructions


A

B

C

D

















FDIZ1812L 12/06/19 Form 8283 (Rev. 11-2019)


6,316 SHARES QUALCOMM 500,006.

9/91 GIFT 9/05/19

,

9/05/19

X



X












A

B

C

D

See instructions


A

B

C

D

















FDIZ1812L 12/06/19 Form 8283 (Rev. 11-2019)


6,090 SHARES QUALCOMM 500,263.

9/91 GIFT 10/29/19

,

10/29/19

X



X

2019 FEDERAL STATEMENTS PAGE 1


STATEMENT 1FORM 1040WAGE SCHEDULE

FEDERAL MEDI- STATE LOCALTAXPAYER - EMPLOYER WAGES W/H FICA CARE W/H W/H

UNIVERSITY OF SAN DIEGO 14,564. 849. 903. 211. 84. 146.GRAND TOTAL 14,564. 849. 903. 211. 84. 146.

STATEMENT 2FORM 1040PENSION AND ANNUITIES SCHEDULE

TOTAL TAXABLE FEDERAL STATETAXPAYER - PAYER RECEIVED AMOUNT W/H W/H

GREAT WEST RETIREMENT SERVICESGRAND TOTAL 0. 0. 0. 0.

STATEMENT 3FORM 1040, LINE 2ATAX-EXEMPT INTEREST

IN-STATE PRIVATE TOTALMUNICIPAL ACTIVITY MUNICIPAL

PAYER BONDS BONDS BONDS

MERRILL LYNCH-14414 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,500. 17,500.MERRILL LYNCH-14414 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,294. 270. 2,294.MERRILL LYNCH-14414-ACRRUED MUNI INT PD. . . . -10,640. -10,640.

TOTAL 9,154. 270. 9,154.

STATEMENT 4FORM 1040, LINE 3AQUALIFIED DIVIDENDS

BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 66,991.BELGARDE CAPITAL FUND LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,180.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,350.MERRILL LYNCH-12841 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609,531.MERRILL LYNCH-12846 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41,958.SJJ CHARITABLE REMAINDER UNITRUST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,674.

TOTAL $ 800,684.

STATEMENT 5SCHEDULE 1, LINE 1TAXABLE REFUNDS OF STATE AND LOCAL INCOME TAXES

1. STATE AND LOCAL TAX REFUNDS (PRIOR YEAR) $ 14,034.2. REFUNDS ATTRIBUTABLE TO POST 12/31/2018 PAYMENTS PER IRS PUB. 525 8,347.3. NET STATE AND LOCAL TAX REFUNDS 5,687.



STATEMENT 5 (CONTINUED)SCHEDULE 1, LINE 1TAXABLE REFUNDS OF STATE AND LOCAL INCOME TAXES

4. STATE AND LOCAL TAXES INCLUDED ON PRIOR YEAR SCH. A, LINE 5E 10,000.5. PRIOR YEAR ALLOWABLE SALES TAX DEDUCTION 1,919.6. EXCESS OF INCOME TAXES DEDUCTED OVER SALES TAXES 8,081.7. ENTER THE SMALLER OF LINE 3 OR LINE 6 5,687.8. REFUND WITH NO BENEFIT DUE TO AMT, NONREFUNDABLE CREDITS,

0% CAPITAL GAIN RATE, SALT LIMIT -5,687.9. STATE AND LOCAL REFUNDS TAXABLE THIS YEAR $ 0.

STATE REFUNDS TAXABLE IN 2019 - RECOMPUTED TAX(TO DETERMINE IF TAX BENEFIT RECEIVED PER IRS PUB. 525 -AMT / UNUSED CREDITS / 0% RATE CAPITAL GAIN, QUALIFIED DIVIDENDS, SALT LIMIT)

RECOMPUTATION OF 2018 TAX:

1. ACTUAL TAXABLE INCOME 2,088,665.2. ACTUAL REGULAR TAX 390,653.3. ACTUAL AMT 2,000.4. ACTUAL TOTAL TAX BEFORE CREDITS 392,653.5. LESS: ACTUAL CREDITS 1,582.6. ACTUAL TAX AFTER CREDITS 391,071.7. TAXABLE INCOME RECOMPUTED WITH SCH. A TAXES

REDUCED BY STATE TAX REFUNDS 2,088,665.8. RECOMPUTED REGULAR TAX 390,653.9. RECOMPUTED AMT 2,000.

10. RECOMPUTED TOTAL TAX BEFORE CREDITS 392,653.11. LESS: RECOMPUTED CREDITS 1,582.12. RECOMPUTED TAX AFTER CREDITS 391,071.13. DIFFERENCE BETWEEN ACTUAL AND RECOMPUTED TAX

(SUBTRACT LINE 12 FROM LINE 6) 0.

RECOMPUTATION OF 2018 CREDIT CARRYOVERS:

14, ACTUAL CREDIT CARRYOVERS 133.15. RECOMPUTED CREDIT CARRYOVERS 133.16. DIFFERENCE BETWEEN ACTUAL AND RECOMPUTED CARRYOVERS


NET CHANGE TO TAX LIABILITY, CARRYOVERS, ETC.(CHANGE IN TAX LESS CHANGE IN CARRYOVERS/CREDITS) 0.

ZERO OR POSITIVE CHANGE - NO TAX BENEFIT WAS RECEIVED AND SO NONE OF THEREFUND IS TAXABLE.

NOTE: THE ABOVE SCHEDULE CONSIDERS A TAX BENEFIT TO BE A LOWER TAX LIABILITY,HIGHER CREDIT CARRYOVERS, AND/OR HIGHER REFUNDABLE TAX CREDITSAS A RESULT OF DEDUCTING THE STATE TAXES THAT PRODUCED THE REFUND.HOWEVER, AN INCREASE TO CREDIT CARRYOVERS AND/OR REFUNDABLE TAXCREDITS IS NOT CONSIDERED TO BE A TAX BENEFIT IF THE INCREASE IS FULLYOFFSET BY A HIGHER TAX LIABILITY.



STATEMENT 6SCHEDULE A, LINE 9INVESTMENT INTEREST

INVESTMENT INTEREST FROM K-1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 27,387.TOTAL $ 27,387.

STATEMENT 7SCHEDULE A, LINE 11CONTRIBUTIONS BY CASH OR CHECK

CENTER FOR COMMUNITY SOLUTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000.DREAMS FOR ORPHANS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 700.LAWRENCE FAMILY JEWISH COMMUNITY CENTER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,200.MOTHERS OUT FRONT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500.MOXIE THEATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486.PLANNED PARENTHOOD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,500.

TOTAL $ 6,386.

STATEMENT 8SCHEDULE D, LINE 13CAPITAL GAIN DISTRIBUTIONS

MERRILL LYNCH-12846 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 265.TOTAL $ 265.

STATEMENT 9SCHEDULE E, LINE 19 - 2029 CONNECTICUT AVE NW #41OTHER RENTAL AND ROYALTY EXPENSES

ASSOCIATION DUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 53,376.PLUMBING AND ELECTRICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,875.

TOTAL $ 56,251.

STATEMENT 10SCHEDULE E, LINE 19 - 99 JANE ST APT 6LOTHER RENTAL AND ROYALTY EXPENSES

ASSOCIATION DUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 16,559.TOTAL $ 16,559.



STATEMENT 11SCHEDULE E, PAGE 2PART II - INCOME OR LOSS FROM PARTNERSHIPS AND S CORPORATIONS

BASIS ANY PASSIVE PASSIVE NONPASSIVE SECTION NONPASSIVEX IF EMPLOYER COMPUTATI INVST. NOT LOSS FROM INC. FROM LOSS FROM 179 INCOME

NAME TYPE FOREIGN I.D. NO. REQUIRED AT RISK PTP FORM 8582 SCH. K-1 SCH. K-1 DEDUCTION FROM K-1

BELDORE CAPITAL FUND LLC P 26-0505281

CLEARFORK CAPITAL FUND LLC P 26-0158977

OTHER PORTFOLIO INCOME P 26-0158977

MASS PATHWAYS TO ECON ADVANCEMENT P 32-0500335 $ 72,573.

PYA: PASSIVE CARRYOVER P 32-0500335 $ 34,826.

BELGARDE CAPITAL FUND LLC P 61-1897725

TOTAL $ 34,826. $ 72,573. $ 0. $ 0. $ 0.



STATEMENT 12FORM 1116, LINE 1A - GENERAL CATEGORY INCOMEGROSS INCOME FROM SOURCES OUTSIDE U.S.

FOREIGN COUNTRY OR U.S. POSSESSION: VARIOUSGROSS FOREIGN SOURCE QUALIFIED DIVIDENDS. . . . . . . . . . . . . . . . 1,916.

NET FOREIGN SOURCE QUALIFIED DIVIDENDS. . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,916.CAPITAL GAIN DISTRIBUTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265.

NET FOREIGN SOURCE CAPITAL GAIN DISTRIBUTIONS. . . . . . . . . . . . . . . . 265.BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,180.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47,079.BELGARDE CAPITAL FUND LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 961.SJJ CHARITABLE REMAINDER UNITRUST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,071.

TOTAL $ 90,472.

STATEMENT 13FORM 1116, LINE 2- GENERAL CATEGORY INCOMEEXPENSES DIRECTLY ALLOCABLE TO INCOME

BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,064.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762.BELGARDE CAPITAL FUND LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200.

TOTAL $ 2,026.

STATEMENT 14FORM 1116, LINE 1A - GENERAL CATEGORY INCOME (AMT)GROSS INCOME FROM SOURCES OUTSIDE U.S.



NET FOREIGN SOURCE CAPITAL GAIN DISTRIBUTIONS. . . . . . . . . . . . . . . . 265.BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,180.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47,079.BELGARDE CAPITAL FUND LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 961.SJJ CHARITABLE REMAINDER UNITRUST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,071.

TOTAL $ 90,472.

STATEMENT 15FORM 1116, LINE 2- GENERAL CATEGORY INCOME (AMT)EXPENSES DIRECTLY ALLOCABLE TO INCOME

BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,064.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762.BELGARDE CAPITAL FUND LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200.

TOTAL $ 2,026.



STATEMENT 168582WORKSHEET 7 - ACTIVITIES WITH LOSSES ON 2 OR MORE FORMS/SCHEDULES

NAME OF ACTIVITY: BELDORE CAPITAL FUND LLC

NET NET NET LOSS - UNALLOWED ALLOWEDFORM/SCH LOSS INCOME NET INCOME RATIO LOSS LOSS

SH E LN 28 20. 20. 1.000000 19. 1.20. 0. 20. 1.000000 19. 1.


NAME OF ACTIVITY: CLEARFORK CAPITAL FUND LLC


SH E LN 28 3. 3. 1.000000 3.3. 0. 3. 1.000000 3. 0.


NAME OF ACTIVITY: BELGARDE CAPITAL FUND LLC


SH E LN 28 2. 2. 1.000000 2.2. 0. 2. 1.000000 2. 0.




SH E LN 28 20. 20. 1.000000 19. 1.20. 0. 20. 1.000000 19. 1.






SH E LN 28 3. 3. 1.000000 3.3. 0. 3. 1.000000 3. 0.




SH E LN 28 2. 2. 1.000000 2.2. 0. 2. 1.000000 2. 0.

2019 GENERAL ELECTIONS PAGE 1


ELECTION TO USE IRS DISCOUNT RATE FOR MONTH PRIOR TO GIFT

PURSUANT TO SEC. 7820 (A), TAXPAYER ELECTS TO USE IRS DISCOUNT RATE FOR MONTHPRIOR TO GIFT ON ALL CHARITABLE REMAINDER TRUST CONTRIBUTIONS.

PRIORCUR SPECIAL 179/ PRIOR SALVAG

DATE DATE COST/ BUS. 179 DEPR. BONUS/ DEC. BAL /BASIS DEPR. PRIOR CURRENTNO. DESCRIPTION ACQUIRED SOLD BASIS PCT. BONUS ALLOW. SP. DEPR. DEPR. REDUCT BASIS DEPR. METHOD LIFE RATE DEPR.

SCHEDULE E - RESIDENTIAL RENTAL-DC_______________________________________

BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 226,083 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 226,083 76,419

FURNITURE AND FIXTURES______________________

5 LUTRON WINDOW SHADES 1/01/16 58,316 58,316 32,814 200DB HY 7 .12490 7,284

6 LAMP 1/01/16 734 734 413 200DB HY 7 .12490 92

7 STOOL 1/01/16 1,101 1,101 620 200DB HY 7 .12490 138

10 TV CABINETS 1/01/16 9,819 9,819 5,525 200DB HY 7 .12490 1,226

TOTAL FURNITURE AND FIXTURE 69,970 0 0 0 0 0 69,970 39,372 8,740

IMPROVEMENTS____________

4 IMPROVEMENTS 1/01/16 419,640 419,640 45,140 S/L MM 27.5 .03636 15,258

8 LIGHTING 1/01/16 13,857 13,857 7,798 200DB HY 7 .12490 1,731

9 DRAPES 1/01/16 3,512 3,512 1,976 200DB HY 7 .12490 439

TOTAL IMPROVEMENTS 437,009 0 0 0 0 0 437,009 54,914 17,428

LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0

12/31/19 2019 FEDERAL DEPRECIATION SCHEDULE PAGE 1




MACHINERY AND EQUIPMENT_______________________

3 SECURITY SYSTEM 1/01/16 109,935 109,935 78,274 200DB HY 5 .11520 12,665

TOTAL MACHINERY AND EQUIPME 109,935 0 0 0 0 0 109,935 78,274 12,665

TOTAL DEPRECIATION 3,619,380 0 0 0 0 0 3,619,380 398,643 115,252

SCHEDULE E - RESIDENTIAL RENTAL-NY_______________________________________

11 BUILDING 1/01/18 1,250,000 1,250,000 43,563 S/L MM 27.5 .03636 45,450

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 0 200DB HY 7 0

14 COUNTERTOPS 1/01/18 14,790 14,790 0 150DB HY 15 0

15 WINDOW TREATMENTS 1/01/18 22,834 22,834 0 150DB HY 15 0

16 FURNISHINGS 1/01/18 122,248 122,248 0 200DB HY 5 0

TOTAL 2,722,214 0 0 222,214 0 0 2,500,000 43,563 45,450

TOTAL DEPRECIATION 2,722,214 0 0 222,214 0 0 2,500,000 43,563 45,450

GRAND TOTAL DEPRECIATION 6,341,594 0 0 222,214 0 0 6,119,380 442,206 160,702



DATE DATE AMT AMT PRIOR AMT AMT AMT AMT REG. OWN POST-86 REAL PROP LEAS PER 59 (E)(2)NO. DESCRIPTION ACQUIRED SOLD BASIS DEPR. METHOD LIFE RATE DEPR. DEPR. PCT. DEPR ADJ. PREF. PROP PREF AMORT.


BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 226,083 S/L MM 27.5 .03636 76,419 76,419 0

TOTAL BUILDINGS 2,101,726 226,083 76,419 76,419 0 0 0 0


5 LUTRON WINDOW SHADES 1/01/16 58,316 26,167 150DB HY 7 .12250 7,144 7,284 140 0

6 LAMP 1/01/16 734 329 150DB HY 7 .12250 90 92 2 0

7 STOOL 1/01/16 1,101 494 150DB HY 7 .12250 135 138 3 0

10 TV CABINETS 1/01/16 9,819 4,406 150DB HY 7 .12250 1,203 1,226 23 0

TOTAL FURNITURE AND FIXTURE 69,970 31,396 8,572 8,740 168 0 0 0


4 IMPROVEMENTS 1/01/16 419,640 45,140 S/L MM 27.5 .03636 15,258 15,258 0

8 LIGHTING 1/01/16 13,857 6,218 150DB HY 7 .12250 1,697 1,731 34 0

9 DRAPES 1/01/16 3,512 1,576 150DB HY 7 .12250 430 439 9 0

TOTAL IMPROVEMENTS 437,009 52,934 17,385 17,428 43 0 0 0

LAND____

2 LAND 1/01/16 900,740 0 0 0

TOTAL LAND 900,740 0 0 0 0 0 0 0


12/31/19 2019 FEDERAL ALTERNATIVE MINIMUM TAX DEPRECIATION SCHEDULE PAGE 1



3 SECURITY SYSTEM 1/01/16 109,935 64,146 150DB HY 5 .16660 18,315 12,665 -5,650 0

TOTAL MACHINERY AND EQUIPME 109,935 64,146 18,315 12,665 -5,650 0 0 0

TOTAL DEPRECIATION 3,619,380 374,559 120,691 115,252 -5,439 0 0


11 BUILDING 1/01/18 1,250,000 43,563 S/L MM 27.5 .03636 45,450 45,450 0

12 LAND 1/01/18 1,250,000 0 0 0

13 FLOORING 1/01/18 0 200DB HY 7 0 0 0

14 COUNTERTOPS 1/01/18 0 150DB HY 15 0 0 0

15 WINDOW TREATMENTS 1/01/18 0 150DB HY 15 0 0 0

16 FURNISHINGS 1/01/18 0 200DB HY 5 0 0 0

TOTAL 2,500,000 43,563 45,450 45,450 0 0 0 0

TOTAL DEPRECIATION 2,500,000 43,563 45,450 45,450 0 0 0 0

GRAND TOTAL DEPRECIATION 6,119,380 418,122 166,141 160,702 -5,439 0 0 0

12/31/19 2019 FEDERAL ALTERNATIVE MINIMUM TAX DEPRECIATION SCHEDULE


PAGE 2

2019 TAX RETURN

Client:

Prepared for:

Prepared by:

Date:

Comments:

Route to:

FDIL2001L 06/03/19

CALIFORNIA INDIVIDUAL

1178K3

SARA J. JACOBS2604 FIFTH AVE. #403SAN DIEGO, CA 92103

OCTOBER 2, 2020

059

DO NOT MAIL THIS FORM TO THE FTB

TAXABLE YEAR FORM

California e-file Signature Authorization for Individuals2019 8879Your name Your SSN or ITIN

Spouse's/RDP's name Spouse's/RDP's SSN or ITIN

(whole dollars only)Part I Tax Return Information

1 1California Adjusted Gross Income. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 2Amount You Owe. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 3Refund or No Amount Due. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II Taxpayer Declaration and Signature Authorization (Be sure you obtain and keep a copy of your return.)

Under penalties of perjury, I declare that I have examined a copy of my individual income tax return and accompanying schedules andstatements for the tax year ending December 31, 2019, and to the best of my knowledge and belief, it is true, correct, and complete. I furtherdeclare that the information I provided to my electronic return originator (ERO), transmitter, or intermediate service provider (including my name,address, and social security number or individual tax identification number) and the amounts shown in Part I above agree with the informationand amounts shown on the corresponding lines of my electronic income tax return. If applicable, I authorize an electronic funds withdrawal ofthe amount on line 2 and/or the estimated tax payments as shown on my return and on form FTB 8455, California e-file Payment Record forIndividuals, or a comparable form. If applicable, I declare that direct deposit refund amount on line 3 agrees with the direct deposit authorizationstated on my return. If I have filed a joint return, this is an irrevocable appointment of the other spouse/RDP as an agent to authorize anelectronic funds withdrawal or direct deposit. I authorize my ERO, transmitter, or intermediate service provider to transmit my complete return tothe Franchise Tax Board (FTB). If the processing of my return or refund is delayed, I authorize the FTB to disclose to my ERO, intermediateservice provider, and /or transmitter the reason(s) for the delay or the date when the refund was sent. If I am filing a balance due return, Iunderstand that if the FTB does not receive full and timely payment of my tax liability, I remain liable for the tax liability and all applicableinterest and penalties. I acknowledge that I have read and consent to the Electronic Funds Withdrawal Consent included on the copy of myelectronic income tax return. I have selected a personal identification number (PIN) as my signature for my electronic income tax return and, ifapplicable, my Electronic Funds Withdrawal Consent.

Taxpayer's PIN: check one box only

I authorize to enter my PINERO firm name Do not enter all zeros

as my signature on my 2019 e-filed California individual income tax return.

I will enter my PIN as my signature on my 2019 e-filed California individual income tax return. Check this box only if you are enteringyour 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/RDP's PIN: check one box only




Spouse's/RDP'ssignature 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.Do not enter all zeros

I certify that the above numeric entry is my PIN, which is my signature for the 2019 California individual 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 FTB Pub.1345, 2019 Handbook for Authorized e-file Providers.

ERO's signature A Date A

CAIA8501L 11/13/19For Privacy Notice, get FTB 1131 ENG/SP. FTB 8879 2019


7,186,320.

X

TAXABLE YEAR FORMCalifornia Resident2019 540Income Tax Return

AR

RP

Filing If your California filing status is different from your federal filing status, check the box here . . . . . . . . . . . . . . . . . . . . . . . . . . . . Status

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

2 Married/RDP filing jointly. See inst. Qualifying widow(er). Enter year spouse/RDP died.5

See instructions.

3 Married/RDP filing separately. Enter spouse's/RDP's SSN or ITIN above and full name here. . . . .

@6 6If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See instructions . . . . . . . . . . . . . . . .

Exemptions

For line 7, line 8, line 9, and line 10: Multiply the number you enter in the box by the pre-printed dollar amount for that line. Whole dollars onlyG7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked box 2 or 5, enter

x $122 = $7> >2 in the box. If you checked the box on line 6, see instructions. . . . . . . . . . . . . . . . . . . . . . . . .

8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1;x $122 => > $8if both are visually impaired, enter 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1; if both arex $122 = > $965 or older, enter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

10 Dependents: Do not include yourself or your spouse/RDP.

Dependent 2Dependent 1 Dependent 3

First Name > > >

Last Name > > >

SSN @ @ @

Dependent'srelationship > > >to you

$10@Total dependent exemptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x $378 = >

CAIA3912L 01/14/20 3101194 Form 540 2019 Page 1059

***-**-**** JACO 19SARA J JACOBS

2604 FIFTH AVE 403

APE

SAN DIEGO CA 92103

ATTACH FEDERAL RETURN

02-01-1989

X

1 122.

Your name: Your SSN or ITIN:

$11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32. . . . . . . . . . 11>

Taxable Income

12 12@State wages from your federal Form(s) W-2, box 16. . . . . .

13 13Enter federal adjusted gross income from federal Form 1040 or 1040-SR, line 8b . . . . . . >14 California adjustments ' subtractions. Enter the amount from Schedule CA (540),

14@Part I, line 23, column B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 Subtract line 14 from line 13. If less than zero, enter the result in parentheses.

See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

16 California adjustments ' additions. Enter the amount from Schedule CA (540),

Part I, line 23, column C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16@

17 California adjusted gross income. Combine line 15 and line 16. . . . . . . . . . . . . . . . . . . . . . . . 17@

18 Your California itemized deductions from Schedule CA (540), Part II, line 30; OR

Your California standard deduction shown below for your filing status:Enter the$4,537@Single or Married/RDP filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . larger of

$9,074@Married/RDP filing jointly, Head of household, or Qualifying widow(er) . . . . . . . .

If Married/RDP filing separately or the box on line 6 is checked,

18STOP. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @19 Subtract line 18 from line 17. This is your taxable income.

If less than zero, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19>

Tax

Tax Table Tax Rate Schedule31 Tax. Check the box if from:

@ @ @FTB 3800 FTB 3803. . . . . . . . . . . . . . . . . . . . . 31

Exemption credits. Enter the amount from line 11. If your federal AGI32is more than $200,534, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32>

33 Subtract line 32 from line 31. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33>

34 Schedule G-1 FTB 5870A. . . . . 34Tax. See instructions. Check the box if from: @ @ @

35 Add line 33 and line 34. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35>

Special Credits

40 Nonrefundable Child and Dependent Care Expenses Credit. See instructions . . . . . . . . . . 40@

43 Enter credit name . . . . . . . . . and amount . . . . . . . 43@code @

44 Enter credit name . . . . . . . . . and amount . . . . . . . 44@code @

@45 To claim more than two credits. See instructions. Attach Schedule P (540) . . . . . . . . . . . . 45

@46 Nonrefundable renter's credit. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

47 Add line 40 through line 46. These are your total credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47>

48 Subtract line 47 from line 35. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48>

CAIA3912L 01/14/203102194Page 2 Form 540 2019 059


122.

14,564.

7,186,320.

5,534.

7,180,786.

5,534.

7,186,320.

648,611.

6,537,709.

788,901.

0.

788,901.

788,901.

X

OTHER STATE 187 3,663.

3,663.

785,238.


Other Taxes

61 Alternative minimum tax. Attach Schedule P (540). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61@

62 Mental Health Services Tax. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62@

63 63Other taxes and credit recapture. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

64 Add line 48, line 61, line 62, and line 63. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . 64@

Payments

71 California income tax withheld. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71@

72 2019 CA estimated tax and other payments. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . 72@

73 Withholding (Form 592-B and/or 593). See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73@

74 Excess SDI (or VPDI) withheld. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74@

75 Earned Income Tax Credit (EITC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75@

76 Young Child Tax Credit (YCTC). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76@

77 Add lines 71 through 76. These are your total payments.

See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77>

Use Tax

91 Use Tax. Do not leave blank. See instructions . . . . . . . . . . . . . . . . . . . . . . 91@

If line 91 is zero, check if: No use tax is owed.

You paid your use tax obligation directly to CDTFA.

Overpaid Tax/Tax Due

92 Payments balance. If line 77 is more than line 91, subtract line 91 from line 77. . . . . . . . 92>

93 Use Tax balance. If line 91 is more than line 77, subtract line 77 from line 91. . . . . . . . . . 93>

94 Overpaid tax. If line 92 is more than line 64, subtract line 64 from line 92 . . . . . . . . . . . . . 94>

95 Amount of line 94 you want applied to your 2020 estimated tax. . . . . . . . . . . . . . . . . . . . . . . 95@

@96 Overpaid tax available this year. Subtract line 95 from line 94 . . . . . . . . . . . . . . . . . . . . . . . . 96

97 Tax due. If line 92 is less than line 64, subtract line 92 from line 64. . . . . . . . . . . . . . . . . . . 97>

CAIA3912L 01/14/20 3103194 Form 540 2019 Page 3059


20,345.

20,345.

55,377.

840,615.

84.

860,876.

0.

860,960.

0.

860,960.

X


Contributions Code Amount

400@California Seniors Special Fund. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

401@Alzheimer's Disease and Related Dementia Voluntary Tax Contribution Fund . . . . . . . . . .

403@Rare and Endangered Species Preservation Voluntary Tax Contribution Program . . . . . .

405@California Breast Cancer Research Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . .

406@California Firefighters' Memorial Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

407@Emergency Food for Families Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . .

408@California Peace Officer Memorial Foundation Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

410@California Sea Otter Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

413@California Cancer Research Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . .

422@School Supplies for Homeless Children Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

423@State Parks Protection Fund/Parks Pass Purchase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

424@Protect Our Coast and Oceans Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . .

425@Keep Arts in Schools Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

431@Prevention of Animal Homelessness and Cruelty Voluntary Tax Contribution Fund . . . . .

438@California Senior Citizen Advocacy Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . .

439@Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund. . . . . . . . . . . . . . .

440@Rape Kit Backlog Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

441@Organ and Tissue Donor Registry Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . .

442@National Alliance on Mental Illness California Voluntary Tax Contribution Fund. . . . . . . . .

443@Schools Not Prisons Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

444@Suicide Prevention Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

110 110@Add code 400 through code 444. This is your total contribution. . . . . . . . . . . . . . . . . . . . . . . .

CAIA3912L 01/14/203104194Page 4 Form 540 2019 059



Amount 111 AMOUNT YOU OWE. If you do not have an amount on line 96, add line 93, line 97, and line 110. See instructions. Do not send cash.You

111Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001. . . . . . . . . . . . . . @OwePay Online ' Go to ftb.ca.gov/pay for more information.

112 Interest, late return penalties, and late payment penalties. . . . . . . . . . . . . . . . . . . . . . . 112

113 Underpayment of estimated tax.Interestand 113@ @Check the box: @FTB 5805 attached FTB 5805F attached . . . . . . . . . . . . . . . . . . . . Penalties

114 Total amount due. See instructions. Enclose, but do not staple, any payment. . . . 114

115 REFUND OR NO AMOUNT DUE. Subtract the sum of 110, line 112 and line 113 from line 96. See instructions.

115Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0001 . . . . . . . . . . . . . . . . . . @Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip. See instructions.Refund

and Have you verified the routing and account numbers? Use whole dollars only.Direct

All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:Deposit

@Type

116 Direct deposit amount@@Routing number @Account numberChecking

Savings

The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:

@Type

117 Direct deposit amount@@Account number@Routing number Checking

Savings

IMPORTANT: See the instructions to find out if you should attach a copy of your complete federal tax return.

To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to ftb.ca.gov/forms and search for 1131.To request this notice by mail, call 800.852.5711.

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

Your signature Date Spouse's/RDP's signature (if a joint tax return, both must sign)

Your email address. Enter only one email address. Preferred phone number> >SignHere

Paid preparer's signature (declaration of preparer is based on all information of which preparer has any knowledge)It is unlawfulto forge aspouse's/RDP'ssignature. @PTIN

Joint taxreturn? (Seeinstructions) @Firm's FEINFirm's address

@ @Do you want to allow another person to discuss this tax return with us? See instructions . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

CAIA3912L 01/14/20 3105194 Form 540 2019 Page 5059


X

0.

Firm's name (or yours, if self-employed)

X

Print Third Party Designee's Name Telephone Number

TAXABLE YEAR SCHEDULE

2019 CA (540)California Adjustments ' ResidentsImportant: Attach this schedule behind Form 540, Side 5 as a supporting California schedule.Name(s) as shown on tax return SSN or ITIN

Subtractions AdditionsFederal AmountsA B CPart I Income Adjustment ScheduleSee instructions See instructions(taxable amounts from

Section A ' Income from federal Form 1040 or 1040-SR your federal tax return)

1 Wages, salaries, tips, etc. See instructions before making an

> > >entry in column B or C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Taxable interest. a . . . . . . . . . . . . . . . . . 2b > > >>3 3bOrdinary dividends. See instructions. a > > >>

IRA distributions. See instructions.4a a 4b > > >>Pensions and annuities. See instr.c c 4d > > >>

5 Social security benefits. a . . . . . . . . . . . . . 5b > >>6 Capital gain or (loss). See instructions. . . . . . . . . . . . . . . . . . . . . . . . . 6 > > >

Section B ' Additional Income from federal Schedule 1 (Form 1040 or 1040-SR)

1 1Taxable refunds, credits, or offsets of state and local income taxes. . . . . . . . . . . . > >2a 2aAlimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >>3 3Business income or (loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > > >4 Other gains or (losses) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 > > >5 5Rental real estate, royalties, partnerships, S corporations, trusts, etc. . . . . . . . . . . > >>6 Farm income or (loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 > >>7 Unemployment compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 > >

a8 Other income. a>a e b bCalifornia lottery winnings >NOL from FTB 3805Z, 3806,

b 8 c cDisaster loss deduction from FTB 3805V >>3807, or 3809

c f d dFederal NOL (federal Schedule 1 Other (describe): >e e(Form 1040 or 1040-SR), line 8) >>

d f fNOL deduction from FTB 3805V > >g Student loan discharged due to

g g>closure of a for-profit school

9 Total. Combine Section A, line 1 through line 6, and Section B, line 1 through line 8in column A. Add Section A, line 1 through line 6, and Section B, line 1 through

9line 8g in column B and column C. Go to Section C. . . . . . . . . . . . . . . . . . . . . . . . >> >Section C ' Adjustments to Income from federal Schedule 1 (Form 1040 or 1040-SR)

10 Educator expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 > >11 Certain business expenses of reservists, performing artists,

and fee-basis government officials . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 >> >12 Health savings account deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 > >13 Moving expenses. Attach federal Form 3903. See instructions. . . 13 >>14 Deductible part of self-employment tax . . . . . . . . . . . . . . . . . . . . . . . . 14 >15 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . 15 >16 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . 16 >17 Penalty on early withdrawal of savings. . . . . . . . . . . . . . . . . . . . . . . . . 17 >18a Alimony paid.

b Recipient's: SSN >

18aLast name >>>19 IRA deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 >20 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 >>21 Tuition and fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 > >

22 Add line 10 through line 18a and line 19 through line 21 in columns A, B, and C.

22See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >> >23 Total. Subtract line 22 from line 9 in columns A, B, and C.

See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 >> >CAIA4012L 01/23/20

For Privacy Notice, get FTB 1131 ENG/SP. Schedule CA (540) 2019 Page 17731194059


14,564.57,611. 5,375.

806,428. 159.

6,306,787. 5,534.

1.

1,000.

7,186,391. 5,534. 5,534.

71.

71.

7,186,320. 5,534. 5,534.

800,684.9,154.

Subtractions AdditionsFederal AmountsA B CPart II Adjustments to Federal Itemized Deductions(from federal Schedule A See instructions See instructions(Form 1040 or 1040-SR))Check the box if you did NOT itemize for federal but will itemize for California . . . . >

Medical and Dental Expenses See instructions

1 Medical and dental expenses. . . . . . . . . . . 1>2 2Enter amount from fed. Form 1040 or 1040-SR, ln 8b >3 Multiply line 2 by 7.5% (0.075) . . . . . . . . . 3>4 Subtract line 3 from line 1. If line 3 is more than line 1, enter 0 . . 4b > >

Taxes You Paid

5a State and local income tax or general sales taxes. . . . . . . . . . . . . . . 5a > >5b State and local real estate taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b >5c State and local personal property taxes. . . . . . . . . . . . . . . . . . . . . . . . . 5c >5d Add lines 5a through 5c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5d >5e 5eEnter the smaller of line 5d or $10,000 ($5,000 if married filing separately) in col. A >

Enter the amount from line 5a, column B in line 5e, column B . . . . . . . . . . . . . . . . >Enter the difference from line 5d and line 5e, column A in line 5e, column C. . . . . . >Other taxes. List type6 . . . . . . . 6 > > >>Add lines 5e and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 7 > > >

Interest You Paid

8a 8aHome mortgage interest and points reported to you on Form 1098. . . . . . . . . . . . . . > >8b 8bHome mortgage interest not reported to you on Form 1098 . . . . . . . . . . . . . . . . . . . > >8c Points not reported to you on Form 1098. . . . . . . . . . . . . . . . . . . . . . . . 8c > >

> >Mortgage insurance premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8d 8d

>8e Add lines 8a through 8d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8e > >> >9 Investment interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 >

10 Add lines 8e and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 > > >Gifts to Charity

11 Gifts by cash or check. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 > > >12 Other than by cash or check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 > > >13 Carryover from prior year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 > > >14 Add lines 11 through 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 > > >Casualty and Theft Losses

15 Casualty or theft loss(es) (other than net qualified disaster losses). Attach federal15Form 4684. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > > >

Other Itemized Deductions

16 Other'from list in federal instructions . . . . . . . . . . . . . . . . . . . . . . . . . . 16 > > >17 Add lines 4, 7, 10, 14, 15, and 16 in columns A, B, and C. . . . . . . . 17 > > >

18 18Total. Combine line 17 column A less column B plus column C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

CAIA4012L 01/23/20Page 2 Schedule CA (540) 2019 7732194059


737,759. 737,759.

737,759.10,000.

737,759.727,759.

10,000. 737,759. 727,759.

27,387.27,387.

6,386.1,033,985.

1,040,371.

1,077,758. 737,759. 727,759.

1,067,758.

Job Expenses and Certain Miscellaneous Deductions

19 Unreimbursed employee expenses - job travel, union dues, job education, etc.19Attach federal Form 2106 if required. See instructions . . . . . . . . . . . . . . . . . . . . . >

20 Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20>21 21Other expenses - investment, safe deposit box, etc. List type > >22 Add lines 19 through 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22>23 Enter amount from federal Form 1040 or 1040-SR, line 8b >24 Multiply line 23 by 2% (0.02). If less than zero, enter 0 . . . . . . . . . . . . . . . . . . . . 24>

25 Subtract line 24 from line 22. If line 24 is more than line 22, enter 0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25>

26 Total Itemized Deductions. Add line 18 and line 25. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26>

27 Other adjustments. See instructions.

Specify. 27> >

28 Combine line 26 and line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28>29 Is your federal AGI (Form 540, line 13) more than the amount shown below for your filing status?

Single or married/RDP filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200,534

Head of household. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300,805

Married/RDP filing jointly or qualifying widow(er). . . . . . . . . . . . . . . . . . . . $401,072

No. Transfer the amount on line 28 to line 29.

Yes. Complete the Itemized Deductions Worksheet in the instructions for Schedule CA (540), line 29 . . . . . . . . . 29>

30 Enter the larger of the amount on line 29 or your standard deduction listed below

Single or married/RDP filing separately. See instructions. . . . . . . . . . . . . . $4,537

Married/RDP filing jointly, head of household, or qualifying widow(er). . . $9,074

Transfer the amount on line 30 to Form 540, line 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30>

CAIA4012L 01/23/20 Schedule CA (540) 2019 Page 37733194059

648,611.

648,611.

1,067,758.

1,067,758.

0.

143,726.7,186,320.

100,314.97,334.2,980.


REDUCTION -419,147.

STATEMENT 1


California Capital Gain or Loss Adjustment2019 D (540)Do not complete this schedule if all of your California gains (losses) are the same as your federal gains (losses).

Name(s) as shown on return SSN or ITIN

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

Loss GainSales price Cost or other basisDescription of propertyIf (c) is more than If (b) is more thanExample: 100 shares of "Z" Co.(b), subtract (b) (c), subtract (c)

1 from (c) from (b)

a > > > > >b > > > > >c > > > > >d > > > > >e > > > > >f > > > > >g > > > > >h > > > > >i > > > > >j > >>> >k > > > > >l > > > > >

m> > > > >n > > > > >o > > > > >p > > > > >q > > > > >r > > > > >s > > > > >t > > > > >u > > > > >v > > > > >

22 Net gain or (loss) shown on California Schedule(s) K-1 (100S, 541, 565, and 568). . . . . >>3>3 Capital gain distributions (federal Form 1099-DIV, box 2a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total 2019 gains from all sources. Add column (e) amounts of line 1, line 2,44and line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

2019 loss. Add column (d) amounts of line 155 ( )and line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

6 6 ( )California capital loss carryover from 2018, if any. See instructions. . . . . . . . . . . . . . . . . . >7 7Total 2019 loss. Add line 5 and line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > ( )

CAIA6401L 12/31/19

7761194 Schedule D (540) 2019 Page 1For Privacy Notice, get FTB 1131 ENG/SP. 059


174,444.

265.

6,312,321.

SEE ATTACHED MERRILL LYNCH-12846 - SEE ATTACHED STATEMENT

931,859. 901,753. 30,106.

SEE ATTACHED MERRILL LYNCH-12846 - SEE ATTACHED STATEMENT

324,259. 214,521. 109,738.

15150 QUALCOMM 1,009,782. 1,009,782.

6445 QUALCOMM 450,883. 450,883.

7855 QUALCOMM 549,524. 549,524.

25015 QUALCOMM 2,000,153. 2,000,153.

12680 QUALCOMM 1,001,519. 1,001,519.

12041 QUALCOMM 985,907. 985,907.

88 Combine line 4 and line 7. If a loss, go to line 9. If a gain, go to line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >If line 8 is a loss, enter the smaller of: a the loss on line 8.9

9 ( )>b $3,000 ($1,500 if married/RDP filing separate). See instructions. . . . . . . . . . . . . .

1010 Enter the gain or (loss) from federal Form 1040 or 1040-SR, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >1111 Enter the California gain from line 8 or (loss) from line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

12 a If line 10 is more than line 11, enter the difference here and on Schedule CA (540), Part I, Section A,> 12 aline 6, column B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b If line 10 is less than line 11, enter the difference here and on Schedule CA (540), Part I, Section A,12 bline 6, column C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

7762194 CAIA6401L 12/31/19Page 2 Schedule D (540) 2019 059


6,312,321.

6,306,787.

6,312,321.

5,534.

TAXABLE YEAR CALIFORNIA SCHEDULE

2019 Other State Tax Credit SAttach to Form 540, Form 540NR, or Form 541.

Name(s) as shown on your California tax return SSN, ITIN, or FEIN

Double-Taxed Income (Read specific line instructions for Part I before completing.)Part I(a) Income item(s) description (b) Double-taxed income taxable by California (c) Double-taxed income taxable by other state

> > >> > >> > >

> >1 Total double-taxed income. . . . . . . . . . . . . . . . . . . . . . . . . .

Figure Your Other State Tax Credit (Read specific line instructions for Part II before completing.)Part II

2 California tax liability. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2>

3 Double-taxed income taxable by California. Enter the amount from Part I, line 1, column (b). . . . . . . . . . . . . . . . 3>

4 California adjusted gross income. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4>

5 Divide line 3 by line 4. Do not enter more than 1.0000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5>

6 Multiply line 2 by line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6>

7 Income tax liability paid to other state (use state's abbreviation) See instructions . . . . . . . . . . . . . . . . . 7> >

8 Double-taxed income taxable by other state. Enter the amount from Part I, line 1, column (c). . . . . . . . . . . . . . . 8>

9 Adjusted gross income taxable by other state. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9>

10 Divide line 8 by line 9. Do not enter more than 1.0000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10>

11 Multiply line 7 by line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11>

12 Other state tax credit. Enter the smaller of line 6 or line 11. Use Credit Code 187. See instructions. . . . . . . . . . 12>

8021194For Privacy Notice, get FTB 1131 ENG/SP. Schedule S 2019059

CAIA4401L 11/25/19

SARA J. JACOBS

72,573. 72,573.

788,901.

72,573.

7,186,320.

0.0101

7,968.

MA 3,663.

72,573.

72,573.

1.0000

3,663.

3,663.

***-**-****

PARTNERSHIPS, S-CORPS, TRUSTS, E 72,573. 72,573.

TAXABLE YEAR CALIFORNIA FORM

2019 Investment Interest Expense Deduction 3526Attach to Form 540, Form 540NR, or Form 541.Name(s) as shown on tax return SSN, ITIN, or FEIN

1 Investment interest expense paid or accrued in 2019. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1>2 Disallowed investment interest expense from 2018 form FTB 3526, line 7. If zero or less, enter -0-. . . . . . . . . . 2>3 Total investment interest expense. Add line 1 and line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 a Gross income from property held for investment (excluding any net gain from the disposition ofproperty held for investment). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a

4 b Net gain from the disposition of property held for investment. See instructions. . . . 4b

4 c Net capital gain from the disposition of property held for investment.See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4c

4 d Subtract line 4c from line 4b. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4d

4 e Enter all or part of the amount on line 4c that you elect to include in investment income. Do not includemore than the amount on line 4b. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4e

4 f Investment income. Add line 4a, line 4d, and line 4e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 f

5 Investment expenses. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Net investment income. Subtract line 5 from line 4f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Disallowed investment interest expense to be carried forward to 2020. Subtract line 6 from line 3.If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7>

8 Investment interest expense deduction. Enter the smaller of line 3 or line 6. Form 541 filers, stop hereand see instructions. All other filers, go to line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8>

9 Enter the amount from federal Form 4952, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 California investment interest expense deduction adjustment. Enter the difference between line 8 and line 9.See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10>

FTB 3526 2019CAIZ0401L 12/13/197321194For Privacy Notice, get FTB 1131 ENG/SP. 059

SARA J. JACOBS ***-**-****27,387.

0.27,387.

858,505.6,312,321.

6,312,321.0.

6,312,321.7,170,826.

7,170,826.

0.

27,387.27,387.


2019 Passive Activity Loss Limitations 3801Attach to Form 540, Form 540NR, Form 541, or Form 100S (S Corporations).Name(s) as shown on tax return SSN, ITIN, FEIN, or CA corporation no.

Part I 2019 Passive Activity LossSee the instructions for Worksheet 1 and Worksheet 3 for federal Form 8582 before completing Part I.Be sure to use California amounts.

Rental Real Estate Activities with Active Participation

1a Activities with net income from Worksheet 1, column (a). . . . . . . . . . . . . . . . . . . . . . . 1a

1b Activities with net loss from Worksheet 1, column (b). . . . . . . . . . . . . . . . . . . . . . . . . . 1b

1c Prior year unallowed losses from Worksheet 1, column (c). . . . . . . . . . . . . . . . . . . . . 1c

1d Combine line 1a, line 1b, and line 1c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1d






3 Combine line 1d and line 2d. If the result is net income or zero, see the instructions for line 3. If line 3and line 1d are losses, go to line 4. Otherwise, enter -0- on line 9 and go to line 10. See instructions . . . . . . . 3

Part II Special Allowance for Rental Real Estate with Active ParticipationEnter all numbers in Part II as positive amounts. See instructions.

44 Enter the smaller of losses from line 1d or line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Enter $150,000. If married/RDP filing a separate tax return, see instructions. . . . 5

6 Enter federal modified adjusted gross income, but not less than zero.See instructions. If line 6 is equal to or more than line 5, skip line 7 andline 8, enter -0- on line 9, and then go to line 10. Otherwise, go to line 7 . . . . . . . 6

7 Subtract line 6 from line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

88 Multiply line 7 by 50% (.50). Do not enter more than $25,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

99 Enter the smaller of line 4 or line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >Part III Total Losses Allowed

10 Add the income, if any, from line 1a and line 2a and enter the total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Total losses allowed from all passive activities for 2019. Add line 9 and line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

See the instructions on Page 2 to find out how to report the losses on your tax return. CAIZ0601L 12/03/19

For Privacy Notice, get FTB 1131 ENG/SP. 7451194 FTB 3801 2019 Side 1059


-289,921.

-325,242.

-615,163.

72,573.

-23.

-34,828.

37,722.

-577,441.

577,441.

150,000.

7,186,390.

0.

72,573.

72,573.

SEE STATEMENT 2 SEE STATEMENT 3

TAXABLE YEAR CALIFORNIA FORMDepreciation andAmortization Adjustments2019 3885ADo not complete this form if your California depreciation amounts are the same as federal amounts.

Name(s) as shown on tax return SSN or ITIN

Business or activity to which form FTB 3885A relatesIdentify the Activity as Passive or Nonpassive. (See instructions.)Part IThis form is being completed for a passive activity.1

This form is being completed for a nonpassive activity.

Election to Expense Certain Tangible Property (IRC Section 179).Part IIEnter the amount from line 12 of the Tangible Property Expense Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2>

Part III Depreciation (b) (c) (d) (e) (f)(a)MethodDescription of property California basis Life or CaliforniaDate placed

placed in service for depreciation rate depreciationin servicedeductionmm/dd/yyyy

3

4 4Add the amounts on line 3, column (f). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 5California depreciation for assets placed in service prior to 2019. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 6Total California depreciation from this activity. Add the amounts on line 2, line 4, and line 5 . . . . . . . . . . . . . . . .

7 7Total federal depreciation from this activity. Enter depreciation from federal Form 4562, line 22. . . . . . . . . . . . .

8 a If line 6 is more than line 7, enter the difference here and see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 a

b If line 6 is less than line 7, enter the difference here and see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 b

(a) (b) (c) (d) (e) (f)Part IV AmortizationDescription of California basis Code Period or CaliforniaDate

cost for amortization section percentage amortizationamortizationdeductionbegins

mm/dd/yyyy

9

10 10Total California amortization from this activity. Add the amounts on line 9, column (f) . . . . . . . . . . . . . . . . . . . . . .

11 11California amortization of costs that began before 2019. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 12Total California amortization from this activity. Add the amounts on line 10 and line 11. . . . . . . . . . . . . . . . . . . . .

13 13Total federal amortization from this activity. Enter amortization from federal Form 4562, line 44. . . . . . . . . . . . .

a If line 12 is more than line 13, enter the difference here and see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 a14

b If line 12 is less than line 13, enter the difference here and see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 b

7631194 FTB 3885A 2019CAIA3601L 12/19/19059For Privacy Notice, get FTB 1131 ENG/SP.


X

SCHEDULE E (RENTAL)

115,252.115,252.115,252.

REPORTED ON FORM3801








3









mm/dd/yyyy

9









X

SCHEDULE E (RENTAL) #2

103,411.103,411.45,450.57,961.REPORTED ON FORM

3801

2019 CALIFORNIA STATEMENTS PAGE 1


STATEMENT 1SCHEDULE CA, PART II, LINE 21MISCELLANEOUS DEDUCTIONS SUBJECT TO 2% AGI LIMIT

INVESTMENT EXPENSE $ 97,334.TOTAL $ 97,334.

STATEMENT 2FORM 3801 WORKSHEETSCALIFORNIA PASSIVE ACTIVITY WORKSHEET

FEDERAL CALIFORNIA FEDERAL STATENAME OF ACTIVITY SCHEDULE SCHEDULE INCOME ADJUSTMT INCOME

RESIDENTIAL RENTAL-DC SCHEDULE E -195,939. -195,939.RESIDENTIAL RENTAL-NY SCHEDULE E FRM 3885A -36,021. -57,961. -93,982.BELDORE CAPITAL FUND LLC SCHEDULE E -20. -20.CLEARFORK CAPITAL FUND LLC SCHEDULE E -1. -1.MASS PATHWAYS TO ECON ADVAN SCHEDULE E 72,573. 72,573.BELGARDE CAPITAL FUND LLC SCHEDULE E -2. -2.

TOTAL $-159410. $-57,961. $-217,371.

STATEMENT 3FORM 3801 WORKSHEETSCALIFORNIA ADJUSTMENT WORKSHEETS

PASSIVE OR CALIFORNIA FEDERAL CALIFORNIASCHEDULE E ACTIVITIES NONPASSIVE AMOUNT AMOUNT ADJUSTMENT

RESIDENTIAL RENTAL-DC PASSIVE $ -27,741. $ -22,932. $ -4,809.RESIDENTIAL RENTAL-NY PASSIVE -10,005. -14,814. 4,809.MASS PATHWAYS TO ECON ADVAN PASSIVE 37,747. 37,747. 0.

TOTAL $ 1. $ 1. $ 0.

TAXABLE YEAR CALIFORNIA FORMUnderpayment of Estimated Tax2019 5805by Individuals and Fiduciaries

Attach this form to the back of your Form 540, Form 540NR, or Form 541. Also, check the box for underpayment of estimated tax located onForm 540, line 113; Form 540NR, line 123; or Form 541, line 44, whichever applies.

Name(s) as shown on return SSN, ITIN, or FEIN

IMPORTANT: In most cases, the Franchise Tax Board (FTB) can figure the penalty for you and you do not have to complete this form.See General Information B.

If you meet any of the following conditions, you do not owe a penalty for underpayment of estimated tax. Do not complete or file this form if:

The amount of your tax liability (not including tax on lump-sum distributions and accumulation distribution of trusts) less credits?(including the withholding credit) but not including estimated tax payments for either 2018 or 2019 was less than $500 (or less than $250if married/RDP filing a separate return).

Your 2018 return was for a full 12 months (or would have been if you were required to file) and you did not have any tax liability on?that return.

? The amount of your withholding plus your estimated tax payments, if paid in the required installments, is at least 90% of the tax shownon your 2019 return or 100% of the tax shown on your 2018 return (110% if California adjusted gross income (AGI) was more than$150,000 or $75,000 if married/RDP filing a separate return) and you are not using the annualized income installment method. Taxpayerswith California AGI equal to or greater than $1,000,000 (or $500,000 if married/RDP filing a separate return), must use the tax shown ontheir 2019 tax return if they do not meet one of the two conditions above.

Part I Questions. All filers must complete this part. Estates and Trusts, see General information E.

1 Are you requesting a waiver of the penalty? If "Yes," provide an explanation below and be sure to check the box onForm 540, line 113; Form 540NR, line 123; or Form 541, line 44. If you need additional space, attacha statement. See General Information C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >1 Yes No

2 Did you use the annualized income installment method? If "Yes," see instructions for Part III and be sure to2check the box on Form 540, line 113; Form 540NR, line 123; or Form 541, line 44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No>

3 Was your California withholding not withheld in equal installments and are you able to show the actual amountswithheld per period and the actual dates withheld?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Yes No>

N/AIf "Yes," enter the actual uneven amounts withheld on the spaces provided below. The total of the four amountsmust equal the total withholding reported on Form 540, line 71 and line 73; Form 540NR, line 81 and line 83; orForm 541, line 29 and line 31.

$ $ .$ $4/15/19 ; 6/15/19 ; 9/15/19 ; 1/15/20 >> > >4 For estates and trusts: Was the date of death less than two years from the end of the taxable year? See General

Information E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Yes No>

7671194 FTB 5805 2019 Page 1For Privacy Notice, get FTB 1131 ENG/SP. 059CAIZ6112L 11/26/19


X

X

X

Required Annual Payment. All filers must complete this part.Part II

1 Current year tax. Enter your 2019 tax after credits. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Multiply line 1 by 90% (.90). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Withholding taxes. Do not include any estimated tax payments on this line. See instructions. . . . . . . . . . . . . . . . 3

4 Subtract line 3 from line 1. If less than $500 (or less than $250 if married/RDP filing a separate return),stop here. You do not owe the penalty. Do not file form FTB 5805 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Enter the tax shown on your 2018 tax return. See instructions. (110% (1.10) of that amount if the adjustedgross income shown on that return is more than $150,000, or if married/RDP filing a separate return for

52019, more than $75,000). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 Required annual payment. Enter the smaller of line 2 or line 5. (If your California AGI is equal to or greater6than $1,000,000/$500,000 for married/RDP filing a separate return, use line 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Short Method

Caution: See the instructions to find out if you can use the short method. If you answered "Yes" to Question 2 in Part I, skip this part and go toPart III. If you answered "No" to Question 2 in Part I and you cannot use the short method, go to Worksheet II in the instructions.(pg.4)

7 Enter the amount, if any, from Part II, line 3 above. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Enter the total amount, if any, of estimated tax payments you made. . . . . . . . . . . . 8

9 Add line 7 and line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Total underpayment for the year. Subtract line 9 from line 6. If zero or less, stop here. You do not owe thepenalty. Do not file form FTB 5805. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Multiply line 10 by .03898393. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 ? If the amount on line 10 was paid on or after 4/15/20, enter -0-.? If the amount on line 10 was paid before 4/15/20, enter the result of the following computation:

Amount on Number of days paidX X .00014. . . . . . . . . . . . . . . . . . 12line 10 before 4/15/20

13 PENALTY. Subtract line 12 from line 11. Enter the result here and on Form 540, line 113; Form 540NR, line 123; or

13Form 541, line 44. Also, check the box for "FTB 5805."A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

7672194 CAIZ6112L 11/26/19Page 2 FTB 5805 2019 059


840,615.756,554.

84.

840,531.

756,554.

756,554.

Part III Annualized Income Installment Method Schedule.

Use this schedule ONLY if you earned taxable income at an UNEVEN RATE during 2019(See Example A). If you earned your income atapproximately the same rate each month (See Example B), then you should not complete this schedule. If you choose to figure the penalty,see Worksheet II, Regular Method to Figure Your Underpayment and Penalty, on page 4 of the instructions.

Example A: If you were a commissioned salesperson who earned no income during the first three months of the year, earned most of yourincome during the following six months, and earned very little during the last three months, you should complete this schedule. You may beable to benefit by using the annualized income installment method. The required installment of estimated tax figured using the annualizedmethod may be less than your required installment figured using the required installment method.

Example B: If you worked all year and earned a monthly salary that did not change much during the year, you should not complete this schedule.

To complete this schedule correctly, you must first complete Page 2, Part II,(a) (b) (c) (d)

line 1 through line 6. Estates and trusts, do not use the period ending1/1/19 to 1/1/19 to 1/1/19 to 1/1/19 todates shown to the right. Instead, use the following: 2/28/19, 4/30/19,3/31/19 5/31/19 8/31/19 12/31/19

7/31/19, and 11/30/19. Fiscal year filers must adjust dates accordingly.

1 Enter your California adjusted gross income (AGI) for eachperiod. Form 540NR filers, see instructions. Estates or Trusts,enter the amount from Form 541, line 20 attributable to each

1period. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22 Annualization amounts. Estates or Trusts, see instructions. . . 4 2.4 1.5 13 3Annualized income. Multiply line 1 by line 2 . . . . . . . . . . . . .

4 Enter your itemized deductions for the period shown in eachcolumn. If you do not itemize deductions, enter -0- here andon line 6. Estates or Trusts, enter -0- here, skip to line 9, and

4enter the amount from line 3 on line 9. . . . . . . . . . . . . . . . . .

5 Annualization amounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2.4 1.5 15

Annualized itemized deductions. Multiply line 4 by line 5. See66instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 Enter your standard deduction from your 2019 Form 540, orForm 540NR, line 18. Enter the total standard deduction

7amount in each column. See instructions. . . . . . . . . . . . . . . .

8 8Enter line 6 or line 7, whichever is larger. . . . . . . . . . . . . . .

9 9Subtract line 8 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Figure the tax on the amount in each column of line 9 usingthe tax table or the tax rate schedule in the instructions forForm 540, Form 540NR, or Form 541. Also, include any

10tax from form FTB 3803. Estates or Trusts, see instructions. .

Enter the total amount of exemption credits from your 201911Form 540, line 32 or Form 541, line 22. If you filed a

11Form 540NR, see instructions. . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 11 from line 10. Form 540NR filers,1212complete Worksheet I on page 3 of the instructions . . . . . . . .

Enter the total credit amount from your 2019 Form 540, line131347; or Form 541, line 23. Form 540NR filers, see inst. . . . . . .

14 a a14Subtract line 13 from line 12. If zero or less, enter -0-. . . . Enter the alternative minimum tax and mental health tax.b

14bSee Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c 14cAdd line 14a and line 14b. . . . . . . . . . . . . . . . . . . . . . . . .

Enter the excess SDI from Form 540, line 74 or Formd14d540NR, line 84 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e 14eSubtract line 14d from line 14c. If zero or less, enter -0- . .

15 15Applicable percentage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27% 63% 63% 90%16 16Multiply line 14e by line 15. . . . . . . . . . . . . . . . . . . . . . . . . .

Complete Line 17 through Line 23 of each column before yougo to the next column.

Enter the combined amounts shown on line 23 from all1717preceding columns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18Subtract line 17 from line 16. If zero or less, enter -0-. . . . . . 18

Enter 30% of the amount shown on form FTB 5805, Part II,19line 6 in columns (a & d), enter 40% of the amount on line 6

19in column b, enter -0- in column c . . . . . . . . . . . . . . . . . . . .

2020 Enter the amount from line 22 from the preceding column . . .

21Add line 19 and line 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21


Enter line 18 or line 21, whichever is less. Transfer these23amounts to Worksheet II, Regular Method to Figure Your > >23 > >Underpayment and Penalty, line 1. . . . . . . . . . . . . . . . . . . . .

If you use the annualized income installment method for one payment due date, you must use it for all payment due dates.This schedule automatically selects the smaller of your annualized income installment or your regular installment.

7673194CAIZ6112L 11/26/19 FTB 5805 2019 Page 3059


203,865. 5,488,785. 6,097,129. 7,186,320.

815,460. 13,173,084. 9,145,694. 7,186,320.

30,000. 75,000. 95,632. 1,067,758.

120,000. 180,000. 143,448. 648,611.

4,537. 4,537. 4,537. 4,537.120,000. 180,000. 143,448. 648,611.695,460. 12,993,084. 9,002,246. 6,537,709.

70,304. 1,582,912. 1,092,039. 788,901.

0. 0. 0. 0.

70,304. 1,582,912. 1,092,039. 788,901.

3,663. 3,663. 3,663. 3,663.66,641. 1,579,249. 1,088,376. 785,238.

55,377. 55,377. 55,377. 55,377.122,018. 1,634,626. 1,143,753. 840,615.

122,018. 1,634,626. 1,143,753. 840,615.

32,945. 1,029,814. 720,564. 756,554.

32,945. 529,588. 529,588.32,945. 996,869. 190,976. 226,966.

226,966. 302,622. 226,966.194,021.

226,966. 496,643. 0. 226,966.194,021. 0. 0. 0.

32,945. 496,643. 0. 226,966.

Worksheet II Regular Method to Figure Your Underpayment and Penalty.

Payment Due Dates

Part I Figure Your Underpayment. (a) (b) (c) (d)4/15/19 6/15/19 9/15/19 1/15/20

1 Required Installments. See instructions 1

2 Estimated tax paid and tax withheld.See instructions. For column (a) only,also enter the amount from line 2 online 6. (If line 2 is equal to or morethan line 1 for all payment periods,stop here; you do not owe the penalty.Do not file form FTB 5805 unless you

2answer "Yes" to a question in Part I). . . .

COMPLETE LINE 3 THROUGH LINE 9 OFONE COLUMN BEFORE GOING TO THENEXT COLUMN.

3 Enter amount, if any, from line 9 of3previous column. . . . . . . . . . . . . . . . . . . . . . .

44 Add line 2 and line 3. . . . . . . . . . . . . . . . . . .

5 Add amounts on line 7 and line 8 of5the previous column . . . . . . . . . . . . . . . . . . .

6 Subtract line 5 from line 4. If zero orless, enter -0-. For column (a) only,

6enter the amount from line 2 . . . . . . . . . . .

If the amount on line 6 is zero,7subtract line 4 from line 5. Otherwise,

7enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 Underpayment. If line 1 is equal to ormore than line 6, subtract line 6 fromline 1. Then go to line 3 of next

8column. Otherwise, go to line 9. . . . . . . G

9 Overpayment. If line 6 is more thanline 1, subtract line 1 from line 6. Then

9go to line 3 of next column. . . . . . . . . . . . .

Complete line 10 through line 15 of one column before going to the next column.Part II Figure the Penalty.Rate Period 1:

April 15, 2019 ' June 30, 2019 4/15/19 6/15/19 9/15/19 1/15/20

10 Number of days from the date shown Days: Days:above line 10 to the date the amounton line 8 was paid or 6/30/19,

10whichever is earlier. . . . . . . . . . . . . . . . . . . .

11 Underpayment Number ofx x .05on line 8 days on line 10

(see instructions) 365 $ $G 11

Rate Period 2:

7/1/19 7/1/19 9/15/19 1/15/20July 1, 2019 ' December 31, 2019

12 Number of days from the date shown Days: Days: Days:above line 12 to the date the amounton line 8 was paid or 12/31/19,



(see instructions) 365 $ $ $13GRate Period 3:

January 1, 2020 ' April 15, 2020 1/1/20 1/1/20 1/1/20 1/15/20

14 Number of days from the date shown Days: Days: Days: Days:above line 14 to the date the amounton line 8 was paid or 04/15/20,



(see instructions) 366 $ $ $ $15G16 PENALTY. Add amounts on line 11, line 13, and line 15 in all columns. Enter the total here, on form

FTB 5805, Side 2, Part II, line 13, and on Form 540, line 113; Form 540NR, line 123; or

$14Form 541, line 44, and check the box on that line. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

CAIZ6103L 01/31/20FTB 5805 Schedule B 2019


32,945. 496,643. 226,966.

85,901. 500,034. 275,025.

52,956. 56,347. 56,347.552,990. 56,347. 331,372.

85,901. 552,990. 56,347. 331,372.

0. 0.

52,956. 56,347. 56,347.

Required Payment PenaltyInstallment

Days Amount of Penalty perDate Amount Underpayment RateType *Late Penalty ** Period

TOTAL UNDERPAYMENT PENALTY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

= Overpayment1* ** Days LateUnderpayment x x Rate= Withholding2 365 or 366

= Estimate3= Extension4= Paid with return5

FDIL1601L 12/20/19

2019 UNDERPAYMENT PENALTY WORKSHEET


FIRST QTR32,945. 4/15/19 1 14,017. 18,928.

4/15/19 2 25. 18,903.4/15/19 3 18,903.

SECOND QTR496,643. 6/15/19 3 52,956. 443,687.

6/15/19 2 34. 443,653.6/15/19 3 443,653.

THIRD QTR

FOURTH QTR226,966. 9/15/19 3 56,347. 170,619.

1/15/20 2 25. 170,594.1/15/20 3 170,594.

0.

Government of the2019 D-30 SUB UnincorporatedDistrict of Columbia

Business Franchise Tax Return

*190303S11032*

Number of business locations SOFTWARE DEVELOPER USE ONLYFEINTaxpayer Identification Number (TIN) Mark if:

VENDOR ID#SSN 1032In DC Outside DC

Registered Business Name Tax period ending (MMDDYYYY)

Mark if: Amended Return

Mark if: Final ReturnBusiness Mailing address line #1

Mark if: Combined Report*

*You must fill in the Designated Agent info belowBusiness Mailing address line #2

Worldwide**Mark if:

City State Zipcode **Worldwide form must be filed with this return

Designated Agent Name Designated Agent FEIN

Enter dollar amounts only. If amount is zero, leaveline blank. if minus, enter amount and mark X.

1 Gross receipts, minus returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 .00$2 Cost of goods sold (from D-30, Schedule A) and/or operations. . . . . . . . . . . . . . . . . . . . . . . . . . 2 .00$

3 Mark if minusGross profit Line 1 minus Line 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 .00$

Dividends Minus Subpart F income (attach statement). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 .004 $Interest (attach statement showing calculations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .005 5 $

6 Gross rental income (attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .006 $Gross royalties (attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .007 7 $

Mark if minusNet capital gain (loss) (attach a copy of your federal Schedule D) . . . . . . . . . . . . . . . . . . 8 a .008a$Mark if minusb 8b .00Ordinary gain (loss) from Part II, federal Form 4797 (attach copy). . . . . . . . . . . . . . . . . $

9 .00$Mark if minus9 Other income (loss) (attach detailed statement). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark if minusTotal gross income Add Lines 3-9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10 .00$IF LINE 10 IS $12,000 OR LESS, YOU ARE NOT REQUIRED TO FILE THIS RETURNunless you may need Clean Hands Certification.

11 $Salaries and wages (Do not include owner(s)/member(s)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 .0012 $Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0012

13 $13 Bad debts (attach a copy of any statement filed with your federal return). . . . . . . . . . . . . . . . .00

Royalty payments made. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 a .0014cMinus nondeductible payments to related entities. . . . . . . = $b .00 .00

15 Rent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 $ .0016 $Taxes from Form D-30, Schedule C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 .00

a Interest payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 .00b Minus nondeductible payments to related entities. . . . . . . = 17c$.00 .00

Contributions and/or gifts from D-30, Schedule B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 18 $ .0019 $Amortization (attach copy of your Federal Form 4562, Part VI). . . . . . . . . . . . . . . . . . . . . . . . . . .0019

20 $Depreciation (attach copy of your Federal Form 4562. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 .00Do not include any additional IRC 179 expenses or IRC 168(k) depreciation.)

21Other allowable deductions from D-30, Schedule G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 $ .0022 $ .00Total deductions Add Lines 11-21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Rev. 10/19 DCIZ3112 11/07/19

X********* 1 0

RESIDENTIAL RENTAL 12312019

2604 FIFTH AVE 403

SAN DIEGO CA 92103

59465

59465

10130

33629

2287122871

115252

73522255404

SEE STMT 1

Taxpayer Name:

*190303S21032*

Enter dollar amounts onlyTaxpayer Identification Number

23Mark if minus $ .0023 Net income Line 10 minus Line 22

Net operating loss deduction for years before 2000 2424 $ .00

Mark if minusNet income after NOL deduction. Line 23 minus Line 2425 25 .00$

26a 26aMark if minusNon-business income/state adjustment (attach statement) $ .0026bb Minus: Related expenses (attach an allocation statement) .00$26cSubtract Line 26(b) from Line 26(a) .00$c Mark if minus

27 .00Mark if minus $27 Net income from trade or business subject to apportionmentLine 25 minus Line 26c

28 DC apportionment factor From D-30 Schedule F, Col 3, Line 2 28

If Combined Report, from Combined Reporting Schedule 2A, Col. 1, Line 9

Mark if minus .0029 29 $Net income from trade or business apportioned to DCMultiply Line 27 by the factor on Line 28.

30 30Other income/deductions attributable to DC (attach statement) .00Mark if minus $31 Mark if minusTotal DC net income (loss) Combine Lines 29 and 30 31 .00$

3232 Salary for owner(s) or member(s) services From Form D-30 Schedule J, Column 4. .00$33 33Exemption: Maximum amount $5000 Must enter days in DC. O 33a .00$

If fewer than 365 days in DC, see instructions for amount to claim.

Mark if minusTotal taxable income before apportioned NOL deduction34 34 .00$Line 31 minus total of Lines 32 and 33.

Apportioned NOL deduction (Losses occurring in year 2000 and later)*35 35 .00$*(Losses occurring in tax year 2018 or later are limited to 80%. See instructions.)

.00$Tentative DC taxable income Line 34 minus Line 3536 36Mark if minus

37 .0037 $Allocated/apportioned net capital gain from sale or exchange of an eligible investment

in a DC QHTC, from Schedule QCGI, Line 3.00$Mark if minus38 38DC taxable income. Line 36 minus Line 37..00$39 39Tentative tax 8.25% of Line 38.

.00$40 403% tax on eligible QHTC capital gain income, from Schedule QCGI, Line 4.

.00$41 41Total tax. Add Line 39 and Line 40

.00$Minus nonrefundable credits from Schedule UB, Line 2042 42

43 43Total DC gross receipts from Line 4 MTLGR worksheet .00$

44 $ .00Net tax. Line 41 minus Line 42. The minimum tax is $250 if DC gross receipts are44$1M or less or $1,000 if DC gross receipts are greater than $1M

45 Payments:

.00$a 45 aTax paid, if any, with request for an extension of time to file

.00$b 45 bTax paid, if any, with original return if this is an amended return2019 estimated franchise tax payments .00c 45 c $Refundable credits from Schedule UB, Line 22d 45 d $ .00

46 $ .0046 If this is an amended 2019 return, enter refund requested with original return.

.00Total payments and credits. Add Lines 45(a) through 45(d). Do not include Line 46. 4747 $$ .0048(Mark if D-2220 attached)48 Estimated tax interest

$ .0049 49Total Amount Due. If Line 47 is smaller than the total of Lines 44 and 48, enter amount due.

Yes No See instructionsWill this payment come from an account outside the U.S.?

.00$50 50Overpayment. If Line 47 is larger than the total of Lines 44 and 48, enter amount overpaid.

$ .0051 Amount you want to apply to your 2020 estimated franchise tax. 51

$ .0052 Amount to be refunded Line 50 minus Line 51. 52

Rev. 10/19 DCIZ3112 11/18/19

RESIDENTIAL RENTAL

*********

195939X

X 195939

X 195939

1.000000

X 195939

X 195939

X 195939

X 195939

195939X

59465

250

250X

D-30 FORM, PAGE 3

*190303S31032*Taxpayer Name:

Taxpayer Identification Number

Round cents to the nearest dollar. If an amount is zero, make no entry.

Schedule A ' COST OF GOODS SOLD (See specific instructions for Line 2.)

$Inventory at beginning of year (if different from last year's closing inventory, attach an explanation)1

$Purchases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Enter result here O$Minus cost of items withdrawn for personal use. . . . . .

Cost of Labor.3

Material and supplies.4

Other costs (attach statement) ' (Additional federal depreciation and5additional IRC §179 expenses are not allowed.)

$Total of lines 1 through 5.6

$Inventory at end of year.7

$8 Cost of goods sold (Line 6 minus Line 7). Enter here and on D-30, Line 2.

Method of inventory valuation used

Schedule B ' CONTRIBUTIONS AND/OR GIFTS (See specific instructions for Line 18.)

$ $

TOTAL (Limited to 15% of net income ' also$enter on D-30, Line 18.)

Schedule C ' TAXES (See specific instructions for Line 16.)

Type of Tax Amount Type of Tax Amount

$ $

$TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*Schedule E ' INTEREST EXPENSE (See specific instructions for Line 17.)

Name and Address of Payee Amount Name and Address of Payee Amount

$ $

$TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* Schedule D has been deleted.

Rev. 10/19

DCIZ3134 11/07/19

33,629.

*********RESIDENTIAL RENTAL

22,871.

R/E & OTHER TAXES (SCH 33,629.

SEE STATEMENT 2

D-30 PAGE 4

Taxpayer Name:

*190303S41032*Taxpayer Identification Number

Note: If this is a combined report do not use Schedule F to derive the apportionment factor for the group.

Leave Schedule F blank. Use Combined Reporting Schedule 2A, Line 9 instead.Schedule F ' DC apportionment factor (See instructions)

Carry all factors to six decimal places and truncateRound cents to the nearest dollar. If an amount is zero, leave the line blank.

DC ApportionmentColumn 1 TOTAL Column 2 in DCFactor1 SALES FACTOR: All gross receipts of the unincorporated business

(Column 2 divided byother than gross receipts from items of non-business income. Column 1)$ $.00 .00

2 DC APPORTIONMENT FACTOR: Column 2 divided by Column 1. Enter on D-30, Line 28.

Schedule G ' Other allowable deductions

Nature of Deduction Amount$

TOTAL (Also enter on D-30, Line 21.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Schedule H ' Income not reported (claimed as nontaxable)(See instructions.)

Nature of Income Amount$

$TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Third Party Designee To authorize another person to discuss this return with OTR, mark here and enter the name and phone number

Designee's name Phone

Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on the information available to the preparer.

PLEASESIGN Officer's signature Title Date Telephone number of person to contactHERE

PAIDPREPARER

ONLYPreparer's signature (If other than taxpayer) Date Firm name Firm address

If you want to allow the preparer to discuss this returnPreparer's PTINwith the Office of Tax and Revenue, mark here

Rev. 10/19

DCIZ3134 11/07/19

73,522.

1.000000

*********

RESIDENTIAL RENTAL

59,46559,465

PREPARERX

ASSOCIATION DUES (SCH. E) 53,376.INSURANCE (SCH. E) 13,740.MANAGEMENT FEES (SCH. E) 3,000.PLUMBING & ELECTRICAL (SCH. E) 2,875.SUPPLIES (SCH. E) 38.UTILITIES (SCH. E) 493.

********* X

D-30 FORM, PAGE 5

Taxpayer Name:


Beginning of Taxable Year End of Taxable YearSchedule I ' BALANCE SHEETS (See Instructions.)

(A) Amount (B) Total (A) Amount (B) Total

Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Trade notes and accounts receivable . . . . . 2

MINUS: Allowance for bad debts. . . . . . . . . . a

Inventories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Gov't obligations: a U.S. and its instrumentalities

States, subdivisions thereof, etc. . . . . b

Other current assets (attach statement) . . . . . . . . . . . 5

Mortgage and real estate loans. . . . . . . . . . . 6

Other investments (attach statement). . . . . 7

Buildings and other fixed depreciable assets. . . . . . . . 8

MINUS: Accumulated depreciation. . . . . . . . a

Depletable assets . . . . . . . . . . . . . . . . . . . . . . . 9

MINUS: Accumulated depletion. . . . . . . . . . . a

Land (net of any amortization). . . . . . . . . . . . 10

Intangible assets (amortizable only) . . . . . . 11

MINUS: Accumulated amortization. . . . . . . . a

Other assets (attach statement) . . . . . . . . . . 12

TOTAL ASSETS. . . . . . . . . . . . . . . . . . . . . . . . . 13

Accounts payable. . . . . . . . . . . . . . . . . . . . . . . . 14

15 Mortgages, notes, bonds payable in less than 1 year. .

Other current liabilities (attach statement) . . . . . . . . . 16

17 Mortgages, notes, bonds payable in 1 year or more. . .

Other liabilities (attach statement). . . . . . . . 18

Capital stock. . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

TOTAL LIABILITIES AND CAPITAL . . . . . . . 20

Schedule J ' DISTRIBUTION AND RECONCILIATION OF NET INCOME (OR LOSS)

Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7 Col. 8Percentage Percentage Exemption Net IncomeSalary Claimed Net Loss Total Income (or Loss) Not

of Time of (or Loss)DC Sources Taxable to theClaimedDevoted Ownership from UnincorporatedName and Address of Taxpayerto this Outside DC Business (Add Columns 4Owner(s)/ Member(s) Identification

Business through 7)Number

% % $ $ $ $ $

$ $ $ $ $TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Col. 4 ' See Instructions. Enter total taxable income as shown on Line 34 of D-30 . . . . . . . . . . . . $Col. 5 ' See Instructions.

Col. 6 ' Any loss amount from Line 31 of D-30.Net income of Unincorporated Business from both withinCol. 7 ' Enter the difference between Line 25 and Line 31 of D-30. $and outside DC (from Line 25 of D-30). . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rev. 10/19

RESIDENTIAL RENTAL

*********

-195,939. -195,939.

-195,939.

-195,939.

STATEMENT 3

D-30 FORM, PAGE 6

Taxpayer Name:


SUPPLEMENTAL INFORMATIONPRINCIPAL BUSINESS ACTIVITY DATE BUSINESS BEGAN2 3During 2019, has the Internal Revenue1

Service made or proposed any adjustmentsto your federal income tax returns, or did you

IF BUSINESS HAS TERMINATED, STATE REASON TERMINATION DATE4 5file any amended returns with the Internal

Revenue Service? . . . Yes No

If "Yes", submit separately an amended FormTYPE OF OWNERSHIP (sole proprietor, partnership, etc)6D-30 and a detailed statement, concerning

adjustments, to the Office of Tax andRevenue. See instructions for address.

Place where federal income tax return for period covered by this return was filed:7

Name(s) under which federal return for period covered by this return was filed:8

Yes No If no, please state reason:9 Have you filed annual Federal Information Returns, (forms 1096and 1099) pertaining to compensation payments for 2019?

Yes NoIs this return reported on the accrual basis? Cash basis10 If no, fill in the methodused: Other (specify)

11 Yes NoDid you withhold DC income tax from the wagesIf no, state reason:of your DC employees during 2019?

12 Yes NoDid you file a franchise tax return for the businessIf no, state reason:with the District of Columbia for the year 2018?

If yes, enter name under which return was filed:

Yes No13 Does this return include income from more thanone business conducted by the taxpayer?(If yes, list businesses and net income (loss)of each.)

Yes No14 Is income from any other business or businessinterest owned by the proprietors of this businessbeing reported in a separate return?(If yes, list names and addresses of theother businesses.)

15 a Yes NoIs this business unitary with a partnershipIf yes, explain:or another corporation?

Yes No

If yes, explain:b Is this business unitary with a combined group?

Yes No

16 a Did you file an annual ballpark fee return?

Rev. 10/19

DCIZ3105 11/07/19

X

X

X

X

X

X

SARA J. JACOBSEFILE

SOLE PROPRIETOR

X

1/01/16RENTAL

*********

RESIDENTIAL RENTAL

X

RESIDENTIAL RENTAL

X

X

2019 UBFT STATEMENTS PAGE 1


STATEMENT 1FORM D-30, PAGE 1, LINE 6GROSS RENTAL INCOME

RESIDENTIAL RENTAL-DC2029 CONNECTICUT AVE NW #41, WASHINGTON, DC 20008-6142 . . . . . . . . . . . . . . . . . . . . . . . . . . $ 59,465.

TOTAL $ 59,465.

STATEMENT 2FORM D-30, PAGE 3, SCHEDULE EINTEREST EXPENSE

NAME AND ADDRESS OF PAYEE AMOUNT

BANK OF AMERICAPO BOX 660576DALLASTX75266INTEREST EXPENSE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22871.

TOTAL $ 22871.

STATEMENT 3FORM D-30, PAGE 5, SCHEDULE JDISTRIBUTIONS AND RECONCILIATION OF NET INCOME (OR LOSS)

% OF % OF SALARY EXEMPTION NET LOSS NET INCOME TOTALNAME/ADDRESS/SSN TIME OWN CLAIMED CLAIMED (DC SOURCE) OUTSIDE DC INCOME(LOSS)

SARA J. JACOBS2604 FIFTH AVE. #403SAN DIEGO, CA 92103***-**-**** 100% 100% $ 0. $ 0. $ -195,939. $ 0. $ -195,939.

$ 0. $ 0. $ -195,939. $ 0. $ -195,939.

Government of the D-30P SUB Payment Voucher for2019District of Columbia

Unincorporated Franchise Tax

InstructionsUse the D-30P Payment Voucher to make any payments due on your D-30 return.

Do not use this voucher to make estimated tax payments.?Enter your Taxpayer Identification Number. Mark an X indicating if this is your FEIN or SSN.?Enter name and address exactly as they appear on your return.?Enter the amount of your payment.?Make the check or money order (US dollars) payable to DC Treasurer.?Write your TIN, tax period and type of return filed (D-30) on the payment.?Staple your check or money order to the D-30P voucher only. Do not attach your payment to your D-30 return.?Mail the D-30P with but not attached to, your D-30 tax return to:?

Office of Tax and RevenuePO Box 96165

Washington, DC 20090-6165

Notes:

If your payment exceeds $5,000 in any period, you must pay electronically.?Visit www.MyTax.DC.gov

For electronic filers, in order to comply with banking rules, you will be asked the question "Will the funds for this payment come from an?account outside of the United States?" If the answer is yes, you will be required to pay by money order (US dollars) or credit card. Pleasenotify this agency if your response changes in the future. You will be charged a $65 fee if your check or electronic payment is not honoredby your financial institution and returned to OTR.

Detach at perforation before mailing

Government of the 2019 D-30P SUB Payment Voucher forDistrict of Columbia

Unincorporated Business Franchise Tax

*19030PS11032*Amount of Payment .00$(dollars only)

SOFTWARE DEVELOPER USE ONLYTaxpayer Identification Number Mark if FEIN To avoid penalties and interest, your payment must bepostmarked no later than the due date of your return.

Mark if SSN VENDOR ID# 1032Business or Designated Agent Name Tax period ending (MMDDYYYY)

Business mailing address (number, street and suite/apartment number if applicable)


City State Zipcode + 4

Rev. 10/19 DCIZ9601L 11/06/19

250

********* X



1

SAN DIEGO CA 92103

2019 TAX RETURN

Client:

Prepared for:

Prepared by:

Date:

Comments:

Route to:

FDIL2001L 06/03/19

MASSACHUSETTS INDIVIDUAL

1178K3


OCTOBER 2, 2020

2019Form M-8453MassachusettsIndividual Income Tax DeclarationDepartment offor Electronic FilingRevenue

Please print or type. Privacy Act Notice available upon request. For the year January 1 - December 31, 2019.Your Social Security numberYour first name and initial Last name

Spouse's Social Security numberIf a joint return, spouse's first name and initial Last name

Present street address (and apartment number)

City/Town/Post Office State Zip Filing status: Single Married filing jointly

Married filing separately Head of household

Part 1. Tax Return Information for Electronic Filing

Total 5.05% income (from Form 1, line 10, or Form 1-NR/PY, line 12). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1

Income tax after credits (from Form 1, line 32, or Form 1-NR/PY, line 36) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 2

Massachusetts use tax (from Form 1, line 34, or Form 1-NR/PY, line 38) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 3

Massachusetts income tax withheld (from Form 1, line 38, or Form 1-NR/PY, line 42). . . . . . . . . . . . . . . . . . . . . . .4 4

Refund amount (from Form 1, line 50, or Form 1-NR/PY, line 54) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 5

Tax due (from Form 1, line 51, or Form 1-NR/PY, line 55) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 6

Part 2. Declaration and Signature of Taxpayer

Under pains and penalties of perjury, I declare that I have reviewed the information on my return with the information I have provided to myElectronic Return Originator and that the amounts above agree with the amounts shown on my 2019 Massachusetts return. To the best of myknowledge and belief this information is true, correct and complete. I consent that my return, including this declaration and accompanyingschedules, forms and statements be sent to the Massachusetts Department of Revenue by my Electronic Return Originator. I authorize DOR toinform my Electronic Return Originator and/or the transmitter when my electronic return has been accepted. In the event that it is rejected, Iauthorize DOR to identify the reasons for rejection so that the return can be corrected and re-transmitted. If I have filed a balance due return, Iunderstand that if DOR does not receive full and timely payment of my tax liability, I will remain liable for the tax liability and all applicablepenalties and interest.

Your signature Date DateSpouse's signature (if joint return, both must sign)

Part 3. Declaration and Signature of Electronic Return Originator (ERO)

I declare that I have reviewed the above taxpayer's return and that the entries on this M-8453 are complete and correct to the best of myknowledge. (Collectors are not responsible for reviewing the taxpayer's return; however, they must ensure that the M-8453 accurately reflects thedata on the return.) I have obtained the taxpayer's signature before submitting this return to the Massachusetts Department of Revenue. I haveprovided the taxpayer with a copy of all forms and information filed with the Massachusetts Department of Revenue. If I am also the paidpreparer, under pains and penalties of perjury I declare that I have examined the above taxpayer's return and accompanying schedules andstatements and to the best of my knowledge and belief, they are true, correct and complete. I declare that I have verified the taxpayer's proof ofaccount and it agrees with the name(s) shown on this form. This declaration of paid preparer (other than taxpayer) is based on all information ofwhich the preparer has any knowledge. Original Forms M-8453 should not be sent to DOR, but must instead be retained by the ERO on theERO's business premises for a period of three years from the date the return to which the M-8453 relates was filed.

Check ifERO's signature and SSN or PTIN Date EINself-employed

Check if alsoCity/Town State Zippaid preparer

Part 4. Declaration and Signature of Paid Preparer (if other than ERO)

Under pains and penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and tothe best of my knowledge and belief it is true, correct and complete. This declaration of paid preparer (other than taxpayer) is based on allinformation of which the preparer has any knowledge.

Check ifPaid preparer's signature and SSN or PTIN Date EINself-employed

Firm name (or yours, if self-employed) and address City/Town State Zip

MAIA1501 11/29/19


2604 FIFTH AVE. #403X

SAN DIEGO, CA 92103

72,573.3,663.

X

XFirm name (or yours, if self-employed) and address

2019 Form 1-NR/PYMA19006011032Massachusetts Nonresident/Part-Year ResidentIncome Tax ReturnFor the year January 1 ' December 31, 2019 or other taxable

Year beginning Ending

Apt. no.Fill in if: Original return Amended return Amended return due to federal change

$1 You $1 Spouse TOTALState Election Campaign Fund:

Fill in if veteran of U.S. armed forces who served in Operations Enduring Freedom, Iraqi Freedom, Noble EagleYou Spouseor Sinai PeninsulaYou SpouseTaxpayer deceasedYou SpouseFill in if under age 18

Nonresident Filing as both nonresident and part-year resident Name/address changed since 2018Check one:

Part-year resident Nonresident composite Fill in if noncustodial parent

a Total federal income

b Federal adjusted gross incomeSingle Fill in if filing Schedule TDS1 Filing status (select one only):

Married filing jointly

Married filing separate return

Head of household You are a custodial parent who has released claim to exemption for child(ren)

From To2 Part-year residents. Enter dates as Massachusetts resident:

Total days as Massachusetts resident e 365 =3 3

SIGN HERE. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.

Your signature Date Spouse's signature Date

PRIVACY ACT NOTICE AVAILABLE UPON REQUEST

MAIA0613L 11/01/19

SARA J JACOBS *********

2604 FIFTH AVE. #403 SAN DIEGO CA 92103

X

X

71863917186320

X

[email protected]

100220 094259 A

2019 Form 1-NR/PY, pg. 2MA19006021032Massachusetts Nonresident/Part-Year Resident Income Tax Return

4 Exemptions:

a Personal exemptions 4 a

x $1,000 =Number of dependents. (Do not include yourself or your spouse.) Enter numberb 4 b

c You + Spouse =Age 65 or over before 2020 x $700 = 4 c

d Blindness You + x $2,200 =Spouse = 4 d

e Medical/dental 4 e

4 ff Adoption

g Total exemptions. Add items 4a through 4f. Enter here and on line 22a 4 g

5 Wages, salaries, tips 5

6 Taxable pensions and annuities 6

7 Mass. bank interest: =exemptiona 7- b

8 Business/profession income/loss Farming income/lossa + b

8=

9 Rental, royalty and REMIC, partnership, S corp., trust income/loss 9

10 a Unemployment 10 a

10 b Mass. lottery winnings 10 b

11 Other income 11

12 TOTAL 5.05% INCOME 12

13 NONRESIDENT APPORTIONMENT WORKSHEET. You cannot apportion Mass. wages as shown on Form W-2. Do not use thisworksheet if you know the exact amount of your Mass. source income. Only use when income from employment/business is earned bothinside and outside Mass. and the exact Mass. amount is not known.

Basis: working days miles sales other:

Working days (or other basis) outside Massachusetts 13 a

Working days (or other basis) inside Massachusetts 13 b

Total working days 13c

Nonworking days (holidays, weekends, etc.) 13d

Massachusetts ratio 13e

13fTotal income being apportioned. You cannot apportion Massachusetts wages as shown on Form W-2

Massachusetts income 13g

BE SURE TO INCLUDE THIS PAGE WITH FORM 1-NR/PY, PAGE 1

MAIA0613L 11/01/19

*********

4400

4400

72573

72573

100220 094259 A


14 NONRESIDENT DEDUCTION AND EXEMPTION RATIO

a Total 5.05% income 14a

b Interest income 14b

c Total capital gain income 14c

d Total income this return 14d

e Non-Massachusetts source income. Not less than "0" 14e

f Total income 14f

g Deduction and exemption ratio 14g

15 a Amount paid to Soc. Sec. Medicare, R.R., U.S. or Mass. Retirement 15a

15 b Amount your spouse paid to Soc. Sec., Medicare, R.R., U.S. or Mass. Retirement 15b

16 Child under age 13, or disabled dependent/spouse care expenses 16

17 Number of dependent member(s) of household under age 12, or dependents age 65 or over (not you or your spouse)

as of 12/31/19, or disabled dependent(s)

Not more than two. a bx $3,600 = Part-year residents multiply line 17b by line 3;

nonresidents multiply line 17b by line 14g 17

18 Rental deduction. a e 2 = 18

Nonresidents, fill in if during 2019 you did not have a family home or any dwelling outside Massachusetts to which you generally or customarily returned or

intend to return in the future

19 Other deductions from Schedule Y, line 19 19

20 Total deductions. Add lines 15 through 19 20

21 5.05% INCOME AFTER DEDUCTIONS. Subtract line 20 from line 12. Not less than "0" 21

aExemption amount.22 22

23 5.05% INCOME AFTER EXEMPTIONS. Subtract line 22 from line 21. Not less than "0" 23

24 INTEREST AND DIVIDEND INCOME 24

25 TOTAL TAXABLE 5.05% INCOME. Add lines 23 and 24 25

26 TAX ON 5.05% INCOME. Note: If choosing the optional 5.85% tax rate, fill in and multiply line 25 and the

amount in Schedule D, line 21 by .0585 26


MAIA0613L 11/19/19


72573

72573712297271955450.0101

72573444400

72529

72529

3663

100220 094259 A


x .12 =27 a 2712% INCOME. Not less than "0."

28 28TAX ON LONG-TERM CAPITAL GAINS. Not less than "0." Fill in if filing Schedule D-IS

Fill in if any excess exemptions were used in calculating lines 24, 27 or 28

Credit recapture amount (from Credit Recapture Schedule)29 29

30 Additional tax on installment sale 30

31 If you qualify for No Tax Status, fill in and enter "0" on line 32

32 TOTAL INCOME TAX. Add lines 26 through 30 32

33 Limited Income Credit 33

34 Income tax due to another state or jurisdiction 34

35 Other credits (from Credit Manager Schedule) 35

36 36INCOME TAX AFTER CREDITS. Subtract the total of lines 33 through 35 from line 32. Not less than "0"

37 Voluntary Contributions

a Endangered Wildlife Conservation 37a

b Organ Transplant Fund 37 b

c Massachusetts Public Health HIV and Hepatitis Fund 37 c

d Massachusetts U.S. Olympic Fund 37 d

e Massachusetts Military Family Relief Fund 37 e

f Homeless Animal Prevention and Care 37 f

Total. Add lines 37a through 37f 37

38 Use tax due on Internet, mail order and other out-of-state purchases 38

39 Health care penalty a You + b Spouse 39

40 Amended return only. Overpayment from original return 40

41 INCOME TAX AFTER CREDITS PLUS CONTRIBUTIONS AND USE TAX. Add lines 36 through 40 41

MAIA0613L 11/01/19

*********

0

3663

3663

3663

100220 094259 A


42 Massachusetts income tax withheld 42

43 2018 overpayment applied to your 2019 estimated tax 43

44 2019 Massachusetts estimated tax payments 44

45 Payments made with extension 45

Amended return only. Payments made with original return. Not less than "0"46 46

47 a b cx .30 =Earned Income Credit. Number of qualifying children Amount from U.S. return

47Part-year residents, multiply line 47c by line 3Note: You cannot claim the Earned Income Credit if your filing status is married filing separately unless you qualify

for an exception (see instructions). Fill in if you qualify for this exception

48 Senior Circuit Breaker Credit 4849 Other Refundable Credits 4950 Excess Paid Family Leave Withholding 5051 TOTAL. Add lines 42 through 50 5152 Overpayment. Subtract line 41 from line 51 52

Amount of overpayment you want applied to your 2020 estimated tax53 5354 Refund. Subtract line 53 from line 52. Mail to: Massachusetts DOR, PO Box 7000, Boston, MA 02204 54

checkingDirect deposit of refund. Type of account

savings

RTN # account #

55 Tax due. Pay online at www.mass.gov/dor/payonline. Mail to: Mass. DOR, PO Box 7003, Boston, MA 02204 55

EX encloseInterest Penalty M-2210 amt.Form M-2210

Yes

(this may delay your refund)Paid preparer's

Date Check if self-employed SSN/PTIN

Paid preparer's phone


MAIA0613L 11/01/19

*********

3663

3663

XMay the Department of Revenue discuss this return with the preparer shown here?

I do not want preparer to file my return electronically

Print paid preparer's name

Paid preparer's signature X

8584610115

********* Paid preparer's EIN

100220 094259 A

DEL MAR, CA 92014

2019 Schedule BMA19010011032

Part 1. Interest and Dividend IncomeTotal interest income1 1

Total ordinary dividends2 2

Other interest and dividends not included above3 3

Total interest and dividends4 4

Total interest from Massachusetts banks5 5

Other interest and dividends to be excluded6a 6a

Part-year/Nonresidents only6b 6b

Subtotal7 7

Allowable deductions from your trade or business8 8

Subtotal9 9

Part 2. Short-Term Capital Gains/Losses and Long-Term Gains on CollectiblesMassachusetts short-term capital gains10 10

Massachusetts long-term capital gains on collectibles and pre-1996 installment sales11 11

Massachusetts gain on the sale, exchange or involuntary conversion of property used in a trade12or business and held for one year or less 12

Add lines 10 through 1213a 13a


Subtract line 13b from line 13a. Not less than 013c 13c


Subtotal15 15

MA short-term capital losses16 16

Massachusetts loss on the sale, exchange or involuntary conversion of property used in a trade17or business and held for one year or less 17

Prior short-term unused losses for years beginning after 198118 18

MAIA0138 11/01/19


66765806428

873193

873193

139217

139217139217

-5073

100220 094259 A

SEE STATEMENT 2

SEE STATEMENT 1

2019 Schedule B, pg. 2MA19010021032

Combine lines 15 through 1819a 19a

19bPart-year/Nonresidents only19b

19c 19cExclude line 19b losses from line 19a

Short-term losses applied against interest and dividends20 20

Available short-term losses21 21

Short-term losses applied against long-term gains22 22

Short-term losses available for carryover in 202023 23

Short-term gains and long-term gains on collectibles24 24

Long-term losses applied against short-term gain25 25

Subtotal26 26

Long-term gains deduction27 27

Short-term gains after long-term gains deduction28 28

Part 3. Adjusted Gross Interest, Dividends, Short-Term Capital Gains and Long-Term Gains on CollectiblesEnter the amount from line 929 29

Short-term losses applied against interest and dividends30 30

Subtotal interest and dividends31 31

Long-term losses applied against interest and dividends32 32

Adjusted interest and dividends33 33

Enter the amount from line 2834 34

Adjusted gross interest, dividends and certain capital gains35 35

Excess exemptions36 36

Subtract line 36 from line 3537 37

Interest and dividends taxable at 5.05%38 38

Taxable 12% capital gains39 39

Available short-term losses for carryover in 202040 40

MAIA0138 11/01/19

*********

SARA JJACOBS

-5073-5073

100220 094259 A

SEE STMT 3

2019 Schedule DMA19012011032Long-Term Capital Gains and LossesExcluding Collectibles

Part 1. Long-Term Capital Gains and Losses, Excluding CollectiblesEnter amounts from U.S. Schedule D, lines 8a and 8b, col. h1 1

Enter amounts from U.S. Schedule D, line 9, col. h2 2





Massachusetts long-term capital gains and losses included in U.S. Form 4797, Part II7 7

Carryover losses from prior years8 8

Combine lines 1 through 89 9

Massachusetts adjustments10a 10a


Combine lines 10a and 10b10c 10c

Massachusetts capital gains and losses11 11

Long-term gains on collectibles and pre-1996 installment sales12 12

Subtotal13 13

Capital losses applied against capital gains14 14

Subtotal15 15

Long-term capital losses applied against interest and dividends16 16

Subtotal17 17


Subtotal19 19

Excess exemptions20 20

Taxable long-term capital gains21 21

Tax on long-term capital gains22 22

Massachusetts available losses for carryover23 23

MAIA0201 11/01/19


1097385997768

64872265

6172643

61726436172643

100220 094259 A

SEE STMT 4

2019 Schedule EMA19013041032

Income or Loss from Real Estate and Royalties:

Income

1 Rents received 1

2 Royalties received 2

Expenses3 Advertising 3

4 Auto and travel 4

5 Cleaning and maintenance 5

6 Commissions 6

7 Insurance 7

8 Legal and other professional fees 8

9 Management fees 9

10 Mortgage interest paid to banks, etc. 10

11 Other interest 11

12 Repairs 12

13 Supplies 13

14 Taxes 14

15 Utilities 15

16 Other expenses 16

17 Add lines 3 through 16 17

18 Depreciation expense or depletion 18

19 Total expenses. Add lines 17 and 18 19

20 Income or loss from rental real estate or royalty properties 20

21 Deductible rental real estate loss 21

22 Income. Enter positive amounts shown on line 20 22

23 Losses. Add royalty losses from line 20 and real estate losses from line 21 23

24 Rental real estate and royalty income or loss 24

MAIA0104 11/01/19


134744

22218

2599122871

1013038

51451493

72810206002160702366704

-231960-37746

-37746-37746

100220 094259 A

2019 Schedule E, pg. 2MA19013051032

Income or Loss from Partnerships and S CorporationsPassive loss allowed25 25

Passive income26 26

Non-passive loss27 27

Section 179 expense deduction28 28

Non-passive income29 29

Combine lines 26 and 2930 30

Combine lines 25, 27 and 2831 31

Partnership and S corporation income or loss. Combine lines 30 and 3132 32

Interest (other than MA banks) and dividends if included in line 3233 33

Interest from Massachusetts banks if included in line 3234 34

Total income or loss from partnerships and S corporations35 35

Check if you are reporting any loss not allowed in a prior year due to the at-risk, or basis limitations; a prior year36

disallowed loss from a passive activity (was not reported on U.S. Form 8582) or un-reimbursed partnership expenses

Income or Loss from Estates and TrustsPassive deduction or loss allowed37 37

Passive income38 38

Non-passive deduction or loss39 39

Non-passive other income40 40

Add lines 38 and 4041 41

Add lines 37 and 3942 42

Estate and trust income or loss. Combine lines 41 and 4243 43

Estate or non-grantor-type trust income44 44

Grantor-type trust and non-Massachusetts estate and trust income45 45

Interest and dividends if included in line 4546 46

Adjustments to 5.05% income47 47

Subtotal. Combine lines 46 and 4748 48

Income or loss from grantor type and non-Mass estates and trusts49 49

Income or Loss from REMICsExcess inclusion50 50

Taxable income or loss51 51

Income52 52


MAIA0104 11/01/19

*********

3482672573

72573-3482637747

37747

X

100220 094259 A

2019 Schedule E, pg. 3MA19013061032

Farm IncomeNet farm rental income or loss54 54

SummaryIncome or loss. Combine lines 24, 35, 49, 53 and 5455 55

Massachusetts differences. Enclose statement56 56

Abandoned building renovation deduction57 57

Total income or loss. Combine lines 55, 56 and 5758 58

MAIA0104 11/01/19

*********

172572

72573

100220 094259 A

STATEMENT 5

2019 Schedule E-1MA19013011032

Check one: Real estate Royalty Rental property used for short-term rentals

Income or Loss from Real Estate and Royalties

Income1 Rents received 1



4 Auto and travel 4


6 Commissions 6

7 Insurance 7


9 Management fees 9



12 Repairs 12

13 Supplies 13

14 Taxes 14

15 Utilities 15








23 Losses. Enter royalty losses from line 20 or rental real estate losses from line 21 23


25 Check if this rental property was used by you or your family for more than 14 days or more than 10%

of the total number of days that the property was rented at fair market value

MAIA0701L 11/01/19

SARA J JACOBS *********RESIDENTIAL RENTAL-DC2029 CONNECTICUT AVE NW #WASHINGTON DC 200086142

X

59465

13740

300022871

1013038

33629493

56251140152115252255404

-195939-22932

-22932-22932

100220 094259 A

SEE STATEMENT 6

2019 Schedule E-1MA19013011032

Check one: Real estate Royalty Rental property used for short-term rentals

Income or Loss from Real Estate and Royalties

Income1 Rents received 1



4 Auto and travel 4


6 Commissions 6

7 Insurance 7


9 Management fees 9



12 Repairs 12

13 Supplies 13

14 Taxes 14

15 Utilities 15








23 Losses. Enter royalty losses from line 20 or rental real estate losses from line 21 23


25 Check if this rental property was used by you or your family for more than 14 days or more than 10%

of the total number of days that the property was rented at fair market value

MAIA0701L 11/01/19

SARA J JACOBS *********RESIDENTIAL RENTAL-NY99 JANE ST APT 6L NEW YORK NY 10014

X

75279

8478

22991

17822

165596585045450

111300-36021-14814

-14814-14814

100220 094259 A

SEE STATEMENT 7

2019 Schedule E-2MA19013021032

Check one: S corp. partnership


Passive income2 2

Non-passive loss3 3











Check if any amount of this investment not at risk13

MAIA0801L 11/01/19

SARA J JACOBS *********BELDORE CAPITAL FUND LLC 260505281

X

100220 094259 A

2019 Schedule E-2MA19013021032



Passive income2 2

Non-passive loss3 3












MAIA0801L 11/01/19

SARA J JACOBS *********CLEARFORK CAPITAL FUND LLC 260158977

X

100220 094259 A

2019 Schedule E-2MA19013021032



Passive income2 2

Non-passive loss3 3












MAIA0801L 11/01/19

SARA J JACOBS *********MASS PATHWAYS TO ECON ADVANCEMENT 320500335

X

3482672573

72573-3482637747

37747

X

100220 094259 A

2019 Schedule E-2MA19013021032



Passive income2 2

Non-passive loss3 3












MAIA0801L 11/01/19

SARA J JACOBS *********BELGARDE CAPITAL FUND LLC 611897725

X

100220 094259 A

Massachusetts Department of Revenue

Form M-4868Massachusetts Income Tax Extension

Payment Worksheet and Voucher

endingFor the year January 1 ' December 31, 2019 or other taxable year beginning

Worksheet for Tax DueTotal tax you expect to owe for 2019 (Form 1, lines 28 and 34 (if applicable); Form 1-NR/PY, lines 32 and 38 (if applicable) . . . . . . . . . . . . .001 1

Massachusetts income tax withheld (Form 1, lines 38 and 46 (if applicable); Form 1-NR/PY, lines 42 and 50 (if applicable). . . . . . . . . . . . . .002 2

2018 overpayment applied to your 2019 estimated tax (do not enter 2018 refund) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .003 3

2019 Massachusetts estimated tax payments (do not include amount in line 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .004 4

Credits (see Form 1, lines 29 through 31 and 43 through 45; Form 1-NR/PY, lines 33 through 35 and 47 through 49) . . . . . . . . . . . . . . . . . . .005 5

Total. Add lines 2 through 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .006 6

Amount due. Subtract line 6 from line 1; not less than "0". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .007 7

DETACH HERE MAIZ1401 09/19/19

2019 Form M-4868Massachusetts Extension Payment VoucherPayment for period end date (mm/dd/yyyy) Tax type Voucher type ID type Vendor code

053 18 005 1032Name of taxpayer Social Security number

Name of taxpayer's spouse Social Security number of taxpayer's spouse Type of form you plan to file

Form 1 Form 1-NR/PYMailing address

City/Town State Zip Amount enclosed

.00$Pay online at mass.gov/masstaxconnect. Or, return this voucher with check or money order payable to: Commonwealth of Massachusetts.Mail to: Massachusetts Department of Revenue, PO Box 7062, Boston, MA 02204.

3,663

3,663

IF YOU HAVE PAID AT LEAST 80% OF YOUR TAX DUE BY THE ORIGINAL DUE DATE, YOU GET AN

AUTOMATIC 6 MONTH EXTENSION. DO NOT FILE THIS FORM. SEE TIR 16-10 ON WWW.MASS.GOV.

FILING YOUR EXTENSION ELECTRONICALLY (E-FILE OR VIA THE WEB)

(1) YOU ARE REQUIRED TO FILE YOUR EXTENSION ELETRONICALLY AND PAY ELECTRONICALLYIF YOU ARE MAKING AN EXTENSION PAYMENT OF $5,000 OR MORE.

(2) ALL OTHER INDIVIDUAL TAXPAYERS MUST PAY ONLINE AT MASS.GOV/MASSTAXCONNECT, OR VIAELECTRONIC FUNDS WITHDRAWAL (DIRECT DEBIT), OR MAIL A CHECK WITH THE VOUCHER BELOW.

TO FILE AN EXTENSION ELECTRONICALLY VIA THE WEB, GO TO MASS.GOV/MASSTAXCONNECT.

12/31/2019


X


SAN DIEGO CA 92103 3,663

**********************************************************









































FDIZ1901L 07/25/19

MA COPY - MA AMOUNTS


-231,960.

-512,215.-744,175.

72,573.

-23.

-34,828.37,722.

-706,453.

706,453.150,000.

7,186,390.

0.

72,573.

72,573.

SEE STATEMENT 8

Form 8582 (2019) Page 2


















GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

FDIZ1902L 07/25/19BAA Form 8582 (2019)

***-**-****SARA J. JACOBSMA COPY - MA AMOUNTS

706,453.744,200.

34,828.23.72,573.

512,215.231,960.




Form 8582 (2019) Page 3



GTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Name of activity:



































***-**-****MA COPY - MA AMOUNTS

37,746.706,429.744,175.

SARA J. JACOBS


SEE STATEMENT 9









































FDIZ1901L 07/25/19

MA SOURCE COPY - MA SOURCE AMOUNTS


72,573.

72,573.

72,573.

7,186,390.

0.

SEE STATEMENT 10

Form 8582 (2019) Page 2


















GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

FDIZ1902L 07/25/19BAA Form 8582 (2019)

***-**-****SARA J. JACOBSMA SOURCE COPY - MA SOURCE AMOUNTS

72,573.

MASS PATHWAYS TO ECON ADVANCE 72,573. 72,573.

Form 8582 (2019) Page 3



GTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Name of activity:



































0.0.0.

0.0.0.

***-**-****MA SOURCE COPY - MA SOURCE AMOUNTS

0.

SARA J. JACOBS

2019 MASSACHUSETTS STATEMENTS PAGE 1


STATEMENT 1SCHEDULE B, LINE 6BPART-YEAR/NONRESIDENTS ONLY

NON-MASSACHUSETTS SOURCE INTEREST AND DIVIDENDSINTEREST:MERRILL LYNCH - 12754. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,498.MERRILL LYNCH - 846. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203.MERRILL LYNCH -841 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,291.OID-STATE OF ISRAEL BOND. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50.MERRILL LYNCH-14414. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 822.BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,445.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 969.BELGARDE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199.SJJ CHARITABLE REMAINDER UNITRUST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,134.

DIVIDENDS:MERRILL LYNCH-12841. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609,531.MERRILL LYNCH-12846. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43,959.MERRILL LYNCH-14414. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277.BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67,682.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,316.BELGARDE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,275.SJJ CHARITABLE REMAINDER UNITRUST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,388.

OTHER TAX-EXEMPT INTEREST:MERRILL LYNCH-14414. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,294.MERRILL LYNCH-14414. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,500.

TOTAL $ 883,833.


MA SCH.B, LINE 10: MA SOURCE AMOUNT DIFFERENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 139,217.TOTAL $ 139,217.


MA SCH.B, LINE 16: MA SOURCE AMOUNT DIFFERENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -5,073.TOTAL $ -5,073.

STATEMENT 4SCHEDULE D, LINE 10BPART-YEAR/NONRESIDENTS ONLY

MA SCH.D, LINE 1: MA SOURCE AMOUNT DIFFERENCE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 109,738.MA SCH.D, LINE 2: MA SOURCE AMOUNT DIFFERENCE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,997,768.MA SCH.D, LINE 5: MA SOURCE AMOUNT DIFFERENCE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64,872.MA SCH.D, LINE 6: MA SOURCE AMOUNT DIFFERENCE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265.

TOTAL $ 6,172,643.



STATEMENT 5SCHEDULE E, LINE 56MA DIFFERENCES

NON-MASS. SOURCE RENTAL INCOME. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 37,746.NON-MASS. SOURCE PARTNERSHIP & S-CORPORATION INCOME. . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,826.

TOTAL $ 72,572.

STATEMENT 6SCHEDULE E-1, LINE 16OTHER RENTAL AND ROYALTY EXPENSES

ASSOCIATION DUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53,376.PLUMBING AND ELECTRICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,875.

TOTAL $ 56,251.

STATEMENT 7SCHEDULE E-1, LINE 16OTHER RENTAL AND ROYALTY EXPENSES

ASSOCIATION DUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,559.TOTAL $ 16,559.

STATEMENT 8FORM 8582MASSACHUSETTS WORKSHEET

FEDERAL ADJUSTMENT FEDERAL STATENAME OF ACTIVITY FORM REPORT ON INCOME ADJUSTMENT INCOME

RESIDENTIAL RENTAL-DC SH E LN 22 -195,939. 0. -195,939.RESIDENTIAL RENTAL-NY SH E LN 22 -36,021. 0. -36,021.BELDORE CAPITAL FUND LLC SH E LN 28 -20. 0. -20.CLEARFORK CAPITAL FUND LLC SH E LN 28 -1. 0. -1.MASS PATHWAYS TO ECON ADVAN SH E LN 28 72,573. 0. 72,573.BELGARDE CAPITAL FUND LLC SH E LN 28 -2. 0. -2.

-159,410. 0. -159,410.






SH E LN 28 20. 20. 1.000000 19. 1.20. 0. 20. 1.000000 19. 1.




SH E LN 28 3. 3. 1.000000 3.3. 0. 3. 1.000000 3. 0.




SH E LN 28 2. 2. 1.000000 2.2. 0. 2. 1.000000 2. 0.

STATEMENT 10FORM 8582MASSACHUSETTS WORKSHEET

FEDERAL ADJUSTMENT FEDERAL STATENAME OF ACTIVITY FORM REPORT ON INCOME ADJUSTMENT INCOME

MASS PATHWAYS TO ECON ADVAN SH E LN 28 72,573. 0. 72,573.72,573. 0. 72,573.

2019 TAX RETURN

Client:

Prepared for:

Prepared by:

Date:

Comments:

Route to:

FDIL2001L 06/03/19

NEW YORK INDIVIDUAL

1178K3


OCTOBER 2, 2020

Department of Taxation and Finance

NYIA6101L 10/22/19New York State E-File Signature Authorization for Tax Year 2019For Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210

Electronic return originator (ERO): Do not mail this form to the Tax Department. Keep it for your records.

Spouse's name (jointly filed return only)Taxpayer's name

EROs must complete Part C prior to transmitting electronically filed incomePurposetax returns (Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and

Form TR-579-IT must be completed to authorize an ERO to e-file a personal NYC-210).income tax return and to transmit bank account information for the electronicfunds withdrawal. Both the paid preparer and the ERO are required to sign Part C. However, if

an individual performs as both the paid preparer and the ERO, he or she isonly required to sign as the paid preparer. It is not necessary to include theGeneral instructionsERO signature in this case. Please note that an alternative signature can be

Taxpayers must complete Part B before the ERO transmits the taxpayer's used as described in Publication 58, Information for Income Tax Returnelectronically filed Forms IT-201, Resident Income Tax Return, IT-201-X, Preparers, available on our website.Amended Resident Income Tax Return, IT-203, Nonresident and Part-Year Resident Income Tax Return, IT-203-X, Amended Nonresident and This form is not required for electronically filed Form IT-370, ApplicationPart-Year Resident Income Tax Return, IT-214, Claim for Real Property for Automatic Six-Month Extension of Time to File for Individuals. SeeTax Credit, NYC-208, Claim for New York City Enhanced Real Property Form TR-579.1-IT, New York State Taxpayer Authorization for ElectronicTax Credit, or NYC-210, Claim for New York City School Tax Credit. Funds Withdrawal for Tax Year 2019 Form IT-370 and Tax Year 2020

Form IT-2105.For returns filed jointly, both spouses must complete and signForm TR-579-IT.

Part A ' Tax return information1 Federal adjusted gross income (from applicable line). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

2 Refund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

3 Amount you owe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.

4 Financial institution routing number. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.

5 Financial institution account number. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.

6 Account type: Personal checking Personal savings Business checking Business savings

Part B ' Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210serve as the electronic signature for the return and any authorized paymentUnder penalty of perjury, I declare that I have examined the information ontransaction. If I am paying my New York State personal income taxes duemy 2019 New York State electronic personal income tax return, includingby electronic funds withdrawal, I certify that the account holder hasany accompanying schedules, attachments, and statements, and certify thatauthorized the New York State Tax Department and its designated financialmy electronic return is true, correct, and complete. The ERO has myagents to initiate an electronic funds withdrawal from the financial institutionconsent to send my 2019 New York State electronic return to New Yorkaccount indicated on my 2019 electronic return, and authorized theState through the Internal Revenue Service (IRS). In addition, by using afinancial institution to withdraw the amount from that account. As New Yorkcomputer system and software to prepare and transmit my formdoes not support International ACH Transactions (IAT), I attest the sourceelectronically, I consent to the disclosure to New York State of all informationfor these funds is within the United States. I understand and agree that Ipertaining to the transmission of my tax form electronically. I understand thatmay revoke this authorization for payment only by contacting theby executing this Form TR-579-IT, I am authorizing the ERO to sign and fileTax Department no later than two (2) business days prior to the paymentthis return on my behalf and agree that the ERO's submission of mydate.personal income tax return to the IRS, together with this authorization, will

DateTaxpayer's signature

Spouse's signature (jointly filed return only) Date

Part C ' Declaration of electronic return originator (ERO) and paid preparerthe return. If I am the paid preparer, under penalty of perjury I declare thatUnder penalty of perjury, I declare that the information contained in this I have examined this 2019 New York State electronic personal income tax2019 New York State electronic personal income tax return is the return, and, to the best of my knowledge and belief, the return is true,information furnished to me by the taxpayer. If the taxpayer furnished me correct, and complete. I have based this declaration on all informationa completed paper 2019 New York State return signed by a paid preparer, available to me.I declare that the information contained in the taxpayer's 2019 New York

State electronic return is identical to that contained in the paper copy of

Do not mail Form TR-579-IT to the Tax Department:ERO's must keep this form for three years and present it to the Tax Department upon request.

Print nameERO's signature Date

Paid preparer's signature Date

www.tax.ny.gov1032TR-579-IT (9/19)

SARA J. JACOBS

7,186,320.

Print name

NYIA2701L 11/12/19Department of Taxation and Finance IT-370Application for Automatic Six-MonthExtension of Time to File for Individuals (with instructions)

Instructionsincome tax returns because you are out of the country (forGeneral informationadditional information, see When to file/important dates on the

Purpose back cover of the instructions for the return you are filing) andyou need an additional four months to file (October 15, 2020);File Form IT-370 on or before the due date of the return to get

an automatic six-month extension of time to file Form IT-201, • June 15, 2020, if you are a U.S. nonresident alien for federalResident Income Tax Return, or Form IT-203, Nonresident and income tax purposes and you qualify to file your federal andPart-Year Resident Income Tax Return. New York State income tax returns on June 15, 2020, and you

need an additional six months to file (December 15, 2020); orNote: We no longer accept a copy of the federal extension form• July 14, 2020, (if your due date is April 15, 2020) orin place of Form IT-370.

September 14, 2020 (if you are a nonresident alien andIf you are requesting an extension of time to file using your due date is June 15, 2020), if you qualify for a 90-dayForm IT-370, you may still file Form IT-201 or Form IT-203 extension of time to file because your spouse died withinelectronically, provided you meet the conditions for electronic 30 days before your return due date and you need additionalfiling as listed in the instructions for the forms. time to file. However, you must file your return on or before

October 15, 2020, if your due date is April 15, 2020, or on orIf you have to file Form Y-203, Yonkers Nonresident Earningsbefore December 15, 2020, if you are a nonresident alien andTax Return, the time to file is automatically extended when youyour due date is June 15, 2020.file Form IT-370. For more information on who is required to file

Form Y-203, see the instructions for the form. See Special condition codes on page 2.We cannot grant an extension of time to file for more than If you qualify for an extension of time to file beyond sixsix months if you live in the United States. However, you months, you must file Form IT-370 on or before the filingmay qualify for an extension of time to file beyond six deadline for your return.months under section 157.3(b)(1) of the personal income taxregulations because you are outside the United States and How to filePuerto Rico, or you intend to claim nonresident status under Complete Form IT-370 and file it, along with payment for any taxsection 605(b)(1)(A)(ii) of the Tax Law (548-day rule), as due, on or before the due date of your return. Use the worksheetexplained in the instructions for Form IT-203 under Additional on page 3 to determine if a payment is required.information. Also see the special condition code instructions forthe return you will be filing (Form IT-201 or Form IT-203). Payment of tax – To obtain an extension of time to file, you

must make full payment of the properly estimated tax balancesWhen to file due. Payment may be made by check or money order. See

Payment options below.File one completed Form IT-370 on or before the filing deadlinefor your return (extension applications filed after the filing

Penaltiesdeadline for the return are invalid). Generally, the filing deadlineis the fifteenth day of the fourth month following the close of your Late payment penalty – If you do not pay your tax liability whentax year (April 15, 2020, for calendar-year filers). due (determined with regard to any extension of time to pay),

you will have to pay a penalty of ½ of 1% of the unpaid amountHowever, you may file Form IT-370 on or before: for each month or part of a month it is not paid, up to a maximum• June 15, 2020, if you qualify for an automatic two-month of 25%. The penalty will not be charged if you can show

extension of time to file your federal and New York State

B Detach (cut) here B Do not submit with your return.

Department of Taxation and Finance IT-370Application for Automatic Six-Month Extension of Time to File for Individuals

Paid preparer? Mark an X in the box and complete page 2. . . . . . . . . . . . . .

Enter your 2-character special condition code Spouse's full SSN (only if filing a joint return)Your full Social Security number (SSN) if applicable (see instructions) . . . . . . . . . . . . . . . . . . ?

Mark an X in the box for each tax that you are subject to:Your first name and middle initial Your last name

NYS tax NYC tax Yonkers tax MCTMTSpouse's first name and middle initial Spouse's last name

Dollars Cents

Apartment numberMailing address (number and street or PO box) 00.Sales and use tax . . . . . 1

State ZIP codeCity, village, or post office (see instructions) 00.Total payment. . . . . . . . . 2

Email:

3701191032

X

*********

SARA J. JACOBS

CA [email protected]

************


SAN DIEGO

Page 2 of 3 IT-370 (2019)

reasonable cause for paying late. This penalty is in addition to Specific instructionsthe interest charged for late payments.

Married taxpayers who:Reasonable cause will be presumed with respect to the addition• file separate returns must complete separate Forms IT-370.to tax for late payment of tax if the requirements relating to

Do not include your spouse’s SSN or name on your separateextensions of time to file have been complied with, the balanceForm IT-370.due shown on the income tax return, reduced by any sales or

use tax that is owed, is no greater than 10% of the total New • file a joint Form IT-370 will have the monies paid with that formYork State, New York City, and Yonkers tax, and metropolitan divided equally between the spouses’ accounts. Both theircommuter transportation mobility tax (MCTMT) shown on the accounts will be applied to their joint return when they file it.income tax return, and the balance due shown on the income • file a Form IT-203-C, Nonresident or Part-Year Residenttax return is paid with the return. Spouse’s Certification, do not list the spouse with no New

York source income on Form IT-370. If the spouse is listed,Late filing penalty – If you do not file your Form IT-201 orthe monies paid will be divided between the two accounts.Form IT-203 when due (determined with regard to any extensionWhen the return is filed with a Form IT-203-C attached, theof time to file), or if you do not file Form IT-370 on time andaccount of the spouse with no New York source income willobtain an extension of time to file, you will have to pay a penaltynot be applied, unless we receive prior authorization.of 5% of the tax due for each month, or part of a month, the

return is late, up to a maximum of 25%. However, if your return Name and address box – Enter your name (both names ifis not filed within 60 days of the time prescribed for filing a return filing a joint application), address, and entire Social Security(including extensions), this penalty will not be less than the number(s). Failure to provide the entire Social Security numberlesser of $100 or 100% of the amount required to be shown as may invalidate this extension or result in monies not being properlytax due on the return reduced by any tax paid and by any credit credited to your account. If you do not have a Social Securitythat may be claimed. The penalty will not be charged if you can number, enter do not have one. If you do not have a Socialshow reasonable cause for filing late. Security number, but have applied for one, enter applied for.

Foreign addresses – Enter the information in the followingInterestorder: city, province or state, and then country (all in the City,Interest will be charged on income tax, MCTMT, or sales or usevillage, or post office box). Follow the country’s practice fortax that is not paid on or before the due date of your return, evenentering the postal code. Do not abbreviate the country name.if you received an extension of time to file your return. Interest

is a charge for the use of money and in most cases may not be Special condition codes – If you are out of the country andwaived. Interest is compounded daily and the rate is adjusted need an additional four months to file (October 15, 2020),quarterly. enter special condition code E3. If you are a nonresident alien

and your filing due date is June 15, 2020, and you need anFee for payments returned by banks additional six months to file (December 15, 2020), enter specialThe law allows the Tax Department to charge a $50 fee when a condition code E4. If you qualified for a 90-day extension ofcheck, money order, or electronic payment is returned by a bank time to file because your spouse died, and you need additionalfor nonpayment. However, if an electronic payment is returned time to file (on or before October 15, 2020, or in the case ofas a result of an error by the bank or the department, the a nonresident alien, on or before December 15, 2020), enterdepartment won’t charge the fee. If your payment is returned, special condition code D9. Also enter the applicable special

condition code, E3, E4, or D9 on Form IT-201 or Form IT-203we will send a separate bill for $50 for each return or other taxdocument associated with the returned payment. when you file your return.

Privacy notificationSee our website or Publication 54, Privacy Notification.

NYIA2701L 11/12/19 B Detach (cut) here B Do not submit with your return.

IT-370 (2019) Page 2 When completing this section, enter your New York tax preparer registrationidentification number (NYTPRIN) if you are required to have one. If you arePayment options ' Full payment must be made by check or money order of not required to have a NYTPRIN, enter in the NYTPRIN excl. code box oneany balance due with this automatic extension of time to file. Make the checkof the specified 2-digit codes listed below that indicates why you are exemptor money order payable in U.S. funds to New York State Income Tax andfrom the registration requirement. You must enter a NYTPRIN or an exclusionwrite the last four digits of your Social Security number and 2019 Income Taxcode. Also, you must enter your federal preparer tax identification numberon it. For online payment options, see our website (at www.tax.ny.gov).(PTIN) if you have one; if not, you must enter your Social Security number.

Paid preparers ' Under the law, all paid preparers must sign and completeExemption typeCode Exemption typeCodethe paid preparer section of the form. Paid preparers may be subject to civil

and/or criminal sanctions if they fail to complete this section in full. 01 02Attorney Employee of attorney

03 04CPA Employee of CPADate:B Paid preparer must complete (see instructions)B

05 06PA (Public Accountant) Employee of PAPreparer's NYTPRINPreparer's signature DD 07 08 Employee of enrolledEnrolled agent

B Preparer's PTIN or SSNFirm's name (or yours, if self-employed) agent09 10Volunteer tax preparer Employee of business

Address ? Employer identification number preparing thatbusiness' return

NYTPRIN See our website for more information about the tax preparerexcl. coderegistration requirements.

Email:

3702191032

0 3

************

NYIA1612L 11/14/19Department of Taxation and Finance IT-203Nonresident and Part-Year ResidentNew York State?New York City?Yonkers? MCTMTIncome Tax Return

19For the year January 1, 2019, through December 31, 2019, or fiscal year beginning .

and ending. . . . . .

For help completing your return, see the instructions, Form IT-203-I.Your first name and middle initial Your Social Security numberYour last name (for a joint return, enter spouse's name on line below) Your date of birth (mmddyyyy)

Spouse's first name and middle initial Spouse's last name Spouse's Social Security numberSpouse's date of birth (mmddyyyy)

Apartment number New York State county of residenceMailing address (see instructions) (number and street or PO box)

School district nameCity, village, or post office State ZIP code Country (if not United States)

Taxpayer's permanent home address (see instrs) (no. and street or rural route) Apartment no. City, village, or post officeSchool districtcode number

State ZIP code Country (if not United States) Taxpayer's date of death Spouse's date of deathDecedentinformation

E New York City part-year residents only (see instrs)1 SingleA FilingNumber of months you lived in NY City in 2019 . . . (1)status Married filing joint return(mark an 2 (2)Number of months your spouse lived(enter both spouses' Social Security numbers above)X in one in NY City in 2019. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Married filing separate returnbox): 3 F Enter your 2-character special condition(enter both spouses' Social Security numbers above)code(s) if applicable (see instructions). . . .

Head of household (with qualifying person)4 G New York State part-year residents (see instructions)Enter the date you moved intoor out of NYS (mmddyyyy) . . . . . . . . . . . . . . . . Qualifying widow(er)5On the last day of the tax year (mark an X in one box):B Did you itemize your deductions on your 20191) Lived in NYS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . federal income tax return?. . . . . . . . . . . . . . . . . . . . . . . Yes No2) Lived outside NYS; received income fromC Can you be claimed as a dependent on another NYS sources during nonresident period. . . . . . . . . . . . . . taxpayer's federal return? . . . . . . . . . . . . . . . . . . . . . . . NoYes3) Lived outside NYS; received no income fromD1 Did you have a financial account located in a NYS sources during nonresident period. . . . . . . . . . . . . . foreign country? (see instructions). . . . . . . . . . . . . . . . Yes NoNew York State nonresidents (see instructions)HD2 Yonkers part-year residents only:Did you or your spouse maintainDid you receive a property tax relief credit? (see instrs) Yes No(1)living quarters in NYS in 2019?. . . . . . . . . . Yes No(if Yes, complete Form IT-203-B).00Enter the amount. . . . (2)

Were you required to report, any nonqualified deferredD3compensation, as required by IRC §457A on your

Yes No2019 federal return? (see instructions) . . . . . . . . . . . . . .

I Dependent information (see instructions)

First name and middle initial Last name Relationship Social Security number Date of birth (mmddyyyy)

If more than 6 dependents, mark an X in the box.

203001191032 For office use only

*********

X

X

NR

NR92103CASAN DIEGO


JACOBSSARA

X

J 02011989

X

X

X

NYIA1612L 11/14/19Enter your Social Security numberPage 2 of 4 IT-203 (2019)

Federal amount New York State amountFederal income and adjustments (see instructions) Whole dollars only Whole dollars only

Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 1.00 .002 2 2.00 .00Taxable interest income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 3 3.00 .00Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Taxable refunds, credits, or offsets of state and local4 4.00 .00income taxes (also enter on line 24) . . . . . . . . . . . . . . . . . . . . . .

5 5 5.00 .00Alimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Business income or loss (submit a copy of federal Sch. C, Form 1040). . . . . . . . . . 6 6 6.00 .00Capital gain or loss (if required, submit a copy of federal Sch. D, Form 1040). . . . . . 7 7 7.00 .00

8 8 8.00 .00Other gains or losses (submit a copy of federal Form 4797) . . . .

9 9 9.00Taxable amount of IRA distributions. Beneficiaries: mark X in box .00Taxable amount of pensions/annuities. Beneficiaries: mark X in box10 10 10.00 .00Rental real estate, royalties, partnerships, S corporations,11

11 11trusts, etc. (submit a copy of federal Schedule E, Form 1040) .00.00Rental real estate included12

.0012in line 11 (federal amount)

.00.00Farm income or loss (submit a copy of federal Sch. F, Form 1040) . . . . . . 13 13 13.00 .0014 14 14Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Taxable amount of Social Security benefits (also enter on line 26). . .00 .0015 15 15Identify: .00 .0016 16 16Other income (see instrs)

Add lines 1 through 11 and 13 through 16 . . . . . . . . . . . . . . . . . . 17 17 17.00 .00Total federal adjustments to income (see instructions)18Identify: .00 .0018 18Federal adjusted gross income (subtract line 18 from line 17). .19 19 19.00 .00

(see instructions)New York additions

20 Interest income on state and local bonds and obligations(but not those of New York State or its localities). . . . . . . . . . . . 20 20.00 .00

21 21 21Public employee 414(h) retirement contributions . . . . . . . . . . . . . . .00 .0022 22 22Other (Form IT-225, line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .00

Add lines 19 through 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 23 23.00 .00

(see instructions)New York subtractions

Taxable refunds, credits, or offsets of state and24local income taxes (from line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0024 24

Pensions of NYS and local governments and the25federal government (see instructions) . . . . . . . . . . . . . . . . . . . . . .00 .0025 25

.00 .0026 26 26Taxable amount of Social Security benefits (from line 15). . . . . .

.00 .0027 27 27Interest income on U.S. government bonds . . . . . . . . . . . . . . . . . .

28 Pension and annuity income exclusion. . . . . . . . . . . . . . . . . . . . . . . .00 .0028 28.00 .0029 29 29Other (Form IT-225, line 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0030 30 30Add lines 24 through 29. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0031 New York adjusted gross income (subtract line 30 from line 23). . . . . . . 31 31

32 Enter the amount from line 31, Federal amount column. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32G .00

(see instructions)Standard deduction or itemized deduction

33 Enter your standard deduction (table in instructions) or your itemized deduction (from Form IT-196).33 .00Mark an X in the appropriate box: . Standard - or - Itemized

34 Subtract line 33 from line 32 (if line 33 is more than line 32, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 .0035 Dependent exemptions (enter the number of dependents listed in Item I; see instructions) . . . . . . . . . . . . . . . 35 000.0036 New York taxable income (subtract line 35 from line 34). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 .00

203002191032

SARA J. JACOBS *********

9154

7195474 -25000

5796157961

7137513 -25000

1456457611

806428

6306787

1 -25000

10007186391 -25000

717186320 -25000

-37746

SEE STATEMENT 1

SEE STATEMENT 2

Name(s) as shown on page 1 Enter your Social Security number IT-203 (2019) Page 3 of 4NYIA1634L 11/14/19

Tax computation, credits, and other taxes37 37New York taxable income (from line 36 on page 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0038 38New York State tax on line 37 amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0039 39New York State household credit (see instructions, table 1, 2, or 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0040 40Subtract line 39 from line 38 (if line 39 is more than line 38, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0041 41New York State child and dependent care credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0042 42Subtract line 41 from line 40 (if line 41 is more than line 40, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0043 43New York State earned income credit (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

44 .00Base tax (subtract line 43 from line 42; if line 43 is more than line 42, leave blank) . . . . . . . . . . . . . . . . . . . . . . 44

Round result to 4 decimal placesFederal amount from line 31New York State amount from line 3145 Incomepercentage e = 45.00 .00(see instrs)

46 46Allocated New York State tax (multiply line 44 by the decimal on line 45). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0047 47New York State nonrefundable credits (Form IT-203-ATT, line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0048 48Subtract line 47 from line 46 (if line 47 is more than line 46, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0049 49Net other New York State taxes (Form IT-203-ATT, line 33). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

5050 Total New York State taxes (add lines 48 and 49). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

New York City and Yonkers taxes, credits, and surcharges, and MCTMT51 51Part-year New York City resident tax (Form IT-360.1) . . . . . . . . .00 See instructions on pages 3152 Part-year resident nonrefundable New York City and 32 to compute New York

City and Yonkers taxes,child and dependent care credit. . . . . . . . . . . . . . . . . . . . . . . . . 52 .00credits, and surcharges, and52 a Subtract line 52 from 51 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52a .00 MCTMT.MCTMT net52 b

52b .00earnings base. . . .

MCTMT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 c .0052c53 53Yonkers nonresident earnings tax (Form Y-203) . . . . . . . . . . . . . .0054 Part-year Yonkers resident income tax surcharge

54(Form IT-360.1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0055 55Total New York City and Yonkers taxes / surcharges and MCTMT (add lines 52a, and 52c through 54) .00

5656 Sales or use tax (See the instructions. Do not leave line 56 blank.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

5757 Voluntary contributions (Form IT-227, Part 2, line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0058 Total New York State, New York City, Yonkers, and sales or use taxes, MCTMT,

58and voluntary contributions (add lines 50, 55, 56, and 57). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

203003191032


0.0000-25000 7137513

0

Enter your Social Security numberPage 4 of 4 IT-203 (2019)NYIA1634L 11/14/19

59 Enter amount from line 58. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 .00

Payments and refundable credits (see instructions)

If applicable, complete60Part-year NYC school tax credit (fixed amount) (also complete E on front)60 .00Form(s) IT-2 and/or IT-1099-R60a60a NYC school tax credit (rate reduction amount). . . . . . . . . . . . . . . . . .00 and submit them with your61 .0061 Other refundable credits (Form IT-203-ATT, line 17) . . . . . . . . . . . return (see pages 12 and 13).

62 .00Total New York State tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . .62 Do not send federal63 .00Total New York City tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . .63 Form W-2 with your return.64 .00Total Yonkers tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6465Total estimated tax payments/amount paid with Form IT-370. . . . .0065

Total payments and refundable credits (add lines 60 through 65). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 .0066

(see instructions)Your refund, amount you owe, and account information67Amount overpaid (if line 66 is more than line 59, subtract line 59 from line 66; see page 36). . . . . . . . . . .67 .006868 .00Amount of line 67 available for refund (subtract line 69 from line 67). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a68 .00a68 Amount of line 68 that you want to deposit into a NYS 529 account (Form IT-195, line 4) (also submit Form IT-195). . . . . . . . . .68bTotal refund after NYS 529 account deposit (subtract line 68a from line 68). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0068b

direct deposit to checking or paper Refund? Direct deposit is the- or -savings account (fill in line 73) check. . . .Mark one refund choice: easiest, fastest way to get yourAmount of line 67 that you want applied to your 202069 refund.

69 .00estimated tax (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . See page 37 for payment70 Amount you owe (if line 66 is less than line 59, subtract line 66 from line 59). To pay by electronic options.

funds withdrawal, mark an X in the box and fill in lines 73 and 74. If you pay by check70or money order you must complete Form IT-201-V and mail it with your return. . . . . . . . . . . . . . . . . . . . . . .00

71 Estimated tax penalty (include this amount on line 70,See page 40 for the proper71 .00or reduce the overpayment on line 67; see instructions). . . . . . .assembly of your return.7272 Other penalties and interest (see instructions). . . . . . . . . . . . . . . . . .00

73 Account information for direct deposit or electronic funds withdrawal (see instructions).

If the funds for your payment (or refund) would come from (or go to) an account outside the U.S., mark an X in this box (see instructions)

73a Personal checking - or - Personal savings - or - Business checking - or -Account type: Business savings

73b Routing number Account number73c

.0074 Date AmountElectronic funds withdrawal (see instructions). . . . . . . . . . . . . . . . .

Designee's phone number Personal identificationThird-party designee? number (PIN)(see instructions) ( )

Email:Yes NoPreparer's NYTPRINI Paid preparer must complete I NYTPRIN Taxpayer(s) must sign hereI I(see instructions) excl. code

Your signaturePreparer's signature

Your occupationPreparer's PTIN or SSN

Spouse's signature and occupation (if joint return)Employer identification number

Date Daytime phone numberDate ( )Email:Email:

See instructions for where to mail your return.

203004191032

********* SARA J. JACOBS

Print designee's name

858 461-0115X 92014

0 3

********* POLITICIAN

Preparer's printed name


Address

Department of Taxation and Finance NYIA1610L 01/06/20 IT-196New York Resident, Nonresident, andPart-Year Resident Itemized Deductions

Submit this form with Form IT-201 or IT-203. See instructions for completing Form IT-196.Name(s) as shown on your Form IT-201 or IT-203 Your Social Security number

Medical and dental expenses (see instructions)

Caution: Do not include expenses reimbursed or paid by others.

.001 1Medical and dental expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.002 Enter amount from Form IT-201 or IT-203, line 19 . . . . . . . . . . . . . 2

Multiply line 2 by 10% (0.10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .003 3

.004Subtract line 3 from line 1 (if line 3 is more than line 1, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

(see instructions)Taxes you paid

5 State and local (Mark an X in only one box)

5 .00a Income taxes - or - b General sales tax. . . . .

.006 6State and local real estate taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

77 State and local personal property taxes. . . . . . . . . . . . . . . . . . . . . . . .008 Other taxes. List type and amount

.008

.00Add lines 5 through 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Interest you paid (see instructions)

10 Home mortgage interest and points reported to you on.0010federal Form 1098. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 Home mortgage interest not reported to you on federalForm 1098. If paid to the person from whom youbought the home, show that person’s name, identifyingnumber, and address

.0011

Points not reported to you on federal Form 1098. . . . . . . . . . . . . . . .0012 12

13 13Mortgage insurance premiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

.0014 14Investment interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.0015 Add lines 10 through 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

(see instructions)Gifts to charity

16 Gifts by cash or check. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .001616a Qualified contributions

16a .00included in line 16. . . . .

17 Other than by cash or check. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0017

Carryover from prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 18 .00

19Add lines 16, 17, and 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 .00

196001191032


X 737759

737759

27387

27387

6386

1033985

1040371

SEE STMT 4

NYIA1610L 01/06/20Page 2 of 3 IT-196 (2019) Your Social Security number

Casualty and theft losses

Casualty or theft loss(es) other than federal qualified disaster losses (see instructions). . . . . . . . . . . . . . . . . 2020 .00

Job expenses and certain miscellaneous deductions (see instructions)

21 Unreimbursed employee expenses – job travel,union dues, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 .00

Job related education expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 22 .00

23Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 .00Other expenses – investment, safe deposit box, etc.24

List type and amount

24 .00

25 25Add lines 21 through 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

26Enter amount from Form IT-201 or IT-203, line 19 . . . . . . . . . . . . 26 .00

Multiply line 26 by 2% (0.02) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0027 27

Subtract line 27 from line 25 (if line 27 is more than line 25, leave blank) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 .0028

Other miscellaneous deductions

Gambling losses (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . 29 29 .00

Casualty and theft losses of income-producing property30(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 .00

31 Federal estate tax on income in respect of a decedent31(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

3232 Deduction for amortizable bond premiums (see instructions) .0033 An ordinary loss attributable to a contingent payment

33debt instrument or an inflation-indexed debt instrument .0034 Deduction for repayment of amounts under a claim of

34 .00right if over $3000 (see instructions) . . . . . . . . . . . . . . . . . . . . . .

3535 Certain unrecovered investments in a pension (see instructions) .0036 Impairment-related work expenses of a disabled person

36(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

37Federal qualified disaster loss (see instructions). . . . . . . . . . . . . . 37 .00

38 38Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3939 Add lines 29 through 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

Total itemized deductions (see instructions)

Is Form IT-201 or IT-203, line 19, over $163,850? (Mark an X in the appropriate box)

If No, your deduction is not limited. Add the amounts in the far right column forlines 4 through 39 and enter the amount on line 40.

If Yes, your deduction may be limited. See the Line 40, Total itemized deductions worksheet, in the instructions to compute theamount to enter on line 40.

40 40. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

196002191032

*********

2980

37173

40153

7186320

143726

X

1598122

SEE STATEMENT 5

Page 3 of 3IT-196 (2019)Your Social Security numberNYIA1610L 01/06/20

(see instructions)Adjustments

State, local, and foreign income taxes (or general sales tax, if applicable), and other4141subtraction adjustments (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

42 Subtract line 41 from line 40 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 .00College tuition itemized deduction (Form IT-203 filers only, IT-201 filers leave blank and skip to line 44)43

43 .00(Form IT-203-B, line 2; see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4444 .00Addition adjustments (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45 Add lines 42, 43, and 44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 .00

46 Itemized deduction adjustment (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0046

4747 Subtract line 46 from line 45 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0048 College tuition itemized deduction (Form IT-201 filers only, IT-203 filers leave blank and skip to

48 .00line 49) (See Form IT-272, Claim for College Tuition Credit or Itemized Deduction) (see instructions) . .

49 New York State itemized deduction (add lines 47 and 48; enter on Form IT-201, line 34 or49 .00Form IT-203, line 33) (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

196003191032

*********

651736

946386

946386

426200

520186

520186

STATEMENT 6

NYIZ2712L 07/23/19Department of Taxation and Finance IT-225New York State ModificationsAttachment to Form IT-201, IT-203, IT-204, or IT-205

Identifying number as shown on returnName(s) as shown on return

Complete all parts that apply to you; see instructions (Form IT-225-I). Submit this form with Form IT-201, IT-203, IT-204, or IT-205.

IT-201 IT-203 IT-204 IT-205Mark an X in the box identifying the return you are filing:

Schedule A ' New York State additions (enter whole dollars only)

Part 1 ' Individuals, partnerships, and estates or trustsNew York State additions1

A ' Total amountNumber B ' NYS allocated amount1 a A - .00 .00

b A - .00 .001.00 .00c A -1.00 .00d A -1

e .00 .00A -11 f A - .00 .001g A - .00 .00

2 2Total (add column A, lines 1a through 1g) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

3 3Total of Schedule A, Part 1, column A amounts from additional Form(s) IT-225, if any . . . . . . . . . . . . . . . . . .00

4 4Add lines 2 and 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

Part 2 ' Partners, shareholders, and beneficiaries

Form IT-201 filers: do not enter EA-113Form IT-203 filers: do not enter EA-113Form IT-205 filers: do not enter EA-113 or EA-201

New York State additions5A ' Total amountNumber B ' NYS allocated amount

5 a EA - .00 .00EA - .005 b .00

.00EA - .005cEA - .00 .005dEA -e .00 .005EA -5 f .00 .00

5g EA - .00 .00

6 6Total (add column A, lines 5a through 5g) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

Total of Schedule A, Part 2, column A amounts from additional Form(s) IT-225, if any . . . . . . . . . . . . . . . . . 7 7 .00

8 8Add lines 6 and 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

9 9Total additions (add lines 4 and 8; see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00(continued)

225001191032


X

NYIZ2712L 07/23/19IT-225 (2019) (Page 2)

Schedule B ' New York State subtractions (enter whole dollars only)

Part 1 ' Individuals, partnerships, and estates or trusts

New York State subtractions10A ' Total amountNumber B ' NYS allocated amount

10a S - .00 .00S -10b .00 .00S - .00 .0010cS - .00 .0010d

e S - .00 .001010f S- .00 .0010g S - .00 .00

11Total (add column A, lines 10a through 10g) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 .00

12 12Total of Schedule B, Part 1, column A amounts from additional Form(s) IT-225, if any. . . . . . . . . . . . . . . . . .00

13 13Add lines 11 and 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

Part 2 ' Partners, shareholders, and beneficiaries

Form IT-201 filers: do not enter ES-106, ES-107, or ES-125Form IT-203 filers: do not enter ES-106, ES-107, or ES-125Form IT-205 filers: do not enter ES-125

New York State subtractions14A ' Total amountNumber B ' NYS allocated amount

.00 .0014a ES -ES -14b .00 .00

c ES - .00 .0014ES - .00 .0014dES - .00 .0014eES -14f .00 .00

14g ES - .00 .00

15 .00Total (add column A, lines 14a through 14g) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

16 .0016Total of Schedule B, Part 2, column A amounts from additional Form(s) IT-225, if any. . . . . . . . . . . . . . . . .

17 .0017Add lines 15 and 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1818 .00Total subtractions (add lines 13 and 17; see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

225002191032


57961

57961

57961

213 57961 0

NYIA6601L 9/20/19Department of Taxation and Finance IT-2Summary of W-2 StatementsNew York State @ New York City @ Yonkers

Do not detach or separate the W-2 Records below. File Form IT-2 as an entire page with your return. See instructions.Box c Employer's informationEmployer's nameW-2 Record 1

Box a Employee's Social Security numberfor this W-2 Record Employer's address (number and street)

Box b Employer identification number (EIN) City Country (if not United States)State ZIP code

DescriptionBox 1 Wages, tips, other compensation Box 12a Amount Box 14a AmountCode

.00 .00 .00Box 14b AmountCodeBox 8 Allocated tips DescriptionBox 12b Amount

.00 .00 .00Box 10 Dependent care benefits DescriptionCode Box 14c AmountBox 12c Amount

.00 .00 .00DescriptionBox 12d AmountBox 11 Nonqualified plans Box 14d AmountCode

.00 .00 .00

Retirement planBox 13 Statutory employee Corrected (W-2c)Third-party sick pay

Box 17a NYS income tax withheldBox 16a NYS wages, tips, etc.Box 15aNY State information: N YNY State .00 .00

Box 17b Other state income tax withheldBox 16b Other state wages, tips, etc.Box 15bOther state information:other state .00.00

Box 20 Locality nameBox 19 Local income tax withheldBox 18 Local wages, tips, etc.NYC and Yonkersinformation (see instr.): Locality a Locality a.00 Locality a .00

.00Locality b Locality bLocality b.00

Do not detach. Box c Employer's informationEmployer's nameW-2 Record 2

Box a Employee's Social Security numberfor this W-2 Record Employer's address (number and street)

Box b Employer identification number (EIN) City State ZIP code Country (if not United States)

Box 1 Wages, tips, other compensation Box 14a AmountCode DescriptionBox 12a Amount

.00 .00 .00Box 14b Amount DescriptionBox 8 Allocated tips CodeBox 12b Amount

.00 .00 .00Box 14c AmountCode DescriptionBox 12c AmountBox 10 Dependent care benefits

.00 .00.00Box 14d AmountCode DescriptionBox 12d AmountBox 11 Nonqualified plans

.00 .00 .00

Box 13 Statutory employee Corrected (W-2c)Retirement plan Third-party sick pay

Box 17a NYS income tax withheldBox 16a NYS wages, tips, etc.Box 15aNY State information: N Y .00 .00NY State

Box 16b Other state wages, tips, etc. Box 17b Other state income tax withheldBox 15bOther state information:

.00 .00other state

Box 19 Local income tax withheld Box 20 Locality nameBox 18 Local wages, tips, etc.NYC and Yonkersinformation (see instr.): .00 .00 Locality aLocality aLocality a

Locality b.00 .00Locality b Locality b

102001191032

UNIVERSITY OF SAN DIEGO

********* 5998 ALCALA PARK

SAN DIEGO CA 92110952544535

14564 146 STATE DISABILIT

C A 14564 84

NYIA9712L 9/11/19Department of Taxation and Finance IT-182Passive Activity Loss LimitationsFor Nonresidents and Part-Year Residents

Submit with your Form IT-203 or IT-205.Name as shown on return Identifying number as shown on return

See the instructions before completing this form.Part I ' Passive activity lossRental real estate activities with active participation1a 1a .00Activities with net income from Worksheet 1, column (a). . . . . . . . . . . . . . . . . . . . . . . . . .

.001b 1bActivities with net loss from Worksheet 1, column (b). . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.001 Prior years unallowed losses from Worksheet 1, column (c) (see instructions). . . . . . . c 1c.001d Add lines 1a, 1b, and 1c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1d

Commercial revitalization deductions from rental real estate activities.002a 2aCommercial revitalization deductions from Worksheet 2, column (a) . . . . . . . . . . . . . . .

.002 Prior year unallowed commercial revitalization deductions from Worksheet 2, column (b). . . . . . . . 2bbAdd lines 2a and 2b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .002c 2c

All other passive activities.003a 3aActivities with net income from Worksheet 3, column (a). . . . . . . . . . . . . . . . . . . . . . . . . . .003b 3bActivities with net loss from Worksheet 3, column (b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .003c 3cPrior years unallowed losses from Worksheet 3, column (c) (see instructions). . . . . . .

Add lines 3a, 3b, and 3c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .003d 3d

Add lines 1d, 2c, and 3d. Note: If this line is zero or more, stop here and submit this form with your return; all losses are allowed,4including any prior year unallowed losses entered on line 1c, 2b, or 3c. Report the losses on theforms and schedules normally used. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .004

Line 1d is a loss, go to Part II.?If line 4 is a loss and: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 Part IV, line 15.?

Caution: If married filing separately, filing status '3', and you lived with your spouse at any time during the year, do not complete Part IIor Part III. Instead, go to line 15.

Part II ' Special allowance for rental real estate activities with active participationNote: Enter all numbers in Part II as positive amounts (greater than zero). See instructions.

.00Enter the smaller of the loss on line 1d or the loss on line 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55.0066 Enter 150,000 (if married filing separately, see instructions). . . . . . . . . . . . . . . . . . . . . . . .00Enter federal modified adjusted gross income, but not less than zero (see instr.) 77

Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9, andleave line 10 blank. Otherwise, go to line 8.

.008 8Subtract line 7 from line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.009 Multiply line 8 by 50% (.5). Do not enter more than 25,000. (If married filing separately, filing status '3', see instructions). . . . 9

.0010 10Enter the smaller of line 5 or line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 (greater than zero). See instructions..0011 11Enter 25,000 reduced by the amount, if any, on line 10. (If married filing separately, filing status '3', see instructions).0012 12Enter the loss from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.0013 13Subtract line 10 from line 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.0014 14Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part IV ' Total losses allowed

.0015 Add the income, if any, from lines 1a and 3a and enter the total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1516 Total losses allowed from all passive activities for this year. (Add lines 10, 14, and 15. See the

.0016instructions to find out how to report the losses on your return.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

182001191032

JACOBS, SARA J. *********

93982217059

-311041

-311041

311041150000

1500002500025000

25000

NYIA9712L 9/11/19Page 2 of 3 IT-182 (2019)

Caution: File this form and its worksheets with your tax return. Keep a copy for your records.

Worksheet 1 ' For Form IT-182, lines 1a, 1b, and 1c (see instructions)Current year Prior years Overall gain or loss

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

Date ofName of activity/property Date of UnallowedNet lossNet incomedescription and address acquisition loss (line 1c)sale (line 1b)(line 1a) Gain Loss

.00 .00 .00.00 .00

.00 .00.00 .00 .00

.00 .00.00 .00 .00

.00 .00.00 .00 .00

.00 .00 .00 .00.00

Totals. Enter on Form IT-182, lines 1a, 1b, and 1c . . . . . . . . . . . . .00 .00 .00

Worksheet 2 ' For Form IT-182, lines 2a and 2b (see instructions)(a) (b) (c)

Current yearName of activity/property Prior years'description and address unallowed deductions (line 2b) Overall lossdeductions (line 2a)

.00 .00 .00

.00 .00 .00

.00 .00 .00

.00 .00 .00Totals. Enter on Form IT-182,lines 2a and 2b. . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .00


(d)(a) (b) (c) (e)Date ofName of activity/property Date of Net loss UnallowedNet income

description and address acquisition sale (line 3b) loss (line 3c) Gain Loss(line 3a).00 .00 .00 .00 .00.00 .00 .00 .00 .00.00 .00 .00 .00 .00.00 .00 .00 .00 .00.00 .00 .00 .00 .00


Worksheet 4 ' Use this worksheet if an amount is shown on Form IT-182, line 10 or 14 (see instructions)(a) (b) (c) (d)Form or schedule

Subtract column (c)Name of activity/property Specialand line numberfrom column (a)description and address Allowanceto be reported on RatioLoss

.00 .00 .00

.00 .00 .00

.00 .00 .00

.00 .00 .00

.00 .00 .00Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

182002191032

28604125000311041

21705993982


RESIDENTIAL RENTAL 0 93982 217059 0 311041

NYIA9703L 9/11/19 IT-182 (2019) Page 3 of 3

Worksheet 5 ' Allocation of unallowed losses (see instructions)(c)(a) (b)Form or schedule

Name of activity/property and line number Unalloweddescription and address to be reported on lossRatioLoss.00 .00.00 .00.00 .00.00 .00

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00.00 .00

Worksheet 6 ' Allowed losses (see instructions)(b)(a) (c)Form or schedule

Name of activity/property Allowedand line number Unalloweddescription and address lossto be reported on lossLoss

.00.00 .00

.00.00 .00

.00.00 .00

.00.00 .00

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00.00 .00

Worksheet 7 ' Activities with losses reported on two or more different forms or schedules (see instructions)(a) (e)(b) (c) (d)Name of activity/property description and

address: Allowed UnallowedlosslossRatio

Form or schedule and line number tobe reported on (see instructions):

1a Net loss plus prior year unallowed loss fromform or schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

1b Net income from form or schedule. . . . . . . . . . . . . .00

1c Subtract line 1b from line 1a. If zero or less, leave blank . . . . . . . . . . . .00 .00 .00Form or schedule and line number tobe reported on (see instructions):

1a Net loss plus prior year unallowed loss from formor schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

1b .00Net income from form or schedule. . . . . . . . . . . . .




Subtract line 1b from line 1a. If zero or less, leave blank. . . . . . . . . . . 1c .00 .00 .00

Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00.00 .00 .00

182003191032

25000286041311041

286041286041


RESIDENTIAL RENTAL-NY SCH E LN 22 286041 1.000000 286041

RESIDENTIAL RENTAL-NY SCH E LN 22 311041 286041 25000

NYIZ2501L 9/10/19Department of Taxation and Finance IT-398New York State Depreciation Schedule forIRC Section 168(k) Property

Use this form only for property placed in service inside or outside New York State after May 31, 2003.Name(s) as shown on return Identifying number as shown on return

Mark an X in one box to show the income tax return you are filing and submit this form with that return.

IT-201, Resident IT-203, Nonresident and part-year resident IT-204, Partnership IT-205, Fiduciary

Part 1 ' Depreciation information for Internal Revenue Code (IRC) section 168(k) property (except for resurgence zone property andNew York liberty zone property described in IRC section 1400L(b)(2)) placed in service inside or outside New York State,beginning after May 31, 2003 (see instructions)

FDA GEB CNew York Federal depreciationDate placed Conv.Description of property Depreciable Method

in service depreciation deduction deduction(use additional sheet if needed) basis(mmddyyyy)

.00.00.00.00 .00 .00.00 .00 .00.00 .00 .00

1 .00.00Enter column F and column G totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Transfer the column F total to: Transfer the column G total to:

Form IT-225, line 10, Total amount column and enter Form IT-225, line 1, Total amount column and entersubtraction modification S-213 in the Number column. addition modification A-209 in the Number column.

Part 2 ' Year-of-disposition adjustment for IRC section 168(k) property (except for resurgence zone property and New York libertyzone property described in IRC section 1400L(b)(2)) placed in service inside or outside New York State, beginning afterMay 31, 2003 (see instructions)

Mark an X in the box if you claimed an investment credit on Form IT-212, Investment Credit, for any property listedbelow (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

A B C D EDescription of property Date of Method of Total New York Total federal

(use additional sheet if needed) disposition disposition depreciation deduction depreciation deduction

.00.00

.00.00.00 .00.00 .00

Enter column D and column E totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2 .00 .00Enter amount from line 2, column E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3 .00Enter amount from line 2, column D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .004 4Subtract line 4 from line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5 .00

Transfer the line 5 amount to Form IT-225, line 10, Total amount column and entersubtraction modification S-214 in the Number column.

398001191032

00000

057961

X

609248638JACOBS, SARA J.

COUNTERTOPS 01012018 14790 HY 150DB 1405FLOORING 01012018 62342 HY 200DB 15268FURNISHINGS 01012018 122248 HY 200DB 39119WINDOW TREATMENTS 01012018 22834 HY 150DB 2169

2019 NEW YORK STATEMENTS PAGE 1


STATEMENT 1FORM IT-203, LINE 16OTHER INCOME

FEDERAL NEW YORK

PACIFIC VIEW CHARTER-1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000.TOTAL $ 1,000. $ 0.

STATEMENT 2FORM IT-203, LINE 18ADJUSTMENTS TO INCOME

FEDERAL NEW YORK

DEDUCTIBLE PORTION OF SE TAX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 71.TOTAL $ 71. $ 0.

STATEMENT 3FORM IT-196, LINE 14INVESTMENT INTEREST

INVESTMENT INTEREST FROM K-1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 27,387.TOTAL $ 27,387.

STATEMENT 4FORM IT-196, LINE 16CONTRIBUTIONS BY CASH OR CHECK

CENTER FOR COMMUNITY SOLUTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000.DREAMS FOR ORPHANS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 700.LAWRENCE FAMILY JEWISH COMMUNITY CENTER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,200.MOTHERS OUT FRONT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500.MOXIE THEATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486.PLANNED PARENTHOOD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,500.

TOTAL $ 6,386.

STATEMENT 5FORM IT-196, 2% MISC. OTHER EXP.OTHER EXPENSES

MERRILL LYNCH-12846 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 31,622.MERRILL LYNCH-14414 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,551.

TOTAL $ 37,173.

2019 NEW YORK STATEMENTS PAGE 2


STATEMENT 6FORM IT-196, LINE 41STATE, LOCAL, FOREIGN TAX, OTHER SUBTRACTIONS

A - STATE, LOCAL, FOREIGN, AND GENERAL SALES TAXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 737,759.TOTAL $ 737,759.

* SUBTRACTION LIMITED - SEE SUBTRACTION LIMITATION WORKSHEET




an automatic six-month extension of time to file Form IT-201, • June 15, 2020, if you are a U.S. nonresident alien for federalResident Income Tax Return, or Form IT-203, Nonresident and income tax purposes and you qualify to file your federal andPart-Year Resident Income Tax Return. New York State income tax returns on June 15, 2020, and you













Enter your 2-character special condition code Spouse's full SSN (only if filing a joint return)Your full Social Security number (SSN) if applicable (see instructions) . . . . . . . . . . . . . . . . . . ?



Dollars Cents



Email:

3701191032

X

*********

SARA J. JACOBS


************


SAN DIEGO

Page 2 of 3 IT-370 (2019)






return is late, up to a maximum of 25%. However, if your return Name and address box – Enter your name (both names ifis not filed within 60 days of the time prescribed for filing a return filing a joint application), address, and entire Social Security(including extensions), this penalty will not be less than the number(s). Failure to provide the entire Social Security numberlesser of $100 or 100% of the amount required to be shown as may invalidate this extension or result in monies not being properlytax due on the return reduced by any tax paid and by any credit credited to your account. If you do not have a Social Securitythat may be claimed. The penalty will not be charged if you can number, enter do not have one. If you do not have a Socialshow reasonable cause for filing late. Security number, but have applied for one, enter applied for.







IT-370 (2019) Page 2 When completing this section, enter your New York tax preparer registrationidentification number (NYTPRIN) if you are required to have one. If you arePayment options ' Full payment must be made by check or money order of not required to have a NYTPRIN, enter in the NYTPRIN excl. code box oneany balance due with this automatic extension of time to file. Make the checkof the specified 2-digit codes listed below that indicates why you are exemptor money order payable in U.S. funds to New York State Income Tax andfrom the registration requirement. You must enter a NYTPRIN or an exclusionwrite the last four digits of your Social Security number and 2019 Income Taxcode. Also, you must enter your federal preparer tax identification numberon it. For online payment options, see our website (at www.tax.ny.gov).(PTIN) if you have one; if not, you must enter your Social Security number.








Email:

3702191032

CA 92014 0 3

************

2019UNINCORPORATED BUSINESS TAX RETURN FOR INDIVIDUALS- 202SFor CALENDAR YEAR 2019 beginning , 2019 and ending

First name and initial Last name TAXPAYER'S EMAIL ADDRESSNameChange

In Care Of

Business name SOCIAL SECURITY NUMBER

Business address (number and street)AddressChange

BUSINESS CODE NUMBERCity and State Zip Code Country (if not US) FROM FEDERAL SCHEDULE C:

Business Telephone Number Date business began in NYC (mm-dd-yy) Date business ended in NYC (mm-dd-yy)

If the purpose of the amended return is to report a IRS change Date of FinalAmended return federal or state change, check the appropriate box: Determination

NYS change

Final return- ceased operations

Enter 2-character special condition code if applicable (see instructions)

Engaged in a fully exempt unincorporated business activityEngaged in a partially exempt unincorporated business activity

SCHEDULE A Computation of Tax BEGIN WITH SCHEDULE B ON PAGE 2. COMPLETE ALL OTHER SCHEDULES. TRANSFER APPLICABLE AMOUNTS TO SCH A.

Payment Amount

A.Amount being paid electronically with this return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A PaymentBusiness income (from page 2, Schedule B, line 6). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.

Less: allowance for taxpayer's services ' do not enter more than 20% of line 1 or $10,000,2whichever is less (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

Balance before exemption (line 1 less line 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3.

Less: exemption ' $5,000 (taxpayer operating more than one business or short period taxpayer,4see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.

Taxable income (line 3 less line 4) (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5.

TAX: 4% of amount on line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6.

Less: business tax credit (select the applicable credit condition from the Business Tax Credit7Computation schedule on page 2 and enter amount) (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.

UNINCORPORATED BUSINESS TAX (line 6 less line 7) (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 8.

Payment of estimated Unincorporated Business Tax, including carryover credit from preceding year9and payment with extension, NYC-EXT (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.

If line 8 is larger than line 9, enter balance due. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10.

If line 8 is smaller than line 9, enter overpayment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 11.

Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 12.

Amount of line 11 to be: Refunded '13 (a) 13a.Paper check.Direct deposit - fill out line 13c OR

(b) 13b.Credited to 2020 Estimated Tax on Form NYC-5UBTI. . . . . . . . . . . . . . . . . . . . . . . . . ACCOUNT TYPERouting Account13c

Number Number Checking Savings

14 Total remittance due. Line 10 plus line 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.

Gross receipts or sales from federal return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 15.

CERTIFICATION

I hereby certify that this return, including any accompanying rider, is, to the best of my knowledge and belief, true, correct and complete.G

YESI authorize the Department of Finance to discuss this return with the preparer listed below. (see instructions). . . . . S HI E

Preparer's SSN or PTING RTaxpayer'sN E

Title: Date:Signature:

MM-DD-YYGP Preparer's Preparer'sUR signature: printed name: Date:SEE MM-DD-YYP

AORNE

Check if self-LRemployedY'

S Firm's name Address Zip CodeJ J

THIS RETURN MUST BE SIGNED. (SEE MAILING INSTRUCTIONS.)

61411918 YCIA3412L 9/19/19 18NYC-202S 2019

SARA J. JACOBS



92103

-36,021

-36,021

5,000-41,021

X

Firm's Employer Identification No.

X

[email protected]

Firm's Email Address:

Form NYC-202S 2019 Page 2

Name: SSN:

SCHEDULE B Computation of Total IncomeItems of business income, gain, loss or deduction

Net profit (or loss) from business, as reported for federal tax purposes from1federal Schedule C, Schedule C-EZ or Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

Other business income (or loss) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2.

Income taxes and unincorporated business tax paid this year and deducted on federal return . . . . . . . . . . . . . . 3 3.

Total income (combine lines 1, 2 and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4.

Less: Charitable contributions (not to exceed 5% of line 4) (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5.

Balance (line 4 less line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6.

Business Tax Credit Computation

1 3 If the amount on page 1, line 6, is over $3,400 but less than $5,400,If the amount on page 1, line 6, is $3,400 or less, your credityour credit is computed by the following formula:on line 7 is the entire amount of tax on line 6. (NO TAX WILL

BE DUE.)

x =Amount on page 1, line 6 $5,400 minus tax on line 62 { }If the amount on page 1, line 6, is $5,400 or over, no credit is

your credit$2,000allowed. Enter "0" on line 7.

SCHEDULE C The following information must be entered for this return to be complete.Nature of business or profession:1

2 New York State Sales Tax ID Number:

Did you file a New York City Unincorporated Business Tax Return for the following years:3

YES NO YES NO2017: 2018:

If "NO", state reason:

Enter home address: Zip Code:4

If business terminated during the current taxable year, state date terminated. (mm-dd-yy)5

(Attach a statement showing disposition of business property.)

Has the Internal Revenue Service or the New York State Department of Taxation and Finance increased or decreased any taxable6

income (loss) reported in any tax period, or are you currently being audited? YES NO

If "YES", by whom? State period(s): Beg.: End.:Internal Revenue ServiceMM-DD-YY MM-DD-YY

State period(s): Beg.: End.:New York State Department of Taxation and FinanceMM-DD-YY MM-DD-YY

If "YES" to question 6:7YES NOFor years prior to 1/1/15, has Form(s) NYC-115 (Report of Federal/State Change in Taxable Income) been filled?. . . 7a

For years beginning on or after 1/1/15, has an amended return(s) been filed?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7b YES NODoes this taxpayer pay rent greater than $200,000 for any premises in NYC in the borough of Manhattan south of8

YES NO96th Street for the purpose of carrying on any trade, business, profession, vocation or commercial activity? . . . . . . . .

If "YES", were all required Commercial Rent Tax Returns filed?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO9

Please enter Employer Identification Number or Social Security Number which was used on the Commercial Rent Tax Return:

PREPAYMENTS CLAIMED ON SCHEDULE A, LINE 9 DATE AMOUNT

Payment with declaration, Form NYC-5UBTI (1) . . . . . . . . . . . . . . . . . . . . . A.

Payment with Notice of Estimated Tax Due (2) . . . . . . . . . . . . . . . . . . . . . . B.

Payment with Notice of Estimated Tax Due (3) . . . . . . . . . . . . . . . . . . . . . . C.

Payment with Notice of Estimated Tax Due (4) . . . . . . . . . . . . . . . . . . . . . . D.

Payment with extension, Form NYC-EXT. . . . . . . . . . . . . . . . . . . . . . . . . . . . E.

Overpayment credited from preceding year. . . . . . . . . . . . . . . . . . . . . . . . . . F.

G. TOTAL of A, B, C, D, E, F (enter on Schedule A, line 9). . . . . . . . . . . . .

MAILING INSTRUCTIONS

Attach copy of federal Form 1040, Schedule C, Schedule C-EZ or Schedule F. If this is a final return, attach an entirecopy of federal Form 1040. Make remittance payable to the order of NYC DEPARTMENT OF FINANCE.

Payment must be made in U.S. dollars and drawn on a U.S. bank.To receive proper credit, you must enter your correct Social Security Number on your tax return and remittance.

The due date for the calendar year 2019 return is on or before April 15, 2020.For fiscal years beginning in 2019, file on or before the 15th day of the fourth month following the close of the fiscal year.

REMITTANCESALL RETURNS EXCEPT REFUND RETURNS RETURNS CLAIMING REFUNDSPAY ONLINE WITH FORM NYC-200V

NYC DEPARTMENT OF FINANCENYC DEPARTMENT OF FINANCE AT NYC.GOV/ESERVICESOR UNINCORPORATED BUSINESS TAXUNINCORPORATED BUSINESS TAX

Mail Payment and Form NYC-200V ONLY to:P.O. BOX 5563P.O. BOX 5564

NYC DEPARTMENT OF FINANCEP.O. BOX 3933 BINGHAMTON, NY 13902-5563BINGHAMTON, NY 13902-5564

NEW YORK, NY 10008-393361421918 18YCIA3412L 9/19/19


-36,021

-36,021

-36,021

REAL ESTATE RENTAL

X X

2604 FIFTH AVE. #403, SAN DIEGO, CA 92103

X

XX

X

4-15-20196-17-20199-16-20191-15-20204-15-2020

SEE STMT 1

2019 NEW YORK CITY UBT STATEMENTS PAGE 1


STATEMENT 1FORM NYC-202S, SCHEDULE B, LINE 2OTHER BUSINESS INCOME OR LOSS

RENTAL AND ROYALTY INCOME FROM FEDERAL SCHEDULE E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -36,021.TOTAL $ -36,021.

NEW YORK CITY DEPARTMENT OF FINANCE

NYC 2019Signature Authorization for579-UBTI E-Filed Unincorporated Business Tax Return for Individuals

ELECTRONIC RETURN ORIGINATORS (ERO): DO NOT MAIL THIS FORM TO THE DEPARTMENT OF FINANCE. KEEP THIS FOR YOUR RECORDS.LAST NAMEFIRST NAME AND INITIAL: SOCIAL SECURITY NUMBER

EMAIL ADDRESS:TYPE OF NYC-5UBTI (2020) NYC-EXTFORM:

NYC-202 NYC-202S

Financial Institution Information ' must be included if electronic payment is authorizedAMOUNT OF AUTHORIZED DEBIT: FINANCIAL INSTITUTION ROUTING NUMBER: FINANCIAL INSTITUTION ACCOUNT NUMBER:

Part A ' Declaration and authorization of Taxpayer for Forms NYC-202, NYC-202S, NYC-EXT or NYC-5UBTIUnder penalty of perjury, I declare that I am the taxpayer and that I have examined the information on its 2019 New York City electronicallyfiled Unincorporated Business Tax return, including any accompanying schedules, attachments and statements or other report, and to the bestof my knowledge and belief, the electronically filed document is true, correct and complete. The ERO has my consent to send the 2019 NewYork City electronically filed Unincorporated Business Tax return or other report checked above to the New York City Department of Financethrough the Internal Revenue Service. I authorize the ERO to enter my PIN as my signature on the 2019 New York City electronically filedUnincorporated Business Tax return or other report, as indicated above or I will enter my PIN as my signature on the document indicatedabove. If I am paying the New York City Unincorporated Business Tax owed by electronic funds withdrawal, I authorize the New York CityDepartment of Finance and its designated financial agents to initiate an electronic funds withdrawal from the financial institution accountindicated on the Unincorporated Business Tax return or other report, and I authorize the financial institution to debit the amount from thataccount.

I authorize to enter my PIN:

ERO FIRM NAME

as my signature on the 2019 Unincorporated Business Tax return or other report, as indicated above

As the taxpayer I will enter my PIN as my signature on the 2019 Unincorporated Business Tax return or other report, as indicated above.

Signature of Taxpayer Official title Date

Part B ' Declaration of electronic return originator (ERO) and paid preparer

Under penalty of perjury, I declare that the information contained in the above-named taxpayer's 2019 New York City electronically filedunincorporated business tax return or other report checked above is the information furnished to me by the taxpayer. If the taxpayer furnishedme with a completed 2019 New York City paper unincorporated business tax return or other report signed by a paid preparer, I declare thatthe information contained in the taxpayer's 2019 New York City electronically filed unincorporated business tax return or report is identical tothat contained in the paper return. If I am the paid preparer, under penalty of perjury I declare that I have examined this 2019 New York Cityelectronically filed unincorporated business tax return or other report, and, to the best of my knowledge and belief, the return is true, correct,and complete. I have based this declaration on all information available to me.

ERO EFIN/PIN: Enter your six-digit EFIN followed by your five digit PIN:

ERO's Signature Date

Paid Preparer's Signature Date

PURPOSE - A completed Form NYC-579-UBTI provides documentation that an ERO has been authorized to electronically file theUnincorporated Business Tax return or other report. The taxpayer may designate the ERO to electronically sign the return or other report byentering the taxpayer's personal identification number (PIN). The form also authorizes payment of tax due on an electronically submittedreturn or report by an automatic clearing house (ACH) debit from a designated checking or savings account of the taxpayer.You cannot revoke this authorization.

GENERAL INSTRUCTIONS

Part A must be completed by the taxpayer before the ERO transmits the electronically filed Form NYC-202 (Unincorporated BusinessPart A -Tax Return for Individuals and Single Member LLC's); NYC-202S (Unincorporated Business Tax Return for Individuals); NYC-EXT(Application for 6-Month Extension to File Business Income Tax Return); or NYC-5UBTI (Declaration of Estimated UnincorporatedBusiness Tax for Individuals, Estates and Trusts).

EROs/paid preparers must complete Part B prior to transmitting electronically filed unincorporated business tax returns or reports (FormsNYC-202, NYC-202S, NYC-EXT or NYC-5UBTI). Both the paid preparer and the ERO are required to sign Part B. However, if an individualperforms as both the paid preparer and the ERO, he or she is only required to sign as the paid preparer. It is not necessary to include theERO signature in this case.

Do not mail Form NYC-579-UBTI to the Department of Finance. The EROs/paid preparers must keep the completed Form NYC-579-UBTI forthree years from the due date of the return or report or the date the return or report was filed, whichever is later, and must present it to theDepartment of Finance upon request.

18YCIA4001L 09/20/19 NYC-579-UBTI 2019


[email protected]

X 11781

Print Name

Print Name

2019 PREPARER E-FILE INSTRUCTIONS - FORM NYC-202 PAGE 1


THE TAXPAYER'S NYC UBT TAX RETURN IS NOT FINISHED UNTIL YOU COMPLETE THE FOLLOWINGINSTRUCTIONS.

PRIOR TO TRANSMISSION OF THE RETURN

FORM NYC-202STHE TAXPAYER SHOULD REVIEW THEIR NYC UNINCORPORATED BUSINESS TAX RETURN ALONG WITHANY ACCOMPANYING SCHEDULES AND STATEMENTS.

E-FILE SIGNATURESTHE TAXPAYER SHOULD REVIEW, SIGN AND DATE NYC 579-UBTI - UNINCORPORATED BUSINESSTAX SIGNATURE AUTHORIZATION PRIOR TO YOU E-FILING THE RETURN.

EVEN RETURNNO PAYMENT IS REQUIRED.

AFTER TRANSMISSION OF THE RETURN

RECEIVE ACKNOWLEDGEMENT OF YOUR E-FILE TRANSMISSION STATUS.WITHIN SEVERAL HOURS, CONNECT WITH LACERTE AND GET YOUR FIRST ACKNOWLEDGEMENT(ACK) THAT LACERTE HAS RECEIVED YOUR TRANSMISSION FILE.

CONNECT WITH LACERTE AGAIN AFTER 24 AND THEN 48 HOURS TO RECEIVE YOUR NEW YORKACKS.

KEEP A SIGNED COPY OF FORM NYC 579-UBTI IN YOUR FILES FOR 0 YEARS.

FORM NYC 579-UBTI - NEW YORK CITY UBT E-FILE SIGNATURE AUTHORIZATION

NYPA0101L 7/23/19Department of Taxation and Finance IT-204-LLPartnership, Limited Liability Company, andLimited Liability Partnership For calendar year 2019 or tax yearFiling Fee Payment Form beginning and ending19

Identification number (see instructions)Legal name

Trade name of business if different from legal name above Change of business information

Mark X here if you have changed your mailingAddress (number and street or rural route) address and have not previously notified us (see instr.)

Date business startedState ZIP codeCity, village, or post office Contact person's telephone number

( )Principal business activity

Enter your 2-digit special conditioncode if applicable (see instructions).

Mark an X in the box identifying the entity for which you are filing this form (mark only one box):

Regular partnership Limited liability company (LLC) or limited liability partnership (LLP)

Part 1 ' General information (mark an X in the appropriate box(es))

Mark applicable box(es) (see instructions):Final Form IT-204-LLRefundAmended Form IT-204-LL

Did this entity have any income, gain, loss, or deduction derived from New York sources during1Yesthe 2019 tax year? (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No

If you answered No, stop; you do not owe a fee. Do not file this form.2 Did this entity have an interest in real property in New York State during the last three years?. . . . . . . . . . . . . . . . . . . . . . . . Yes No3 Has there been a transfer or acquisition of the controlling interest in the entity during the last three years? . . . . . . . . . . . . Yes No

Part 2 ' Partnerships, and LLCs and LLPs treated as partnerships for federal income tax purposesLLCs that are disregarded entities for federal income tax purposes: Skip Part 2 and continue with Part 3.4 Enter the amount from line 15, column B, of the New York source gross income worksheet in

4 .00the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NYS filing fee ' Enter the amount from the appropriate filing fee table in the instructions. . . . . . . . . . . . . . . . . .5 5 .00Make check or money order for the line 5 amount payable to NYS filing fee; write yourEIN and 2019 filing fee on the remittance and submit it with this form.

Part 3 ' LLCs that are disregarded entities for federal income tax purposesLLC disregarded entity: Enter the identification number (EIN or SSN)6

6of the entity or individual who will be reporting the income or loss . . . .

7 .00LLC disregarded entity NYS filing fee ' Enter 25 on this line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Make check or money order for $25 payable to NYS filing fee; write your EIN or SSNand 2019 filing fee on the remittance and submit it with this form.

Certification: I certify that all information contained on this form is true and correct to the best of my knowledge and belief.Date Sign herePaid preparer must complete (see instr.) I II I

Signature of general partnerPreparer's NYTPRINPreparer's signature

Preparer's PTIN or SSN

Employer identification numberDate Daytime phone number

( )NYTPRIN

Email:excl. code

Email:

File this form with payment on or before the 15th day of the third month following the close ofyour tax year (see instructions).

240001191032 Mail to: STATE PROCESSING CENTER, PO BOX 4148, BINGHAMTON NY 13902-4148.

For private delivery services, see Publication 55, Designated Private Delivery Services.

ESSJANE LLC 37-1918990

2604 FIFTH AVE. #403 12-07-2018

SAN DIEGO CA 92103 858 481-2186

RENTAL

X

X

XX

***-**-****

25

Firm's name (or yours, if self-employed)*********

Address

0 3

2019 PREPARER E-FILE INSTRUCTIONS - FORM IT-204-LL

ESSJANE LLC ***-**-****

THE 204-LL, FILING UNDER THE NAME, ESSJANE LLC, FILING FEE PAYMENT FORM IS NOTFINISHED UNTIL YOU COMPLETE THE FOLLOWING INSTRUCTIONS.


FORM IT-204-LLNO SIGNATURE IS REQUIRED WHEN FILING IT204-LL ELECTRONICALLY.

PAPERLESS E-FILEA LIMITED LIABILITY COMPANY MEMBER SHOULD REVIEW, SIGN AND DATE FORMTR-579-PT (IT-204-LL).

BALANCE DUETHERE IS A BALANCE DUE IN THE AMOUNT OF $25.

PER THE NYS DEPARTMENT OF TAXATION AND FINANCE, IF YOU ELECTRONICALLY FILE THEFORM IT-204-LL AND THERE IS A BALANCE DUE, THE ONLY ALLOWABLE PAYMENT OPTION ISTO ELECTRONICALLY PAY VIA THE PROGRAM. PLEASE RIGHT CLICK HERE TO CHECK THEAPPROPRIATE BOX AND ENTER THE REQUIRED BANK INFORMATION IN THE INPUT FIELDSFOR NEW YORK ELECTRONIC PAYMENT LOCATED IN STATE & LOCAL -> TAXES -> NEW YORKIT-204-LL E-FILE/PAYMENT SCREEN (54.099).


RECEIVE ACKNOWLEDGEMENT OF YOUR E-FILE TRANSMISSION STATUS.WITHIN SEVERAL HOURS, CONNECT WITH LACERTE AND GET YOUR FIRSTACKNOWLEDGEMENT (ACK) THAT LACERTE HAS RECEIVED YOUR TRANSMISSION FILE.

CONNECT WITH LACERTE AGAIN AFTER 24 AND THEN 48 HOURS TO RECEIVE YOUR NEWYORK IT-204-LL ACKS.

KEEP A SIGNED COPY OF FORM TR-579-PT (IT-204-LL) IN YOUR FILES FOR 3 YEARS.

DO NOT MAIL:

FORM TR-579-PT (IT-204-LL)

NYPA0101L 7/23/19Department of Taxation and Finance IT-204-LLPartnership, Limited Liability Company, andLimited Liability Partnership For calendar year 2019 or tax yearFiling Fee Payment Form beginning and ending19

Identification number (see instructions)Legal name

Trade name of business if different from legal name above Change of business information

Mark X here if you have changed your mailingAddress (number and street or rural route) address and have not previously notified us (see instr.)

Date business startedState ZIP codeCity, village, or post office Contact person's telephone number

( )Principal business activity

Enter your 2-digit special conditioncode if applicable (see instructions).

Mark an X in the box identifying the entity for which you are filing this form (mark only one box):

Regular partnership Limited liability company (LLC) or limited liability partnership (LLP)

Part 1 ' General information (mark an X in the appropriate box(es))

Mark applicable box(es) (see instructions):Final Form IT-204-LLRefundAmended Form IT-204-LL

Did this entity have any income, gain, loss, or deduction derived from New York sources during1Yesthe 2019 tax year? (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No

If you answered No, stop; you do not owe a fee. Do not file this form.2 Did this entity have an interest in real property in New York State during the last three years?. . . . . . . . . . . . . . . . . . . . . . . . Yes No3 Has there been a transfer or acquisition of the controlling interest in the entity during the last three years? . . . . . . . . . . . . Yes No

Part 2 ' Partnerships, and LLCs and LLPs treated as partnerships for federal income tax purposesLLCs that are disregarded entities for federal income tax purposes: Skip Part 2 and continue with Part 3.4 Enter the amount from line 15, column B, of the New York source gross income worksheet in

4 .00the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NYS filing fee ' Enter the amount from the appropriate filing fee table in the instructions. . . . . . . . . . . . . . . . . .5 5 .00Make check or money order for the line 5 amount payable to NYS filing fee; write yourEIN and 2019 filing fee on the remittance and submit it with this form.

Part 3 ' LLCs that are disregarded entities for federal income tax purposesLLC disregarded entity: Enter the identification number (EIN or SSN)6

6of the entity or individual who will be reporting the income or loss . . . .

7 .00LLC disregarded entity NYS filing fee ' Enter 25 on this line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Make check or money order for $25 payable to NYS filing fee; write your EIN or SSNand 2019 filing fee on the remittance and submit it with this form.

Certification: I certify that all information contained on this form is true and correct to the best of my knowledge and belief.Date Sign herePaid preparer must complete (see instr.) I II I

Signature of general partnerPreparer's NYTPRINPreparer's signature

Preparer's PTIN or SSN

Employer identification numberDate Daytime phone number

( )NYTPRIN

Email:excl. code

Email:

File this form with payment on or before the 15th day of the third month following the close ofyour tax year (see instructions).

240001191032 Mail to: STATE PROCESSING CENTER, PO BOX 4148, BINGHAMTON NY 13902-4148.

For private delivery services, see Publication 55, Designated Private Delivery Services.


99 JANE ST APT 6L

NEW YORK NY 10014

X

X

XX

***-**-****

25

Firm's name (or yours, if self-employed)*********

Address

[email protected] 3

2019 PREPARER E-FILE INSTRUCTIONS - FORM IT-204-LL

ESSJANE LLC ***-**-****

THE 204-LL, FILING UNDER THE NAME, SARA J. JACOBS, FILING FEE PAYMENT FORM IS NOTFINISHED UNTIL YOU COMPLETE THE FOLLOWING INSTRUCTIONS.


FORM IT-204-LLNO SIGNATURE IS REQUIRED WHEN FILING IT204-LL ELECTRONICALLY.

PAPERLESS E-FILEA LIMITED LIABILITY COMPANY MEMBER SHOULD REVIEW, SIGN AND DATE FORMTR-579-PT (IT-204-LL).

BALANCE DUETHERE IS A BALANCE DUE IN THE AMOUNT OF $25.

PER THE NYS DEPARTMENT OF TAXATION AND FINANCE, IF YOU ELECTRONICALLY FILE THEFORM IT-204-LL AND THERE IS A BALANCE DUE, THE ONLY ALLOWABLE PAYMENT OPTION ISTO ELECTRONICALLY PAY VIA THE PROGRAM. PLEASE RIGHT CLICK HERE TO CHECK THEAPPROPRIATE BOX AND ENTER THE REQUIRED BANK INFORMATION IN THE INPUT FIELDSFOR NEW YORK ELECTRONIC PAYMENT LOCATED IN STATE & LOCAL -> TAXES -> NEW YORKIT-204-LL E-FILE/PAYMENT SCREEN (54.099).


RECEIVE ACKNOWLEDGEMENT OF YOUR E-FILE TRANSMISSION STATUS.WITHIN SEVERAL HOURS, CONNECT WITH LACERTE AND GET YOUR FIRSTACKNOWLEDGEMENT (ACK) THAT LACERTE HAS RECEIVED YOUR TRANSMISSION FILE.

CONNECT WITH LACERTE AGAIN AFTER 24 AND THEN 48 HOURS TO RECEIVE YOUR NEWYORK IT-204-LL ACKS.

KEEP A SIGNED COPY OF FORM TR-579-PT (IT-204-LL) IN YOUR FILES FOR 3 YEARS.

DO NOT MAIL:

FORM TR-579-PT (IT-204-LL)




BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 226,083 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 226,083 76,419



6 LAMP 1/01/16 734 734 413 200DB HY 7 .12490 92

7 STOOL 1/01/16 1,101 1,101 620 200DB HY 7 .12490 138

10 TV CABINETS 1/01/16 9,819 9,819 5,525 200DB HY 7 .12490 1,226




8 LIGHTING 1/01/16 13,857 13,857 7,798 200DB HY 7 .12490 1,731

9 DRAPES 1/01/16 3,512 3,512 1,976 200DB HY 7 .12490 439


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0

12/31/19 2019 CALIFORNIA DEPRECIATION SCHEDULE PAGE 1









11 BUILDING 1/01/18 1,250,000 1,250,000 43,563 S/L MM 27.5 .03636 45,450

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 8,909 200DB HY 7 .24490 15,268

14 COUNTERTOPS 1/01/18 14,790 14,790 740 150DB HY 15 .09500 1,405

15 WINDOW TREATMENTS 1/01/18 22,834 22,834 1,142 150DB HY 15 .09500 2,169

16 FURNISHINGS 1/01/18 122,248 122,248 24,450 200DB HY 5 .32000 39,119

TOTAL 2,722,214 0 0 0 0 0 2,722,214 78,804 103,411


GRAND TOTAL DEPRECIATION 6,341,594 0 0 0 0 0 6,341,594 477,447 218,663





BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 226,083 S/L MM 27.5 .03636 76,419 76,419 0

TOTAL BUILDINGS 2,101,726 226,083 76,419 76,419 0 0 0 0


5 LUTRON WINDOW SHADES 1/01/16 58,316 26,167 150DB HY 7 .12250 7,144 7,284 140 0

6 LAMP 1/01/16 734 329 150DB HY 7 .12250 90 92 2 0

7 STOOL 1/01/16 1,101 494 150DB HY 7 .12250 135 138 3 0

10 TV CABINETS 1/01/16 9,819 4,406 150DB HY 7 .12250 1,203 1,226 23 0

TOTAL FURNITURE AND FIXTURE 69,970 31,396 8,572 8,740 168 0 0 0



8 LIGHTING 1/01/16 13,857 6,218 150DB HY 7 .12250 1,697 1,731 34 0

9 DRAPES 1/01/16 3,512 1,576 150DB HY 7 .12250 430 439 9 0


LAND____

2 LAND 1/01/16 900,740 0 0 0

TOTAL LAND 900,740 0 0 0 0 0 0 0


12/31/19 2019 CALIFORNIA ALTERNATIVE MINIMUM TAX DEPRECIATION SCHEDULE PAGE 1



3 SECURITY SYSTEM 1/01/16 109,935 64,146 150DB HY 5 .16660 18,315 12,665 -5,650 0

TOTAL MACHINERY AND EQUIPME 109,935 64,146 18,315 12,665 -5,650 0 0 0

TOTAL DEPRECIATION 3,619,380 374,559 120,691 115,252 -5,439 0 0


11 BUILDING 1/01/18 1,250,000 43,563 S/L MM 27.5 .03636 45,450 45,450 0

12 LAND 1/01/18 1,250,000 0 0 0

13 FLOORING 1/01/18 62,342 6,677 150DB HY 7 .19130 11,926 15,268 3,342 0

14 COUNTERTOPS 1/01/18 14,790 740 150DB HY 15 .09500 1,405 1,405 0

15 WINDOW TREATMENTS 1/01/18 22,834 1,142 150DB HY 15 .09500 2,169 2,169 0

16 FURNISHINGS 1/01/18 122,248 18,337 150DB HY 5 .25500 31,173 39,119 7,946 0

TOTAL 2,722,214 70,459 92,123 103,411 11,288 0 0 0

TOTAL DEPRECIATION 2,722,214 70,459 92,123 103,411 11,288 0 0 0

GRAND TOTAL DEPRECIATION 6,341,594 445,018 212,814 218,663 5,849 0 0 0

12/31/19 2019 CALIFORNIA ALTERNATIVE MINIMUM TAX DEPRECIATION SCHEDULE


PAGE 2




BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 226,083 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 226,083 76,419



6 LAMP 1/01/16 734 734 413 200DB HY 7 .12490 92

7 STOOL 1/01/16 1,101 1,101 620 200DB HY 7 .12490 138

10 TV CABINETS 1/01/16 9,819 9,819 5,525 200DB HY 7 .12490 1,226




8 LIGHTING 1/01/16 13,857 13,857 7,798 200DB HY 7 .12490 1,731

9 DRAPES 1/01/16 3,512 3,512 1,976 200DB HY 7 .12490 439


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0

12/31/19 2019 DIST OF COLUMBIA DEPRECIATION SCHEDULE PAGE 1









11 BUILDING 1/01/18 1,250,000 1,250,000 43,563 S/L MM 27.5 .03636 45,450

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 8,909 200DB HY 7 .24490 15,268




TOTAL 2,722,214 0 0 0 0 0 2,722,214 78,804 103,411








BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 226,083 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 226,083 76,419



6 LAMP 1/01/16 734 734 413 200DB HY 7 .12490 92

7 STOOL 1/01/16 1,101 1,101 620 200DB HY 7 .12490 138

10 TV CABINETS 1/01/16 9,819 9,819 5,525 200DB HY 7 .12490 1,226




8 LIGHTING 1/01/16 13,857 13,857 7,798 200DB HY 7 .12490 1,731

9 DRAPES 1/01/16 3,512 3,512 1,976 200DB HY 7 .12490 439


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0

12/31/19 2019 MASSACHUSETTS DEPRECIATION SCHEDULE PAGE 1









11 BUILDING 1/01/18 1,250,000 1,250,000 43,563 S/L MM 27.5 .03636 45,450

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 0 200DB HY 7 0

14 COUNTERTOPS 1/01/18 14,790 14,790 0 150DB HY 15 0

15 WINDOW TREATMENTS 1/01/18 22,834 22,834 0 150DB HY 15 0

16 FURNISHINGS 1/01/18 122,248 122,248 0 200DB HY 5 0

TOTAL 2,722,214 0 0 222,214 0 0 2,500,000 43,563 45,450

TOTAL DEPRECIATION 2,722,214 0 0 222,214 0 0 2,500,000 43,563 45,450

GRAND TOTAL DEPRECIATION 6,341,594 0 0 222,214 0 0 6,119,380 442,206 160,702

12/31/19 2019 MASSACHUSETTS DEPRECIATION SCHEDULE PAGE 2





BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 226,083 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 226,083 76,419



6 LAMP 1/01/16 734 734 413 200DB HY 7 .12490 92

7 STOOL 1/01/16 1,101 1,101 620 200DB HY 7 .12490 138

10 TV CABINETS 1/01/16 9,819 9,819 5,525 200DB HY 7 .12490 1,226




8 LIGHTING 1/01/16 13,857 13,857 7,798 200DB HY 7 .12490 1,731

9 DRAPES 1/01/16 3,512 3,512 1,976 200DB HY 7 .12490 439


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0

12/31/19 2019 NEW YORK DEPRECIATION SCHEDULE PAGE 1









11 BUILDING 1/01/18 1,250,000 1,250,000 43,563 S/L MM 27.5 .03636 45,450

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 8,909 200DB HY 7 .24490 15,268




TOTAL 2,722,214 0 0 0 0 0 2,722,214 78,804 103,411





FTB e-fileTax Return Signature / Consent to Disclosure

ERO Declaration

I declare that the information contained in this electronic tax return is the information furnished to me by the taxpayer. If the taxpayer furnishedme a completed tax return, I declare that the information contained in this electronic tax return is identical to that contained in the returnprovided by the taxpayer. If the furnished return was prepared by a paid preparer, I declare that the paid preparer manually signed the returnand that I have entered the paid preparer's identifying information in the appropriate portion of this electronic return. If I am also the paidpreparer, under penalties of perjury, I declare that I have examined the above taxpayer's return and accompanying schedules and statements,and to the best of my knowledge and belief, they are true, correct, and complete. I make this declaration based on all information of which Ihave knowledge.

I have provided the taxpayer(s) with a copy of all forms and information that I will file with the FTB and I have followed all other requirementsdescribed in FTB Pub. 1345, 2019 e-file Handbook for Authorized e-file Providers.

(enter EFIN plus 5 Self-Selected numerics)

CAIA9701L 05/21/19


ERO Signature

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

ERO's PIN

OMB No. 1545-0074





R


N



A

R


Y






Form 3468 ' attach a copy of the first page of NPS Form 10-168, Historic Preservation Certification Application (Part 2 ' Description ofRehabilitation), with an indication that it was received by the Department of the Interior or the State Historic Preservation Officer, togetherwith proof that the building is a certified historic structure (or that such status has been requested)

Form 4136 ' attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the provideridentifying the product as renewable diesel and, if applicable, a statement from the reseller



Form 8332, Release/Revocation of Release of Claim to Exemption for Child by Custodial Parent (or certain pages from a divorce decreeor separation agreement, that went into effect after 1984 and before 2009) (see instructions)

Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities (FDEs) and Foreign Branches (FBs)





Form 8453 (2018)BAA For Paperwork Reduction Act Notice, see your tax return instructions.

FDIA5901L 07/16/18


C/O 2728 OCEANFRONT

DEL MAR CA 92014

X


I DETACH HERE I1030

FDIA4601L 07/11/18.Application for Automatic Extension of TimeForm 4868



5 Total 2018 payments. . . . . . . . . . . . . . . . . .



8 Check here if you are 'out of the country' and a U.S.2 3 Gcitizen or resident (see instructions). . . . . . . . . . . . . . . . . . .



464,402.491,387.

0.0.

1

SARA J. JACOBS

***-**-****

*********************************

(99)Department of the Treasury ' Internal Revenue Service

Form 1040 2018 IRS Use Only ' Do not write or staple in this space.U.S. Individual Income Tax Return OMB No. 1545-0074

Filing status: Single Married filing jointly Married filing separately Head of household Qualifying widow(er)

Your first name and initial Last name Your social security number

Your standard deduction: Someone can claim you as a dependent You were born before January 2, 1954 You are blind

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

Full-year health care coverageSpouse standard deduction: Someone can claim your spouse as a dependent Spouse was born before January 2, 1954or exempt (see inst.)

Spouse is blind Spouse itemizes on a separate return or you were dual-status alien

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign(see inst.)

You Spouse

If more than four dependents,City, town or post office, state, and ZIP code. If you have a foreign address, attach Schedule 6.

see inst. and b here G(2) Social securityDependents (see instructions): (3) Relationship to you (4) b if qualifies for (see inst.):

number(1) First name Last name Child tax credit Credit for other dependents

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, theySignare true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Here Your signature Date Your occupation If the IRS sent you an Identity ProtectionPIN, enter itJoint return?here (see inst.)See instructions. A Date Spouse's occupation If the IRS sent you an Identity ProtectionSpouse's signature. If a joint return, both must sign.Keep a copy PIN, enter ithere (see inst.)for your records.

Preparer's name Preparer's signature PTIN Firm's EIN Check if:

3rd Party DesigneePaidSelf-employedGFirm's name Phone no.Preparer

GFirm's addressUse Only

FDIA0112L 01/08/19BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2018)

Form 1040 (2018) Page 2

Attach Form(s) Wages, salaries, tips, etc. Attach Form(s) W-2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1W-2. Also attach

Tax-exempt interest. . . . . . . . . . . . .2a 2a b Taxable interest . . . . . 2bForm(s) W-2Gand 1099-R if tax

Qualified dividends. . . . . . . . . . . . . .3a 3a b Ordinary dividends. . . 3bwas withheld.

IRAs, pensions, and annuities . . .4a 4a b Taxable amount . . . . . 4b

5a Social security benefits. . . . . . . . . . 5a b Taxable amount . . . . . 5b

6 6Total income. Add lines 1 through 5. Add any amount from Schedule 1, line 22 . . . .

7 Adjusted gross income. If you have no adjustments to income, enter the amount fromStandard line 6; otherwise, subtract Schedule 1, line 36, from line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Deduction for '

8 Standard deduction or itemized deductions (from Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . 8? Single or

9 9Qualified business income deduction (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .married filingseparately,

10 10Taxable income. Subtract lines 8 and 9 from line 7. If zero or less, enter '0'. . . . . . . . . . .$12,0001Tax (see inst.) (check if any from: Form(s) 8814a11? Married filing

2 3 )Form 4972jointly orQualifying 11b Add any amount from Schedule 2 and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gwidow(er),$24,000 12 a Child tax credit/credit for other dependents? Head of 12Add any amount from Schedule 3 and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Ghousehold,

13 Subtract line 12 from line 11. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13$18,000Other taxes. Attach Schedule 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 14

? If you15 Total tax. Add lines 13 and 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15checked any16 16Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .box under17 aStandard Refundable credits: EIC (see inst.)

deduction, see b cSch. 8812 Form 8863instructions. Add any amount from Schedule 5 17. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18 Add lines 16 and 17. These are your total payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19 19If line 18 is more than line 15, subtract line 15 from line 18. This is the amount you overpaid . . . . . . . . . . . . . . .RefundG20a Amount of line 19 you want refunded to you. If Form 8888 is attached, check here. . 20a

G Routing number . . . . . . . . Type: Checking SavingsDirect deposit? b cGSee instructions. Account number. . . . . . . .dG

G21 21Amount of line 19 you want applied to your 2019 estimated tax. . . . . . . . 2222 GAmount you owe. Subtract line 18 from line 15. For details on how to pay, see instructions. . . . . . . . . . . . . . . Amount You Owe

23Estimated tax penalty (see instructions). . . . . . . . . . . . . . . . . . G23Form 1040 (2018)Go to www.irs.gov/Form1040 for instructions and the latest information.

2,129,756.41,091.

2,088,665.390,653.

1,582.391,071.

464,402.128.

491,387.26,985.

0.

26,985.

392,653.

2,141.

8,096.

1,064,446.1,051,155.

2,129,756.

73,331.

X

X

491,259.

1,055,073.

491,259.


C/O 2728 OCEANFRONT

X

DEL MAR, CA 92014

GOVERNMENT

XX

X

ST 3

OMB No. 1545-0074SCHEDULE 1Additional Income and Adjustments to Income(Form 1040)

(Rev. January 2020) 2018A Attach to Form 1040.


Your social security numberName(s) shown on Form 1040

1'9bReserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1'9bAdditional10Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . . . . . . 10Income

11 11Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Business income or (loss). Attach Schedule C or C-EZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 12

1313 Capital gain or (loss). Attach Schedule D if required. If not required, check here. . . . . . . . . . G

14 14Other gains or (losses). Attach Form 4797. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15a 15bReserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16bReserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16a

17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. 17

18 18Farm income or (loss). Attach Schedule F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19 19Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20a 20b

21 21Other income. List type and amount

Combine the amounts in the far right column. If you don't have any adjustments to22

income, enter here and include on Form 1040, line 6. Otherwise, go to line 23. . . . . . . . . . . 22

23 23Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Adjustmentsto Income Certain business expenses of reservists, performing artists,24

24and fee-basis government officials. Attach Form 2106. . . . . . .

25 25Health savings account deduction. Attach Form 8889. . . . . . . .

26 Moving expenses for members of the Armed Forces.26Attach Form 3903. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27 27Deductible part of self-employment tax. Attach Schedule SE.

28 28Self-employed SEP, SIMPLE, and qualified plans. . . . . . . . . . .

29 29Self-employed health insurance deduction. . . . . . . . . . . . . . . . . .

30 30Penalty on early withdrawal of savings. . . . . . . . . . . . . . . . . . . . .

GAlimony paid b Recipient's SSN31a 31a

32 32IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33 33Student loan interest deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . .

34 34Tuition and fees. Attach Form 8917. . . . . . . . . . . . . . . . . . . . . . . .

35 35Reserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36 36Add lines 23 through 35. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BAA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040) 2018

FDIA0103L 01/15/20


0.

1,055,032.

41.

1,055,073.

0.

STATEMENT 4

OMB No. 1545-0074SCHEDULE 2Tax(Form 1040)

2018A Attach to Form 1040.



Reserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38-4438-44TaxAlternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 45

Excess advance premium tax credit repayment. Attach Form 8962. . . . . . . . . . . . . . . . . . . . . . 46 46

47 47GAdd the amounts in the far right column. Enter here and include on Form 1040, line 11


FDIA0104L 08/03/18


2,000.

2,000.

OMB No. 1545-0074SCHEDULE 3Nonrefundable Credits(Form 1040)




48 Foreign tax credit. Attach Form 1116 if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48NonrefundableCredits 49 Credit for child and dependent care expenses. Attach Form 2441. . . . . . . . . . . . . . . . . . . 49

50 Education credits from Form 8863, line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

51 Retirement savings contributions credit. Attach Form 8880. . . . . . . . . . . . . . . . . . . . . . . . . 51

52 Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

53 Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Other credits from Form a 3800 b 8801 c 5454

55 Add the amounts in the far right column. Enter here and include on Form 1040,

line 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55


FDIA0105L 03/31/20

1,582.

1,582.


OMB No. 1545-0074SCHEDULE 4Other Taxes(Form 1040)




57 57Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OtherUnreported social security and Medicare tax from: Form 4137a58Taxes

8919 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b 58

Additional tax on IRAs, other qualified retirement plans, and other tax-favored59

accounts. Attach Form 5329 if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Household employment taxes. Attach Schedule H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60a 60a

Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 ifb

required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60b

Health care: individual responsibility (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6161

62 Taxes from: Form 8959 Form 8960a b

Instructions; enter code(s)c 62

Section 965 net tax liability installment from Form 965-A . . . . 63 63

Add the amounts in the far right column. These are your total other taxes. Enter here64

and on Form 1040, line 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64


FDIA0106L 08/02/18


73,331.

X

73,331.

OMB No. 1545-0074SCHEDULE 5Other Payments and Refundable Credits(Form 1040)




Other 65 Reserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Payments66 2018 estimated tax payments and amount applied from 2017 return. . . . . . . . . . . . . . . . . . . . 66

and67a Reserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67a

Refundableb Reserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67bCredits

68-69 Reserved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68-69

7070 Net premium tax credit. Attach Form 8962. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

71 Amount paid with request for extension to file (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 71

72 Excess social security and tier 1 RRTA tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

73 Credit for federal tax on fuels. Attach Form 4136. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

74 Credits from Form: a 2439 b Reserved c 8885 d 74

75 Add the amounts in the far right column. These are your total other payments and refundable credits.

75Enter here and include on Form 1040, line 17. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


FDIA0107L 10/15/18


491,259.

491,259.

OMB No. 1545-0074Underpayment of Estimated Tax byForm 2210

Individuals, Estates, and Trusts 2018G Go to www.irs.gov/Form2210 for instructions and the latest information.Department of the Treasury AttachmentG Attach to Form 1040, 1040NR, 1040NR-EZ, or 1041.Internal Revenue Service 06Sequence No.

Name(s) shown on tax return Identifying number

Do You Have To File Form 2210?

Complete lines 1 through 7 below. Is line 7 less than $1,000? Don't file Form 2210. You don't owe a penalty.

You don't owe a penalty. Don't file Form 2210Complete lines 8 and 9 below. Is line 6 equal to or more than line 9?(but if box E in Part II applies, you must file page 1 ofForm 2210).

You must file Form 2210. Does box B, C, or D inYou may owe a penalty. Does any box in Part II below apply?Part II apply?

You must figure your penalty.

You aren't required to figure your penalty because theDon't file Form 2210. You aren't required to figure your penaltyIRS will figure it and send you a bill for any unpaidbecause the IRS will figure it and send you a bill for any unpaidamount. If you want to figure it, you may use Part III oramount. If you want to figure it, you may use Part III or Part IV as aPart IV as a worksheet and enter your penalty amountworksheet and enter your penalty amount on your tax return, buton your tax return, but file only page 1 of Form 2210.don't file Form 2210.

Part I Required Annual Payment

1 1Enter your 2018 tax after credits from Form 1040, line 13 (see instructions if not filing Form 1040) . . . . . . . . . .

2 Other taxes, including self-employment tax and, if applicable, Additional Medicare Tax and/or Net2Investment Income Tax (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Refundable credits, including the premium tax credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Current year tax. Combine lines 1, 2, and 3. If less than $1,000, stop; you don't owe a penalty. Don't file4Form 2210. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 5Multiply line 4 by 90% (0.90). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 Withholding taxes. Don't include estimated tax payments (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Subtract line 6 from line 4. If less than $1,000, stop; you don't owe a penalty. Don't file Form 2210. . . . . . . . . 7

8 8Maximum required annual payment based on prior year's tax (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 Required annual payment. Enter the smaller of line 5 or line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Next: Is line 9 more than line 6?

No. You don't owe a penalty. Don't file Form 2210 unless box E below applies.

Yes. You may owe a penalty, but don't file Form 2210 unless one or more boxes in Part II below applies.

? If box B, C, or D applies, you must figure your penalty and file Form 2210.? If box A or E applies (but not B, C, or D) file only page 1 of Form 2210. You aren't required to figure your penalty; the IRS willfigure it and send you a bill for any unpaid amount. If you want to figure your penalty, you may use Part III or IV as a worksheet andenter your penalty on your tax return, but file only page 1 of Form 2210.

Reasons for Filing. Check applicable boxes. If none apply, don't file Form 2210.Part II

A You request a waiver (see instructions) of your entire penalty due to tax reform or other reasons. You must check this box and filepage 1 of Form 2210, but you aren't required to figure your penalty.

B You request a waiver (see instructions) of part of your penalty. You must figure your penalty and waiver amount and file Form 2210.

C Your income varied during the year and your penalty is reduced or eliminated when figured using the annualized income installmentmethod. You must figure the penalty using Schedule AI and file Form 2210.

D Your penalty is lower when figured by treating the federal income tax withheld from your income as paid on the dates it was actuallywithheld, instead of in equal amounts on the payment due dates. You must figure your penalty and file Form 2210.

E You filed or are filing a joint return for either 2017 or 2018, but not for both years, and line 8 above is smaller than line 5 above. Youmust file page 1 of Form 2210, but you aren't required to figure your penalty (unless box B, C, or D applies).

BAA For Paperwork Reduction Act Notice, see separate instructions. Form 2210 (2018)

FDIZ0313L 01/17/19


391,071.

73,331.

0.

464,402.417,962.

128.464,274.

1,010,514.417,962.

X

X

Form 2210 (2018) Page 3

Part IV Regular Method (See the instructions if you are filing Form 1040NR or 1040NR-EZ.)

Payment Due DatesSection A ' Figure Your Underpayment (a) (b) (c) (d)

4/15/18 6/15/18 9/15/18 1/15/19

18 Required installments. If box C in Part II applies,enter the amounts from Schedule AI, line 27.Otherwise, enter 25% (0.25) of line 9, Form 2210,

18in each column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated tax paid and tax withheld (see the instruc-19tions). For column (a) only, also enter the amountfrom line 19 on line 23. If line 19 is equal to or morethan line 18 for all payment periods, stop here; youdon't owe a penalty. Don't file Form 2210 unlessyou checked a box in Part II. . . . . . . . . . . . . . . . . . . . . . . . . 19Complete lines 20 through 26 of one columnbefore going to line 20 of the next column.Enter the amount, if any, from line 26 in the20

20previous column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21 21Add lines 19 and 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22 Add the amounts on lines 24 and 25 in theprevious column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

23 Subtract line 22 from line 21. If zero or less, enter -0-.23For column (a) only, enter the amount from line 19. . . .

24 If line 23 is zero, subtract line 21 from line 22.24Otherwise, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25 Underpayment. If line 18 is equal to or more thanline 23, subtract line 23 from line 18. Then go to

25line 20 of the next column. Otherwise, go to line 26 . . G26 Overpayment. If line 23 is more than line 18,

subtract line 18 from line 23. Then go to line 2026of the next column. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section B ' Figure the Penalty (Use the Worksheet for Form 2210, Part IV, Section B ' Figure the Penalty in the instructions.)

27 Penalty. Enter the total penalty from line 14 of the Worksheet for Form 2210, Part IV, Section B ' Figure the Penalty. Also include this amount on Form 1040, line 23;Form 1040NR, line 76; Form 1040NR-EZ, line 26; or Form 1041, line 27.

Don't file Form 2210 unless you checked a box in Part II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27G

Form 2210 (2018)

FDIZ0313L 01/17/19


58,193. 57,425. 61,770. 240,574.

91,291. 75,032. 75,032. 250,032.

33,098. 50,705. 63,967.108,130. 125,737. 313,999.

91,291. 108,130. 125,737. 313,999.

0. 0.

33,098. 50,705. 63,967.

Page 4Form 2210 (2018)

Schedule AI ' Annualized Income Installment Method (See the instructions.)Estates and trusts, don't use the period ending dates shown (a) (b) (c) (d)to the right. Instead, use the following: 2/28/18, 4/30/18,

1/1/18 - 3/31/18 1/1/18 - 5/31/18 1/1/18 - 8/31/18 1/1/18 - 12/31/187/31/18, and 11/30/18.

Part I Annualized Income InstallmentsEnter your adjusted gross income for each period1(see instrs). (Estates and trusts, enter your taxable

1income without your exemption for each period.). . . .

4 2.4 1.5 12Annualization amounts. (Estates & trusts, see instrs).2

33 Annualized income. Multiply line 1 by line 2 . . . . . . .

If you itemize, enter itemized deductions for the4period shown in each column. All others enter -0-,and skip to line 7. Exception: Estates and trusts,

4skip to line 11 and enter amount from line 3. . . . . . .

4 2.4 1.5 1Annualization amounts. . . . . . . . . . . . . . . . . . . . . . . 55

Multiply line 4 by line 5 . . . . . . . . . . . . . . . . . . . . . . 6 6

In each column, enter the full amount of your7standard deduction from Form 1040, line 8.(Form 1040NR or 1040NR-EZ filers, enter -0-.Exception: Indian students and business

7apprentices, see instructions.) . . . . . . . . . . . . . . . . .

8 8Enter the larger of line 6 or line 7 . . . . . . . . . . . . . .

9 9Deduction for qualified business income. . . . . . . . . .

Add lines 8 and 9. . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10

11 11Subtract line 10 from line 3 . . . . . . . . . . . . . . . . . . . .

12 Form 1040, 1040NR, or 1040NR-EZ filers, enter -0-12in each column. (Estates and trusts, see instrs.). . . .

13 Subtract line 12 from line 11. If zero or less,13enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 Figure your tax on the amount on line 13 (see instrs.) 14

15 15Self-employment tax from line 36 (complete Part II below). . . . . . . .

Enter other taxes for each payment period including, if applicable,1616Additional Medicare Tax and/or Net Investment Income Tax (see instrs)

17Total tax. Add lines 14, 15, and 16 . . . . . . . . . . . . . . 17

For each period, enter the same type of credits as allowed on1818Form 2210, Part I, lines 1 & 3 (see instructions). . . . . . . . . . . . .

19 19Subtract line 18 from line 17. If zero or less, enter -0-

22.5% 45% 67.5% 90%20Applicable percentage . . . . . . . . . . . . . . . . . . . . . . . 20

21Multiply line 19 by line 20 . . . . . . . . . . . . . . . . . . . . 21

Complete lines 22 - 27 of one column beforegoing to line 22 of the next column.

22Enter the totl of the amts in all prev columns of ln 2722

23Subtract ln 22 from ln 21. If zero or less, enter -0- . . 23

Enter 25% (0.25) of line 9 on page 1 of Form 22102424in each column . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 27 of the previous column from line 262525of that column. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26Add lines 24 and 25. . . . . . . . . . . . . . . . . . . . . . . . . 26

Enter the smaller of line 23 or line 26 here and on2727Form 2210, Part IV, line 18. . . . . . . . . . . . . . . . . . . . G

Annualized Self-Employment Tax (Form 1040 and Form 1040NR filers only)Part II28 Net earnings from self-employment for the period

28(see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . .

$32,100 $53,500 $85,600 $128,40029 29Prorated social security tax limit. . . . . . . . . . . . . . . .

30 Enter actual wages for the period subject to socialsecurity tax or the 6.2% portion of the 7.65%railroad retirement (tier 1) tax. Exception: If you

30filed Form 4137 or Form 8919, see instructions. . . . .


0.496 0.2976 0.186 0.12432 32Annualization amounts. . . . . . . . . . . . . . . . . . . . . . .

33 33Multiply line 32 by the smaller of line 28 or line 31. .


35 35Multiply line 28 by line 34 . . . . . . . . . . . . . . . . . . . .

36 Add lines 33 and 35. Enter here and on line3615 above. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

FDIZ0305L 01/28/19BAA Form 2210 (2018)


275,233. 455,161. 747,819. 2,129,756.

1,100,932. 1,092,386. 1,121,729. 2,129,756.

10,273. 17,122. 27,394. 41,091.

41,092. 41,093. 41,091. 41,091.

12,000. 12,000. 12,000. 12,000.41,092. 41,093. 41,091. 41,091.

41,092. 41,093. 41,091. 41,091.1,059,840. 1,051,293. 1,080,638. 2,088,665.

0 0 0 0

1,059,840. 1,051,293. 1,080,638. 2,088,665.184,888. 183,179. 189,048. 390,653.

75,331. 75,331. 75,331. 75,331.260,219. 258,510. 264,379. 465,984.

1,582. 1,582. 1,582. 1,582.

258,637. 256,928. 262,797. 464,402.

58,193. 115,618. 177,388. 417,962.

58,193. 115,618. 177,388.58,193. 57,425. 61,770. 240,574.

104,490. 104,490. 104,491. 104,491.

46,297. 93,362. 136,083.104,490. 150,787. 197,853. 240,574.

58,193. 57,425. 61,770. 240,574.

OMB No. 1545-0074SCHEDULE A Itemized Deductions(Form 1040)

G Go to www.irs.gov/ScheduleA for instructions and the latest information.(Rev. January 2020) 2018G Attach to Form 1040.

Department of the Treasury AttachmentInternal Revenue Service Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 16.(99) Sequence No. 07


Caution: Do not include expenses reimbursed or paid by others.Medicaland 1 Medical and dental expenses (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . 1Dental

2 2Enter amount from Form 1040, line 7. . . . . . Expenses3 Multiply line 2 by 7.5% (0.075) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 State and local taxes.Taxes YouPaid a State and local income taxes or general sales taxes. You may

include either income taxes or general sales taxes on line 5a,

but not both. If you elect to include general sales taxes instead

of income taxes, check this box.. . . . . . . . . . . . . . . . . . . . . . . 5aG

b 5bState and local real estate taxes (see instructions) . . . . . . . . . . . . . . . . . . . . . . .

c State and local personal property taxes. . . . . . . . . . . . . . . . . . . . . . . 5c

d Add lines 5a through 5c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5d

e Enter the smaller of line 5d or $10,000 ($5,000 if married filingseparately). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5e

6 Other taxes. List type and amount G

6

7 7Add lines 5e and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 Home mortgage interest and points. If you didn't use all of yourInterestYou Paid home mortgage loan(s) to buy, build, or improve your home,

see instructions and check this box. . . . . . . . . . . . . . . . . . . . Caution: GYour mortgage a Home mortgage interest and points reported to you on Forminterest

1098. See instructions if limited.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8adeduction may

be limited (see b Home mortgage interest not reported to you on Form 1098. Ifinstructions). paid to the person from whom you bought the home, see

instructions and show that person's name, identifying no., and

address G

8b

8cc Points not reported to you on Form 1098. See instructions for special rules. . . . .

d Mortgage insurance premiums (see instructions). . . . . . . . . . . . . . . 8d

e Add lines 8a through 8d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8e

9 Investment interest. Attach Form 4952 if required. See

9instructions.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Add lines 8e and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Gifts by cash or check. If you made any gift of $250 or more,Gifts toCharity see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Other than by cash or check. If any gift of $250 or

more, see instructions. You must attach Form 8283 ifIf you made a gift

and got a benefit for over $500. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12it, see instructions.

13 Carryover from prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14 Add lines 11 through 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Casualty and theft loss(es) from a federally declared disaster (other than net qualified disasterCasualty andTheft Losses losses). Attach Form 4684 and enter the amount from line 18 of that form. See instructions. 15

16 Other'from list in instructions. List type and amount GOtherItemizedDeductions

16

Add the amounts in the far right column for lines 4 through 16.17TotalItemized Also, enter this amount on Form 1040, line 8.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Deductions

18 If you elect to itemize deductions even though they are less than your standard

deduction, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

FDIA0301 01/29/20BAA For Paperwork Reduction Act Notice, see the Instructions for Form 1040. Schedule A (Form 1040) 2018


0.

109,023.

10,000.

22,883.

22,883.

8,208.

8,208.

0.

0.

41,091.

10,000.

109,023.

STATEMENT 6

STMT 5

OMB No. 1545-0074SCHEDULE B Interest and Ordinary Dividends(Form 1040) 2018

G Go to www.irs.gov/ScheduleB for instructions and the latest information.Department of the Treasury AttachmentG Attach to Form 1040.(99)Internal Revenue Service 08Sequence No.



(See instructionsand theinstructions forForm 1040,line 2b.)

Note: If youreceived a Form

11099-INT, Form1099-OID, orsubstitute statementfrom a brokeragefirm, list the firm'sname as the payerand enter the totalinterest shown onthat form.



4 4Subtract line 3 from line 2. Enter the result here and on Form 1040, line 2b. . . . . . . . . . . . . . G

AmountNote: If line 4 is over $1,500, you must complete Part III.


OrdinaryDividends

(See instructionsand theinstructions forForm 1040,line 3b.)

Note: If you received 5a Form 1099-DIV orsubstitute statementfrom a brokeragefirm, list the firm'sname as the payerand enter theordinary dividendsshown on that form.

6 6Add the amounts on line 5. Enter the total here and on Form 1040, line 3b. . . . . . . . . . . . . . . G


Part III You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) hadYes Noa foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.


See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . and TrustsIf 'Yes,' are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR), toreport that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing

(See instructions.) requirements and exceptions to those requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b If you are required to file FinCEN Form 114, enter the name of the foreign country where the financial

account is located G

8 During 2018, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If'Yes,' you may have to file Form 3520. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FDIA0401L 07/20/18 Schedule B (Form 1040) 2018BAA For Paperwork Reduction Act Notice, see your tax return instructions.


8,096.

8,096.

1,064,446.

X

X

BELDORE CAPITAL FUND LLC 1,223.CLEARFORK CAPITAL FUND LLC 1,002.MERRILL LYNCH - 12754 1,433.MERRILL LYNCH - 846 445.MERRILL LYNCH -841 3,943.OID-STATE OF ISRAEL BOND 50.

BELDORE CAPITAL FUND LLC 63,441.CLEARFORK CAPITAL FUND LLC 43,811.MERRILL LYNCH-12841 890,225.MERRILL LYNCH-12846 41,404.SARA JOSEPHINE JACOBS IRREV TRUST 25,565.

OMB No. 1545-0074SCHEDULE D(Form 1040) Capital Gains and Losses

G Attach to Form 1040 or Form 1040NR. 2018G Go to www.irs.gov/ScheduleD for instructions and the latest information.Department of the Treasury



Part I Short-Term Capital Gains and Losses ' Generally Assets Held One Year or Less (see instructions)


to gain or loss from from column (d) andProceeds CostThis form may be easier to complete if you round Form(s) 8949, Part I, combine the result with(sales price) (or other basis)off cents to whole dollars. line 2, column (g) column (g)







Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover6Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any long-term77capital gains or losses, go to Part II below. Otherwise, go to Part III on the back. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II Long-Term Capital Gains and Losses ' Generally Assets Held More Than One Year (see instructions)


to gain or loss from from column (d) andProceeds CostThis form may be easier to complete if you round Form(s) 8949, Part II, combine the result with(sales price) (or other basis)off cents to whole dollars. line 2, column (g) column (g)








Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover14Worksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on1515the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule D (Form 1040) 2018BAA For Paperwork Reduction Act Notice, see your tax return instructions.

FDIA0612L 08/27/18


675,857. 710,650. -34,793.

-551.

-35,344.

1,081,389. 1,004,409. 76,980.

998,746. 998,746.

14,090.

560.

1,090,376.

SEE ST 7

Schedule D (Form 1040) 2018 Page 2

Part III Summary


? If line 16 is a gain, enter the amount from line 16 on Schedule 1 (Form 1040), line 13, or Form 1040NR,line 14. Then go to line 17 below.If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22.?

? If line 16 is zero, skip lines 17 through 21 below and enter -0- on Schedule 1 (Form 1040), line 13, orForm 1040NR, line 14. Then go to line 22.


Yes. Go to line 18.



If you are required to complete the Unrecaptured Section 1250 Gain Worksheet (see1919Ginstructions), enter the amount, if any, from line 18 of that worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 11a (or in the instructions for Form 1040NR, line 42). Don't complete lines21 and 22 below.


If line 16 is a loss, enter here and on Schedule 1 (Form 1040), line 13, or Form 1040NR, line 14,21the smaller of:

? The loss on line 16; or21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



22 Do you have qualified dividends on Form 1040, line 3a, or Form 1040NR, line 10b?

Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 11a (or in the instructions for Form 1040NR, line 42).

No. Complete the rest of Form 1040 or Form 1040NR.

Schedule D (Form 1040) 2018

FDIA0612L 08/27/18


1,055,032.

X

0.

X

OMB No. 1545-0074




Short-Term. Transactions involving capital assets you held 1 year or less are generally short-term (seePart Iinstructions). For long-term transactions, see page 2.









Totals. Add the amounts in columns (d), (e), (g), and (h)2(subtract negative amounts). Enter each total here andinclude on your Schedule D, line 1b (if Box A above ischecked), line 2 (if Box B above is checked), or line 3 (ifBox C above is checked) . . . . . . . . . . . . . . . . . . . . . . . . . . . G



0.675,857.

X


710,650. -34,793.

SEE ATTACHED MERRIL LYNCH-12846 - SEE ATTACHED STATEMENT675,857. 710,650. M -34,793.











Totals. Add the amounts in columns (d), (e), (g), and (h)2(subtract negative amounts). Enter each total here andinclude on your Schedule D, line 8b (if Box D above ischecked), line 9 (if Box E above is checked), or line 10 (if



FDIA9212L 08/24/18 Form 8949 (2018)

0.1,081,389.

X


1,004,409. 76,980.

SEE ATTACHED MERRIL LYNCH-12846 - SEE ATTACHED STATEMENT1,081,389. 1,004,409. M 76,980.














FDIA9212L 08/24/18 Form 8949 (2018)

0.998,746.

X


0. 998,746.



OMB No. 1545-0074Supplemental Income and LossSCHEDULE E(Form 1040) (From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.) 2018

G Attach to Form 1040, 1040NR, or Form 1041.Department of the Treasury Attachment



Income or Loss From Rental Real Estate and Royalties Note: If you are in the business of renting personal property, usePart ISchedule 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.



Physical address of each property (street, city, state, ZIP code)1 a

A

B

CType of Property1 b 2 For each rental real estate property listed Fair Rental Days Personal Use Days QJV(from list below) above, report the number of fair rental and






3 3Rents received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





8 8Commissions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 9Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


11 11Management fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


13 13Other interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 14Repairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 15Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16 16Taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17 17Utilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


19 19Other (list) G









24 Income. Add positive amounts shown on line 21. Do not include any losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here. . . 25 25Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the26result here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter thisamount on Schedule 1 (Form 1040), line 17, or Form 1040NR, line 18. Otherwise, includethis amount in the total on line 41 on page 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Schedule E (Form 1040) 2018FDIZ2301L 02/15/19BAA For Paperwork Reduction Act Notice, see the separate instructions.


2029 CONNECTICUT AVE NW #41, WASHINGTON, DC 20008-614299 JANE ST APT 6L, NEW YORK, NY 10014

12,520. 8,416.

6,000.24,952.

24,952.

109.612.

22,676. 17,146.

553,984.

128,060. 265,777.

393,837.

248,659. 305,325.

-69,659. -256,045.

53,730. 13,986.

228,280.

49,280.179,000.

11

X

SEE STM 8 SEE STM 9

Schedule E (Form 1040) 2018 Attachment Sequence No. 13 Page 2Name(s) shown on return. Do not enter name and social security number if shown on Page 1. Your social security number


Part II Income or Loss From Partnerships and S CorporationsNote: If you report a loss, receive a distribution, dispose of stock, or receive a loan repayment from an S corporation, you must check the box in column (e) on line 28and attach the required basis computation. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box incolumn (f) 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, aprior year unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed

Yes Nopartnership expenses? If you answered "Yes," see instructions before completing this section . . . . . . . . . . . . . . . . . . . . . .

(e) Check if(b) Enter P for (c) Check if (d) Employer (f) Check ifbasispartnership; S28 (a) Name foreign identification any amountcomputationfor S partnership number is not at riskis requiredcorporation

A

B

C

D


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

A

B

C

D

29 a Totals. . . . . . . . . . . . . . . .

b Totals. . . . . . . . . . . . . . . .

30 30Add columns (h) and (k) of line 29a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3131 Add columns (g), (i), and (j) of line 29b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3232 Total partnership and S corporation income or (loss). Combine lines 30 and 31 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part III Income or Loss From Estates and Trusts33 (a) Name (b) Employer ID no.

A

B



A

B

34 a Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



37 37Total estate and trust income or (loss). Combine lines 35 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs) ' Residual Holder(c) Excess inclusion from (d) Taxable income(b) Employer (e) Income from38 (a) Name Schedules Q, line 2c (net loss) fromidentification number Schedules Q, line 3b(see instructions) Schedules Q, line 1b


Part V Summary40 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 Schedule 141G(Form 1040), line 17, or Form 1040NR, line 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42 Reconciliation of farming and fishing income. Enter your gross farmingand 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 AC; and

42Schedule K-1 (Form 1041), box 14, code F (see instructions) . . . . . . . . . . . . . . . . . .

43 Reconciliation for real estate professionals. If you were a real estateprofessional (see instructions), enter the net income or (loss) you reportedanywhere on Form 1040 or Form 1040NR from all rental real estate activities

43in which you materially participated under the passive activity loss rules. . . . . . . .

FDIZ2302L 02/15/19BAA Schedule E (Form 1040) 2018


41.

41.

41.

41.

X

BELDORE CAPITAL FUND LLC P 26-0505281CLEARFORK CAPITAL FUND LLC P 26-0158977MASS PATHWAYS TO ECON ADVANCEMENT P 32-0500335

SARA JOSEPHINE JACOBS IRREV TRUST 33-6266230

41.


(Individual, Estate, or Trust) 2018G Attach to Form 1040, 1040NR, 1041, or 990-T.Department of the Treasury Attachment(99) G Go to www.irs.gov/Form1116 for instructions and the latest information.Internal Revenue Service 19Sequence No.



Passive category income Section 901(j) income Lump-sum distributionsc e gSection 951A incomea

General category income Certain income re-sourced by treatyd fForeign branch incomeb







1 a








c Add lines 3a and 3b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .









Add lines 2, 3g, 4a, 4b, and 5 . . . . . . . . . . . . . . . . . . . . . 6 6






A

B

C




1,023,215. 1,023,215.

2,531.

1,023,215.2,393,380.0.427519

24,956.998,259.

X

1,582.

X

24,956.

22,425.

VARIOUS

1,386. 1,582.196.

SEE ST 11

SEE STATEMENT 10

PageForm 1116 (2018) 2



10 Carryback or carryover (attach detailed computation). . . . . . . . . . . . . . . . . . . . . . . . . . . . 10(If your income was section 951A income (box a above Part I), leaveline 10 blank.)

11 Add lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11









18 Individuals: Enter the amount from Form 1040, line 10; or Form 1040NR,line 41. Estates and trusts: Enter your taxable income without thededuction for your exemption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18



20 Individuals: Enter the total of Form 1040, line 11a, and Schedule 2 (Form 1040), line 46. If you are anonresident alien, enter the total of Form 1040NR, lines 42 and 44. Estates and trusts: Enter the amount fromForm 1041, Schedule G, line 1a; or the total of Form 990-T, lines 40, 41, and 43. Foreign estates and trusts

20should enter the amount from Form 1040NR, line 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






Credit for taxes on section 951A income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 23

Credit for taxes on foreign branch income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 24









Subtract line 32 from line 31. This is your foreign tax credit. Enter here and on Schedule 3 (Form 1040),33G 33line 48; Form 1040NR, line 46; Form 1041, Schedule G, line 2a; or Form 990-T, line 45a . . . . . . . . . . . . . . . . . . . .

Form 1116 (2018)

FDIZ2612L 09/06/18


1,582.

1,582.

1,582.

998,259.

998,259.

2,088,665.

0.477941173

390,653.

186,709.

1,582.

1,582.

1,582.





Passive category income Section 901(j) income Lump-sum distributionsc e gSection 951A incomea

General category income Certain income re-sourced by treatyd fForeign branch incomeb







1 a








c Add lines 3a and 3b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .









Add lines 2, 3g, 4a, 4b, and 5 . . . . . . . . . . . . . . . . . . . . . 6 6






A

B

C





1,023,215. 1,023,215.

2,531.

1,023,215.2,393,380.0.427519

24,956.998,259.

X

1,582.

X

24,956.

22,425.

VARIOUS

1,386. 1,582.196.

SEE ST 13

SEE STATEMENT 12

PageForm 1116 (2018) 2



10 Carryback or carryover (attach detailed computation). . . . . . . . . . . . . . . . . . . . . . . . . . . . 10(If your income was section 951A income (box a above Part I), leaveline 10 blank.)

11 Add lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11












20 Individuals: Enter the total of Form 1040, line 11a, and Schedule 2 (Form 1040), line 46. If you are anonresident alien, enter the total of Form 1040NR, lines 42 and 44. Estates and trusts: Enter the amount fromForm 1041, Schedule G, line 1a; or the total of Form 990-T, lines 40, 41, and 43. Foreign estates and trusts

20should enter the amount from Form 1040NR, line 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






Credit for taxes on section 951A income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 23

Credit for taxes on foreign branch income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 24









Subtract line 32 from line 31. This is your foreign tax credit. Enter here and on Schedule 3 (Form 1040),33G 33line 48; Form 1040NR, line 46; Form 1041, Schedule G, line 2a; or Form 990-T, line 45a . . . . . . . . . . . . . . . . . . . .

Form 1116 (2018)

FDIZ2612L 09/06/18


1,582.

1,582.

1,582.

998,259.

998,259.

2,098,665.

0.475663815

392,653.

186,771.

1,582.

1,582.

1,582.

OMB No. 1545-0074


Department of the Treasury AttachmentInternal Revenue Service (99) 32Attach to Form 1040 or Form 1040NR. Sequence No.GName(s) shown on Form 1040 or Form 1040NR Your social security number


Enter the amount from Form 1040, line 10, if more than zero. If Form 1040, line 10, is zero, subtract lines 81and 9 of Form 1040 from line 7 of Form 1040 and enter the result here. (If less than zero, enter as anegative amount.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

If filing Schedule A (Form 1040), enter the taxes from Schedule A, line 7; otherwise, enter the amount from2a2aForm 1040, line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tax refund from Schedule 1 (Form 1040), line 10 or line 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b 2b

Investment interest expense (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c 2c

Depletion (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d 2d

Net operating loss deduction from Schedule 1 (Form 1040), line 21. Enter as a positive amount. . . . . . . . . . . . . e 2e

Alternative tax net operating loss deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f 2f

Interest from specified private activity bonds exempt from the regular tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g 2g

Qualified small business stock, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h 2h

Exercise of incentive stock options (excess of AMT income over regular tax income) . . . . . . . . . . . . . . . . . . . . . . . i 2i

Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j 2j

Disposition of property (difference between AMT and regular tax gain or loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k 2k

Depreciation on assets placed in service after 1986 (difference between regular tax and AMT) . . . . . . . . . . . . . . l 2l

Passive activities (difference between AMT and regular tax income or loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m 2m

Loss limitations (difference between AMT and regular tax income or loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n 2n

Circulation costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o 2o

Long-term contracts (difference between AMT and regular tax income). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p 2p

Mining costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q 2q

Research and experimental costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r 2r

Income from certain installment sales before January 1, 1987. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s 2s

Intangible drilling costs preference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t 2t


4 Alternative minimum taxable income. Combine lines 1 through 3. (If married filingseparately and line 4 is more than $718,800, see instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4


THEN enter on line 5. . . . . . IF your filing status is. . . . AND line 4 is not over. . . .

Single or head of household. . . . . . . . . . . . . . 500,000. . . . . . . . . . . . . . . 70,300$$1,000,000. . . . . . . . . . . . . . . 109,400Married filing jointly or qualifying widow(er)

Married filing separately. . . . . . . . . . . . . . . . . . . 500,000 . . . . . . . . . . . . . . . 54,700. . . . . . 5If line 4 is over the amount shown above for your filing status, see instructions.

Subtract line 5 from line 4. If more than zero, go to line 7. If zero or less,66enter -0- here and on lines 7, 9, and 11, and go to line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 ? If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter.? If you reported capital gain distributions directly on Schedule 1 (Form 1040), line 13; you reported qualified

dividends on Form 1040, line 3a; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (asrefigured for the AMT, if necessary), complete Part III on the back and enter the amount from line 40 here. 7. . . . . . .

?All others: If line 6 is $191,100 or less ($95,550 or less if married filing separately),multiply line 6 by 26% (0.26). Otherwise, multiply line 6 by 28% (0.28) and subtract $3,822($1,911 if married filing separately) from the result.


Tentative minimum tax. Subtract line 8 from line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9

Add Form 1040, line 11a (minus any tax from Form 4972), and Schedule 2 (Form 1040), line 46. Subtract from the result10any foreign tax credit from Schedule 3 (Form 1040), line 48. If you used Schedule J to figure your tax on Form 1040,

10line 11a, refigure that tax without using Schedule J before completing this line (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 11AMT. Subtract line 10 from line 9. If zero or less, enter -0-. Enter here and on Schedule 2 (Form 1040), line 45 . . . . . . . . . . . . . . . . . . . .



2,088,665.

10,000.

2,098,665.

2,098,665.

392,653.

1,582.

391,071.

389,071.

2,000.

Form 6251 (2018) Page 2


Enter the amount from Form 6251, line 6. If you are filing Form 2555 or 2555-EZ, enter the amount from12line 3 of the worksheet in the instructions for line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions13for Form 1040, line 11a, or the amount from line 13 of the Schedule D Tax Worksheet in the instructions forSchedule D (Form 1040), whichever applies (as refigured for the AMT, if necessary) (see instructions). If

13you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the amount from Schedule D (Form 1040), line 19 (as refigured for the AMT, if necessary) (see1414instructions). If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter. . . . . . . . . . . . . . .

If you did not complete a Schedule D Tax Worksheet for the regular tax or the AMT, enter the amount15from line 13. Otherwise, add lines 13 and 14, and enter the smaller of that result or the amount from line10 of the Schedule D Tax Worksheet (as refigured for the AMT, if necessary). If you are filing Form 2555 or

152555-EZ, see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




Gthe result. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Enter:19




Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions20for Form 1040, line 11a, or the amount from line 14 of the Schedule D Tax Worksheet in the instructions forSchedule D (Form 1040), whichever applies (as figured for the regular tax). If you did not complete eitherworksheet for the regular tax, enter the amount from Form 1040, line 10; if zero or less, enter -0-. If youare filing Form 2555 or 2555-EZ, see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20



23 Enter the smaller of line 21 or line 22. This amount is taxed at 0%. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23


25 Enter:






Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions27for Form 1040, line 11a, or the amount from line 19 of the Schedule D Tax Worksheet, whichever applies(as figured for the regular tax). If you did not complete either worksheet for the regular tax, enter theamount from Form 1040, line 10; if zero or less, enter -0-. If you are filing Form 2555 or Form 2555-EZ,see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

28 Add line 26 and line 27. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28




Add lines 23 and 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 32If lines 32 and 12 are the same, skip lines 33 through 37 and go to line 38. Otherwise, go to line 33.Subtract line 32 from line 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 33


Add lines 17, 32, and 33. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 35



Add lines 18, 31, 34, and 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 38


40 Enter the smaller of line 38 or line 39 here and on line 7. If you are filing Form 2555 or 2555-EZ, do notenter this amount on line 7. Instead, enter it on line 4 of the worksheet in the instructions for line 7. . . . . . . . . 40

FDIA5312L 11/05/18 Form 6251 (2018)


2,098,665.

2,104,691.

2,104,691.

2,098,665.

38,600.

0.

38,600.

2,098,665.

38,600.

2,060,065.

425,800.

38,600.

0.

38,600.387,200.

387,200.

58,080.

425,800.

1,672,865.

334,573.

392,653.

583,804.

392,653.

OMB No. 1545-0191Investment Interest Expense DeductionForm 4952

2018G Go to www.irs.gov/Form4952 for the latest information.

Department of the Treasury Attachment(99) G Attach to your tax return.Internal Revenue Service 51Sequence No.

Identifying numberName(s) shown on return

Part I Total Investment Interest Expense

1 1Investment interest expense paid or accrued in 2018 (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 2Disallowed investment interest expense from 2017 Form 4952, line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total investment interest expense. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3

Part II Net Investment Income

4 a Gross income from property held for investment (excluding any net gain from4 athe disposition of property held for investment) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b 4 bQualified dividends included on line 4a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 cc Subtract line 4b from line 4a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d 4 dNet gain from the disposition of property held for investment. . . . . . . . . . . . . . . . . . .

e Enter the smaller of line 4d or your net capital gain from the disposition of4 eproperty held for investment (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f 4 fSubtract line 4e from line 4d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g 4 gEnter the amount from lines 4b and 4e that you elect to include in investment income (see instructions). . . . .

h 4 hInvestment income. Add lines 4c, 4f, and 4g. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 5Investment expenses (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 6Net investment income. Subtract line 5 from line 4h. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Investment Interest Expense DeductionPart III

7 Disallowed investment interest expense to be carried forward to 2019. Subtract line 6 from line 3. If zero or7less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Investment interest expense deduction. Enter the smaller of line 3 or 6. See instructions . . . . . . . . . . . . . . . . . . 8 8


FDIZ1201L 08/02/18


22,883.

22,883.

1,072,542.

1,051,155.

21,387.

1,055,032.

1,055,032.

1,496.

22,883.

22,883.

0.

22,883.




























Part III Tax Computation12 Net investment income. Subtract Part II, line 11, from Part I, line 8. Individuals, complete lines 13-17.

Estates and trusts, complete lines 18a-21. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12




Enter the smaller of line 12 or line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1616

Net investment income tax for individuals. Multiply line 16 by 3.8% (0.038). Enter here and17

include on your tax return (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Estates and Trusts:Net investment income (line 12 above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 a 18a



c Undistributed net investment income. Subtract line 18b from 18a18c(see instructions). If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






Net investment income tax for estates and trusts. Multiply line 20 by 3.8% (0.038). Enter here21

and include on your tax return (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21


FDIA6801L 08/29/18


8,096.

1,064,446.

41.

41.

1,055,032.

1,055,032.

65,974.2,193,589.

22,883.

10,000.

32,883.

32,883.

2,160,706.

2,129,756.200,000.

1,929,756.1,929,756.

73,331.


G Go to www.irs.gov/Form8801 for instructions and the latest information.Department of the Treasury AttachmentG Attach to Form 1040, 1040NR, or 1041.Internal Revenue Service (99) 74Sequence No.



1 1Combine lines 1, 6, and 10 of your 2017 Form 6251. Estates and trusts, see instructions . . . . . . . . . . . . . . . . . . .




5 Enter: $84,500 if married filing jointly or qualifying widow(er) for 2017; $54,300 if single or head of5household for 2017; or $42,250 if married filing separately for 2017. Estates and trusts, enter $24,100. . . . . . .

Enter: $160,900 if married filing jointly or qualifying widow(er) for 2017; $120,700 if single or head of66household for 2017; or $80,450 if married filing separately for 2017. Estates and trusts, enter $80,450. . . . . . .


8 8Multiply line 7 by 25% (0.25). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 9Subtract line 8 from line 5. If zero or less, enter -0-. If under age 24 at the end of 2017, see instructions . . . .

10 Subtract line 9 from line 4. If zero or less, enter -0- here and on line 15 and go to10Part II. Form 1040NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


? If for 2017 you reported capital gain distributions directly on Form 1040, line 13; you reportedqualified dividends on Form 1040, line 9b (Form 1041, line 2b(2)); or you had a gain on both lines15 and 16 of Schedule D (Form 1040) (lines 18a and 19, column (2), of Schedule D (Form 1041)),complete Part III of Form 8801 and enter the amount from line 55 here. Form 1040NR filers,see instructions. 11? All others: If line 10 is $187,800 or less ($93,900 or less if married filing separately for 2017),multiply line 10 by 26% (0.26). Otherwise, multiply line 10 by 28% (0.28) and subtract $3,756 ($1,878if married filing separately for 2017) from the result. Form 1040NR filers, see instructions.




Net minimum tax on exclusion items. Subtract line 14 from line 13. If zero or less, enter -0-. . . . . . . . . . . . . . . . 15 15

Form 8801 (2018)BAA For Paperwork Reduction Act Notice, see instructions.

FDIZ2413L 07/23/18


3,487,354.

541,300.

4,028,654.

54,300.

120,700.

3,907,954.

976,989.

0.

4,028,654.

784,306.

749.

783,557.

692,951.

90,606.

Form 8801 (2018) Page 2





2017 credit carryforward. Enter the amount from your 2017 Form 8801, line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 19




Enter the amount from your 2018 Form 6251, line 9, or 2018 Form 1041, Schedule I, line 54. . . . . . . . . . . . . . . . 23 23


Minimum tax credit. Enter the smaller of line 21 or line 24. Also enter this amount on your 2018 Schedule 325(Form 1040), line 54 (check box b); Form 1040NR, line 51 (check box b); or Form 1041, Schedule G,line 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Credit carryforward to 2019. Subtract line 25 from line 21. Keep a record of this amount because you26may use it in future years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Form 8801 (2018)

FDIZ2413L 07/23/18


90,606.

90,606.

133.

133.

389,071.

391,071.

0.

133.

Form 8801 (2018) Page 3



Enter the amount from Form 8801, line 10. If you filed Form 2555 or 2555-EZ for 2017, enter the amount27from line 3 of the Foreign Earned Income Tax Worksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Caution: If for 2017 you filed Form 1040NR, 1041, 2555, or 2555-EZ, see the instructions before completinglines 28, 29, and 30.




Add lines 28 and 29, and enter the smaller of that result or the amount from line 10 of your 201730Schedule D Tax Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Enter the smaller of line 27 or line 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3131



G2017) from the result. Form 1040NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Enter:34





Form 1040NR filers, see instructions.


35applies; if zero or less, enter -0-. Form 1040NR filers, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





Enter:40

?$418,400 if single for 2017,






Enter the amount from line 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4141


42your 2017 Form 1041, line 22; if zero or less, enter -0-. Form 1040NR filers, see instructions. . . . . . . . . . . . . . . . .

* The 2017 Qualified Dividends and Capital Gain Tax Worksheet is in the 2017 Instructions for Form 1040. The 2017 Schedule D Tax Worksheetis in the 2017 Instructions for Schedule D (Form 1040) (or the 2017 Instructions for Schedule D (Form 1041)).

Form 8801 (2018)

FDIZ2413L 07/23/18


4,028,654.

3,942,198.

75.

3,942,273.3,942,273.

86,381.

22,459.

37,950.

0.37,950.

3,942,198.37,950.

3,904,248.

418,400.

37,950.

Form 8801 (2018) Page 4


Add lines 41 and 42. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 43




Add lines 38 and 45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 47





Add lines 32, 47, and 48. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5050



Add lines 33, 46, 49, and 52. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 53

If line 27 is $187,800 or less ($93,900 or less if married filing separately for 2017), multiply line 27 by 26%54(0.26). Otherwise, multiply line 27 by 28% (0.28) and subtract $3,756 ($1,878 if married filing separately for2017) from the result. Form 1040NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Enter the smaller of line 53 or line 54 here and on line 11. If you filed Form 2555 or 2555-EZ for 2017,55don't enter this amount on line 11. Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet in

55the instructions for line 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 8801 (2018)

FDIZ2413L 07/23/18


37,950.380,450.380,450.57,068.

418,400.

3,523,798.704,760.

4,028,579.

75.

19.784,306.

1,124,267.

784,306.


2018G See separate instructions.Department of the Treasury G Attach to Form 1040 or Form 1041.(99) AttachmentInternal Revenue Service





1 bActivities with net loss (enter the amount from Worksheet 1, column (b)) . . . . . . . b

1 cPrior years' unallowed losses (enter the amount from Worksheet 1, column (c)). c

1 dCombine lines 1a, 1b, and 1c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d



Prior year unallowed commercial revitalization deductions from Worksheet 2,bcolumn (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 b

Add lines 2a and 2b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 cc






Combine lines 1d, 2c, and 3d. If this line is zero or more, stop here and include this form with your return; all4losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Report the losseson the forms and schedules normally used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4






Enter the smaller of the loss on line 1d or the loss on line 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5


Enter modified adjusted gross income, but not less than zero (see instrs). . . . . . . 7 7

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.













FDIZ1901L 08/10/18


-325,704.

-186,511.-512,215.

-2.

-34,826.-34,828.

-547,043.

512,215.150,000.

2,129,756.

0.

Form 8582 (2018) Page 2


Worksheet 1 ' For Form 8582, Lines 1a, 1b, and 1c (See instructions.)




Worksheet 2 ' For Form 8582, Lines 2a and 2b (See instructions.)

(b) Prior year(a) Current year(c) Overall lossName of activity unalloweddeductions (line 2a)







Worksheet 4 ' Use this worksheet if an amount is shown on Form 8582, line 10 or 14 (See instructions.)


GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00Worksheet 5 ' Allocation of Unallowed Losses (See instructions.)


GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

FDIZ1902L 08/10/18 Form 8582 (2018)BAA


547,043.547,043.

34,826.2.

186,511.325,704.

RESIDENTIAL RENTAL-DC 69,659. 186,511. 256,170.RESIDENTIAL RENTAL-NY 256,045. 256,045.

CLEARFORK CAPITAL FUND LLC 2. 2.MASS PATHWAYS TO ECON ADVANCE 34,826. 34,826.

RESIDENTIAL RENTAL-DC SCH E LN 22 256,170. 0.468281 256,170.RESIDENTIAL RENTAL-NY SCH E LN 22 256,045. 0.468053 256,045.CLEARFORK CAPITAL FUND LLC SCH E LN 28 2. 0.000004 2.MASS PATHWAYS TO ECON ADVANCEMEN SCH E LN 28 34,826. 0.063662 34,826.

Form 8582 (2018) Page 3

Worksheet 6 ' Allowed Losses (See instructions.)


GTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worksheet 7 ' Activities With Losses Reported on Two or More Forms or Schedules (See instructions.)


Name of activity:


































Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 1.00FDIZ1903L 08/10/18 Form 8582 (2018)BAA

0.0.0.

0.2.2.

2.1.0000002.

2.

SCH E LN 28

CLEARFORK CAPITAL FUND LLC

0.547,041.547,041.


RESIDENTIAL RENTAL-DC SCH E LN 22 256,170. 256,170. 0.RESIDENTIAL RENTAL-NY SCH E LN 22 256,045. 256,045. 0.MASS PATHWAYS TO ECON ADVANCEMEN SCH E LN 28 34,826. 34,826. 0.












Prior year unallowed commercial revitalization deductions from Worksheet 2,bcolumn (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 b





























FDIZ1901L 08/10/18



-322,071.

-166,060.-488,131.

-2.

-34,826.-34,828.

-522,959.

488,131.150,000.

2,129,756.

0.

Form 8582 (2018) Page 2


















GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

FDIZ1902L 08/10/18 Form 8582 (2018)BAA


522,959.522,959.

34,826.2.

166,060.322,071.

RESIDENTIAL RENTAL-DC 66,026. 166,060. 232,086.RESIDENTIAL RENTAL-NY 256,045. 256,045.

CLEARFORK CAPITAL FUND LLC 2. 2.MASS PATHWAYS TO ECON ADVANCE 34,826. 34,826.

RESIDENTIAL RENTAL-DC SCH E LN 22 232,086. 0.443794 232,086.RESIDENTIAL RENTAL-NY SCH E LN 22 256,045. 0.489608 256,045.CLEARFORK CAPITAL FUND LLC SCH E LN 28 2. 0.000004 2.MASS PATHWAYS TO ECON ADVANCEMEN SCH E LN 28 34,826. 0.066594 34,826.

Form 8582 (2018) Page 3



GTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Name of activity:



































0.0.0.

0.2.2.

2.1.0000002.

2.

SCH E LN 28

CLEARFORK CAPITAL FUND LLC


0.522,957.522,957.


RESIDENTIAL RENTAL-DC SCH E LN 22 232,086. 232,086. 0.RESIDENTIAL RENTAL-NY SCH E LN 22 256,045. 256,045. 0.MASS PATHWAYS TO ECON ADVANCEMEN SCH E LN 28 34,826. 34,826. 0.

OMB No. 1545-0172Depreciation and Amortization

Form 4562 (Including Information on Listed Property) 2018G Attach to your tax return.Department of the Treasury AttachmentG Go to www.irs.gov/Form4562 for instructions and the latest information.Internal Revenue Service (99) 179Sequence No.


Business or activity to which this form relates

Election To Expense Certain Property Under Section 179Part INote: If you have any listed property, complete Part V before you complete Part I.

1 1Maximum amount (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 2Total cost of section 179 property placed in service (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 3Threshold cost of section 179 property before reduction in limitation (see instructions). . . . . . . . . . . . . . . . . . . . . .

4 4Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing55separately, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Description of property Cost (business use only) Elected cost6 (a) (b) (c)

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

8 8Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7. . . . . . . . . . . . . . . . . . . . . . .

Tentative deduction. Enter the smaller of line 5 or line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9

10 10Carryover of disallowed deduction from line 13 of your 2017 Form 4562. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 11Business income limitation. Enter the smaller of business income (not less than zero) or line 5. See instrs . .

Section 179 expense deduction. Add lines 9 and 10, but don't enter more than line 11. . . . . . . . . . . . . . . . . . . . . . 12 12

GCarryover of disallowed deduction to 2019. Add lines 9 and 10, less line 12. . . . . . . . 13 13

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.)

Special depreciation allowance for qualified property (other than listed property) placed in service during the1414tax year. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 15Property subject to section 168(f)(1) election. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Part III MACRS Depreciation (Don't include listed property. See instructions.)

Section A

17 17MACRS deductions for assets placed in service in tax years beginning before 2018. . . . . . . . . . . . . . . . . . . . . . . . .

If you are electing to group any assets placed in service during the tax year into one or more general18Gasset accounts, check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section B ' Assets Placed in Service During 2018 Tax Year Using the General Depreciation System

Basis for depreciation(c)Month and Depreciation(a) (b) (d) (e) (f) (g)(business/investment useClassification of property year placed Recovery period Convention Method deduction

in service only ' see instructions)

19 a 3-year property . . . . . . . . . .

b 5-year property . . . . . . . . . .

c 7-year property . . . . . . . . . .

d 10-year property. . . . . . . . .

e 15-year property. . . . . . . . .

f 20-year property. . . . . . . . .

g 25-year property. . . . . . . . . 25 yrs S/Lh Residential rental 27.5 yrs MM S/L

property. . . . . . . . . . . . . . . . . 27.5 yrs MM S/Li Nonresidential real 39 yrs MM S/L

property. . . . . . . . . . . . . . . . . MM S/LSection C ' Assets Placed in Service During 2018 Tax Year Using the Alternative Depreciation System

20a Class life. . . . . . . . . . . . . . . . S/Lb 12-year. . . . . . . . . . . . . . . . . . 12 yrs S/Lc 30-year. . . . . . . . . . . . . . . . . . 30 yrs MM S/Ld 40-year. . . . . . . . . . . . . . . . . . 40 yrs MM S/L

(See instructions.)Part IV Summary21 21Listed property. Enter amount from line 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on22the appropriate lines of your return. Partnerships and S corporations ' see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

For assets shown above and placed in service during the current year, enter2323the portion of the basis attributable to section 263A costs. . . . . . . . . . . . . . . . . . . . . . . .

FDIZ0812L 07/26/18 Form 4562 (2018)BAA For Paperwork Reduction Act Notice, see separate instructions.

SCHEDULE E (RENTAL) - RESIDENTIAL RENTAL-NY

1,000,000.

1,250,000.1/01/18

265,777.

43,563.


222,214.

2,500,000.





UNIVERSITY OF SAN DIEGO 2,141. 128. 133. 31. 12. 21.GRAND TOTAL 2,141. 128. 133. 31. 12. 21.




STATEMENT 3FORM 1040, LINE 3AQUALIFIED DIVIDENDS

BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 60,998.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40,083.MERRILL LYNCH-12841 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 890,225.MERRILL LYNCH-12846 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,484.SARA JOSEPHINE JACOBS IRREV TRUST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,365.

TOTAL $ 1,051,155.

STATEMENT 4SCHEDULE 1, LINE 10TAXABLE REFUNDS OF STATE AND LOCAL INCOME TAXES

1. STATE AND LOCAL TAX REFUNDS (PRIOR YEAR) $ 66,728.2. REFUNDS ATTRIBUTABLE TO POST 12/31/2017 PAYMENTS PER IRS PUB. 525 0.3. NET STATE AND LOCAL TAX REFUNDS 66,728.4. STATE AND LOCAL TAXES FROM PRIOR YEAR SCHEDULE A, LINE 5 529,493.5. PRIOR YEAR ALLOWABLE SALES TAX DEDUCTION 2,220.6. EXCESS OF INCOME TAXES DEDUCTED OVER SALES TAXES DEDUCTED 527,273.7. ENTER THE SMALLER OF LINE 3 OR LINE 6 66,728.8. REFUND WITH NO BENEFIT DUE TO AMT, NONREF. CRED., 0% CAP GAIN RATE -66,728.9. STATE AND LOCAL REFUNDS TAXABLE THIS YEAR $ 0.

STATE REFUNDS TAXABLE IN 2018 - RECOMPUTED TAX(TO DETERMINE IF TAX BENEFIT RECEIVED PER IRS PUB. 525-AMT/UNUSED CREDITS)


1. ACTUAL TAXABLE INCOME 3,601,558.2. ACTUAL REGULAR TAX 693,700.3. ACTUAL AMT 90,606.4. ACTUAL TOTAL TAX BEFORE CREDITS 784,306.5. LESS: ACTUAL CREDITS 749.



STATE REFUNDS TAXABLE IN 2018 - RECOMPUTED TAX (CONTINUED)(TO DETERMINE IF TAX BENEFIT RECEIVED PER IRS PUB. 525-AMT/UNUSED CREDITS)

6. ACTUAL TAX AFTER CREDITS 783,557.7. TAXABLE INCOME RECOMPUTED WITH SCH. A TAXES

REDUCED BY STATE TAX REFUNDS 3,668,286.8. RECOMPUTED REGULAR TAX 707,045.9. RECOMPUTED AMT 77,261.

10. RECOMPUTED TOTAL TAX BEFORE CREDITS 784,306.11. LESS: RECOMPUTED CREDITS 749.12. RECOMPUTED TAX AFTER CREDITS 783,557.13. DIFFERENCE BETWEEN ACTUAL AND RECOMPUTED TAX









INVESTMENT INTEREST FROM K-1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,425.MERRILL LYNCH-12828 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458.

TOTAL $ 22,883.


ACCESS DEMOCRACY EDUCATION FUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 250.DREAMS FOR ORPHANS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,227.HOME OF GUIDING HANDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 570.JEWISH FEDERATION OF SAN DIEGO COUNTY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180.NORTH COUNTY LGBTQ RESOURCE CENTER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,231.PLANNED PARENTHOOD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,500.SAN DIEGO FOOD BANK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250.

TOTAL $ 8,208.






ASSOCIATION DUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 52,320.GARDENING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160.PLUMBING AND ELECTRICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,250.

TOTAL $ 53,730.

STATEMENT 9SCHEDULE E, LINE 19 - 99 JANE ST APT 6LOTHER RENTAL AND ROYALTY EXPENSES

ASSOCIATION DUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 13,986.TOTAL $ 13,986.




NET FOREIGN SOURCE CAPITAL GAIN DISTRIBUTIONS. . . . . . . . . . . . . . . . 560.BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64,664.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59,805.SARA JOSEPHINE JACOBS IRREV TRUST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,293.

TOTAL $ 1,023,215.


BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,409.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 953.SARA JOSEPHINE JACOBS IRREV TRUST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169.

TOTAL $ 2,531.






NET FOREIGN SOURCE CAPITAL GAIN DISTRIBUTIONS. . . . . . . . . . . . . . . . 560.BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64,664.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59,805.SARA JOSEPHINE JACOBS IRREV TRUST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,293.

TOTAL $ 1,023,215.


BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,409.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 953.SARA JOSEPHINE JACOBS IRREV TRUST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169.

TOTAL $ 2,531.




BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 149,664 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 149,664 76,419



6 LAMP 1/01/16 734 734 285 200DB HY 7 .17490 128

7 STOOL 1/01/16 1,101 1,101 427 200DB HY 7 .17490 193

10 TV CABINETS 1/01/16 9,819 9,819 3,808 200DB HY 7 .17490 1,717




8 LIGHTING 1/01/16 13,857 13,857 5,374 200DB HY 7 .17490 2,424

9 DRAPES 1/01/16 3,512 3,512 1,362 200DB HY 7 .17490 614


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0










11 BUILDING 1/01/18 1,250,000 1,250,000 S/L MM 27.5 .03485 43,563

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 0 200DB HY 7 .14290 0

14 COUNTERTOPS 1/01/18 14,790 14,790 0 150DB HY 15 .05000 0

15 WINDOW TREATMENTS 1/01/18 22,834 22,834 0 150DB HY 15 .05000 0

16 FURNISHINGS 1/01/18 122,248 122,248 0 200DB HY 5 .20000 0

TOTAL 2,722,214 0 222,214 0 0 0 2,500,000 0 43,563

TOTAL DEPRECIATION 2,722,214 0 222,214 0 0 0 2,500,000 0 43,563

GRAND TOTAL DEPRECIATION 6,341,594 0 222,214 0 0 0 6,119,380 270,583 171,623





BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 149,664 S/L MM 27.5 .03636 76,419 76,419 0

TOTAL BUILDINGS 2,101,726 149,664 76,419 76,419 0 0 0 0


5 LUTRON WINDOW SHADES 1/01/16 58,316 17,402 150DB HY 7 .15030 8,765 10,199 1,434 0

6 LAMP 1/01/16 734 219 150DB HY 7 .15030 110 128 18 0

7 STOOL 1/01/16 1,101 329 150DB HY 7 .15030 165 193 28 0

10 TV CABINETS 1/01/16 9,819 2,930 150DB HY 7 .15030 1,476 1,717 241 0

TOTAL FURNITURE AND FIXTURE 69,970 20,880 10,516 12,237 1,721 0 0 0



8 LIGHTING 1/01/16 13,857 4,135 150DB HY 7 .15030 2,083 2,424 341 0

9 DRAPES 1/01/16 3,512 1,048 150DB HY 7 .15030 528 614 86 0


LAND____

2 LAND 1/01/16 900,740 0 0 0

TOTAL LAND 900,740 0 0 0 0 0 0 0





3 SECURITY SYSTEM 1/01/16 109,935 44,523 150DB HY 5 .17850 19,623 21,108 1,485 0

TOTAL MACHINERY AND EQUIPME 109,935 44,523 19,623 21,108 1,485 0 0 0

TOTAL DEPRECIATION 3,619,380 250,132 124,427 128,060 3,633 0 0


11 BUILDING 1/01/18 1,250,000 S/L MM 27.5 .03485 43,563 43,563 0

12 LAND 1/01/18 1,250,000 0 0 0

13 FLOORING 1/01/18 0 200DB HY 7 .14290 0 0 0

14 COUNTERTOPS 1/01/18 0 150DB HY 15 .05000 0 0 0

15 WINDOW TREATMENTS 1/01/18 0 150DB HY 15 .05000 0 0 0

16 FURNISHINGS 1/01/18 0 200DB HY 5 .20000 0 0 0

TOTAL 2,500,000 0 43,563 43,563 0 0 0 0

TOTAL DEPRECIATION 2,500,000 0 43,563 43,563 0 0 0 0




PAGE 2

2018 TAX RETURN

Client:

Prepared for:

Prepared by:

Date:

Comments:

Route to:

FDIL2001L 05/22/18


1178K3

SARA J. JACOBSC/O 2728 OCEANFRONT DEL MAR, CA 92014

OCTOBER 2, 2020

059


TAXABLE YEAR FORM






















I certify that the above numeric entry is my PIN, which is my signature for the 2018 California individual 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 FTB Pub.1345, 2018 Handbook for Authorized e-file Providers.




2,129,762.

X LARRY M. KATZ, CPA 11781

TAXABLE YEAR FORMCalifornia Resident2018 540Income Tax Return

A

R

RP

Filing If your California filing status is different from your federal filing status, check the box here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Status

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

2 Married/RDP filing jointly. See inst. Qualifying widow(er). See instructions. Enter year spouse/RDP died5

See instructions.

3 Married/RDP filing separately. Enter spouse's/RDP's SSN or ITIN above and full name here. . . . .

CAIA3912L 01/10/19 3101186 Form 540 2018 Side 1059

1

0

0

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***-**-**** JACO 18SARA J JACOBS

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31

4847

165805 5805F145870A

12 SCHG1

103803

093800

06

APE

01

APE

063

FN

040

26899072

TPID

DEL MAR CA 92014


DESIGNEE

0413

1

02-01-1989

0403

44

0117

043

IRC1341

0116

0401

0115

0400 3809

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075

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00286245 00000000000

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@6 6If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See instructions. .

Exemptions For line 7, line 8, line 9, and line 10: Multiply the amount you enter in the box by the pre-printed dollar amount for that line.GWhole dollars only

7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked box 2 or 5, enter 2, inx $118 = $7the box. If you checked the box on line 6, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > >x $118 = $8 8Blind: If you (or your spouse/RDP) are visually impaired, enter 1; if both are visually impaired, enter 2. > >x $118 = $9 9@ >Senior: If you (or your spouse/RDP) are 65 or older, enter 1; if both are 65 or older, enter 2. . . . . . . . .



First Name > > >

Last Name > > >

SSN @ @ @

Dependent's

relationship > > >to you

$10@Total dependent exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x $367 =>> $11 11Exemption amount: Add line 7 through line 10. Transfer this amount to line 32. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Taxable Income 12 12@State wages from your Form(s) W-2, box 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13 13Enter federal adjusted gross income from Form 1040, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

@14 14California adjustments ' subtractions. Enter the amount from Schedule CA (540), line 37, column B . . . . . . . . . .

15 15Subtract line 14 from line 13. If less than zero, enter the result in parentheses. See instructions. . . . . . . . . . . . . . . . .

@16 16California adjustments ' additions. Enter the amount from Schedule CA (540), line 37, column C. . . . . . . . . . . . .

@17 17California adjusted gross income. Combine line 15 and line 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the18 Your California itemized deductions from Schedule CA (540), Part II, line 30; ORlarger of Your California standard deduction shown below for your filing status:

$4,401@Single or Married/RDP filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$8,802@Married/RDP filing jointly, Head of household, or Qualifying widow(er). . . . . . . . .

If Married/RDP filing separately or the box on line 6 is checked, STOP. See instructions. . . . . . . 18@

19 19Subtract line 18 from line 17. This is your taxable income. If less than zero, enter -0-. . . . . . . . . . . . . . . . . . . . . >

Tax 31 Tax. Check the box if from: Tax Table Tax Rate Schedule

31@ @ @FTB 3803 . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTB 3800

Exemption credits. Enter the amount from line 11. If your federal AGI is more than $194,504,32see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32>

33 33Subtract line 32 from line 31. If less than zero, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

34 34@@ FTB 5870A. . . . . . . . . . . . . . @Tax. See instructions. Check the box if from: Schedule G-1

35 35Add line 33 and line 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

CAIA3912L 01/10/193102186Side 2 Form 540 2018 059


1 118.

118.

2,141.

2,129,756.

2,129,756.

6.

2,129,762.

26,403.

2,103,359.

243,934.

0.

243,934.

243,934.

X


@Special Credits 40 40Nonrefundable Child and Dependent Care Expenses Credit. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43 43@code @ and amount. . . . . . . . . . . . . . . . . . . . . . . Enter credit name

44 44@code @ and amount. . . . . . . . . . . . . . . . . . . . . . . Enter credit name

45 45@To claim more than two credits, see instructions. Attach Schedule P (540). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

46 46@Nonrefundable renter's credit. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

47 47Add line 40 through line 46. These are your total credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

Subtract line 47 from line 35. If less than zero, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 48>

Alternative minimum tax. Attach Schedule P (540) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Taxes 61 61@

62 62@Mental Health Services Tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@63 63Other taxes and credit recapture. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

64 64@Add line 48, line 61, line 62, and line 63. This is your total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Payments 71 71@California income tax withheld. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

72 72@2018 CA estimated tax and other payments. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

73 73@Withholding (Form 592-B and/or 593). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

74 74@Excess SDI (or VPDI) withheld. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 75@Earned Income Tax Credit (EITC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

76 Add lines 71 through 75. These are your total payments.

76See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

Use Tax 91 91@Use Tax. Do not leave blank. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . .

If line 91 is zero, check if: No use tax is owed.

You paid your use tax obligation directly to CDTFA.

Overpaid Tax/ 92 92Payments balance. If line 76 is more than line 91, subtract line 91 from line 76. . . . . . . . . . . . . . . . . . . . . . . . . . >Tax Due

93 93Use Tax balance. If line 91 is more than line 76, subtract line 76 from line 91 . . . . . . . . . . . . . . . . . . . . . . . . . . >

94 94Overpaid tax. If line 92 is more than line 64, subtract line 64 from line 92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

95 95@Amount of line 94 you want applied to your 2019 estimated tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@96 96Overpaid tax available this year. Subtract line 95 from line 94. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

97 97Tax due. If line 92 is less than line 64, subtract line 92 from line 64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

CAIA3912L 01/10/19 3103186 Form 540 2018 Side 3059


14,034.

14,017.

17.

243,934.

11,034.

254,968.

12.

268,990.

0.

269,002.

0.

269,002.

X


Code AmountContributions

400@California Seniors Special Fund. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

401@Alzheimer's Disease and Related Dementia Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

403@Rare and Endangered Species Preservation Voluntary Tax Contribution Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

405@California Breast Cancer Research Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

406@California Firefighters' Memorial Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

407@Emergency Food for Families Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

408@California Peace Officer Memorial Foundation Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

410@California Sea Otter Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

413@California Cancer Research Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

422@School Supplies for Homeless Children Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

423@State Parks Protection Fund/Parks Pass Purchase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

424@Protect Our Coast and Oceans Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

425@Keep Arts in Schools Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

430@State Children's Trust Fund for the Prevention of Child Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

431@Prevention of Animal Homelessness and Cruelty Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

432@Revive the Salton Sea Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

433@California Domestic Violence Victims Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

434@Special Olympics Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

435@Type 1 Diabetes Research Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

436@California YMCA Youth and Government Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

437@Habitat for Humanity Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

438@California Senior Citizen Advocacy Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

439@Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

440@Rape Backlog Kit Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

441@Organ and Tissue Donor Registry Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

442@National Alliance on Mental Illness California Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

443@Schools Not Prisons Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

110 110@Add code 400 through code 443. This is your total contribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CAIA3912L 01/10/193104186Side 4 Form 540 2018 059



111Amount AMOUNT YOU OWE. If you do not have an amount on line 96, add line 93, line 97, and line 110. See instructions. Do not send cash.You Owe Mail to: FRANCHISE TAX BOARD

PO BOX 942867

SACRAMENTO CA 94267-0001. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111@

Pay online ' Go to ftb.ca.gov/pay for more information.

112 112Interest, late return penalties, and late payment penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interest andPenalties

113 113@ @ @FTB 5805F attached. . . . . . Underpayment of estimated tax. Check the box: FTB 5805 attached

114 114Total amount due. See instructions. Enclose, but do not staple, any payment. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

115 REFUND OR NO AMOUNT DUE. Subtract the sum of line 110, line 112 and line 113 from line 96. See instructions.Refund andDirect Deposit

Mail to: FRANCHISE TAX BOARD

PO BOX 942840

115@SACRAMENTO CA 94240-0001. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip. See instructions.

Have you verified the routing and account numbers? Use whole dollars only.

All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:

@Type

@@Routing number @Account numberChecking Direct deposit amount116

Savings


@Type

@@Routing number @Account numberChecking Direct deposit amount117

Savings

IMPORTANT: See the instructions to find out if you should attach a copy of your complete federal tax return.

To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to ftb.ca.gov/forms and search for

1131. To request this notice by mail, call 800.852.5711. Under penalties of perjury, I declare that I have examined this tax return, including accompanying

schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.

Your signature Date Spouse's/RDP's signature (if a joint tax return, both must sign)

Your email address. Enter only one email address. Preferred phone number> >SignHere

Paid preparer's signature (declaration of preparer is based on all information of which preparer has any knowledge)It is unlawfulto forge aspouse's/ @PTINFirm's name (or yours, if self-employed)RDP'ssignature.

Joint tax @FEINFirm's addressreturn? (Seeinstructions)

@ @Do you want to allow another person to discuss this tax return with us? See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Print Third Party Designee's Name Telephone Number

CAIA3912L 01/10/19 3105186 Form 540 2018 Side 5059


X 17.

0.

LARRY M. KATZ, CPA

3070 RACETRACK VIEW DR.DEL MAR, CA 92014

X

LARRY M KATZ CPA 858-461-0115


2018 CA (540)California Adjustments ' ResidentsImportant: Attach this schedule behind Form 540, Side 5 as a supporting California schedule.Name(s) as shown on tax return SSN or ITIN

A B CSubtractions AdditionsPart I Income Adjustment Schedule Federal AmountsSee instructions See instructions(taxable amounts fromSection A ' Income

your federal tax return)from federal form 1040

Wages, salaries, tips, etc. See instructions before making an11entry in column B or C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > >>

. . . . . . . . . . . . . . . . . 2 (a) 2bTaxable interest > > >>3 3b(a)Ordinary dividends. See instructions. > > >>4 (a) 4b >>IRAs, pensions, and annuities. See instructions. >>5 (a) 5bSocial security benefits. . . . . . . . . . . . . . >>>

Section B ' Additional Incomefrom federal Schedule 1 (Form 1040)

10 10 >>Taxable refunds, credits, or offsets of state and local income taxes. . . . . . . . . . . .

11 11Alimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >>12 12Business income or (loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >> >13 13 >>Capital gain or (loss). See instructions. . . . . . . . . . . . . . . . . . . . . . . . . >14 14Other gains or (losses) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >> >15a 15aReserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16a 16bReserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17 17 >> >Rental real estate, royalties, partnerships, S corporations, trusts, etc. . . . . . . . . . .

18 18Farm income or (loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >> >19 19Unemployment compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >>20a 20aReserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

aa21 Other income. >a California lottery winnings bbe >NOL from FTB 3805Z, 3806,

3807, or 3809b Disaster loss deduction from FTB 3805V c21 c >>c f Other (describe): dd >Federal NOL (federal Schedule 1

(Form 1040), line 21) ee> >d NOL deduction from FTB 3805V ff > >

22 Total. Combine line 1 through line 21 in column A. Add line 1> >>22through line 21f in column B and column C. Go to Section C. . . .

Section C ' Adjustments to Incomefrom federal Schedule 1 (Form 1040)

23 23Educator expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >>24 Certain business expenses of reservists, performing artists,

24and fee-basis government officials . . . . . . . . . . . . . . . . . . . . . . . . . . . . > >>25 25Health savings account deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >>

26Moving expenses. Attach federal Form 3903. See instructions. . . 26 >>27 27Deductible part of self-employment tax . . . . . . . . . . . . . . . . . . . . . . . . >28 28Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . >29 29Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . >

30Penalty on early withdrawal of savings. . . . . . . . . . . . . . . . . . . . . . . . . 30 >Alimony paid.31a

b >Recipient's: SSN

Last name 31a> >>32 32IRA deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >33 33Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >>34 34Tuition and fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

35 35Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add line 23 through line 31a and line 32 through line 35 in columns A, B, and C.36

>>36 >See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total. Subtract line 36 from line 22 in columns A, B, and C.3737See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > >>

CAIA4012L 03/11/20 Schedule CA (540) 2018 Side 17731184059


2,141.8,096.

1,064,446. 6.

1,055,032.

41.

2,129,756. 6.

2,129,756. 6.

1,051,155.

Part II Adjustments to Federal Itemized Deductions A B CSubtractions AdditionsFederal Amounts(from federal Schedule See instructions See instructions>Check the box if you did NOT itemize for federal but will itemize for California . . . . A (Form 1040))

Medical and Dental Expenses

>1 1Medical and dental expenses

2 2>Enter amount from federal Form 1040, line 7

3 3>Multiply line 2 by 7.5% (0.075)

4 4bSubtract line 3 from line 1. If line 3 is more than line 1, enter 0 . . >Taxes You Paid

5a 5aState and local income tax or general sales taxes. . . . . . . . . . . . . . . >>5b 5bState and local real estate taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >5c 5cState and local personal property taxes. . . . . . . . . . . . . . . . . . . . . . . . . >5d 5dAdd lines 5a through 5c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

Enter the smaller of line 5d or $10,000 ($5,000 if married filing separately) in. . . . . 5e 5e >column A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

>Enter the amount from line 5a, column B in line 5e, column B . . . . . . . . . . . . . . . .

Enter the difference from line 5d and line 5e, column A in line 5e, column C. . . . . . >6 6Other taxes. List type . . . . . . . > > >7 7Add lines 5e and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > > >Interest You Paid

8a 8aHome mortgage interest and points reported to you on Form 1098. . . . . . . . . . . . . . > >8b 8bHome mortgage interest not reported to you on Form 1098 . . . . . . . . . . . . . . . . . . . >>

8c8c Points not reported to you on Form 1098. . . . . . . . . . . . . . . . . . . . . . . . >>8d 8dMortgage insurance premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8e 8eAdd lines 8a through 8d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > >9 9Investment interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > > >10 10Add lines 8e and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >>>Gifts to Charity

11 11Gifts by cash or check. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > > >12 12Other than by cash or check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > > >13 13Carryover from prior year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > > >14 14Add lines 11 through 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > > >Casualty and Theft Losses

15 Casualty or theft loss(es) (other than net qualified disaster losses). Attach federal > >15 >Form 4684. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other Itemized Deductions

16 16Other'from list in federal instructions . . . . . . . . . . . . . . . . . . . . . . . . . . >> >17 17Add lines 4, 7, 10, 14, 15, and 16 in columns A, B, and C. . . . . . . . > > >

18 18>Total Adjustments to Federal Itemized Deductions. Combine line 17 column A less column B plus column C. . . . . . . . . . . . .

CAIA4012L 03/11/20Side 2 Schedule CA (540) 2018 (REV 02-20) 7732184059


109,023. 109,023.

109,023.10,000.

109,023.99,023.

10,000. 109,023. 99,023.

22,883.22,883.

8,208.

8,208.

41,091. 109,023. 99,023.

31,091.

Job Expenses and Certain Miscellaneous Deductions

19 Unreimbursed employee expenses - job travel, union dues, job education, etc.19>Attach federal Form 2106 if required. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20 20Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >21 Other expenses - investment,

21safe deposit box, etc. List type > . . . . . . . . . . . . . >22 22Add lines 19 through 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >23 >Enter amount from federal Form 1040, line 7

24 24Multiply line 23 by 2% (0.02). If less than zero, enter 0 . . . . . . . . . . . . . . . . . . . >

>25 25Subtract line 24 from line 22. If line 24 is more than line 22, enter 0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26 26Total Itemized Deductions. Add line 18 and line 25. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

27 Other adjustments. See instructions.

27Specify. > >

28Combine line 26 and line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 >29 Is your federal AGI (Form 540, line 13) more than the amount shown below for your filing status?

$194,504Single or married/RDP filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$291,760Head of household. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$389,013Married/RDP filing jointly or qualifying widow(er). . . . . . . . . . . . . . . . . . . .

No. Transfer the amount on line 28 to line 29.

29Yes. Complete the Itemized Deductions Worksheet in the instructions for Schedule CA (540), line 29 . . . . . . . . . >

30 Enter the larger of the amount on line 29 or your standard deduction listed below

$4,401Single or married/RDP filing separately. See instructions. . . . . . . . . . . . . .

$8,802Married/RDP filing jointly, head of household, or qualifying widow(er). . .

Transfer the amount on line 30 to Form 540, line 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30>

CAIA4012L 04/16/19 Schedule CA (540) 2018 Side 37733184059

26,403.

26,403.

40,485.

40,485.

9,394.

42,595.2,129,756.

51,989.51,989.


REDUCTION -14,082.

SEE STATEMENT 1

TAXABLE YEAR CALIFORNIA SCHEDULEAlternative Minimum Tax andCredit Limitations ' Residents2018 P (540)

Attach this schedule to Form 540.Name(s) as shown on Form 540 Your SSN or ITIN

Alternative Minimum Taxable Income (AMTI) Important: See instructions for information regarding California/federal differences.Part I

1 If you itemized deductions, go to line 2. If you did not itemize deductions, enter your standard deduction1from Form 540, line 18, and go to line 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2Medical and dental expense. Enter the smaller of Schedule A (Form 1040), line 4, or 2-1/2% (.025) of Form 1040, line 7. . . . . . . . . . . . . . 2 >33 Personal property taxes and real property taxes. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

4 Certain interest on a home mortgage not used to buy, build, or improve your home. See instructions. . . . . . . . 4>55 Miscellaneous itemized deductions. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >66 Refund of personal property taxes and real property taxes. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

Do not include your state income tax refund on this line.

77 Investment interest expense adjustment. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >88 Post-1986 depreciation. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >99 Adjusted gain or loss. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

1010 Incentive stock options and California qualified stock options (CQSOs). See instructions. . . . . . . . . . . . . . . . . . . . >1111 Passive activities adjustment. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >1212 Beneficiaries of estates and trusts. Enter the amount from Schedule K-1 (541), line 12a. . . . . . . . . . . . . . . . . . . . >

13 Other adjustment and preferences. Enter the amount, if any, for each item, a through l, and enter the total on line 13. See instructions.

a gCirculation expenditures. . . Mining costs. . . . . . . . . . . . . . . > >b hDepletion. . . . . . . . . . . . . . . . . Patron's adjustment. . . . . . . . > >

ic Installment sales. . . . . . . . . . Pollution control facilities. . . >>d jIntangible drilling costs. . . . Research and experimental.> >e kLong-term contracts. . . . . . . Tax shelter farm activities. . > >f lLoss limitations. . . . . . . . . . . Related adjustments . . . . . . . >>

13>1414 Total Adjustments and Preferences. Combine line 1 through line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >1515 Enter taxable income from Form 540, line 19. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >16Net operating loss (NOL) deductions from Schedule CA (540), Part I, line 21b, line 21d, and line 21e, column B. Enter as a positive amount16 >1717 AMTI exclusion. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

18 If your federal adjusted gross income (AGI) is less than the amount for your filing status (listed below), skipthis line and go to line 19. If you itemized deductions and your federal AGI is more than the amount for your

18filing status, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >Single or married/RDP filing separately. . . . . . . . . . . . . . . . . $194,504

Married/RDP filing jointly or qualifying widow(er) . . . . . . . . $389,013

Head of household . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $291,760

1919 Combine line 14 through line 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >2020 Alternative minimum tax NOL deduction. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

21 Alternative Minimum Taxable Income. Subtract line 20 from line 19 (if married/RDP filing separately andline 21 is more than $369,562, see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21>

Alternative Minimum Tax (AMT)Part II22 Exemption Amount. (If this schedule is for a certain child under age 24, see instructions.)

If your filing status is: And line 21 is not over: Enter on line 22:

$268,237 $71,531Single or head of household$357,650 $95,373Married/RDP filing jointly or qualifying widow(er) 22>$178,822 $47,685Married/RDP filing separately

If Part I, line 21 is more than the amount shown above for your filing status, see instructions.

2323 Subtract line 22 from line 21. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24>24 Tentative Minimum Tax. Multiply line 23 by 7.0% (.07). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2525 Regular tax before credits from Form 540, line 31. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >26 Alternative Minimum Tax. Subtract line 25 from line 24. If zero or less, enter -0- here and on

Form 540, line 61. If more than zero, enter here and on Form 540, line 61. If you make estimatedtax payments for taxable year 2019, enter amount from line 26 on the 2019 Form 540-ES, EstimatedTax Worksheet, line 16. (Exception: If you have carryover credit for solar energy or commercial

26solar energy, first enter the result on Side 2, Part III, Section C, line 22 or 23). . . . . . . . . . . . . . . . . . . . . . . . . . . . >

CAIA4212L 12/06/18

7971184For Privacy Notice, get FTB 1131 ENG/SP. Schedule P (540) 2018 Side 1059


0.

9,394.

35.

9,429.2,103,359.

-13,539.

-14,082.

2,085,167.

2,085,167.

0.

2,085,167.145,962.243,934.

0.

Part III Credits that Reduce Tax Note: Be sure to attach your credit forms to Form 540.

11 Enter the amount from Form 540, line 35. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >22 Enter the tentative minimum tax from Side 1, Part II, line 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

(c)(a) (b) (d)Tax balance that mayCredit amount Credit used this year Credit carryover

Section A ' Credits that reduce excess tax. be offset by credits

Subtract line 2 from line 1. If zero or less enter -0- and see instructions.33This is your excess tax which may be offset by credits. . . . . . . . . . . . >

Credits that reduce excess tax and have noA1carryover provisions.

>44 Code: 162 Prison inmate labor credit (FTB 3507). . . . . . 5 Code: 232 Child and dependent care expenses credit >5(FTB 3506) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Credits that reduce excess tax and have carryover provisions. SeeA2instructions.

Credit Name:Code:6 6> > >Credit Name:Code:7 7 >> >Credit Name:Code:8 8 >> >Credit Name:Code:9 9> > >

Code: 188 Credit for prior year alternative minimum tax. . . . . . . . . . . 10 10 >>>Section B ' Credits that may reduce tax below tentative minimum tax.

If Part III, line 3 is zero, enter the amount from line 1. If line 3 is more than11zero, enter the total of line 2 and the last entry in column (c). . . . . . . 11 >

B1 Credits that reduce net tax and have nocarryover provisions.

1212 Code: 170 Credit for joint custody head of household. . >13 Code: 173 Credit for dependent parent . . . . . . . . . . . . . . . 13 >

1414 Code: 163 Credit for senior head of household. . . . . . . . >15 15Nonrefundable renter's credit . . . . . . . . . . . . . . . . . . . . . . . . >B2 Credits that reduce net tax and have

carryover provisions. See instructions.

Credit Name:Code:16 16> >>Credit Name:Code:17 17> >>Credit Name:Code:18 18> > >Credit Name:Code:19 19> >>

B3 Other state tax credit.

20 Code: 187 Other state tax credit . . . . . . . . . . . . . . . . . . . . . 20 >Section C ' Credits that may reduce alternative minimum tax.

Enter your alternative minimum tax from Side 1, Part II, line 26. . . . . 21 21 >>>Code: 180 Solar energy credit carryover from Section B2, column (d). 22 22

23 Code: 181 Commercial solar energy credit carryover>23from Section B2, column (d). . . . . . . . . . . . . . . . . . . . . . . . . >

24 Adjusted AMT. Enter the balance from line 23,column (c) here and on Form 540, line 61 . . . . . . . . . . . . >24

7972184 CAIA4212L 12/06/18Side 2 Schedule P (540) 2018 059


243,934.145,962.

97,972.

243,934.


2018 Investment Interest Expense Deduction 3526Attach to Form 540, Long Form 540NR, or Form 541.Name(s) as shown on tax return SSN, ITIN, or FEIN

1 1Investment interest expense paid or accrued in 2018. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >2 2Disallowed investment interest expense from 2017 form FTB 3526, line 7. If zero or less, enter -0-. . . . . . . . . . >3 3Total investment interest expense. Add line 1 and line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 a Gross income from property held for investment (excluding any net gain from the disposition of4 aproperty held for investment). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 b 4 bNet gain from the disposition of property held for investment. See instructions. . . .

4 c Net capital gain from the disposition of property held for investment.4 cSee instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 d 4 dSubtract line 4c from line 4b. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 e Enter all or part of the amount on line 4c that you elect to include in investment income. Do not include4 emore than the amount on line 4b. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 f 4 fInvestment income. Add line 4a, line 4d, and line 4e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 5Investment expenses. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 6Net investment income. Subtract line 5 from line 4f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 Disallowed investment interest expense to be carried forward to 2019. Subtract line 6 from line 3.7If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

8 Investment interest expense deduction. Enter the smaller of line 3 or line 6. Form 541 filers, stop here8and see instructions. All other filers, go to line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

9 9Enter the amount from federal Form 4952, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 California investment interest expense deduction adjustment. Enter the difference between line 8 and line 9.10See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >


SARA J. JACOBS ***-**-****22,883.

0.22,883.

1,072,548.1,055,032.

1,055,032.0.

1,055,032.2,127,580.

9,394.2,118,186.

0.

22,883.22,883.


2018 Passive Activity Loss Limitations 3801Attach to Form 540, Long Form 540NR, Form 541, or Form 100S (S Corporations).Name(s) as shown on tax return SSN, ITIN, FEIN, or CA corporation no.

Part I 2018 Passive Activity LossSee the instructions for Worksheet 1 and Worksheet 3 for federal Form 8582 before completing Part I.Be sure to use California amounts.











3 Combine line 1d and line 2d. If the result is net income or zero, see the instructions for line 3. If line 3and line 1d are losses, go to line 4. Otherwise, enter -0- on line 9 and go to line 10. See instructions . . . . . . . 3

Part II Special Allowance for Rental Real Estate with Active ParticipationEnter all numbers in Part II as positive amounts. See instructions.

44 Enter the smaller of losses from line 1d or line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Enter $150,000. If married/RDP filing a separate tax return, see instructions. . . . 5

6 Enter federal modified adjusted gross income, but not less than zero.See instructions. If line 6 is equal to or more than line 5, skip line 7 andline 8, enter -0- on line 9, and then go to line 10. Otherwise, go to line 7 . . . . . . . 6

7 Subtract line 6 from line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

88 Multiply line 7 by 50% (.50). Do not enter more than $25,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

99 Enter the smaller of line 4 or line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >Part III Total Losses Allowed

10 Add the income, if any, from line 1a and line 2a and enter the total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Total losses allowed from all passive activities for 2018. Add line 9 and line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

See the instructions on Page 2 to find out how to report the losses on your tax return. CAIZ0601L 11/28/18



-138,731.

-186,511.

-325,242.

-2.

-34,826.

-34,828.

-360,070.

325,242.

150,000.

2,129,756.

0.

SEE STATEMENT 2 SEE STATEMENT 3








3









mm/dd/yyyy

9









X

SCHEDULE E (RENTAL)

128,060.128,060.128,060.

REPORTED ON FORM3801








3









mm/dd/yyyy

9









X

SCHEDULE E (RENTAL) #2

BUILDING 1/01/2018 1,250,000. S/L 27.5000 43,563.LAND 1/01/2018 1,250,000. 0 0.FLOORING 1/01/2018 62,342. 200DB 7.00000 8,909.COUNTERTOPS 1/01/2018 14,790. 150DB 15.0000 740.WINDOW TREATMENTS 1/01/2018 22,834. 150DB 15.0000 1,142.FURNISHINGS 1/01/2018 122,248. 200DB 5.00000 24,450.

78,804.

78,804.265,777.

REPORTED ON FORM3801 186,973.



STATEMENT 1SCHEDULE CA, PART II, LINE 21MISCELLANEOUS DEDUCTIONS SUBJECT TO 2% AGI LIMIT

INVESTMENT EXPENSE $ 51,989.TOTAL $ 51,989.



RESIDENTIAL RENTAL-DC SCHEDULE E -69,659. -69,659.RESIDENTIAL RENTAL-NY SCHEDULE E FRM 3885A -256,045. 186,973. -69,072.CLEARFORK CAPITAL FUND LLC SCHEDULE E -2. -2.

TOTAL $-325706. $186,973. $-138,733.

STATEMENT 3FORM 3801 WORKSHEETSCALIFORNIA ADJUSTMENT WORKSHEETS

PASSIVE OR CALIFORNIA FEDERAL CALIFORNIASCHEDULE E ACTIVITIES NONPASSIVE AMOUNT AMOUNT ADJUSTMENT

SARA JOSEPHINE JACOBS IRREV PASSIVE $ 41. $ 41. $ 0.TOTAL $ 41. $ 41. $ 0.


Attach this form to the back of your Form 540, Long Form 540NR, or Form 541. Also, check the box for underpayment of estimated tax locatedon Form 540, line 113; Long Form 540NR, line 123; or Form 541, line 44, whichever applies.








Are you requesting a waiver of the penalty? If "Yes," provide an explanation below and be sure to check the box on1Form 540, line 113; Long Form 540NR, line 123; or Form 541, line 44. If you need additional space, attacha statement. See General Information C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >1 Yes No

Did you use the annualized income installment method? If "Yes," see instructions for Part III and be sure to22check the box on Form 540, line 113; Long Form 540NR, line 123; or Form 541, line 44 . . . . . . . . . . . . . . . . . . . . . . . . . Yes No>

Was your California withholding not withheld in equal installments and are you able to show the actual amounts3withheld per period and the actual dates withheld?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No3 >If "Yes," enter the actual uneven amounts withheld on the spaces provided below. The total of the four amounts

N/Amust equal the total withholding reported on Form 540, line 71 and line 73; Form 540NR, line 81 and line 83; orForm 541, line 29 and line 31.

$ $ .$ $4/15/18 ; 6/15/18 ; 9/15/18 ; 1/15/19 >> > >For estates and trusts: Was the date of death less than two years from the end of the taxable year? See General4

NoYes4 >Information E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7671184 FTB 5805 2018 Side 1For Privacy Notice, get FTB 1131 ENG/SP. 059CAIZ6112L 10/01/18


X

X

X


11 Current year tax. Enter your 2018 tax after credits. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22 Multiply line 1 by 90% (.90). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




52018, more than $75,000). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Short Method


77 Enter the amount, if any, from Part II, line 3 above. . . . . . . . . . . . . . . . . . . . . . . . . . . .

88 Enter the total amount, if any, of estimated tax payments you made. . . . . . . . . . . .

99 Add line 7 and line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Total underpayment for the year. Subtract line 9 from line 6. If zero or less, stop here. You do not owe thepenalty. Do not file form FTB 5805. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

1111 Multiply line 10 by .03103836. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Amount on Number of days paidX X 12.00014. . . . . . . . . . . . . . . . . . line 10 before 4/15/19

PENALTY. Subtract line 12 from line 11. Enter the result here and on Form 540, line 113; Long Form 540NR, line 123; or1313Form 541, line 44. Also, check the box for "FTB 5805."A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

7672184 CAIZ6112L 10/1/18Side 2 FTB 5805 2018 059


254,968.229,471.

12.

254,956.

229,471.

229,471.

17.


Use this schedule ONLY if you earned taxable income at an UNEVEN RATE during 2018 (See Example A). If you earned your income atapproximately the same rate each month (See Example B), then you should not complete this schedule. If you choose to figure the penalty,see Worksheet II, Regular Method to Figure Your Underpayment and Penalty, in the instructions.



To complete this schedule correctly, you must first complete Side 2, Part II,(a) (b) (c) (d)

line 1 through line 6. Estates and trusts, do not use the period ending1/1/18 to 1/1/18 to 1/1/18 to 1/1/18 todates shown to the right. Instead, use the following: 2/28/18, 4/30/18,3/31/18 5/31/18 8/31/18 12/31/18


1 Enter your California adjusted gross income (AGI) for eachperiod. Long Form 540NR filers, see instructions. Estates orTrusts, enter the amount from Form 541, line 20 attributable

1to each period. See instructions . . . . . . . . . . . . . . . . . . . . . .






7 Enter your standard deduction from your 2018 Form 540, orLong Form 540NR, line 18. Enter the total standard deduction




10 Figure the tax on the amount in each column of line 9 usingthe tax table or the tax rate schedule in the instructions forForm 540, Long Form 540NR, or Form 541. Also, include any


Enter the total amount of exemption credits from your 201811Form 540, line 32 or Form 541, line 22. If you filed a Long


Subtract line 11 from line 10. Long Form 540NR filers,1212complete Worksheet I in the instructions. . . . . . . . . . . . . . . .

Enter the total credit amount from your 2018 Form 540, line131347; or Form 541, line 23. Long Form 540NR filers, see inst. . .



c 14cAdd line 14a and line 14b. . . . . . . . . . . . . . . . . . . . . . . . .

Enter the excess SDI from Form 540, line 74 or Long Formd14d540NR, line 84 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e 14eSubtract line 14d from line 14c. If zero or less, enter -0- . .








21Add line 19 and line 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21




7673184CAIZ6112L 10/01/18 FTB 5805 2018 Side 3059


269,072. 455,161. 747,820. 2,129,762.

1,076,288. 1,092,386. 1,121,730. 2,129,762.

10,121. 16,869. 26,990. 40,485.

26,404. 26,404. 26,403. 26,403.

4,401. 4,401. 4,401. 4,401.26,404. 26,404. 26,403. 26,403.

1,049,884. 1,065,982. 1,095,327. 2,103,359.

114,357. 116,337. 119,946. 243,934.

0. 0. 0. 0.

114,357. 116,337. 119,946. 243,934.

114,357. 116,337. 119,946. 243,934.

11,034. 11,034. 11,034. 11,034.125,391. 127,371. 130,980. 254,968.

125,391. 127,371. 130,980. 254,968.

33,856. 80,244. 82,517. 229,471.

33,856. 80,244. 82,517.33,856. 46,388. 2,273. 146,954.

68,841. 91,788. 68,842.34,985. 80,385. 78,112.

68,841. 126,773. 80,385. 146,954.34,985. 80,385. 78,112. 0.

33,856. 46,388. 2,273. 146,954.


Payment Due Dates



2 Estimated tax paid and tax withheld.See instructions. For column (a) only,also enter the amount from line 2 online 6. (If line 2 is equal to or morethan line 1 for all payment periods,stop here; you do not owe the penalty.Do not file form FTB 5805 unless you

2answer 'Yes' to a question in Part I). . . .


3 Enter amount, if any, from line 9 of3previous column . . . . . . . . . . . . . . . . . . . . . .

44 Add line 2 and line 3. . . . . . . . . . . . . . . . . .

5 Add amounts on line 7 and line 8 of5the previous column. . . . . . . . . . . . . . . . . . .

6 Subtract line 5 from line 4. If zero orless, enter -0-. For column (a) only,

6enter the amount from line 2. . . . . . . . . . .


7enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 Underpayment. If line 1 is equal to ormore than line 6, subtract line 6 fromline 1. Then go to line 3 of next

8column. Otherwise, go to line 9. . . . . . . . G

9 Overpayment. If line 6 is more thanline 1, subtract line 1 from line 6. Then

9go to line 3 of next column . . . . . . . . . . . .

Complete line 10 and line 11 of one column before going to the next column.Part II Figure the Penalty.Rate Period 1:

April 15, 2018 'December 31, 2018 4/15/18 6/15/18 9/15/18 1/15/19

10 Number of days from the date shown Days: Days: Days:above line 10 to the date the amounton line 8 was paid or 4/15/19,

10whichever is earlier . . . . . . . . . . . . . . . . . . .

Number of11 Underpayment days onon line 8 x x .04line 10(see instructions)365 $ $ $11G

Rate Period 2:

January 1, 2019 'April 15, 2019 1/1/19 1/1/19 1/1/19 1/15/19

12 Number of days from the date shown Days: Days: Days: Days:above line 10 to the date the amounton line 8 was paid or 4/15/19,


Number of13 Underpayment days onon line 8 x x .05line 12(see instructions)

365 $ $ $ $13G

14 PENALTY. Add amounts on line 11 and line 13 in all columns. Enter the total here, on form

FTB 5805, Side 2, Part II, line 13, and on Form 540, line 113; Long Form 540NR, line 123;

$14or Form 541, line 44, and check the box on that line. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

FTB 5805 Schedule B 2018 CAIZ6103L 08/22/18


33,856. 46,388. 2,273. 146,954.

48,994. 60,005. 3.

15,138. 28,755. 26,482.75,143. 28,755. 26,485.

48,994. 75,143. 28,755. 26,485.

0. 0.

120,469.

15,138. 28,755. 26,482.

1

16.50

17.




= Overpayment1* ** Days LateUnderpayment x x Rate= Withholding2 365


FDIL1601L 05/22/18



FIRST QTR33,856. 4/15/18 1 18,990. 14,866.

4/15/18 2 4. 14,862.4/15/18 3 14,862.

SECOND QTR46,388. 6/15/18 3 15,138. 31,250.

6/15/18 2 5. 31,245.6/15/18 3 31,245.

THIRD QTR2,273. 9/15/18 3 2,273.

FOURTH QTR146,954. 9/15/18 3 26,482. 120,472.

1/15/19 2 3. 120,469. 1 0.050 16.501/16/19 3 120,469.

TOTAL 16.50

17.

2018 UBT WORKSHEETS PAGE 1

RESIDENTIAL RENTAL ***-**-****

MINIMUM TAX LIABILITY GROSS RECEIPTS WORKSHEET

1. AMOUNT FROM NUMERATOR OF DC SALES APPORTIONMENT FACTOR FROMSCHEDULE F, LINE 1, COLUMN 2 OF FORM D-30 179,000.

2. ADD THE ADJUSTED BASIS OF PROPERTY (LESS DEPRECIATION) FORWHICH GAINS ARE REPORTED IN LINE 1 0.

3. ADD NON-BUSINESS INCOME ALLOCTED TO DC REPORTEDPER FORM D-30, LINE 30 0.

4. TOTAL GROSS RECEIPTS (ADD LINES 1, 2, AND 3) 179,000.



*180303S11032*


VENDOR ID# 1032SSN In DC Outside DC

Registered Business Name Tax period ending (MMYY)

Mark if: Amended Return

Final ReturnBusiness Mailing address line # 1

Combined Report*

*You must fill in the Designated Agent info belowBusiness Mailing address line # 2

Worldwide**

**Worldwide form must be filed with this returnCity State Zipcode

Designated Agent Name Designated Agent TIN

Enter dollar amounts only. If amount is zero, leave line blank.if minus, enter amount and mark X in oval.





Mark if minusNet capital gain (attach a copy of your federal Schedule D). . . . . . . . . . . . . . 8 a .008a$Mark if minusb 8b .00Ordinary gain (loss) from Part II, federal Form 4797 (attach copy). . . . . . . . . . . . . . . . . $

9 .00$Mark if minus9 Other income (attach detailed statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark if minusTotal gross income Add Lines 3-9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10 .00$IF LINE 10 IS $12,000 OR LESS, STOP HERE, YOU ARE NOT REQUIRED TO FILE THIS RETURN.





a Interest payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 .00b Minus nondeductible payments to related entities. . . . . . . = 17c$.00 .00


20 $Depreciation (attach copy of your Federal Form 4562. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 .00Do not include any additional IRC 179 expenses or IRC 168(k) depreciation.)


Rev. 10/18 DCIZ3112L 11/01/18

********* 1 0X


CO 2728 OCEANFRONT

DEL MAR CA 92014

179000

179000

109

22676

2495224952

128060

72862248659

SEE STMT 1

Taxpayer Name:

*180303S21032*


23Mark if minus $ .0023 Net income Line 10 minus Line 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Net operating loss deduction for years before 2000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2424 $ .00

Mark if minusNet income after NOL deduction. Line 23 minus Line 24. . . . . . . . . . . . . . . . . . . . 25 25 .00$

26a 26 aMark if minusNon-business income/state adjustment (attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . $ .0026 bb Minus: Related expenses (attach an allocation statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00$26 cSubtract Line 26(b) from Line 26(a).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00$c Mark if minus

27 .00Mark if minus $27 Net income from trade or business subject to apportionment Line 25 minus Line 26c. . . . . .

28 DC apportionment factor From Form D-30 Schedule F, Col 3, Line 2. . . . . . . . . . . . . . . . . . . 28


Mark if minus .0029 29 $Net income from trade or business apportioned to DC . . . . . . . . . . . . . . . . .

Multiply Line 27 by the factor on Line 28.

30 30Other income/deductions attributable to DC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00Mark if minus $(attach statement)

31 Mark if minusTotal DC net income (loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 .00$Combine Lines 29 and 30

3232 Salary for owner(s) or member(s) services From Form D-30 Schedule J, Column 4. . . . . .00$33 33a 33Exemption: Maximum amount $5000 Must enter days in DC > .00$


Mark if minusTotal taxable income before apportioned NOL deduction. . . . . . . . . . . . . . . 34 34 .00$Line 31 minus total of Lines 32 and 33.

Apportioned NOL deduction Losses occurring in year 2000 and later. . . . . . . . . . . . . . . . . . .35 35 .00$Total DC taxable income Line 34 minus Line 35. . . . . . . . . . . . . . . . . . . . . . . 36 36Mark if minus .00$

.00$37 37Tax 8.25% of Line 36. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.00$Minus Nonrefundable Credits from Schedule UB, Line 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 38

.00$39 39Total DC Gross Receipts from Line 4 MTLGR worksheet. . . . . . . .

Net Tax. Line 37 minus Line 38. The minimum tax is $250 if DC gross receipts are4040 $$1M or less or $1,000 if DC gross receipts are greater than $1M . . . . . . . . . . . . . . . . . . . . . . .00

41 Payments:

.00$a 41aTax paid, if any, with request for an extension of time to file. . . . . . . . . . . . . . . . . . . . . . . . . .

.00$b 41bTax paid, if any, with original return if this is an amended return . . . . . . . . . . . . . . . . . . . . . .

2018 estimated franchise tax payment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00c 41c $Refundable credits from Schedule UB, Line 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d 41d $ .00

42 $ .0042 If this is an amended 2018 return, enter refund requested with original . . . . . . . . . . . . . . . .

Total payments and credits. Add Lines 41(a) through 41(d). Do not include Line 42. . . . . 4343 $ .0044. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Estimated tax interest (Mark if D-2220 attached) .00$

45 45Total Amount Due. If Line 43 is smaller than the total of Lines 40 and 44, enter amount due. . . . . . . . . . . .00$Yes No See instructionsWill this payment come from an account outside the U.S.?

46 46 .00Overpayment. If Line 43 is larger than the total of Lines 40 and 44, enter amount overpaid. . . . . . . . . . . . . $47 Amount you want to apply to your 2019 estimated franchise tax. . . . . . . . . . . . . . . . . . . . . . 47 $ .0048 Amount to be refunded Line 46 minus Line 47. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 $ .00Third Party Designee To authorize another person to discuss this return with OTR, mark here and enter the name and phone number


Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on the information availableto the preparer.

PLEASESIGN

Officer's signature Title Date Telephone number of person to contactHERE

PAIDPREPARER

Preparer's signature (If other than taxpayer) Date Firm name Firm addressONLYIf you want to allow the preparer to discuss this returnPreparer's PTIN

with the Office of Tax and Revenue, mark here

Rev. 10/18 DCIZ3112L 11/01/18

RESIDENTIAL RENTAL

*********

69659X

X 69659

69659X1.000000

X 69659

69659X

X 69659

69659X250

179000

250

250X

XPREPARER 8584610115

X*********

D-30 FORM, PAGE 3

Taxpayer Name:




$Inventory at beginning of year (if different from last year's closing inventory, attach an explanation). . . . . . . . . . . . 1

$Purchases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Enter result here O$Minus cost of items withdrawn for personal use. . . . . .

Cost of Labor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Material and supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Other costs (attach statement) ' (Additional federal depreciation and5additional IRC §179 expenses are not allowed.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$Total of lines 1 through 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

$Inventory at end of year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

$8 Cost of goods sold (Line 6 minus Line 7). Enter here and on D-30, Line 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



$ $

TOTAL (Limited to 15% of net income ' also$enter on D-30, Line 18.). . . . . . . . . . . . . . . . . . . .



$ $

$TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



$ $

$TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Rev. 10/18

DCIZ3134L 12/17/18

22,676.

*********

RESIDENTIAL RENTAL

24,952.


MORTGAGE INT - BANKS (S 24,952.

D-30 PAGE 4

Taxpayer Name:


Note: If this is a combined report do not use Schedule F to derive the apportionment factor for the group.

Leave Schedule F blank. Use Combined Reporting Schedule 2A, Line 9 instead.Schedule F ' DC apportionment factor (See instructions)

Carry all factors to six decimal placesRound cents to the nearest dollar. If an amount is zero, leave the line blank.


(Column 2 divided byother than gross receipts from items of non-business income. . . . . . Column 1)$ $.00 .00


For Combined Reporters

Enter the number of members in the combined group

Complete Schedule 1 from the DC Combined Reporting Schedule 1A Designated Agent

Schedule 1 ' Combined Report Tax Due

Tax Due Tax Due Tax Due Tax Due Tax DueCombined Group Report Intercompany Eliminations Total Before Eliminations Designated Agent Member 1

Tax Due Tax Due Tax Due Tax DueMember 2 Member 3 Member 4 Member 5




Schedule H ' Income not reported (claimed as nontaxable)(See instructions.)


$TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rev. 10/18

DCIZ3134L 12/18/18

72,862.

1.000000

*********

RESIDENTIAL RENTAL

179,000179,000

ASSOCIATION DUES (SCH. E) 52,320.GARDENING (SCH. E) 160.INSURANCE (SCH. E) 12,520.MANAGEMENT FEES (SCH. E) 6,000.PLUMBING & ELECTRICAL (SCH. E) 1,250.SUPPLIES (SCH. E) 612.

D-30 FORM, PAGE 5

Taxpayer Name:




Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1



Inventories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3














TOTAL ASSETS. . . . . . . . . . . . . . . . . . . . . . . . . 13






Capital stock. . . . . . . . . . . . . . . . . . . . . . . . . . . . 19



Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7 Col. 8Percentage Percentage Exemption Net IncomeSalary Claimed Net Loss Total Income (or Loss) Not

of Time of (or Loss)DC Sources Taxable to theClaimedDevoted Ownership from UnincorporatedName and Address of Taxpayerto this Outside DC Business (Add Columns 4Owner(s)/ Member(s) Identification

Business through 7)Number

% % $ $ $ $ $

$ $ $ $ $TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Col. 6 ' Any loss amount from Line 31 of D-30.Net income of Unincorporated Business from both withinCol. 7 ' Enter the difference between Line 25 and Line 31 of D-30. $and outside DC (from Line 25 of D-30). . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rev. 10/18

RESIDENTIAL RENTAL

*********

-69,659. -69,659.

-69,659.

-69,659.

STATEMENT 2

D-30 FORM, PAGE 6

Taxpayer Name:






If "Yes", submit separately an amended FormTYPE OF OWNERSHIP (sole proprietor, partnership, etc)6D-30 and a detailed statement, concerning










Is income from any other business or business14 Yes Nointerest owned by the proprietors of this businessbeing reported in a separate return?(If yes, list names and addresses of theother businesses.)


Yes No


Yes No


Rev. 10/18

DCIZ3105L 12/17/18

X

X

X

X

X

X

SOLE PROPRIETOR

X

*********

RESIDENTIAL RENTAL

X

RESIDENTIAL RENTAL

X

X




RESIDENTIAL RENTAL-DC2029 CONNECTICUT AVE NW #41, WASHINGTON, DC 20008-6142 . . . . . . . . . . . . . . . . . . . . . . . . . . $ 179,000.

TOTAL $ 179,000.



SARA J. JACOBSC/O 2728 OCEANFRONTDEL MAR, CA 92014***-**-**** 100% 100% $ 0. $ 0. $ -69,659. $ 0. $ -69,659.

$ 0. $ 0. $ -69,659. $ 0. $ -69,659.



InstructionsUse the D-30P Payment Voucher to make any payments due on your D-30 return.




Notes:


For electronic filers, in order to comply with banking rules, you will be asked the question "Will the funds for this payment come from an?account outside of the United States?" If the answer is yes, you will be required to pay by money order (US dollars) or credit card. Pleasenotify this agency if your response changes in the future.




*18030PS11032*Amount of Payment $ .00(dollars only)


Mark if SSN VENDOR ID# 1032Business or Designated Agent Name Tax period ending (MMYY)




Rev. 09/18 DCIZ9601L 12/12/18

250

********* X


C/O 2728 OCEANFRONT

1

DEL MAR CA 92014

2018 TAX RETURN

Client:

Prepared for:

Prepared by:

Date:

Comments:

Route to:

FDIL2001L 05/22/18

NEW YORK INDIVIDUAL

1178K3

SARA J. JACOBSC/O 2728 OCEANFRONT DEL MAR, CA 92014

OCTOBER 2, 2020

Department of Taxation and Finance

NYIA6101L 12/06/18New York State E-File Signature Authorization for Tax Year 2018For Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210

Electronic return originator (ERO): Do not mail this form to the Tax Department. Keep it for your records.

Taxpayer's name: Spouse's name:

(jointly filed return only)

EROs must complete Part C prior to transmitting electronically filedPurposeincome tax returns (Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214,Form TR-579-IT must be completed to authorize an ERO to e-file aNYC-208, and NYC-210).personal income tax return and to transmit bank account information for

the electronic funds withdrawal. Both the paid preparer and the ERO are required to sign Part C.However, if an individual performs as both the paid preparer and the

General instructions ERO, he or she is only required to sign as the paid preparer. It is notTaxpayers must complete Part B before the ERO transmits the necessary to include the ERO signature in this case. Please note thattaxpayer's electronically filed Forms IT-201, Resident Income Tax an alternative signature can be used as described in Publication 58,Return, IT-201-X, Amended Resident Income Tax Return, IT-203, Information for Income Tax Return Preparers. Visit our website atNonresident and Part-Year Resident Income Tax Return, IT-203-X, www.tax.ny.gov to view this document.Amended Nonresident and Part-Year Resident Income Tax Return,

Do not mail Form TR-579-IT to the Tax Department. EROs must IT-214, Claim for Real Property Tax Credit, NYC-208, Claim for New

keep this form for three years and present it to the Tax DepartmentYork City Enhanced Real Property Tax Credit, or NYC-210, Claim for

upon request.New York City School Tax Credit.

This form is not required for electronically filed Form IT-370, ApplicationFor returns filed jointly, both spouses must complete and sign

for Automatic Six-Month Extension of Time to File for Individuals. Form TR-579-IT.

See Form TR-579.1-IT, New York State Taxpayer Authorization for Electronic Funds Withdrawal for Tax Year 2018 Form IT-370 and TaxYear 2019 Form IT-2105.

Part A ' Tax return information

1 Federal adjusted gross income (from applicable line). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

2 Refund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

3 Amount you owe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.

4.4 Financial institution routing number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.5 Financial institution account number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 Account type: Personal checking Personal savings Business checking Business savings

Part B ' Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210

Under penalty of perjury, I declare that I have examined the information on my 2018 New York State electronic personal income tax return, includingany accompanying schedules, attachments, and statements, and certify that my electronic return is true, correct, and complete. The ERO has myconsent to send my 2018 New York State electronic return to New York State through the Internal Revenue Service (IRS). In addition, by using acomputer system and software to prepare and transmit my form electronically, I consent to the disclosure to New York State of all informationpertaining to the transmission of my tax form electronically. I understand that by executing this Form TR-579-IT, I am authorizing the ERO to signand file this return on my behalf and agree that the ERO's submission of my personal income tax return to the IRS, together with this authorization,will serve as the electronic signature for the return and any authorized payment transaction. If I am paying my New York State personal incometaxes due by electronic funds withdrawal, I certify that the account holder has authorized the New York State Tax Department and its designatedfinancial agents to initiate an electronic funds withdrawal from the financial institution account indicated on my 2018 electronic return, andauthorized the financial institution to withdraw the amount from that account. As New York does not support International ACH Transactions (IAT),I attest the source for these funds is within the United States. I understand and agree that I may revoke this authorization for payment only bycontacting the Tax Department no later than two (2) business days prior to the payment date.

Taxpayer's signature: Date:

Spouse's signature: Date:


Part C ' Declaration of electronic return originator (ERO) and paid preparer

Under penalty of perjury, I declare that the information contained in this 2018 New York State electronic personal income tax return is theinformation furnished to me by the taxpayer. If the taxpayer furnished me a completed paper 2018 New York State return signed by a paidpreparer, I declare that the information contained in the taxpayer's 2018 New York State electronic return is identical to that contained in thepaper copy of the return. If I am the paid preparer, under penalty of perjury I declare that I have examined this 2018 New York State electronicpersonal income tax return, and, to the best of my knowledge and belief, the return is true, correct, and complete. I have based this declarationon all information available to me.

Date:ERO's signature:

Print name:

Paid preparer's signature: Date:

Print name:

1032TR-579-IT (12/18)

SARA J. JACOBS

2,129,756.

LARRY M. KATZ, CPA




an automatic six-month extension of time to file Form IT-201, • June 17, 2019, if you are a U.S. nonresident alien for federalResident Income Tax Return, or Form IT-203, Nonresident and income tax purposes and you qualify to file your federal andPart-Year Resident Income Tax Return . New York State income tax returns on June 17, 2019, and you













Enter your 2-character special condition code Spouse's full SSN (only if filing a joint return)Your full social security number (SSN) if applicable (see instructions) . . . . . . . . . . . . . . . . . . ?



Dollars Cents



E-mail:

3701181032

X

*********

SARA J. JACOBS


************

C/O 2728 OCEANFRONT

DEL MAR

Page 2 of 3 IT-370 (2018)






return is late, up to a maximum of 25%. However, if your return Name and address box – Enter your name (both names ifis not filed within 60 days of the time prescribed for filing a return filing a joint application), address, and entire social security(including extensions), this penalty will not be less than the number(s). Failure to provide the entire social security numberlesser of $100 or 100% of the amount required to be shown as may invalidate this extension or result in monies not being properlytax due on the return reduced by any tax paid and by any credit credited to your account. If you do not have a social securitythat may be claimed. The penalty will not be charged if you can number, enter do not have one. If you do not have a socialshow reasonable cause for filing late. security number, but have applied for one, enter applied for.







IT-370 (2018) Page 2 When completing this section, enter your New York tax preparer registrationidentification number (NYTPRIN) if you are required to have one. If you arePayment options ' Full payment must be made by check or money order of not required to have a NYTPRIN, enter in the NYTPRIN excl. code box oneany balance due with this automatic extension of time to file. Make the checkof the specified 2-digit codes listed below that indicates why you are exemptor money order payable in U.S. funds to New York State Income Tax andfrom the registration requirement. You must enter a NYTPRIN or an exclusionwrite the last four digits of your social security number and 2018 Income Taxcode. Also, you must enter your federal preparer tax identification numberon it. For online payment options, see our website (at www.tax.ny.gov).(PTIN) if you have one; if not, you must enter your social security number.








E-mail:

3702181032

LARRY M. KATZ, CPA

3070 RACETRACK VIEW DR.DEL MAR CA 92014 0 3

[email protected]

************

NYIA1612L 12/03/18Department of Taxation and Finance IT-203Nonresident and Part-Year ResidentNew York State?New York City?Yonkers? MCTMTIncome Tax Return

18For the year January 1, 2018, through December 31, 2018, or fiscal year beginning .

and ending. . . . . .

For help completing your return, see the instructions, Form IT-203-I.Your first name and middle initial Your social security numberYour last name (for a joint return, enter spouse's name on line below) Your date of birth (mmddyyyy)

Spouse's first name and middle initial Spouse's last name Spouse's social security numberSpouse's date of birth (mmddyyyy)



Taxpayer's permanent home address (see instrs) (no. and street or rural route) Apartment no. City, village, or post officeSchool districtcode number


E New York City part-year residents only (see instrs)1 SingleA FilingNumber of months you lived in NY City in 2018 . . . (1)status Married filing joint return(mark an 2 (2)Number of months your spouse lived(enter both spouses' social security numbers above)X in one in NY City in 2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Married filing separate returnbox): 3 F Enter your 2-character special condition(enter both spouses' social security numbers above)code(s) if applicable (see instructions). . . .

Head of household (with qualifying person)4 G New York State part-year residents (see instructions)Enter the date you moved intoor out of NYS (mmddyyyy) . . . . . . . . . . . . . . . . Qualifying widow(er)5On the last day of the tax year (mark an X in one box):B Did you itemize your deductions on your 20181) Lived in NYS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . federal income tax return?. . . . . . . . . . . . . . . . . . . . . . . Yes No2) Lived outside NYS; received income fromC Can you be claimed as a dependent on another NYS sources during nonresident period. . . . . . . . . . . . . . taxpayer's federal return? . . . . . . . . . . . . . . . . . . . . . . . NoYes3) Lived outside NYS; received no income fromD1 Did you have a financial account located in a NYS sources during nonresident period. . . . . . . . . . . . . . foreign country? (see instructions). . . . . . . . . . . . . . . . Yes NoNew York State nonresidents (see instructions)HD2 Yonkers part-year residents only:Did you or your spouse maintainDid you receive a property tax relief credit? (see instrs) Yes No(1)living quarters in NYS in 2018?. . . . . . . . . . Yes No(if Yes, complete Form IT-203-B).00Enter the amount. . . . (2)

Were you required to report, any nonqualified deferredD3compensation, as required by IRC §457A on your

Yes No2018 federal return? (see instructions) . . . . . . . . . . . . . .

I Dependent information (see instructions)

First name and middle initial Last name Relationship Social security number Date of birth (mmddyyyy)


203001181032 For office use only

*********

X

X

NR

NR92014CADEL MAR

C/O 2728 OCEANFRONT

JACOBSSARA

X

J 02011989

X

X

X

NYIA1612L 12/03/18Enter your social security numberPage 2 of 4 IT-203 (2018)



3 3 3.00 .00Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Business income or loss (submit a copy of federal Sch. C or C-EZ, Form 1040) . . . . 6 6 6.00 .00Capital gain or loss (if required, submit a copy of federal Sch. D, Form 1040). . . . . . 7 7 7.00 .00


9 9 9.00Taxable amount of IRA distributions. Beneficiaries: mark X in box .00Taxable amount of pensions/annuities. Beneficiaries: mark X in box10 10 10.00 .00Rental real estate, royalties, partnerships, S corporations,11

.00 .0011 11trusts, etc. (submit a copy of federal Schedule E, Form 1040)Rental real estate included12


.00 .00Farm income or loss (submit a copy of federal Sch. F, Form 1040) . . . . . . 13 13 13

.00 .0014 14 14Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Taxable amount of social security benefits (also enter on line 26). . . .00 .0015 15 15Identify: .00 .0016 16 16Other income (see instrs)

.00 .0017 Add lines 1 through 11 and 13 through 16 . . . . . . . . . . . . . . . . . . 17 17Total federal adjustments to income (see instructions)18Identify: .00 .0018 18Federal adjusted gross income (subtract line 18 from line 17). . .00 .0019 19 19


20 Interest income on state and local bonds and obligations(but not those of New York State or its localities). . . . . . . . . . . . 20 20.00 .00

21 21 21Public employee 414(h) retirement contributions . . . . . . . . . . . . . . .00 .0022 22 22Other (Form IT-225, line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0023 Add lines 19 through 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 23.00 .00


Taxable refunds, credits, or offsets of state and24local income taxes (from line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0024 24

Pensions of NYS and local governments and the25federal government (see instructions) . . . . . . . . . . . . . . . . . . . . . .00 .0025 25

.00 .0026 26 26Taxable amount of social security benefits (from line 15). . . . . . .


28 Pension and annuity income exclusion. . . . . . . . . . . . . . . . . . . . . . . .00 .0028 28.00 .0029 29 29Other (Form IT-225, line 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0030 30 30Add lines 24 through 29. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0031 New York adjusted gross income (subtract line 30 from line 23). . . . . . . 31 31



33 Enter your standard deduction (table in instructions) or your itemized deduction (from Form IT-196).33 .00. . . . . . . Mark an X in the appropriate box: . Standard - or - Itemized

34 34Subtract line 33 from line 32 (if line 33 is more than line 32, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0035 35Dependent exemptions (enter the number of dependents listed in Item I; see instructions) . . . . . . . . . . . . . . . 000.0036 New York taxable income (subtract line 35 from line 34). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 .00

203002181032


2129756 -25000

2129756 -25000

21418096

1064446

1055032

41 -25000

2129756 -25000

2129756 -25000

Name(s) as shown on page 1 Enter your social security number IT-203 (2018) Page 3 of 4NYIA1634L 12/03/18

Tax computation, credits, and other taxes37 37New York taxable income (from line 36 on page 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0038 38New York State tax on line 37 amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0039 39New York State household credit (see instructions, table 1, 2, or 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0040 40Subtract line 39 from line 38 (if line 39 is more than line 38, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0041 41New York State child and dependent care credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0042 42Subtract line 41 from line 40 (if line 41 is more than line 40, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0043 43New York State earned income credit (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

44 .00Base tax (subtract line 43 from line 42; if line 43 is more than line 42, leave blank) . . . . . . . . . . . . . . . . . . . . . . 44


46 46Allocated New York State tax (multiply line 44 by the decimal on line 45). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0047 47New York State nonrefundable credits (Form IT-203-ATT, line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0048 48Subtract line 47 from line 46 (if line 47 is more than line 46, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0049 49Net other New York State taxes (Form IT-203-ATT, line 33). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

5050 Total New York State taxes (add lines 48 and 49). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00


City and Yonkers taxes,child and dependent care credit. . . . . . . . . . . . . . . . . . . . . . . . . 52 .00credits, and surcharges, and52 a Subtract line 52 from 51 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52a .00 MCTMT.MCTMT net52 b

52bearnings base. . . . .00MCTMT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 c .0052c

53 53 .00Yonkers nonresident earnings tax (Form Y-203) . . . . . . . . . . . . .

54 Part-year Yonkers resident income tax surcharge54(Form IT-360.1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

55 55Total New York City and Yonkers taxes / surcharges and MCTMT (add lines 52a, and 52c through 54) . . . . . .00

5656 Sales or use tax (See the instructions. Do not leave line 56 blank.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

(see instructions)Voluntary contributions

a o57 57.00 .0057a 57o Veterans' HomesReturn a Gift to Wildlifep57 .00b57 .0057 57pb Love Your Library FundMissing/Exploited Childrenq57c57 .0057 .00c 57qBreast Cancer Research Lupus Fundrd 575757 .00 .00d 57 rAlzheimer's Fund Military Family Fundse 57 s 57.0057 .00CUNY Fund57e Olympic Fund ($2 or $4)

.00f5757f Prostate Cancer57g57 .00g 9/11 Memorial

h57 .0057h Volunteer Firefighting57 .00i57i Teen Health Education

j5757 .00j Veterans Remembrance57k57 .00Homeless Veteransk5757 ll .00Mental Illness Anti-Stigma

m5757 Women's Cancers Fundm .00nn 5757 .00Autism Fund

57 57 .00Total voluntary contributions (add lines 57a through 57s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

58 Total New York State, New York City, Yonkers, and sales or use taxes, MCTMT,and voluntary contributions (add lines 50, 55, 56, and 57) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 .00

203003181032


0.0000-25000 2129756

0

Enter your social security numberPage 4 of 4 IT-203 (2018)NYIA1634L 03/15/19

59 Enter amount from line 58. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 .00


If applicable, complete60Part-year NYC school tax credit (fixed amount) (also complete E on front)60 .00Form(s) IT-2 and/or IT-1099-R60a60a NYC school tax credit (rate reduction amount). . . . . . . . . . . . . . . . . .00 and submit them with your61 .0061 Other refundable credits (Form IT-203-ATT, line 17) . . . . . . . . . . . return (see page 13).

62 .0062 Total New York State tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . Do not send federal63 .0063 Total New York City tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . . Form W-2 with your return.64 .0064 Total Yonkers tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65Total estimated tax payments/amount paid with Form IT-370. . . . .0065

Total payments and refundable credits (add lines 60 through 65). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 .0066

(see instructions)Your refund, amount you owe, and account information67Amount overpaid (if line 66 is more than line 59, subtract line 59 from line 66; see page 37). . . . . . . . . . .67 .006868 .00Amount of line 67 available for refund (subtract line 69 from line 67). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a68 .00a68 Amount of line 68 that you want to deposit into a NYS 529 account (Form IT-195, line 4) (also submit Form IT-195). . . . . . . . . .68bTotal refund after NYS 529 account deposit (subtract line 68a from line 68). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0068b

direct deposit to checking or paper Refund? Direct deposit is the- or -savings account (fill in line 73) check. . . .Mark one refund choice: easiest, fastest way to get yourAmount of line 67 that you want applied to your 201969 refund.

.0069estimated tax (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . See page 38 for payment70 Amount you owe (if line 66 is less than line 59, subtract line 66 from line 59). To pay by electronic options.

funds withdrawal, mark an X in the box and fill in lines 73 and 74. If you pay by check70or money order you must complete Form IT-201-V and mail it with your return. . . . . . . . . . . . . . . . . . . . . . .00

71 Estimated tax penalty (include this amount on line 70,See page 41 for the proper71 .00or reduce the overpayment on line 67; see instructions). . . . . . .assembly of your return.7272 Other penalties and interest (see instructions). . . . . . . . . . . . . . . . . .00




73b Routing number Account number73c

74 Electronic funds withdrawal (see instructions) . . . . . . . . . . . . . . . . . Date Amount .00

Print designee's name Designee's phone number Personal identificationThird-party designee? number (PIN)(see instructions) ( )

E-mail:Yes NoPreparer's NYTPRINI Paid preparer must complete I NYTPRIN Taxpayer(s) must sign hereI I(see instructions) excl. code

Your signaturePreparer's signature Preparer's printed name

Your occupationPreparer's PTIN or SSNFirm's name (or yours, if self-employed)

Spouse's signature and occupation (if joint return)Address Employer identification number

Date Daytime phone numberDate ( )E-mail:E-mail:


203004181032


LARRY M. KATZ, CPA 858 461-0115X [email protected] 92014

0 3

********* GOVERNMENT

LARRY M. KATZ, CPA

LARRY M. KATZ, CPA

3070 RACETRACK VIEW DR.DEL MAR, CA 92014

[email protected]

NYIA6601L 10/08/18Department of Taxation and Finance IT-2Summary of W-2 StatementsNew York State @ New York City @ Yonkers


Box a Employee's social security numberfor this W-2 Record Employer's address (number and street)

Box b Employer identification number (EIN) City Country (if not United States)State ZIP code


.00 .00.00Box 14b AmountCodeBox 8 Allocated tips DescriptionBox 12b Amount

.00.00.00Box 10 Dependent care benefits DescriptionCode Box 14c AmountBox 12c Amount

.00 .00.00DescriptionBox 12d AmountBox 11 Nonqualified plans Box 14d AmountCode

.00.00.00











.00 .00.00Box 14c AmountCode DescriptionBox 12c AmountBox 10 Dependent care benefits


.00 .00.00




.00 .00other state



102001181032

UNIVERSITY OF SAN DIEGO

********* 5998 ALCALA PARK

CA 92110952544535 SAN DIEGO

STATE DISABILIT2141 21

C A 2141 12

NYIA9712L 11/16/18Department of Taxation and Finance IT-182Passive Activity Loss LimitationsFor Nonresidents and Part-Year Residents




.001 Prior years unallowed losses from Worksheet 1, column (c) (see instructions). . . . . . . c 1c1d Add lines 1a, 1b, and 1c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .001d



All other passive activities.003a 3aActivities with net income from Worksheet 3, column (a). . . . . . . . . . . . . . . . . . . . . . . . . . .003b 3bActivities with net loss from Worksheet 3, column (b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .003c 3cPrior years unallowed losses from Worksheet 3, column (c) (see instructions). . . . . . .









.009 Multiply line 8 by 50% (.5). Do not enter more than 25,000. (If married filing separately, filing status '3', see instructions). . . . 9




.0013 13Subtract line 10 from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





182001181032


242059

-242059

-242059

242059150000

1500002500025000

25000

NYIA9712L 11/16/18Page 2 of 3 IT-182 (2018)



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


.00 .00 .00.00 .00

.00 .00.00 .00 .00

.00 .00.00 .00 .00

.00 .00.00 .00 .00

.00 .00 .00 .00.00




.00 .00 .00

.00 .00 .00

.00 .00 .00



(d)(a) (b) (c) (e)Date ofName of activity/property Date of Net loss UnallowedNet income





.00 .00 .00

.00 .00 .00

.00 .00 .00

.00 .00 .00

.00 .00 .00Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

182002181032

21705925000242059

242059



NYIA9703L 11/16/18 IT-182 (2018) Page 3 of 3



Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00.00 .00

Worksheet 6 ' Allowed losses (see instructions)(b)(a) (c)Form or schedule


.00.00 .00

.00.00 .00

.00.00 .00

.00.00 .00

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00.00 .00













Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00.00 .00 .00

182003181032

25000217059242059

217059217059


RESIDENTIAL RENTAL-NY SCH E LN 22 217059 1.000000 217059

RESIDENTIAL RENTAL-NY SCH E LN 22 242059 217059 25000

NYIZ2501L 09/14/18Department of Taxation and Finance IT-398New York State Depreciation Schedule forIRC Section 168(k) Property

Use this form only for property placed in service inside or outside New York State after May 31, 2003.Name(s) as shown on return Identifying number as shown on return

Mark an X in one box to show the income tax return you are filing and submit this form with that return.

IT-201, Resident IT-203, Nonresident and part-year resident IT-204, Partnership IT-205, Fiduciary

Part 1 ' Depreciation information for Internal Revenue Code (IRC) section 168(k) property (except for resurgence zone property andNew York liberty zone property described in IRC section 1400L(b)(2)) placed in service inside or outside New York State,beginning after May 31, 2003 (see instructions)

FDA GEB CNew York Federal depreciationDate placed Conv.Description of property Depreciable Method

in service depreciation deduction deduction(use additional sheet if needed) basis(mmddyyyy)

.00.00.00.00 .00 .00.00 .00 .00.00 .00 .00

.00.00Enter column F and column G totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1

Transfer the column F total to: Transfer the column G total to:

Form IT-225, line 10, Total amount column and enter Form IT-225, line 1, Total amount column and entersubtraction modification S-213 in the Number column. addition modification A-209 in the Number column.

Part 2 ' Year-of-disposition adjustment for IRC section 168(k) property (except for resurgence zone property and New York libertyzone property described in IRC section 1400L(b)(2)) placed in service inside or outside New York State, beginning afterMay 31, 2003 (see instructions)

Mark an X in the box if you claimed an investment credit on Form IT-212, Investment Credit, for any property listedbelow (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

A B C D EDescription of property Date of Method of Total New York Total federal

(use additional sheet if needed) disposition disposition depreciation deduction depreciation deduction

.00.00

.00.00.00 .00.00 .00

Enter column D and column E totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2 .00 .00Enter amount from line 2, column E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3 .00Enter amount from line 2, column D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .004 4Subtract line 4 from line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5 .00

Transfer the line 5 amount to Form IT-225, line 10, Total amount column and entersubtraction modification S-214 in the Number column.

398001181032

00000

22221435241

X

609248638JACOBS, SARA J.

COUNTERTOPS 01012018 14790 HY 150DB 740 14790FLOORING 01012018 62342 HY 200DB 8909 62342FURNISHINGS 01012018 122248 HY 200DB 24450 122248WINDOW TREATMENTS 01012018 22834 HY 150DB 1142 22834




BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 149,664 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 149,664 76,419



6 LAMP 1/01/16 734 734 285 200DB HY 7 .17490 128

7 STOOL 1/01/16 1,101 1,101 427 200DB HY 7 .17490 193

10 TV CABINETS 1/01/16 9,819 9,819 3,808 200DB HY 7 .17490 1,717




8 LIGHTING 1/01/16 13,857 13,857 5,374 200DB HY 7 .17490 2,424

9 DRAPES 1/01/16 3,512 3,512 1,362 200DB HY 7 .17490 614


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0










11 BUILDING 1/01/18 1,250,000 1,250,000 S/L MM 27.5 .03485 43,563

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 200DB HY 7 .14290 8,909

14 COUNTERTOPS 1/01/18 14,790 14,790 150DB HY 15 .05000 740

15 WINDOW TREATMENTS 1/01/18 22,834 22,834 150DB HY 15 .05000 1,142

16 FURNISHINGS 1/01/18 122,248 122,248 200DB HY 5 .20000 24,450

TOTAL 2,722,214 0 0 0 0 0 2,722,214 0 78,804

TOTAL DEPRECIATION 2,722,214 0 0 0 0 0 2,722,214 0 78,804






BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 149,664 S/L MM 27.5 .03636 76,419 76,419 0

TOTAL BUILDINGS 2,101,726 149,664 76,419 76,419 0 0 0 0



6 LAMP 1/01/16 734 219 150DB HY 7 .15030 110 128 18 0

7 STOOL 1/01/16 1,101 329 150DB HY 7 .15030 165 193 28 0

10 TV CABINETS 1/01/16 9,819 2,930 150DB HY 7 .15030 1,476 1,717 241 0




8 LIGHTING 1/01/16 13,857 4,135 150DB HY 7 .15030 2,083 2,424 341 0

9 DRAPES 1/01/16 3,512 1,048 150DB HY 7 .15030 528 614 86 0


LAND____

2 LAND 1/01/16 900,740 0 0 0

TOTAL LAND 900,740 0 0 0 0 0 0 0







TOTAL DEPRECIATION 3,619,380 250,132 124,427 128,060 3,633 0 0


11 BUILDING 1/01/18 1,250,000 S/L MM 27.5 .03485 43,563 43,563 0

12 LAND 1/01/18 1,250,000 0 0 0

13 FLOORING 1/01/18 62,342 150DB HY 7 .10710 6,677 8,909 2,232 0

14 COUNTERTOPS 1/01/18 14,790 150DB HY 15 .05000 740 740 0

15 WINDOW TREATMENTS 1/01/18 22,834 150DB HY 15 .05000 1,142 1,142 0

16 FURNISHINGS 1/01/18 122,248 150DB HY 5 .15000 18,337 24,450 6,113 0

TOTAL 2,722,214 0 70,459 78,804 8,345 0 0 0

TOTAL DEPRECIATION 2,722,214 0 70,459 78,804 8,345 0 0 0




PAGE 2




BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 149,664 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 149,664 76,419



6 LAMP 1/01/16 734 734 285 200DB HY 7 .17490 128

7 STOOL 1/01/16 1,101 1,101 427 200DB HY 7 .17490 193

10 TV CABINETS 1/01/16 9,819 9,819 3,808 200DB HY 7 .17490 1,717




8 LIGHTING 1/01/16 13,857 13,857 5,374 200DB HY 7 .17490 2,424

9 DRAPES 1/01/16 3,512 3,512 1,362 200DB HY 7 .17490 614


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0










11 BUILDING 1/01/18 1,250,000 1,250,000 S/L MM 27.5 .03485 43,563

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 200DB HY 7 .14290 8,909




TOTAL 2,722,214 0 0 0 0 0 2,722,214 0 78,804








BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 149,664 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 149,664 76,419



6 LAMP 1/01/16 734 734 285 200DB HY 7 .17490 128

7 STOOL 1/01/16 1,101 1,101 427 200DB HY 7 .17490 193

10 TV CABINETS 1/01/16 9,819 9,819 3,808 200DB HY 7 .17490 1,717




8 LIGHTING 1/01/16 13,857 13,857 5,374 200DB HY 7 .17490 2,424

9 DRAPES 1/01/16 3,512 3,512 1,362 200DB HY 7 .17490 614


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0










11 BUILDING 1/01/18 1,250,000 1,250,000 S/L MM 27.5 .03485 43,563

12 LAND 1/01/18 1,250,000 1,250,000 0

13 FLOORING 1/01/18 62,342 62,342 200DB HY 7 .14290 8,909




TOTAL 2,722,214 0 0 0 0 0 2,722,214 0 78,804






ERO Declaration




CAIA9701L 05/26/18


ERO Signature


ERO's PIN

OMB No. 1545-0074





R


N



A

R


Y






Form 3468 ' attach a copy of the first page of NPS Form 10-168, Historic Preservation Certification Application (Part 2 ' Description ofRehabilitation), with an indication that it was received by the Department of the Interior or the State Historic Preservation Officer, togetherwith proof that the building is a certified historic structure (or that such status has been requested)




Form 8332, Release/Revocation of Release of Claim to Exemption for Child by Custodial Parent (or certain pages from a divorce decreeor separation agreement, that went into effect after 1984 and before 2009) (see instructions)

Form 8858, Information Return of U.S. Persons With Respect To Foreign Disregarded Entities






FDIA5901L 10/02/17


C/O 13974 BOQUITA DRIVE

DEL MAR CA 92014

X


I DETACH HERE I1030

FDIA4601L 07/21/17.Application for Automatic Extension of TimeForm 4868



5 Total 2017 payments. . . . . . . . . . . . . . . . . .



8 Check here if you are 'out of the country' and a U.S.2 3 Gcitizen or resident (see instructions). . . . . . . . . . . . . . . . . .



MAKE YOUR CHECK PAYABLE TO THE "UNITED STATES TREASURY"INCLUDE YOUR SSN, DAYTIME PHONE # AND "2017 FORM 4868"MAIL YOUR PAYMENT TO:

INTERNAL REVENUE SERVICEP.O. BOX 7122SAN FRANCISCO, CA 94120-7122

1,010,732.915,732.

95,000.95,000.

1

SARA J. JACOBS

***-**-****

*********************************

Department of the Treasury ' Internal Revenue Service (99)

Form 1040 2017U.S. Individual Income Tax Return IRS Use Only ' Do not write or staple in this space.OMB No. 1545-0074

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

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

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) aboveJ and on line 6c are correct.

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign

Check here if you, or your spouse if filingjointly, want $3 to go to this fund. Checking

Foreign country name Foreign province/state/county Foreign postal codea box below will not change your tax or

refund. You Spouse

Head of household (with qualifying person). (SeeSingle1 4Filing Status instructions.) If the qualifying person is a childMarried filing jointly (even if only one had income)2 but not your dependent, enter this child's

Gname here. . . GMarried filing separately. Enter spouse's SSN above & full3Check only

G Qualifying widow(er) (see instructions)name here. . 5one box.

Boxes checkedYourself. If someone can claim you as a dependent, do not check box 6a. . . . . . . . . . . 6aExemptionson 6a and 6b. . . No. of childrenSpouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . bon 6c who:

(2) Dependent's (3) Dependent'sc Dependents: (4) b iflived?child undersocial security relationship

with you. . . . . . age 17number to you qualifying for

did not?child tax creditLast name(1) First name live with you(see instructions)due to divorceor separation(see instructions). . If more than fourDependentsdependents, seeon 6c not

instructions and entered above. . Gcheck here. . . Add numbers

on linesGd above. . . . . . Total number of exemptions claimed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 7Wages, salaries, tips, etc. Attach Form(s) W-2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Income Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a 8a

b 8 bTax-exempt interest. Do not include on line 8a. . . . . . . . . . . . . .

9a 9aOrdinary dividends. Attach Schedule B if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Attach Form(s)b 9 bQualified dividends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-2 here. Also

attach Forms 10 10Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . . . . . . W-2G and 1099-R

11 11Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . if tax was withheld.12 12Business income or (loss). Attach Schedule C or C-EZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If you did not 13 13Capital gain or (loss). Attach Schedule D if required. If not required, check here. . . . . . . . . . Gget a W-2,14 14Other gains or (losses). Attach Form 4797. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see instructions.15a 15 a b 15bIRA distributions. . . . . . . . . . . . Taxable amount. . . . . . . . . . . . .

16a 16 a b 16bPensions and annuities . . . . . Taxable amount. . . . . . . . . . . . .

17 17Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E.

1818 Farm income or (loss). Attach Schedule F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19 19Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20a 20 a b 20bTaxable amount. . . . . . . . . . . . . Social security benefits . . . . . . . . . .

21 21Other income. List type and amount

22 22GCombine the amounts in the far right column for lines 7 through 21. This is your total income. . . . . . . . . . . . .

23 23Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Certain business expenses of reservists, performing artists, and fee-basisAdjusted 2424government officials. Attach Form 2106 or 2106-EZ . . . . . . . . . . . . . . . . . . . . Gross

25 25Income Health savings account deduction. Attach Form 8889. . . . . . . .

26 26Moving expenses. Attach Form 3903. . . . . . . . . . . . . . . . . . . . . . .

27 27Deductible part of self-employment tax. Attach Schedule SE. . . . . . . . . . . . . .

28 28Self-employed SEP, SIMPLE, and qualified plans. . . . . . . . . . .

29 29Self-employed health insurance deduction. . . . . . . . . . . . . . . . . .

30 30Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . .

GAlimony paid31a 31ab Recipient's SSN . . . .

32 32IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33 33Student loan interest deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . .

34 34Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . . .

35 35Domestic production activities deduction. Attach Form 8903. . . . . . . . . . . . . .

36 36Add lines 23 through 35. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

GSubtract line 36 from line 22. This is your adjusted gross income. . . . . . . . . . . . . . . . . . . . . 37 37

FDIA0112L 02/22/18 Form 1040 (2017)BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.



X

X 1

186,731.11,884.

329,185.

0.

3,640,490.

4,068,290.

0.4,068,290.

326,707.

DEL MAR, CA 92014

STATEMENT 4ST 3

Form 1040 (2017) Page 2

38 Amount from line 37 (adjusted gross income). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Tax and You were born before January 2, 1953,39a Blind.Check Total boxesCredits Spouse was born before January 2, 1953, 39aif: Blind. Gchecked

b If your spouse itemizes on a separate return or you were a dual-status alien, check here . . . . . . . . . G 39bStandardDeduction 40 40Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . . . . . . . . . . . . . . . . . . .for ' 41 Subtract line 40 from line 38. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instrs. . . . . . 42? People who43check any box Taxable income. Subtract line 42 from line 41.

43If line 42 is more than line 41, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .on line 39a or39b or who can Tax (see instructions). Check if any from:44 a cForm(s) 8814be claimed as a

44b Form 4972. . . . . . . . . . . . . . . . . . . . . . . . . . .dependent, seeinstructions. Alternative minimum tax (see instructions). Attach Form 6251. . . . . . . . . . . . . . . . . . . . . . . . . .45 45? All others: Excess advance premium tax credit repayment. Attach Form 8962. . . . . . . . . . . . . . . . . . . . . .46 46Single or GAdd lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 47Married filing

48 48Foreign tax credit. Attach Form 1116 if required. . . . . . . . . . . . .separately,49 49$6,350 Credit for child and dependent care expenses. Attach Form 2441 . . . . . . . . . .

50 50Education credits from Form 8863, line 19. . . . . . . . . . . . . . . . . .Married filingjointly or 51 51Retirement savings contributions credit. Attach Form 8880. . .Qualifying

52 52Child tax credit. Attach Schedule 8812, if required . . . . . . . . . .widow(er),$12,700 53 53Residential energy credits. Attach Form 5695. . . . . . . . . . . . . . .

Head of a b c 5454 3800 8801Other crs from Form:household,Add lines 48 through 54. These are your total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 55$9,350

GSubtract line 55 from line 47. If line 55 is more than line 47, enter -0-. . . . . . . . . . . . . . . . . . 56 56

57 57Self-employment tax. Attach Schedule SE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other58 a b 588919. . . . . . . . . . . . . . . . . . . . . . .Unreported social security and Medicare tax from Form: 4137Taxes59 59Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required. . . . . . . . . . . . . . . . . . .

60a 60aHousehold employment taxes from Schedule H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b 60bFirst-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . . . . . . . . . . . .

61Health care: individual responsibility (see instructions) Full-year coverage . . . . . . . . . . . 61

62 62b caTaxes from: Form 8959 Form 8960 Instrs; enter code(s)

6363 GAdd lines 56 through 62. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

64 64Federal income tax withheld from Forms W-2 and 1099 . . . . .Payments65 652017 estimated tax payments and amount applied from 2016 return. . . . . . . .If you have a

qualifying Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66a 66achild, attach Gb 66bNontaxable combat pay election . . . . .Schedule EIC.

67 67Additional child tax credit. Attach Schedule 8812. . . . . . . . . . . .

68 68American opportunity credit from Form 8863, line 8. . . . . . . . .

69 69Net premium tax credit. Attach Form 8962. . . . . . . . . . . . . . . . . .

70 70Amount paid with request for extension to file . . . . . . . . . . . . . .

71 71Excess social security and tier 1 RRTA tax withheld. . . . . . . . .

72 72Credit for federal tax on fuels. Attach Form 4136. . . . . . . . . . . .

7373 Credits from Form: 2439 Reserved 8885a b c d

74 74GAdd lines 64, 65, 66a, and 67 through 73. These are your total payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 75If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid . . . . . . . . . . . . . . .RefundGAmount of line 75 you want refunded to you. If Form 8888 is attached, check here. . 76a 76a

b cG GRouting number . . . . . . . . Type: Checking SavingsDirect deposit? dG Account number. . . . . . . .See instructions.

G77 77Amount of line 75 you want applied to your 2018 estimated tax. . . . . . . . 78 78GAmount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions. . . . . . . . . . . . . . . Amount

You Owe 79 79Estimated tax penalty (see instructions). . . . . . . . . . . . . . . . . . . .

Do you want to allow another person to discuss this return with the IRS (see instructions)?. . . . . . . . . . . Yes. Complete below. NoThird PartyDesignee's Phone Personal identificationDesignee G G Gname no. number (PIN)

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, theySign are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on allinformation of which preparer has any knowledge.Here

Your signature Date Your occupation Daytime phone numberJoint return?See instructions.

A Date Spouse's occupation If the IRS sent you an Identity ProtectionSpouse's signature. If a joint return, both must sign.Keep a copyPIN, enter it

for your records. here (see inst.)

Print/Type preparer's name Preparer's signature Date PTINCheck ifPaid self-employedPreparer GFirm's nameUse Only

Firm's address Firm's EING G

Phone no.FDIA0112L 02/22/18

Form 1040 (2017)

SARA J. JACOBS ***-**-****4,068,290.

466,732.3,601,558.

0.

3,601,558.

693,700.

749.

749.783,557.

90,606.

135,092.918,649.

17,230.898,502.

95,000.

1,010,732.

92,083.0.

91,259.

824.

GOVERNMENT

X

784,306.

X

92014

XX

OMB No. 1545-0074Underpayment of Estimated Tax byForm 2210

Individuals, Estates, and Trusts 2017G Go to www.irs.gov/Form2210 for instructions and the latest information.Department of the Treasury AttachmentG Attach to Form 1040, 1040A, 1040NR, 1040NR-EZ, or 1041.Internal Revenue Service 06Sequence No.

Name(s) shown on tax return Identifying number

Do You Have To File Form 2210?

Complete lines 1 through 7 below. Is line 7 less than $1,000? Don't file Form 2210. You don't owe a penalty.

You don't owe a penalty. Don't file Form 2210Complete lines 8 and 9 below. Is line 6 equal to or more than line 9?(but if box E in Part II applies, you must file page 1of Form 2210).

You must file Form 2210. Does box B, C, or D inYou may owe a penalty. Does any box in Part II below apply?Part II apply?

You must figure your penalty.

You aren't required to figure your penalty because theDon't file Form 2210. You aren't required to figure your penaltyIRS will figure it and send you a bill for any unpaidbecause the IRS will figure it and send you a bill for any unpaidamount. If you want to figure it, you may use Part III oramount. If you want to figure it, you may use Part III or Part IV as aPart IV as a worksheet and enter your penalty amountworksheet and enter your penalty amount on your tax return, buton your tax return, but file only page 1 of Form 2210.don't file Form 2210.

Part I Required Annual Payment

1 1Enter your 2017 tax after credits from Form 1040, line 56 (see instructions if not filing Form 1040) . . . . . . . . . .

2 Other taxes, including self-employment tax and, if applicable, Additional Medicare Tax and/or Net2Investment Income Tax (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Refundable credits, including the premium tax credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Current year tax. Combine lines 1, 2, and 3. If less than $1,000, stop; you don't owe a penalty. Don't file4Form 2210. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 5Multiply line 4 by 90% (0.90). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Withholding taxes. Don't include estimated tax payments (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6

7 7Subtract line 6 from line 4. If less than $1,000, stop; you don't owe a penalty. Don't file Form 2210. . . . . . . . .

8 8Maximum required annual payment based on prior year's tax (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . .

Required annual payment. Enter the smaller of line 5 or line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9

Next: Is line 9 more than line 6?

No. You don't owe a penalty. Don't file Form 2210 unless box E below applies.

Yes. You may owe a penalty, but don't file Form 2210 unless one or more boxes in Part II below applies.

? If box B, C, or D applies, you must figure your penalty and file Form 2210.? If box A or E applies (but not B, C, or D) file only page 1 of Form 2210. You aren't required to figure your penalty; the IRS will figureit and send you a bill for any unpaid amount. If you want to figure your penalty, you may use Part III or IV as a worksheet and enteryour penalty on your tax return, but file only page 1 of Form 2210.

Reasons for Filing. Check applicable boxes. If none apply, don't file Form 2210.Part II

A You request a waiver (see instructions) of your entire penalty. You must check this box and file page 1 of Form 2210, but you aren'trequired to figure your penalty.

You request a waiver (see instructions) of part of your penalty. You must figure your penalty and waiver amount and file Form 2210.B

C Your income varied during the year and your penalty is reduced or eliminated when figured using the annualized income installmentmethod. You must figure the penalty using Schedule AI and file Form 2210.

D Your penalty is lower when figured by treating the federal income tax withheld from your income as paid on the dates it was actuallywithheld, instead of in equal amounts on the payment due dates. You must figure your penalty and file Form 2210.

E You filed or are filing a joint return for either 2016 or 2017, but not for both years, and line 8 above is smaller than line 5 above. Youmust file page 1 of Form 2210, but you aren't required to figure your penalty (unless box B, C, or D applies).

Form 2210 (2017)BAA For Paperwork Reduction Act Notice, see separate instructions.

FDIZ0313L 09/04/17


783,557.

135,092.

0.

918,649.826,784.

17,230.901,419.742,647.742,647.

X

X

Form 2210 (2017) Page 3

Part IV Regular Method (See the instructions if you are filing Form 1040NR or 1040NR-EZ.)

Payment Due DatesSection A ' Figure Your Underpayment (a) (b) (c) (d)

4/15/17 6/15/17 9/15/17 1/15/18

Required installments. If box C in Part II applies,18enter the amounts from Schedule AI, line 25.Otherwise, enter 25% (0.25) of line 9, Form 2210,

18in each column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Estimated tax paid and tax withheld (see the instruc-19tions). For column (a) only, also enter the amountfrom line 19 on line 23. If line 19 is equal to or morethan line 18 for all payment periods, stop here; youdon't owe a penalty. Don't file Form 2210 unlessyou checked a box in Part II. . . . . . . . . . . . . . . . . . . . . . . . . 19Complete lines 20 through 26 of one columnbefore going to line 20 of the next column.Enter the amount, if any, from line 26 in the20

20previous column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21 21Add lines 19 and 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22 Add the amounts on lines 24 and 25 in theprevious column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

23 Subtract line 22 from line 21. If zero or less, enter -0-.23For column (a) only, enter the amount from line 19. . . .

24 If line 23 is zero, subtract line 21 from line 22.24Otherwise, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Underpayment. If line 18 is equal to or more than25line 23, subtract line 23 from line 18. Then go to

25line 20 of the next column. Otherwise, go to line 26 . . G26 Overpayment. If line 23 is more than line 18,

subtract line 18 from line 23. Then go to line 2026of the next column. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section B ' Figure the Penalty (Use the Worksheet for Form 2210, Part IV, Section B ' Figure the Penalty in the instructions.)

27 Penalty. Enter the total penalty from line 14 of the Worksheet for Form 2210, Part IV, Section B 'Figure the Penalty. Also include this amount on Form 1040, line 79; Form 1040A, line 51;Form 1040NR, line 76; Form 1040NR-EZ, line 26; or Form 1041, line 26.

Don't file Form 2210 unless you checked a box in Part II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27G

Form 2210 (2017)

FDIZ0313L 09/04/17


101,835. 101,835. 103,161. 435,816.

102,810. 79,308. 79,307. 654,307.

975.80,283. 79,307. 654,307.

21,552. 45,406.

102,810. 80,283. 57,755. 608,901.

0. 0.

21,552. 45,406.

975.

824.

Page 4Form 2210 (2017)

Schedule AI ' Annualized Income Installment Method (See the instructions.)Estates and trusts, don't use the period ending dates (a) (b) (c) (d)shown to the right. Instead, use the following: 2/28/17,

1/1/17 - 3/31/17 1/1/17 - 5/31/17 1/1/17 - 8/31/17 1/1/17 - 12/31/174/30/17, 7/31/17, and 11/30/17.

Part I Annualized Income InstallmentsEnter your adjusted gross income for each period1(see instrs). (Estates and trusts, enter your taxable

1income without your exemption for each period.). . . .

4 2.4 1.5 12Annualization amounts. (Estates & trusts, see instrs).2

33 Annualized income. Multiply line 1 by line 2 . . . . . . .

If you itemize, enter itemized deductions for the4period shown in each column. All others enter -0-,and skip to line 7. Exception: Estates and trusts,

4skip to line 9 and enter amount from line 3. . . . . . . .

4 2.4 1.5 1Annualization amounts. . . . . . . . . . . . . . . . . . . . . . . 55

Multiply line 4 by line 5 (see instructions if line 3 is66more than $156,900) . . . . . . . . . . . . . . . . . . . . . . . .

In each column, enter the full amount of your7standard deduction from Form 1040, line 40, or Form1040A, line 24. (Form 1040NR or 1040NR-EZ filers,enter -0-. Exception: Indian students and business

7apprentices, see instructions.) . . . . . . . . . . . . . . . . .

8 8Enter the larger of line 6 or line 7 . . . . . . . . . . . . . .

9 9Subtract line 8 from line 3. . . . . . . . . . . . . . . . . . . .

In each column, multiply $4,050 by the total number10of exemptions claimed (see instructions if line 3 ismore than $156,900). (Estates, trusts, and Form

101040NR or 1040NR-EZ filers, see instructions.) . . . . . Subtract line 10 from line 9.11 11If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . .

12Figure your tax on the amount on line 11 (see instrs). .1213 Self-employment tax from line 34 (complete

13Part II below) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 Enter other taxes for each payment period including,if applicable, Additional Medicare Tax and/or

14Net Investment Income Tax (see instructions). . . . . .

15Total tax. Add lines 12, 13, and 14 . . . . . . . . . . . . . . 15

For each period, enter the same type of credits as1616allowed on Form 2210, Part I, lines 1 & 3 (see instrs)


22.5% 45% 67.5% 90%18Applicable percentage . . . . . . . . . . . . . . . . . . . . . . . 18

19Multiply line 17 by line 18 . . . . . . . . . . . . . . . . . . . . 19

Complete lines 20 - 25 of one column beforegoing to line 20 of the next column.

20Enter the totl of the amts in all prev columns of ln 2520


Enter 25% (0.25) of line 9 on page 1 of Form 2210 in2222each column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 25 of the previous column from line 242323of that column. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24Add lines 22 and 23. . . . . . . . . . . . . . . . . . . . . . . . . 24

Enter the smaller of line 21 or line 24 here and on2525Form 2210, Part IV, line 18. . . . . . . . . . . . . . . . . . . . G

(Form 1040 and Form 1040NR filers only)Annualized Self-Employment TaxPart II26 Net earnings from self-employment for the period

26(see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . .

$31,800 $53,000 $84,800 $127,20027 27Prorated social security tax limit. . . . . . . . . . . . . . . .

28 Enter actual wages for the period subject to socialsecurity tax or the 6.2% portion of the 7.65%railroad retirement (tier 1) tax. Exception: If you

28filed Form 4137 or Form 8919, see instructions. . . . .



31 31Multiply line 30 by the smaller of line 26 or line 29. .


33 33Multiply line 26 by line 32 . . . . . . . . . . . . . . . . . . . .

34 Add lines 31 and 33. Enter here and on line3413 above. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

FDIZ0305L 09/04/17 Form 2210 (2017)BAA


364,253. 607,090. 977,408. 4,068,290.

1,457,012. 1,457,016. 1,466,112. 4,068,290.

55,391. 92,319. 147,408. 580,936.

185,699. 185,701. 184,974. 466,732.

6,350. 6,350. 6,350. 6,350.185,699. 185,701. 184,974. 466,732.

1,271,313. 1,271,315. 1,281,138. 3,601,558.

0. 0. 0. 0.1,271,313. 1,271,315. 1,281,138. 3,601,558.

227,651. 227,651. 229,616. 693,700.

225,698. 225,698. 225,698. 225,698.453,349. 453,349. 455,314. 919,398.

749. 749. 749. 749.452,600. 452,600. 454,565. 918,649.

101,835. 203,670. 306,831. 826,784.

101,835. 203,670. 306,831.101,835. 101,835. 103,161. 519,953.

185,661. 185,662. 185,662. 185,662.

83,826. 167,653. 250,154.185,661. 269,488. 353,315. 435,816.

101,835. 101,835. 103,161. 435,816.






FDIL1601L 07/17/17



FIRST QTR101,835. 4/15/17 1 98,502. 3,333.

4/15/17 2 3,333.

SECOND QTR101,835. 6/15/17 2 975. 100,860.

6/15/17 2 4,308. 96,552.6/15/17 3 75,000. 21,552. 92 0.040 217.299/15/17 2 4,307. 17,245.9/15/17 3 17,245.

TOTAL 217.29THIRD QTR103,161. 9/15/17 103,161.

9/15/17 3 57,755. 45,406. 122 0.040 607.071/15/18 2 4,307. 41,099.1/15/18 3 41,099.

TOTAL 607.07FOURTH QTR

435,816. 1/15/18 435,816.1/15/18 3 435,816.

824.

OMB No. 1545-0074SCHEDULE A Itemized Deductions(Form 1040)

G Go to www.irs.gov/ScheduleA for instructions and the latest information. 2017G Attach to Form 1040.Department of the Treasury Attachment

(99)Internal Revenue Service 07Sequence No.Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 28.Name(s) shown on Form 1040 Your social security number

Caution: Do not include expenses reimbursed or paid by others.Medicaland Medical and dental expenses (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1Dental

Enter amount from Form 1040, line 38. . . . . . 22Expenses

3 3Multiply line 2 by 7.5% (0.075) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 4Subtract line 3 from line 1. If line 3 is more than line 1, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . .

Taxes You State and local (check only one box):5Paid Income taxes, ora 5

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b General sales taxes

6 6Real estate taxes (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . .

7 Personal property taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Other taxes. List type and amount G

8

9 9Add lines 5 through 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 10Interest Home mortgage interest and points reported to you on Form 1098. . . . . . . . . . . . You Paid Home mortgage interest not reported to you on Form 1098. If paid to the person11

from whom you bought the home, see instructions and show that person's name,identifying no., and address G

Note:Your mortgageinterestdeduction maybe limited (see

11instructions).

12Points not reported to you on Form 1098. See instructions for special rules. . . . . 1213 13Mortgage insurance premiums (see instructions) . . . . . . . . . . . . . .

14 Investment interest. Attach Form 4952 if required.

14See instructions.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 15Add lines 10 through 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gifts by cash or check. If you made any gift of $250 or16Gifts toCharity 16more, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17 Other than by cash or check. If any gift of $250 orIf you made amore, see instructions. You must attach Form 8283 ifgift and got a

benefit for it, 17over $500. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see instructions.

18 18Carryover from prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add lines 16 through 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 19

20 Casualty or theft loss(es) other than net qualified disaster losses. Attach Form 4684 andCasualty andTheft Losses enter the amount from line 18 of that form. See instructions.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

21 Unreimbursed employee expenses'job travel, union dues,Job Expensesjob education, etc. Attach Form 2106 or 2106-EZ ifand Certain

Miscellaneous required. See instructions. GDeductions

21

22 22Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23 Other expenses'investment, safe deposit box, etc. Listtype and amount G

23

24 24Add lines 21 through 23. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25 25Enter amount from Form 1040, line 38. . . . .

26 26Multiply line 25 by 2% (0.02). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- . . . . . . . . . . . . . . . . . . . . . . 27

Other Other'from list in instructions. List type and amount G28MiscellaneousDeductions

28

Total Is Form 1040, line 38, over $156,900?29Itemized No. Your deduction is not limited. Add the amounts in the far right columnDeductions for lines 4 through 28. Also, enter this amount on Form 1040, line 40.

29. . . . . . . . . . . . . . . . . . . . . . . Yes. Your deduction may be limited. See the Itemized Deductions Worksheetin the instructions to figure the amount to enter.

30 If you elect to itemize deductions even though they are less than your standarddeduction, check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

FDIA0301L 02/22/18 Schedule A (Form 1040) 2017BAA For Paperwork Reduction Act Notice, see the Instructions for Form 1040.


0.

529,493.

11,807.

541,300.

39,286.39,286.

350.

350.

0.

2,785.

36,837.39,622.

4,068,290.81,366.

0.

0.REDUCTION-114,204.

466,732.

X

X

MERRILL LYNCH 36,837.

STATEMENT 7

STMT 6

SEE STATEMENT 5

OMB No. 1545-0074SCHEDULE B Interest and Ordinary Dividends(Form 1040A or 1040) 2017

G Attach to Form 1040A or 1040.Department of the Treasury AttachmentG Go to www.irs.gov/ScheduleB for instructions and the latest information.(99)Internal Revenue Service 08Sequence No.



(See instructionsand theinstructions forForm 1040A, orForm 1040,line 8a.)

Note: If youreceived a Form

11099-INT, Form1099-OID, orsubstitute statementfrom a brokeragefirm, list the firm'sname as the payerand enter the totalinterest shown onthat form.



4 4GSubtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a. . . . . . . . . . . . . . . . . .

AmountNote: If line 4 is over $1,500, you must complete Part III.


OrdinaryDividends

(See instructionsand theinstructions forForm 1040A, orForm 1040,line 9a.)

Note: If you received 5a Form 1099-DIV orsubstitute statementfrom a brokeragefirm, list the firm'sname as the payerand enter theordinary dividendsshown on that form.

6 6GAdd the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a. . . . . . . . . . . . . . . . . . .


Part III You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) hadYes Noa foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.


See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . and TrustsIf 'Yes,' are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR), toreport that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing

(See instructions.) requirements and exceptions to those requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b If you are required to file FinCEN Form 114, enter the name of the foreign country where the financial

account is located G

8 During 2017, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If'Yes,' you may have to file Form 3520. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FDIA0401L 10/25/17 Schedule B (Form 1040A or 1040) 2017BAA For Paperwork Reduction Act Notice, see your tax return instructions.


11,884.

11,884.

329,185.

X

X

MERRILL LYNCH - 12754 6,167.MERRILL LYNCH - 846 101.MERRILL LYNCH -841 923.MORGAN STANLEY-547 1.MORGAN STANLEY-OID FNMA 4,658.OID-STATE OF ISRAEL BOND 34.

BELDORE CAPITAL FUND LLC 42,311.CLEARFORK CAPITAL FUND LLC 30,629.MERRILL LYNCH-12841 210,990.MERRILL LYNCH-12846 45,255.

OMB No. 1545-0074SCHEDULE D(Form 1040) Capital Gains and Losses

G Attach to Form 1040 or Form 1040NR. 2017G Go to www.irs.gov/ScheduleD for instructions and the latest information.Department of the Treasury



Part I Short-Term Capital Gains and Losses ' Assets Held One Year or Less


to gain or loss from from column (d) andProceeds CostThis form may be easier to complete if you round Form(s) 8949, Part I, combine the result with(sales price) (or other basis)off cents to whole dollars. line 2, column (g) column (g)







Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover6Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any long-term77capital gains or losses, go to Part II below. Otherwise, go to Part III on the back. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II Long-Term Capital Gains and Losses ' Assets Held More Than One Year


to gain or loss from from column (d) andProceeds CostThis form may be easier to complete if you round Form(s) 8949, Part II, combine the result with(sales price) (or other basis)off cents to whole dollars. line 2, column (g) column (g)








Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover14Worksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on1515the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule D (Form 1040) 2017BAA For Paperwork Reduction Act Notice, see your tax return instructions.

FDIA0612L 08/16/17


34,892. 30,214. 4,678.

4,678.

753,172. 647,281. 105,891.

2,740,286. 81,437. 2,658,849.

687,987. 687,987.

182,818.

267.

3,635,812.

SEE ST 8

Schedule D (Form 1040) 2017 Page 2

Part III Summary


? If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line 14. Thengo to line 17 below.If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22.?

? If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form 1040NR,line 14. Then go to line 22.


Yes. Go to line 18.



If you are required to complete the Unrecaptured Section 1250 Gain Worksheet (see1919Ginstructions), enter the amount, if any, from line 18 of that worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44 (or in the instructions for Form 1040NR, line 42). Don't complete lines21 and 22 below.


21 If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:

? The loss on line 16 or21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



22 Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b?

Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44 (or in the instructions for Form 1040NR, line 42).

No. Complete the rest of Form 1040 or Form 1040NR.

Schedule D (Form 1040) 2017

FDIA0612L 08/16/17


3,640,490.

X

0.

75.

X

OMB No. 1545-0074




Short-Term. Transactions involving capital assets you held 1 year or less are short term. For long-termPart Itransactions, see page 2.









Totals. Add the amounts in columns (d), (e), (g), and (h)2(subtract negative amounts). Enter each total here andinclude on your Schedule D, line 1b (if Box A above ischecked), line 2 (if Box B above is checked), or line 3 (ifBox C above is checked) . . . . . . . . . . . . . . . . . . . . . . . . . . . G



0.34,892.

X


30,214. 4,678.

SEE ATTTACHED MERRILL LYNCH-12846 - SEE ATTACHED STATEMENT34,892. 30,214. M 4,678.



Long-Term. Transactions involving capital assets you held more than 1 year are long term. ForPart IIshort-term transactions, see page 1.











FDIA9212L 08/14/17 Form 8949 (2017)

0.753,172.

X


647,281. 105,891.

SEE ATTTACHED MERRILL LYNCH-12846 - SEE ATTACHED STATEMENT753,172. 647,281. M 105,891.














FDIA9212L 08/14/17 Form 8949 (2017)

0.2,740,286.

X


81,437. 2,658,849.

41,810 QUALCOMM VARIOUS 11/07/17 2,644,623. 0. 2,644,623.

100,000 FNMA BOND 1/16/91 8/09/17 95,663. 81,437. 14,226.














FDIA9212L 08/14/17 Form 8949 (2017)

0.687,987.

X


0. 687,987.

QCOM-NON TAX DISTR IN EXCESS OF BASISVARIOUS VARIOUS 687,987. 0. 687,987.

OMB No. 1545-0074Supplemental Income and LossSCHEDULE E(Form 1040) (From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.) 2017

G Attach to Form 1040, 1040NR, or Form 1041.Department of the Treasury Attachment



Note: If you are in the business of renting personal property, useIncome or Loss From Rental Real Estate and RoyaltiesPart ISchedule 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.



Physical address of each property (street, city, state, ZIP code)a1

A

B

CType of Property 21 b For each rental real estate property listed Fair Rental Days Personal Use Days QJV(from list below) above, report the number of fair rental and






3 3Rents received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





8 8Commissions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 9Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


11 11Management fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


13 13Other interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 14Repairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 15Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16 16Taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17 17Utilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


19 19Other (list) G









Income. Add positive amounts shown on line 21. Do not include any losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 24

Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here. . . 25 25Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the26result here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter thisamount on Form 1040, line 17, or Form 1040NR, line 18. Otherwise, include this amountin the total on line 41 on page 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Schedule E (Form 1040) 2017FDIZ2301L 10/23/17BAA For Paperwork Reduction Act Notice, see the separate instructions.


2029 CONNECTICUT AVE NW #41, WASHINGTON, DC 20008-6142

7,509.

6,000.26,964.

26,964.

5,131.

27,407.

274,137.

148,247.

148,247.

274,137.

-117,204.

52,879.

156,933.

156,933.

1

X

SEE STM 9

Schedule E (Form 1040) 2017 Attachment Sequence No. 13 Page 2Name(s) shown on return. Do not enter name and social security number if shown on Page 1. Your social security number


Part II Income or Loss From Partnerships and S CorporationsNote: 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 line28 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, aprior year unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed

Yes Nopartnership expenses? If you answered "Yes," see instructions before completing this section . . . . . . . . . . . . . . . . . . . . . . .

(b) Enter P for (c) Check if (d) Employer (e) Check ifpartnership; S(a) Name28 foreign identification any amountfor S partnership number is not at riskcorporation

A

B

C

D


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

A

B

C

D

29 a Totals. . . . . . . . . . . . . . . .

b Totals. . . . . . . . . . . . . . . .

30 30Add columns (g) and (j) of line 29a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31 31Add columns (f), (h), and (i) of line 29b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the result here and3232include in the total on line 41 below. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part III Income or Loss From Estates and Trusts(a) Name (b) Employer ID no.33

A

B



A

B

34 a Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Combine lines 35 and 36. Enter the37 Total estate and trust income or (loss).37result here and include in the total on line 41 below. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs) ' Residual Holder(c) Excess inclusion from (d) Taxable income(b) Employer (e) Income from(a) Name38 Schedules Q, line 2c (net loss) fromidentification number Schedules Q, line 3b(see instructions) Schedules Q, line 1b


Part V SummaryNet farm rental income or (loss) from Form 4835. Also, complete line 42 below. . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 40

Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on4141GForm 1040, line 17, or Form 1040NR, line 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42 Reconciliation of farming and fishing income. Enter your gross farmingand 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

42(Form 1041), box 14, code F (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reconciliation for real estate professionals. If you were a real estate43professional (see instructions), enter the net income or (loss) you reportedanywhere on Form 1040 or Form 1040NR from all rental real estate activities

43in which you materially participated under the passive activity loss rules. . . . . . . .

FDIZ2302L 10/23/17 Schedule E (Form 1040) 2017BAA


X

BELDORE CAPITAL FUND LLC P 26-0505281CLEARFORK CAPITAL FUND LLC P 26-0158977MASS PATHWAYS TO ECON ADVANCEMENT P 32-0500335




Use a separate Form 1116 for each category of income listed below. See Categories of Income in the instructions. Check only one box oneach Form 1116. Report all amounts in U.S. dollars except where specified in Part II below.

Passive category income Section 901(j) income Lump-sum distributionsa c e

General category income Certain income re-sourced by treatyb d

GResident of (name of country)f


Part I Taxable Income or Loss From Sources Outside the United States (for Category Checked Above)Foreign Country or U.S. Possession Total


g Enter the name of the foreign country orGU.S. possession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1 a








c Add lines 3a and 3b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .









Add lines 2, 3g, 4a, 4b, and 5 . . . . . . . . . . . . . . . . . . . . . 6 6



C Credit is claimed Foreign taxes paid or accruedO for taxes (youU In foreign currency In U.S. dollarsmust check one)NT Paid(h) (s) Total foreign(n) Other (r) OtherR Taxes withheld at source on: Taxes withheld at source on: taxes paid or accruedforeign foreignY Accrued(i) (add columns (o)

taxes paid taxes paid through (r))or accrued or accrued(j) Date paid (k) (l) Rents & (m) (o) (p) Rents & (q)


A

B

C

GAdd lines A through C, column (s). Enter the total here and on line 9, page 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 8

FDIZ2612L 12/22/17 Form 1116 (2017)BAA For Paperwork Reduction Act Notice, see instructions.


217,798. 217,798.

2,356.

9,318.

9,318.217,798.

4,225,223.0.051547

480.

16,114.201,684.

X

749.

X

16,114.

13,278.

VARIOUS

749. 749.

SEE ST 11

SEE STATEMENT 10

PageForm 1116 (2017) 2



10 Carryback or carryover (attach detailed computation). . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Add lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11











19 Divide line 17 by line 18. If line 17 is more than line 18, enter '1'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20 Individuals: Enter the total of Form 1040, lines 44 and 46. If you are a nonresident alien, enter the total of Form 1040NR, lines 42 and 44. Estates and trusts: Enter the amount from Form 1041, Schedule G, line 1a; orthe total of Form 990-T, lines 36, 37, and 39. Foreign estates and trusts should enter the amount from Form

201040NR, line 42. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caution: If you are completing line 20 for separate category e (lump-sum distributions), see instructions.










Enter the smaller of line 20 or line 27. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 28


Subtract line 29 from line 28. This is your foreign tax credit. Enter here and on Form 1040, line 48;30G 30Form 1040NR, line 46; Form 1041, Schedule G, line 2a; or Form 990-T, line 41a. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 1116 (2017)

FDIZ2612L 09/04/17


749.

749.

749.

201,684.

201,684.

3,601,558.

0.0560

693,700.

38,847.

749.

749.

749.




Use a separate Form 1116 for each category of income listed below. See Categories of Income in the instructions. Check only one box oneach Form 1116. Report all amounts in U.S. dollars except where specified in Part II below.

Passive category income Section 901(j) income Lump-sum distributionsa c e

General category income Certain income re-sourced by treatyb d

GResident of (name of country)f


Part I Taxable Income or Loss From Sources Outside the United States (for Category Checked Above)Foreign Country or U.S. Possession Total


g Enter the name of the foreign country orGU.S. possession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1 a








c Add lines 3a and 3b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .









Add lines 2, 3g, 4a, 4b, and 5 . . . . . . . . . . . . . . . . . . . . . 6 6



C Credit is claimed Foreign taxes paid or accruedO for taxes (youU In foreign currency In U.S. dollarsmust check one)NT Paid(h) (s) Total foreign(n) Other (r) OtherR Taxes withheld at source on: Taxes withheld at source on: taxes paid or accruedforeign foreignY Accrued(i) (add columns (o)

taxes paid taxes paid through (r))or accrued or accrued(j) Date paid (k) (l) Rents & (m) (o) (p) Rents & (q)


A

B

C

GAdd lines A through C, column (s). Enter the total here and on line 9, page 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 8

FDIZ2612L 12/22/17 Form 1116 (2017)BAA For Paperwork Reduction Act Notice, see instructions.



151,992. 151,992.

2,356.

217,798.4,225,223.0.051547

15,634.136,358.

X

749.

X

15,634.

13,278.

VARIOUS

749. 749.

SEE ST 13

SEE STATEMENT 12

PageForm 1116 (2017) 2



10 Carryback or carryover (attach detailed computation). . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Add lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11











19 Divide line 17 by line 18. If line 17 is more than line 18, enter '1'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20 Individuals: Enter the total of Form 1040, lines 44 and 46. If you are a nonresident alien, enter the total of Form 1040NR, lines 42 and 44. Estates and trusts: Enter the amount from Form 1041, Schedule G, line 1a; orthe total of Form 990-T, lines 36, 37, and 39. Foreign estates and trusts should enter the amount from Form

201040NR, line 42. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caution: If you are completing line 20 for separate category e (lump-sum distributions), see instructions.










Enter the smaller of line 20 or line 27. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 28


Subtract line 29 from line 28. This is your foreign tax credit. Enter here and on Form 1040, line 48;30G 30Form 1040NR, line 46; Form 1041, Schedule G, line 2a; or Form 990-T, line 41a. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 1116 (2017)

FDIZ2612L 09/04/17


749.

749.

749.

136,358.

136,358.

2,807,304.

0.0486

784,306.

38,117.

749.

749.

749.

OMB No. 1545-0074


Department of the Treasury AttachmentInternal Revenue Service (99) 32Attach to Form 1040 or Form 1040NR. Sequence No.GName(s) shown on Form 1040 or Form 1040NR Your social security number


If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41, and go to line 2. Otherwise,1enter the amount from Form 1040, line 38, and go to line 7. (If less than zero, enter as a negative amount.). 1

Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2

Taxes from Schedule A (Form 1040), line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3

Enter the home mortgage interest adjustment, if any, from line 6 of the worksheet in the instructions for this line. . . . . . . . . . . . . . . . . . . . 4 4

Miscellaneous deductions from Schedule A (Form 1040), line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5

If Form 1040, line 38, is $156,900 or less, enter -0-. Otherwise, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6

Tax refund from Form 1040, line 10 or line 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 7

Investment interest expense (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 8

Depletion (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9

Net operating loss deduction from Form 1040, line 21. Enter as a positive amount . . . . . . . . . . . . . . . . . . . . . . . . . 10 10

Alternative tax net operating loss deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 11

Interest from specified private activity bonds exempt from the regular tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 12

Qualified small business stock, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1313

Exercise of incentive stock options (excess of AMT income over regular tax income) . . . . . . . . . . . . . . . . . . . . . . . 14 14

Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 15

Electing large partnerships (amount from Schedule K-1 (Form 1065-B), box 6). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 16

Disposition of property (difference between AMT and regular tax gain or loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 17

Depreciation on assets placed in service after 1986 (difference between regular tax and AMT) . . . . . . . . . . . . . . 18 18

Passive activities (difference between AMT and regular tax income or loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 19

Loss limitations (difference between AMT and regular tax income or loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 20

Circulation costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 21

Long-term contracts (difference between AMT and regular tax income). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 22

Mining costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 23

Research and experimental costs (difference between regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 24

Income from certain installment sales before January 1, 1987. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 25

Intangible drilling costs preference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 26


Alternative minimum taxable income. Combine lines 1 through 27. (If married filing28separately and line 28 is more than $249,450, see instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28


THEN enter on line 29 . . . . IF your filing status is. . . . AND line 28 is not over. . .

Single or head of household. . . . . . . . . . . . . . . $120,700 . . . . . . . . . . . . . . . . $54,300160,900 . . . . . . . . . . . . . . . . 84,500Married filing jointly or qualifying widow(er)

Married filing separately. . . . . . . . . . . . . . . . . . . 80,450 . . . . . . . . . . . . . . . . 42,250. . . . . . 29If line 28 is over the amount shown above for your filing status, see instructions.

Subtract line 29 from line 28. If more than zero, go to line 31. If zero or less,3030enter -0- here and on lines 31, 33, and 35, and go to line 34. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31 ? If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter.? If you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends on Form

1040, line 9b; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (as refigured for the AMT, ifnecessary), complete Part III on the back and enter the amount from line 64 here. 31. . . . . . .

?All others: If line 30 is $187,800 or less ($93,900 or less if married filing separately),multiply line 30 by 26% (0.26). Otherwise, multiply line 30 by 28% (0.28) and subtract$3,756 ($1,878 if married filing separately) from the result.


Tentative minimum tax. Subtract line 32 from line 31. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 33

Add Form 1040, line 44 (minus any tax from Form 4972), and Form 1040, line 46. Subtract from the result34any foreign tax credit from Form 1040, line 48. If you used Schedule J to figure your tax on Form 1040,

34line 44, refigure that tax without using Schedule J before completing this line (see instructions). . . . . . . . . . . . .

AMT. Subtract line 34 from line 33. If zero or less, enter -0-. Enter here and on Form 1040, line 45 . . . . . . . . . 35 35

FDIA5312L 01/11/18 Form 6251 (2017)BAA For Paperwork Reduction Act Notice, see your tax return instructions.


3,601,558.

541,300.

-114,204.

4,028,654.

4,028,654.

784,306.

749.

783,557.

692,951.

90,606.

Form 6251 (2017) Page 2


Enter the amount from Form 6251, line 30. If you are filing Form 2555 or 2555-EZ, enter the amount from36line 3 of the worksheet in the instructions for line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions37for Form 1040, line 44, or the amount from line 13 of the Schedule D Tax Worksheet in the instructions forSchedule D (Form 1040), whichever applies (as refigured for the AMT, if necessary) (see instructions). If

37you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the amount from Schedule D (Form 1040), line 19 (as refigured for the AMT, if necessary) (see3838instructions). If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter. . . . . . . . . . . . . . .

If you did not complete a Schedule D Tax Worksheet for the regular tax or the AMT, enter the amount39from line 37. Otherwise, add lines 37 and 38, and enter the smaller of that result or the amount from line10 of the Schedule D Tax Worksheet (as refigured for the AMT, if necessary). If you are filing Form 2555 or

392555-EZ, see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the smaller of line 36 or line 39. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 40

Subtract line 40 from line 36. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4141


Gthe result. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Enter:43




Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions44for Form 1040, line 44, or the amount from line 14 of the Schedule D Tax Worksheet in the instructions forSchedule D (Form 1040), whichever applies (as figured for the regular tax). If you did not complete eitherworksheet for the regular tax, enter the amount from Form 1040, line 43; if zero or less, enter -0-. If youare filing Form 2555 or 2555-EZ, see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44


Enter the smaller of line 36 or line 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 46

Enter the smaller of line 45 or line 46. This amount is taxed at 0%. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 47


49 Enter:






Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions51for Form 1040, line 44, or the amount from line 19 of the Schedule D Tax Worksheet, whichever applies(as figured for the regular tax). If you did not complete either worksheet for the regular tax, enter theamount from Form 1040, line 43; if zero or less, enter -0-. If you are filing Form 2555 or Form 2555-EZ,see instructions for the amount to enter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

52 Add line 50 and line 51. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52




Add lines 47 and 54. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 56If lines 56 and 36 are the same, skip lines 57 through 61 and go to line 62. Otherwise, go to line 57.Subtract line 56 from line 46. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 57


Add lines 41, 56, and 57. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 59



Add lines 42, 55, 58, and 61. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 62


Enter the smaller of line 62 or line 63 here and on line 31. If you are filing Form 2555 or 2555-EZ, do not64enter this amount on line 31. Instead, enter it on line 4 of the worksheet in the instructions for line 31. . . . . . . 64

FDIA5312L 08/31/17 Form 6251 (2017)


4,028,654.

3,942,198.

75.

3,942,273.

3,942,273.

86,381.

22,459.

37,950.

0.

37,950.

3,942,198.

37,950.

3,904,248.

418,400.

37,950.

0.

37,950.380,450.

380,450.

57,068.

418,400.

3,523,798.

704,760.

4,028,579.

75.19.

784,306.

1,124,267.

784,306.

OMB No. 1545-0191Investment Interest Expense DeductionForm 4952

2017G Go to www.irs.gov/Form4952 for the latest information.

Department of the Treasury Attachment(99) G Attach to your tax return.Internal Revenue Service 51Sequence No.

Identifying numberName(s) shown on return

Part I Total Investment Interest Expense

1 1Investment interest expense paid or accrued in 2017 (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 2Disallowed investment interest expense from 2016 Form 4952, line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total investment interest expense. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3

Part II Net Investment Income

4 a Gross income from property held for investment (excluding any net gain from4 athe disposition of property held for investment) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b 4 bQualified dividends included on line 4a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c 4 cSubtract line 4b from line 4a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d 4 dNet gain from the disposition of property held for investment. . . . . . . . . . . . . . . . . . .

e Enter the smaller of line 4d or your net capital gain from the disposition of4 eproperty held for investment (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f 4 fSubtract line 4e from line 4d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g 4 gEnter the amount from lines 4b and 4e that you elect to include in investment income (see instructions). . . . .

h 4 hInvestment income. Add lines 4c, 4f, and 4g. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 5Investment expenses (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 6Net investment income. Subtract line 5 from line 4h. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Investment Interest Expense DeductionPart III

7 Disallowed investment interest expense to be carried forward to 2018. Subtract line 6 from line 3. If zero or7less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Investment interest expense deduction. Enter the smaller of line 3 or 6. See instructions . . . . . . . . . . . . . . . . . . 8 8


FDIZ1201L 08/01/17


39,286.

39,286.

341,069.

326,707.

14,362.

3,640,490.

3,635,812.

4,678.

20,246.

39,286.

39,286.

0.

39,286.




























Part III Tax Computation12 Net investment income. Subtract Part II, line 11 from Part I, line 8. Individuals complete lines 13-17.

Estates and trusts complete lines 18a-21. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12




Enter the smaller of line 12 or line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1616

Net investment income tax for individuals. Multiply line 16 by 3.8% (.038). Enter here and17

include on your tax return (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Estates and Trusts:Net investment income (line 12 above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 a a18



c Undistributed net investment income. Subtract line 18b from 18a18c(see instructions). If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






Net investment income tax for estates and trusts. Multiply line 20 by 3.8% (.038). Enter here21

and include on your tax return (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21


FDIA6801L 07/28/17


11,884.

329,185.

3,640,490.

3,640,490.

40,237.4,021,796.

39,286.

427,446.

466,732.

466,732.

3,555,064.

4,068,290.200,000.

3,868,290.3,555,064.

135,092.


G Go to www.irs.gov/Form8801 for instructions and the latest information.Department of the Treasury AttachmentG Attach to Form 1040, 1040NR, or 1041.Internal Revenue Service (99) 74Sequence No.



1 1Combine lines 1, 6, and 10 of your 2016 Form 6251. Estates and trusts, see instructions . . . . . . . . . . . . . . . . . . .




5 Enter: $83,800 if married filing jointly or qualifying widow(er) for 2016; $53,900 if single or head of5household for 2016; or $41,900 if married filing separately for 2016. Estates and trusts, enter $23,900. . . . . . .

Enter: $159,700 if married filing jointly or qualifying widow(er) for 2016; $119,700 if single or head of66household for 2016; or $79,850 if married filing separately for 2016. Estates and trusts, enter $79,850. . . . . . .


8 8Multiply line 7 by 25% (0.25). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 9Subtract line 8 from line 5. If zero or less, enter -0-. If under age 24 at the end of 2016, see instructions . . . .

10 Subtract line 9 from line 4. If zero or less, enter -0- here and on line 15 and go to10Part II. Form 1040NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


? If for 2016 you reported capital gain distributions directly on Form 1040, line 13; you reportedqualified dividends on Form 1040, line 9b (Form 1041, line 2b(2)); or you had a gain on both lines15 and 16 of Schedule D (Form 1040) (lines 18a and 19, column (2), of Schedule D (Form 1041)),complete Part III of Form 8801 and enter the amount from line 55 here. Form 1040NR filers,see instructions. 11? All others: If line 10 is $186,300 or less ($93,150 or less if married filing separately for 2016),multiply line 10 by 26% (0.26). Otherwise, multiply line 10 by 28% (0.28) and subtract $3,726 ($1,863if married filing separately for 2016) from the result. Form 1040NR filers, see instructions.




Net minimum tax on exclusion items. Subtract line 14 from line 13. If zero or less, enter -0-. . . . . . . . . . . . . . . . 15 15


FDIZ2413L 11/20/17


2,579,393.

425,914.

3,005,307.

53,900.

119,700.

2,885,607.

721,402.

0.

3,005,307.

574,661.

812.

573,849.

505,552.

68,297.

Form 8801 (2017) Page 2





2016 credit carryforward. Enter the amount from your 2016 Form 8801, line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 19




Enter the amount from your 2017 Form 6251, line 33, or 2017 Form 1041, Schedule I, line 54. . . . . . . . . . . . . . . 23 23


Minimum tax credit. Enter the smaller of line 21 or line 24. Also enter this amount on your 201725Form 1040, line 54 (check box b); Form 1040NR, line 51 (check box b); or Form 1041, Schedule G,line 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Credit carryforward to 2018. Subtract line 25 from line 21. Keep a record of this amount because you26may use it in future years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Form 8801 (2017)

FDIZ2413L 11/20/17


68,430.

68,297.

133.

133.

692,951.

783,557.

0.

133.

Form 8801 (2017) Page 3



Enter the amount from Form 8801, line 10. If you filed Form 2555 or 2555-EZ for 2016, enter the amount27from line 3 of the Foreign Earned Income Tax Worksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Caution: If for 2016 you filed Form 1040NR, 1041, 2555, or 2555-EZ, see the instructions before completinglines 28, 29, and 30.




Add lines 28 and 29, and enter the smaller of that result or the amount from line 10 of your 201630Schedule D Tax Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Enter the smaller of line 27 or line 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3131



G2016) from the result. Form 1040NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Enter:34







35applies; if zero or less, enter -0-. Form 1040NR filers, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





Enter:40

?$415,050 if single for 2016,






Enter the amount from line 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4141


42your 2016 Form 1041, line 22; if zero or less, enter -0-. Form 1040NR filers, see instructions. . . . . . . . . . . . . . . . .

* The 2016 Qualified Dividends and Capital Gain Tax Worksheet is in the 2016 Instructions for Form 1040. The 2016 Schedule D Tax Worksheetis in the 2016 Instructions for Schedule D (Form 1040) (or the 2016 Instructions for Schedule D (Form 1041)).

Form 8801 (2017)

FDIZ2413L 11/20/17


3,005,307.

3,006,332.

3,006,332.3,005,307.

0.

37,650.

0.37,650.

3,005,307.37,650.

2,967,657.

415,050.

37,650.

Form 8801 (2017) Page 4


Add lines 41 and 42. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 43




Add lines 38 and 45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 47





Add lines 32, 47, and 48. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5050



Add lines 33, 46, 49, and 52. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 53

If line 27 is $186,300 or less ($93,150 or less if married filing separately for 2016), multiply line 27 by 26%54(0.26). Otherwise, multiply line 27 by 28% (0.28) and subtract $3,726 ($1,863 if married filing separately for2016) from the result. Form 1040NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Enter the smaller of line 53 or line 54 here and on line 11. If you filed Form 2555 or 2555-EZ for 2016,55don't enter this amount on line 11. Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet in

55the instructions for line 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 8801 (2017)

FDIZ2413L 11/20/17


37,650.377,400.377,400.56,610.

415,050.

2,590,257.518,051.

574,661.

837,760.

574,661.












Prior year unallowed commercial revitalization deductions from Worksheet 2,bcolumn (b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 b





























FDIZ1901L 10/16/17


-117,204.

-69,307.-186,511.

-34,826.

-34,826.

-221,337.

186,511.150,000.

4,068,290.

0.

Form 8582 (2017) Page 2


















GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

FDIZ1902L 08/02/17 Form 8582 (2017)BAA


221,337.221,337.

34,826.

69,307.117,204.

RESIDENTIAL RENTAL 117,204. 69,307. 186,511.


RESIDENTIAL RENTAL SCH E LN 22 186,511. 0.842656 186,511.MASS PATHWAYS TO ECON ADVANCEMEN SCH E LN 28 34,826. 0.157344 34,826.

Form 8582 (2017) Page 3



GTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Name of activity . . . .

















Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 1.00Name of activity . . .


















0.0.0.

0.0.0.

0.221,337.221,337.


RESIDENTIAL RENTAL SCH E LN 22 186,511. 186,511. 0.MASS PATHWAYS TO ECON ADVANCEMEN SCH E LN 28 34,826. 34,826. 0.












Prior year unallowed commercial revitalization deductions from Worksheet 2,bcolumn (b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 b





























FDIZ1901L 10/16/17



-105,375.

-60,685.-166,060.

-34,826.

-34,826.

-200,886.

166,060.150,000.

4,068,290.

0.

Form 8582 (2017) Page 2


















GTotal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

FDIZ1902L 08/02/17 Form 8582 (2017)BAA


200,886.200,886.

34,826.

60,685.105,375.

RESIDENTIAL RENTAL 105,375. 60,685. 166,060.


RESIDENTIAL RENTAL SCH E LN 22 166,060. 0.826638 166,060.MASS PATHWAYS TO ECON ADVANCEMEN SCH E LN 28 34,826. 0.173362 34,826.

Form 8582 (2017) Page 3



GTotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Name of activity . . . .

















Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 1.00Name of activity . . .


















0.0.0.

0.0.0.


0.200,886.200,886.


RESIDENTIAL RENTAL SCH E LN 22 166,060. 166,060. 0.MASS PATHWAYS TO ECON ADVANCEMEN SCH E LN 28 34,826. 34,826. 0.





PIROJECT CONNECT, INC. 86,731. 17,230. 5,377. 1,258. 4,973. 1,247.GRAND TOTAL 86,731. 17,230. 5,377. 1,258. 4,973. 1,247.




STATEMENT 3FORM 1040, LINE 9BQUALIFIED DIVIDENDS

BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 42,311.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30,629.MERRILL LYNCH-12841 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210,990.MERRILL LYNCH-12846 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,777.

TOTAL $ 326,707.

STATEMENT 4FORM 1040, PAGE 1, LINE 10TAXABLE REFUNDS OF STATE AND LOCAL INCOME TAXES

1. STATE AND LOCAL TAX REFUNDS (PRIOR YEAR) $ 40,273.2. REFUNDS ATTRIBUTABLE TO POST 12/31/2016 PAYMENTS PER IRS PUB. 525 0.3. NET STATE AND LOCAL TAX REFUNDS 40,273.4. STATE AND LOCAL TAXES FROM PRIOR YEAR SCHEDULE A, LINE 5 445,286.5. PRIOR YEAR ALLOWABLE SALES TAX DEDUCTION 1,373.6. EXCESS OF INCOME TAXES DEDUCTED OVER SALES TAXES DEDUCTED 443,913.7. ENTER THE SMALLER OF LINE 3 OR LINE 6 40,273.8. REFUND WITH NO BENEFIT DUE TO AMT, NONREF. CRED., 0% CAP GAIN RATE -40,273.9. STATE AND LOCAL REFUNDS TAXABLE THIS YEAR $ 0.

STATE REFUNDS TAXABLE IN 2017 - RECOMPUTED TAX(TO DETERMINE IF TAX BENEFIT RECEIVED PER IRS PUB. 525-AMT/UNUSED CREDITS)


1. ACTUAL TAXABLE INCOME 2,663,818.2. ACTUAL REGULAR TAX 506,364.3. ACTUAL AMT 68,430.4. ACTUAL TOTAL TAX BEFORE CREDITS 574,794.5. LESS: ACTUAL CREDITS 812.6. ACTUAL TAX AFTER CREDITS 573,982.



STATE REFUNDS TAXABLE IN 2017 - RECOMPUTED TAX (CONTINUED)(TO DETERMINE IF TAX BENEFIT RECEIVED PER IRS PUB. 525-AMT/UNUSED CREDITS)

7. TAXABLE INCOME RECOMPUTED WITH SCH. A TAXESREDUCED BY STATE TAX REFUNDS 2,704,091.

8. RECOMPUTED REGULAR TAX 514,418.9. RECOMPUTED AMT 60,376.

10. RECOMPUTED TOTAL TAX BEFORE CREDITS 574,794.11. LESS: RECOMPUTED CREDITS 812.12. RECOMPUTED TAX AFTER CREDITS 573,982.13. DIFFERENCE BETWEEN ACTUAL AND RECOMPUTED TAX








STATEMENT 5SCHEDULE A, LINE 6REAL ESTATE TAXES

NY CONDO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 11,807.TOTAL $ 11,807.


MERRILL LYNCH-12828 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,286.TOTAL $ 39,286.




AMERICAN FRIENDS OF ISRAEL DEMOCROCY INS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 100.COLUMBIA UNIVERSITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250.

TOTAL $ 350.




ASSOCIATION DUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 52,005.PLUMBING AND ELECTRICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 874.

TOTAL $ 52,879.




NET FOREIGN SOURCE CAPITAL GAIN DISTRIBUTIONS. . . . . . . . . . . . . . . . 267.BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,342.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,051.

TOTAL $ 217,798.


BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,436.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 920.

TOTAL $ 2,356.




FOREIGN COUNTRY OR U.S. POSSESSION: VARIOUSGROSS FOREIGN SOURCE QUALIFIED DIVIDENDS. . . . . . . . . . . . . . . . 212,138.FOREIGN SOURCE QUALIFIED DIVIDEND ADJUSTMENT. . . . . . . . . . -65,723.

NET FOREIGN SOURCE QUALIFIED DIVIDENDS. . . . . . . . . . . . . . . . . . . . . . . . . . . $ 146,415.CAPITAL GAIN DISTRIBUTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267.CAPITAL GAIN DISTRIBUTIONS ADJUSTMENT . . . . . . . . . . . . . . . . . . . . -83.

NET FOREIGN SOURCE CAPITAL GAIN DISTRIBUTIONS. . . . . . . . . . . . . . . . 184.BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,342.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,051.

TOTAL $ 151,992.


BELDORE CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,436.CLEARFORK CAPITAL FUND LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 920.

TOTAL $ 2,356.



SCHEDULE E - RESIDENTIAL RENTAL____________________________________

BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 73,245 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 73,245 76,419



6 LAMP 1/01/16 734 734 105 200DB HY 7 .24490 180

7 STOOL 1/01/16 1,101 1,101 157 200DB HY 7 .24490 270

10 TV CABINETS 1/01/16 9,819 9,819 1,403 200DB HY 7 .24490 2,405




8 LIGHTING 1/01/16 13,857 13,857 1,980 200DB HY 7 .24490 3,394

9 DRAPES 1/01/16 3,512 3,512 502 200DB HY 7 .24490 860


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0














BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 73,245 S/L MM 27.5 .03636 76,419 76,419 0

TOTAL BUILDINGS 2,101,726 73,245 76,419 76,419 0 0 0 0



6 LAMP 1/01/16 734 79 150DB HY 7 .19130 140 180 40 0

7 STOOL 1/01/16 1,101 118 150DB HY 7 .19130 211 270 59 0

10 TV CABINETS 1/01/16 9,819 1,052 150DB HY 7 .19130 1,878 2,405 527 0




8 LIGHTING 1/01/16 13,857 1,484 150DB HY 7 .19130 2,651 3,394 743 0

9 DRAPES 1/01/16 3,512 376 150DB HY 7 .19130 672 860 188 0


LAND____

2 LAND 1/01/16 900,740 0 0 0

TOTAL LAND 900,740 0 0 0 0 0 0 0











PAGE 2

2017 TAX RETURN

Client:

Prepared for:

Prepared by:

Date:

Comments:

Route to:

FDIL2001L 07/05/17


1178K3

SARA J. JACOBSC/O 13974 BOQUITA DRIVE DEL MAR, CA 92014

OCTOBER 2, 2020

059


TAXABLE YEAR FORM






















I certify that the above numeric entry is my PIN, which is my signature for the 2017 California individual 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 FTB Pub.1345, 2017 e-file Handbook for Authorized e-file Providers.




2,855,613.

X 11781

TAXABLE YEAR FORMCalifornia Nonresident or Part-Year2017 Long Form 540NRResident Income Tax Return

AR

RP

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

52 Qualifying widow(er) with dependent child. Enter year spouse/RDP diedMarried/RDP filing jointly. See instructions.

3 Married/RDP filing separately. Enter spouse's/RDP's SSN or ITIN above and full name here

If your California filing status is different from your federal filing status, check the box here. . . . . . . . . . . . .

If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See inst.. . . . . . . . 6 6@

Exemptions Whole dollars onlyFor line 7, line 8, line 9, and line 10: Multiply the amount you enter in the box by the pre-printed dollar amount for that line.GPersonal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked box 2 or 5,7

enter 2. If you checked the box on line 6, see instructions . . . . . . . . . . . . . . . . . . . 7 X $114 = $> >Blind: If you (or your spouse/RDP) are visually impaired, enter 1;8

8 X $114 =if both are visually impaired, enter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $> >9 9 X $114 =@ $Senior: If you (or your spouse/RDP) are 65 or older, enter 1; if both are 65 or older, enter 2 . . . . . . >



First Name > > >Last Name > >>SSN @ @ @Dependent'srelationship > > >to you

X $353 =Total dependent exemptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10@ $>Exemption amount: Add line 7 through line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 11 $>

@Total California wages from your Form(s) W-2, box 16 . . . . . . . . . . . . 12 12

Enter federal AGI from Form 1040, line 37; 1040A, line 21; 1040EZ, line 4; 1040NR,13TotalTaxable line 36; or 1040NR-EZ, line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13>Income

1414 California adjustments ' subtractions. Enter the amount from Schedule CA (540NR), line 37, column B. . . . . . . . @15 15Subtract line 14 from line 13. If less than zero, enter the result in parentheses. See instructions. . . . . . . . . . . . . . . .

16 16California adjustments ' additions. Enter the amount from Schedule CA (540NR), line 37, column C . . . . . . . . . . @17Adjusted gross income from all sources. Combine line 15 and line 16. . . . . . . . . . . . . . . . . . . 17 @

Enter the larger of: Your California itemized deductions from Schedule CA (540NR),18

18@line 44; OR Your California standard deduction. See instructions. . . . . . . . . . . . . . . . . . . . . . .

19 Subtract line 18 from line 17. This is your total taxable income. If less than zero, enter -0- . . . . . . . . . . . . . . . . 19>

3131174 Long Form 540NR 2017 Side 1CAIA4812L 12/27/17 059

X

1 114.

114.

4,068,290.

4,068,290.

4,068,290.

41,717.4,026,573.

***-**-**** JACO 17SARA J

C/O 13974 BOQUITA DRDEL MAR CA 92014

APE

02-01-1989

JACOBS



@ 3131 FTB 3803 . . . . Tax. Check the box if from: Tax Table Tax Rate Schedule FTB 3800@ @CATaxable @CA adjusted gross income from Schedule CA (540NR), Part IV, line 45. . . . . . 32 32Income

@CA Taxable Income from Schedule CA (540NR), Part IV, line 49. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 35

CA Tax Rate. Divide line 31 by line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 36>CA Tax Before Exemption Credits. Multiply line 35 by line 36. . . . . . . . . . . . . . . . . . . . . . . . . 3737 >CA Exemption Credit Percentage. Divide line 35 by line 19.38If more than 1, enter 1.0000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38>CA Prorated Exemption Credits. Multiply line 11 by line 38. If the amount on39line 13 is more than $187,203, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39>CA Regular Tax Before Credits. Subtract line 39 from line 37. If less than zero, enter -0-. . . . . . . . . . . . . . . . . 40 40>

41Tax. See instructions. Check the box if from: Schedule G-141 @ @ FTB 5870A. . . . . . . . . . . . @@Add line 40 and line 41 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 42

Nonrefundable Child and Dependent Care Expenses Credit.50@ 50See instructions. Attach form FTB 3506. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Special

Credits @Credit for joint custody head of household. See instructions . . . . 51 51

@Credit for dependent parent. See instructions. . . . . . . . . . . . . . . . . . 52 52

@Credit for senior head of household. See instructions . . . . . . . . . . 5353

Credit percentage. Enter the amount from line 38 here.5454If more than 1, enter 1.0000. See instructions . . . . . . . . . . . . . . . . . >

@Credit amount. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5555

and amount. . . . . . . . . . . . . @Enter credit name code58 58@

and amount. . . . . . . . . . . . . Enter credit name code59 59@@

@To claim more than two credits. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 60

@Nonrefundable renter's credit. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 61

Add line 50 and line 55 through 61. These are your total credits . . . . . . . . . . . . . . . . . . . . . . . 62 62>Subtract line 62 from line 42. If less than zero, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6363 >

Other @Alternative minimum tax. Attach Schedule P (540NR). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 71Taxes @Mental Health Services Tax. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 72

@Other taxes and credit recapture. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7373

@Add line 63, line 71, line 72, and line 73. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . . 74 74

Payments@California income tax withheld. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 81

@ 8282 2017 CA estimated tax and other payments. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@Withholding (Form 592-B and/or 593). See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 83

@Excess SDI (or VPDI) withheld. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 84

@Earned Income Tax Credit (EITC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 85

Add lines 81 through 85. These are your total payments. See instructions. . . . . . . . . . . . . . 86 86>

OverpaidOverpaid tax. If line 86 is more than line 74, subtract line 74 from line 86 . . . . . . . . . . . . . . 101 101Tax/Tax Due >

@Amount of line 101 you want applied to your 2018 estimated tax. . . . . . . . . . . . . . . . . . . . . . . 102102

@Overpaid tax available this year. Subtract line 102 from line 101. . . . . . . . . . . . . . . . . . . . . . . 103103

Tax due. If line 86 is less than line 74, subtract line 86 from line 74. . . . . . . . . . . . . . . . . . . . 104 104>

CAIA4812L 12/27/17Side 2 Long Form 540NR 2017 3132174059


356,010.

375,000.

375,000.

18,990.18,990.

18,263.

337,747.

X 481,044.2,855,613.

2,826,332.0.1195

337,747.

0.7019

337,747.

337,747.


Contributions Code Amount

California Seniors Special Fund. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400@

@Alzheimer's Disease/Related Disorders Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401

@Rare and Endangered Species Preservation Voluntary Tax Contribution Program. . . . . . . . . . . . 403

@California Breast Cancer Research Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . 405

California Firefighters' Memorial Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406@

Emergency Food for Families Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407@

California Peace Officer Memorial Foundation Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408@

@California Sea Otter Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410

@California Cancer Research Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413

School Supplies for Homeless Children Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422@

423@State Parks Protection Fund/Parks Pass Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@Protect Our Coast and Oceans Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . 424

@Keep Arts in Schools Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425

State Children's Trust Fund for the Prevention of Child Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430@

Prevention of Animal Homelessness and Cruelty Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431@

@Revive the Salton Sea Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432

@California Domestic Violence Victims Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433

@Special Olympics Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434

@Type 1 Diabetes Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435

@California YMCA Youth and Government Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . 436

@Habitat for Humanity Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437

@California Senior Citizen Advocacy Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . 438

@Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . 439

@Rape Backlog Kit Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440

@Add code 400 through code 440. This is your total contribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 120

CAIA4812L 12/27/17 Long Form 540NR 2017 Side 33133174059



Amount AMOUNT YOU OWE. Add line 104 and line 120. See instructions. Do not send cash.121You Owe

Mail to: FRANCHISE TAX BOARDPO BOX 942867SACRAMENTO CA 94267-0001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121@

Pay Online ' Go to ftb.ca.gov/pay for more information.

Interest Interest, late return penalties, and late payment penalties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 122andPenalties

@ @ @Underpayment of estimated tax. Check the box: 123123 FTB 5805F attached. . . . . . . FTB 5805 attached

124 Total amount due. See instructions. Enclose, but do not staple,any payment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

REFUND OR NO AMOUNT DUE. Subtract line 120 from line 103.125Refund andDirect Deposit @ 125Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0001 . . . . .

Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or adeposit slip. See instructions. Have you verified the routing and account numbers? Use whole dollars only.

All or the following amount of my refund (line 125) is authorized for direct deposit into the account shown below:

Checking

Savings

Direct deposit amountRouting number Type Account number @ 126@ @ @


Checking

Savings

Routing number Type Account number Direct deposit amount127@@@ @

IMPORTANT: Attach a copy of your complete federal return.

To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to ftb.ca.gov/forms and search for 1131. To requestthis notice by mail, call 800.852.5711.

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

Your signature Spouse's/RDP's signature (if a joint tax return, both must sign)Date

X X

Preferred phone numberYour email address. Enter only one email address.> >Sign

Paid preparer's signature (declaration of preparer is based on all information of which preparer has any knowledge)HereIt is unlawfulto forge a PTIN@Firm's addressspouse's/RDP'ssignature.

Joint tax return? FEIN@(See instructions)

Do you want to allow another person to discuss this tax return with us? See instructions . . . . . . . . . . . . @ Yes No

CAIA4812L 12/27/17Side 4 Long Form 540NR 2017 3134174059


X


33-0009298

XPrint Third Party Designee's Name Telephone Number

TAXABLE YEAR SCHEDULECalifornia Adjustments '2017 Nonresidents or Part-Year Residents CA (540NR)

Important: Attach this schedule behind Long Form 540NR, Side 4 as a supporting California schedule.Name(s) as shown on tax return SSN or ITIN

Part I Residency Information. Complete all lines that apply to you and your spouse/RDP for taxable year 2017.During 2017:

1 My California (CA) Residency (Check one)a bMyself Nonresident Part-Year Resident Resident Spouse Nonresident Part-Year Resident Resident> > > > >>

Yourself Spouse/RDP

2 a I was domiciled in (enter two letter code, see instructions). . . . . . >>b I was in the military and stationed in (enter two letter code) . . . . > >

I became a CA resident (enter state of prior residence3and date (mm/dd/yyyy) of move). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > >

4 I became a CA nonresident (enter new state of residence

and date (mm/dd/yyyy) of move). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > >5 I was a CA nonresident the entire year (enter state of residence) . . . . . . . . . . . . . > >

The number of days I spent in CA for any purpose was: . . . . . . . . 6 > >7 I owned a home/property in CA (enter Y for Yes, N for No) . . . . . > >

> >8 Before 2017: I was a CA resident for the period of . . . . . . . . . . . . . . . . . . . . . . .

> >A B C D EPart II Income Adjustment Schedule

Section A ' Income Federal Subtractions Additions CA AmountsTotal Amounts UsingAmounts (income earned orSee instructions See instructions CA Law As If You

(taxable amounts from received as a CA(difference (difference Were a CA Residentyour federal tax return) resident and incomebetween CA & between CA & (subtract column B

earned or receivedfederal law) federal law) from column A; addfrom CA sources ascolumn C to the result)

a nonresident)Wages, salaries, tips, etc. See instructions7before making an entry in column B

7or C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > >> > >8 b 8 aTaxable interest. > > > >>

Ordinary dividends. See instructions.9

. . . . . . . . . . b 9 a > > > > >>Taxable refunds, credits, or offsets of state10 >>10and local income taxes. . . . . . . . . . . . . . . . .

11 11Alimony received. See instructions . . . . . . . . > > > >12 12Business income or (loss) . . . . . . . . . . . . . . > > > >>13 13Capital gain or (loss). See instructions . . . . . > > > > >14 14Other gains or (losses). . . . . . . . . . . . . . . . . > > > >>

IRA distributions. See instructions.15. . . . . . . . . . a 15 b > > > > >>

Pensions & annuities. See instructions.16. . . . . . . . . . a 16 b > > > >>>

Rental real estate, royalties, partnerships,1717S corporations, trusts, etc. . . . . . . . . . . . . . . > > > > >18Farm income or (loss) . . . . . . . . . . . . . . . . . 18 > > > >>

19 19Unemployment compensation . . . . . . . . . . . . > >Social security benefits.20

. . . . . . . . . . a 20 b >>>Other income.21

a a>a California lottery winnings

b Disaster loss deduction from FTB 3805Vb b>

c Federal NOL (Form 1040, line 21) c> > > >21 c 21 21NOL deduction from FTB 3805Vd >d dNOL from FTB 3805Z, FTB 3806,eFTB 3807, or FTB 3809 e e>Other (describe): > >f f f

a22 Total: Combine line 7 through line 21 in> > > > >each column. Continue to Side 2. . . . . . . . . . 22 a

CAIA4912L 02/28/18

7741174For Privacy Notice, get FTB 1131 ENG/SP. Schedule CA (540NR) 2017 (REV 02-18) Side 1059


NYN/ANY

11/01/2017

N/AN/A61N

86,731. 86,731.11,884. 11,884.

329,185. 329,185. 210,990.

3640490. 3640490. 2644623.

4068290. 4068290. 2855613.

326,707.

1/01/2014

X

2/01/1989

Income Adjustment Schedule A B C D E

CA AmountsSubtractions Additions Total Amounts UsingSection B ' Adjustments to Income Federal Amounts(income earned orCA Law As If YouSee instructions(taxable amounts from See instructionsreceived as a CAWere a CA Resident(difference betweenyour federal tax return) (difference between

resident and income(subtract column BCA & federal law) CA & federal law)earned or receivedfrom column A; add

from CA sources as acolumn C to the result)nonresident)

Enter totals from Side 1, line 22a,22 b > > >> >22bcolumn A through column E . . . . . . . . . . . . .

23 23Educator expenses. . . . . . . . . . . . . . . . > >Certain business expenses of reservists,24performing artists, and fee-basisgovernment officials. . . . . . . . . . . . . . . . . . . > > > > >24

25 25Health savings account deduction. . >>26 26Moving expenses . . . . . . . . . . . . . . . . . > > >27 27Deductible part of self-employment tax . . . . . > > >

Self-employed SEP, SIMPLE, and2828 > >>qualified plans. . . . . . . . . . . . . . . . . . . .

29 29 > > >Self-employed health insurance deduction. . .

30 30Penalty on early withdrawal of savings . . . . . > > >Alimony paid. Enter recipient's:31 a b

SSN >

Lastname 31a> > > > >

32 32IRA deduction . . . . . . . . . . . . . . . . . . . . > > >33 33Student loan interest deduction. . . . . . . . . . . > > > >34 34Tuition and fees . . . . . . . . . . . . . . . . . . > >35 35Domestic production activities deduction. . . . > >

Add line 23 through line 35 in each36column, A through E

36 > > > > >Total. Subtract line 36 from line 22b in each37 > > > > >37column, A through E. See instructions. . . . . .

Part III ' Adjustments to Federal Itemized DeductionsFederal Itemized Deductions. Enter the amount from federal Schedule A (Form 1040), lines 4, 9, 15, 19, 20,3827, and 28 (or Schedule A (Form 1040NR), lines 1, 5, 6, 13, and 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38>Enter total of federal Schedule A (Form 1040), line 5 (State Disability Insurance, and state and local income tax,39or General Sales Tax), and line 8 (foreign taxes only) (or Schedule A (Form 1040NR), line 1). See instructions . 39>Subtract line 39 from line 38. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 40>Other adjustments including California lottery losses. See instructions. Specify41

41>4242 Combine line 40 and line 41. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

43 Is your federal AGI (Long Form 540NR, line 13) more than the amount shown below for your filing status?

$187,203Single or married/RDP filing separately . . . . . . . . . . . . . . . . . . . . . . . . . . .

$280,808Head of household. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$374,411Married/RDP filing jointly or qualifying widow(er). . . . . . . . . . . . . . . . . . .

Transfer the amount on line 42 to line 43.No.

Yes. 43Complete the Itemized Deductions Worksheet in the instructions for Schedule CA (540NR), line 43 . . . . . . . >Enter the larger of the amount on line 43 or your standard deduction. See instructions. . . . . . . . . . . . . . . . . . . . . . . 44 44>

Part IV ' California Taxable IncomeCalifornia AGI. Enter your California AGI from line 37, column E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 45>

46 46Enter your deductions from line 44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >47 Deduction Percentage. Divide line 37, column E by line 37, column D. Carry the decimal to four places.

47If the result is greater than 1.0000, enter 1.0000. If less than zero, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . >California Itemized/Standard Deductions. Multiply line 46 by the percentage on line 47. . . . . . . . . . . . . . . . . . . . . . . . 48 48>California Taxable Income. Subtract line 48 from line 45. Transfer this amount to Long Form 540NR, line 35.49

49If less than zero, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

7742174 CAIA4912L 02/28/18Side 2 Schedule CA (540NR) 2017 (REV 02-18) 059


4068290. 4068290. 2855613.

4068290. 4068290. 2855613.

580,936.

529,493.51,443.

51,443.

41,717.

REDUCTION-9,726.

2,826,332.

29,281.0.7019

41,717.2,855,613.

41,717.


2017 Investment Interest Expense Deduction 3526Attach to Form 540, Long Form 540NR, or Form 541.Name(s) as shown on tax return SSN, ITIN, or FEIN

1 1Investment interest expense paid or accrued in 2017. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >2 2Disallowed investment interest expense from 2016 form FTB 3526, line 7. If zero or less, enter -0-. . . . . . . . . . >3 3Total investment interest expense. Add line 1 and line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 a Gross income from property held for investment (excluding any net gain from the disposition of4 aproperty held for investment). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 b 4 bNet gain from the disposition of property held for investment. See instructions. . . .

4 c Net capital gain from the disposition of property held for investment.4 cSee instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 d 4 dSubtract line 4c from line 4b. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter all or part of the amount on line 4c that you elect to include in investment income. Do not include4 e4 emore than the amount on line 4b. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 f 4 fInvestment income. Add line 4a, line 4d, and line 4e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 5Investment expenses. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 6Net investment income. Subtract line 5 from line 4f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 Disallowed investment interest expense to be carried forward to 2018. Subtract line 6 from line 3.7If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

8 Investment interest expense deduction. Enter the smaller of line 3 or line 6. Form 541 filers, stop here8and see instructions. All other filers, go to line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

9 9Enter the amount from federal Form 4952, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 California investment interest expense deduction adjustment. Enter the difference between line 8 and line 9.10See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >


SARA J. JACOBS ***-**-****39,286.

0.39,286.

341,069.3,640,490.

3,640,490.0.

3,640,490.3,981,559.

3,981,559.

0.

39,286.39,286.


2017 Passive Activity Loss Limitations 3801Attach to Form 540, Long Form 540NR, Form 541, or Form 100S (S Corporations).Name(s) as shown on tax return SSN, ITIN, FEIN, or CA. corporation no.

Part I 2017 Passive Activity LossSee the instructions for Worksheet 1 and Worksheet 3 for federal Form 8582 before completing Part I. Be sure to useCalifornia amounts.


1 a 1 aActivities with net income from Worksheet 1, column (a). . . . . . . . . . . . . . . . . . . . . . .

1 b 1 bActivities with net loss from Worksheet 1, column (b). . . . . . . . . . . . . . . . . . . . . . . . . .

1 c 1 cPrior year unallowed losses from Worksheet 1, column (c). . . . . . . . . . . . . . . . . . . . .

1 d 1 dCombine line 1a, line 1b, and line 1c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






Combine line 1d and line 2d. If the result is net income or zero, see the instructions for line 3. If line 33and line 1d are losses, go to line 4. Otherwise, enter -0- on line 9 and go to line 10. See instructions . . . . . . . 3

Special Allowance for Rental Real Estate with Active ParticipationPart IIEnter all numbers in Part II as positive amounts. See instructions.

Enter the smaller of losses from line 1d or line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4

5Enter $150,000. If married/RDP filing a separate tax return, see instructions. . . . 5

Enter federal modified adjusted gross income, but not less than zero.6See instructions. If line 6 is equal to or more than line 5, skip line 7 and

6line 8, enter -0- on line 9, and then go to line 10. Otherwise, go to line 7 . . . . . . .

7Subtract line 6 from line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 8Multiply line 7 by 50% (.50). Do not enter more than $25,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the smaller of line 4 or line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9>Part III Total Losses Allowed

10 10Add the income, if any, from line 1a and line 2a and enter the total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 Total losses allowed from all passive activities for 2017. Add line 9 and line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . 11See the instructions on Page 2 to find out how to report the losses on your tax return. CAIZ0601L 12/29/17


AMOUNTS FROM ALL SOURCES


-117,204.

-69,307.

-186,511.

-34,826.

-34,826.

-221,337.

186,511.

150,000.

4,068,290.

0.

SEE STATEMENT 1


2017 Passive Activity Loss Limitations 3801Attach to Form 540, Long Form 540NR, Form 541, or Form 100S (S Corporations).Name(s) as shown on tax return SSN, ITIN, FEIN, or CA. corporation no.

Part I 2017 Passive Activity LossSee the instructions for Worksheet 1 and Worksheet 3 for federal Form 8582 before completing Part I. Be sure to useCalifornia amounts.











Combine line 1d and line 2d. If the result is net income or zero, see the instructions for line 3. If line 33and line 1d are losses, go to line 4. Otherwise, enter -0- on line 9 and go to line 10. See instructions . . . . . . . 3

Special Allowance for Rental Real Estate with Active ParticipationPart IIEnter all numbers in Part II as positive amounts. See instructions.

Enter the smaller of losses from line 1d or line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4

5Enter $150,000. If married/RDP filing a separate tax return, see instructions. . . . 5

Enter federal modified adjusted gross income, but not less than zero.6See instructions. If line 6 is equal to or more than line 5, skip line 7 and

6line 8, enter -0- on line 9, and then go to line 10. Otherwise, go to line 7 . . . . . . .

7Subtract line 6 from line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 8Multiply line 7 by 50% (.50). Do not enter more than $25,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter the smaller of line 4 or line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9>Part III Total Losses Allowed

10 10Add the income, if any, from line 1a and line 2a and enter the total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 Total losses allowed from all passive activities for 2017. Add line 9 and line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . 11See the instructions on Page 2 to find out how to report the losses on your tax return. CAIZ0601L 12/29/17


AMOUNTS FROM CALIFORNIA SOURCE ONLY


4,068,290.





RESIDENTIAL RENTAL SCHEDULE E -117,204. -117,204.MASS PATHWAYS TO ECON ADVAN SCHEDULE E -34,826. -34,826.

TOTAL $-152030. $ 0. $-152,030.


Attach this form to the back of your Form 540, Long Form 540NR, or Form 541. Also, check the box for underpayment of estimated tax locatedon Form 540, line 113; Long Form 540NR, line 123; or Form 541, line 44, whichever applies.








Are you requesting a waiver of the penalty? If "Yes," provide an explanation below and be sure to check the box on1Form 540, line 113; Long Form 540NR, line 123; or Form 541, line 44. If you need additional space, attacha statement. See General Information C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >1 Yes No

Did you use the annualized income installment method? If "Yes," see instructions for Part III and be sure to22check the box on Form 540, line 113; Long Form 540NR, line 123; or Form 541, line 44 . . . . . . . . . . . . . . . . . . . . . . . . . Yes No>

Was your California withholding not withheld in equal installments and are you able to show the actual amounts3withheld per period and the actual dates withheld?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No3 >If "Yes," enter the actual uneven amounts withheld on the spaces provided below. The total of the four amounts

N/Amust equal the total withholding reported on Form 540, line 71 and line 73; Form 540NR, line 81 and line 83; orForm 541, line 29 and line 31.

$ $ .$ $4/15/17 ; 6/15/17 ; 9/15/17 ; 1/15/18 >> > >For estates and trusts: Was the date of death less than two years from the end of the taxable year? See General4

NoYes4 >Information E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7671174 FTB 5805 2017 Side 1For Privacy Notice, get FTB 1131 ENG/SP. 059CAIZ6112L 12/19/17


X

X

X


1Current year tax. Enter your 2017 tax after credits. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2Multiply line 1 by 90% (.90). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2




52017, more than $75,000). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Short Method


7Enter the amount, if any, from Part II, line 3 above. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8Enter the total amount, if any, of estimated tax payments you made. . . . . . . . . . . . 8

9Add line 7 and line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Total underpayment for the year. Subtract line 9 from line 6. If zero or less, stop here. You do not owe the10penalty. Do not file form FTB 5805. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11Multiply line 10 by .02828493. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11


Number of days paidAmount onX X 12.00011. . . . . . . . . . . . . . . . . . before 4/15/18line 10

PENALTY. Subtract line 12 from line 11. Enter the result here and on Form 540, line 113; Long Form 540NR, line 123; or1313Form 541, line 44. Also, check the box for "FTB 5805."A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >

7672174 CAIZ6112L 12/19/17Side 2 FTB 5805 2017 059


356,010.320,409.

356,010.

320,409.

320,409.


Use this schedule ONLY if you earned taxable income at an UNEVEN RATE during 2017 (See Example A). If you earned your income atapproximately the same rate each month (See Example B), then you should not complete this schedule. If you choose to figure the penalty,see Worksheet II, Regular Method to Figure Your Underpayment and Penalty, in the instructions.



To complete this schedule correctly, you must first complete Side 2, Part II,(d)(c)(b)(a)

line 1 through line 6. Estates and trusts, do not use the period ending1/1/17 to1/1/17 to1/1/17 to1/1/17 todates shown to the right. Instead, use the following: 2/28/17, 4/30/17,12/31/178/31/175/31/173/31/17


1 Enter your California adjusted gross income (AGI) for eachperiod. Long Form 540NR filers, see instructions. Estates orTrusts, enter the amount from Form 541, line 20 attributable

1to each period. See instructions . . . . . . . . . . . . . . . . . . . . . .






7 Enter your standard deduction from your 2017 Form 540, orLong Form 540NR, line 18. Enter the total standard deduction




10 Figure the tax on the amount in each column of line 9 usingthe tax table or the tax rate schedule in the instructions forForm 540, Long Form 540NR, or Form 541. Also, include any


Enter the total amount of exemption credits from your 201711Form 540, line 32 or Form 541, line 22. If you filed a Long


Subtract line 11 from line 10. Long Form 540NR filers,1212complete Worksheet I in the instructions. . . . . . . . . . . . . . . .

Enter the total credit amount from your 2017 Form 540, line131347; or Form 541, line 23. Long Form 540NR filers, see inst. . .



14c cAdd line 14a and line 14b. . . . . . . . . . . . . . . . . . . . . . . . .

Enter the excess SDI from Form 540, line 74 or Long Formd14d540NR, line 84 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14e eSubtract line 14d from line 14c. If zero or less, enter -0- . .








21Add line 19 and line 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21




7673174CAIZ6112L 12/19/17 FTB 5805 2017 Side 3059


4,068,290.

4,068,290.

12,861. 21,435. 34,295. 51,443.

41,719. 41,718. 41,718. 41,717.

4,236. 4,236. 4,236. 4,236.41,719. 41,718. 41,718. 41,717.

-41,719. -41,718. -41,718. 4,026,573.

481,044.

0. 0. 0. 0.

337,747.

0. 0. 0. 337,747.

18,263.0. 0. 0. 356,010.

0. 0. 0. 356,010.

320,409.

0. 0. 0. 320,409.

96,123. 128,164. 96,122.96,123. 224,287. 224,287.

96,123. 224,287. 224,287. 320,409.96,123. 224,287. 224,287. 0.

0. 0. 0. 320,409.


Payment Due Dates



Estimated tax paid and tax withheld.2See instructions. For column (a) only,also enter the amount from line 2 online 6. (If line 2 is equal to or morethan line 1 for all payment periods,stop here; you do not owe the penalty.Do not file form FTB 5805 unless you

2answer 'Yes' to a question in Part I). . . .


Enter amount, if any, from line 9 of33previous column . . . . . . . . . . . . . . . . . . . . . .

4Add line 2 and line 3. . . . . . . . . . . . . . . . . . 4

Add amounts on line 7 and line 8 of55the previous column. . . . . . . . . . . . . . . . . . .

Subtract line 5 from line 4. If zero or6less, enter -0-. For column (a) only,

6enter the amount from line 2. . . . . . . . . . .


7enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Underpayment. If line 1 is equal to or8more than line 6, subtract line 6 fromline 1. Then go to line 3 of next

8column. Otherwise, go to line 9. . . . . . . . G

Overpayment. If line 6 is more than9line 1, subtract line 1 from line 6. Then

9go to line 3 of next column . . . . . . . . . . . .

Complete line 10 and line 11 of one column before going to the next column.Part II Figure the Penalty.Rate Period 1:

4/15/17 6/15/17April 15, 2017 'April 15, 2018 9/15/17 1/15/18

Number of days from the date shown Days: Days:10 Days: Days:above line 10 to the date the amounton line 8 was paid or 4/15/18,


Number of11 Underpayment days onon line 8 x x .04line 10(see instructions)365 $ $ $ $11G

PENALTY. Add amounts on line 11 in all columns. Enter the total here, on form FTB 5805, Side 2,12

Part II, line 13, and on Form 540, line 113; Long Form 540NR, line 123; or Form 541, line 44,$12and check the box on that line. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

FTB 5805 Schedule B 2017 CAIZ6103L 12/13/17


320,409.

375,000.

375,000.

0. 0. 0. 375,000.

0. 0.






FDIL1601L 07/17/17



FIRST QTR

SECOND QTR

THIRD QTR

FOURTH QTR320,409. 12/28/17 3 320,409.

0.

2017 UBT WORKSHEETS PAGE 1

RESIDENTIAL RENTAL ***-**-****

MINIMUM TAX LIABILITY GROSS RECEIPTS WORKSHEET

1. AMOUNT FROM NUMERATOR OF DC SALES APPORTIONMENT FACTOR FROMSCHEDULE F, LINE 1, COLUMN 2 OF FORM D-30 156,933.

2. ADD THE ADJUSTED BASIS OF PROPERTY (LESS DEPRECIATION) FORWHICH GAINS ARE REPORTED IN LINE 1 0.

3. ADD NON-BUSINESS INCOME ALLOCTED TO DC REPORTEDPER FORM D-30, LINE 30 0.

4. TOTAL GROSS RECEIPTS (ADD LINES 1, 2, AND 3) 156,933.



*170303S11032*


VENDOR ID# 1032SSN In DC Outside DC

Registered Business Name Tax period ending (MMYY)

Amended ReturnMark if:

Final ReturnBusiness Mailing address line # 1

Combined Report*

*You must fill in the Designated Agent info belowBusiness Mailing address line # 2

Worldwide**

**Worldwide form must be filed with this returnCity State Zipcode

Designated Agent Name Designated Agent TIN

Enter dollar amounts only. If amount is zero, leave line blank.if minus, enter amount and mark X in oval..





Mark if minusNet capital gain (attach a copy of your federal Schedule D). . . . . . . . . . . . . . 8 a .008a$Mark if minusb 8b .00Ordinary gain (loss) from Part II, federal Form 4797 (attach copy). . . . . . . . . . . . . . . . . $

9 .00$Mark if minus9 Other income (attach detailed statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark if minusTotal gross income Add Lines 3-9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 10 .00$IF LINE 10 IS $12,000 OR LESS, STOP HERE, DO NOT FILE THIS RETURN.





a Interest payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 .00b 17cMinus nondeductible payments to related entities. . . . . . . = $.00 .00


20 $Depreciation (attach copy of your Federal Form 4562. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 .00Do not include the additional federal bonus depreciation.)


Rev. 10/17 DCIZ3112L 10/12/17

********* 1 0X


CO 13974 BOQUITA DRIVE

DEL MAR CA 92014

156933

156933

5131

27407

2696426964

148247

66388274137

SEE STMT 1

Taxpayer Name:

*170303S21032*


23Mark if minus $ .00Net income Line 10 minus Line 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

24Net operating loss deduction for years before 2000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 $ .00

Mark if minusNet income after NOL deduction. Line 23 minus Line 24. . . . . . . . . . . . . . . . . . . . 25 25 .00$

26a 26 aMark if minusNon-business income/state adjustment (attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . $ .0026 bb Minus: Related expenses (attach an allocation statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00$26 c .00Subtract Line 26(b) from Line 26(a).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $c Mark if minus

27 .00Mark if minus $27 Net income from trade or business subject to apportionment Line 25 minus Line 26c. . . . . .

28 DC apportionment factor. From Form D-30 Schedule F, Col 3, Line 2 . . . . . . . . . . . . . . . . . . 28


Mark if minus .002929 $Net income from trade or business apportioned to DC . . . . . . . . . . . . . . . . .

Multiply Line 27 by the factor on Line 28.

30 30Other income/deductions attributable to DC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00Mark if minus $(attach statement)

31 Mark if minusTotal DC net income (loss). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 .00$Combine Lines 29 and 30

3232 Salary for owner(s) or member(s) services From Form D-30, Schedule J, Column 4. . . . . .00$33 33a 33Exemption: Maximum amount $5000 Must enter days in DC > .00


Mark if minusTotal taxable income before apportioned NOL deduction. . . . . . . . . . . . . . . 3434 .00$Line 31 minus total of Lines 32 and 33.

Apportioned NOL deduction Losses occurring in year 2000 and later. . . . . . . . . . . . . . . . . . .35 35 .00$Total DC taxable income Line 34 minus Line 35. . . . . . . . . . . . . . . . . . . . . . . 3636 Mark if minus .00$

.00$37 37Tax 9.0% of Line 36. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.00$Minus Nonrefundable Credits from Schedule UB, Line 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 38

.00$39 39Total DC Gross Receipts from Line 4 MTLGR worksheet. . . . . . . .

Net Tax. Line 37 minus Line 38. The minimum tax is $250 if DC gross receipts are4040 $$1M or less or $1,000 if DC gross receipts are greater than $1M . . . . . . . . . . . . . . . . . . . . . . .00

Payments:41

.00$a 41aTax paid, if any, with request for an extension of time to file. . . . . . . . . . . . . . . . . . . . . . . . . .

.00$b 41bTax paid, if any, with original return if this is an amended return . . . . . . . . . . . . . . . . . . . . . .

2017 estimated franchise tax payment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00c 41c $Add Lines 41(a), 41(b) and 41(c). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 42 $ .00

43 RESERVED

44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Estimated tax interest44 (Mark if D-2220 attached) .00$4545 Total Amount Due. If Line 42 is smaller than the total of Lines 40 and 44, enter amount due. . . . . . . . . . . .00$

Yes No See instructionsWill this payment come from an account outside the U.S.?

.0046 46Overpayment. If Line 42 is larger than the total of Lines 40 and 44, enter amount overpaid. . . . . . . . . . . . . $Amount you want to apply to your 2018 estimated franchise tax. . . . . . . . . . . . . . . . . . . . . . 47 47 $ .00Amount to be refunded Line 46 minus Line 47 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 48 $ .00

Third Party Designee To authorize another person to discuss this return with OTR, mark here and enter the name and phone number


Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on the information availableto the preparer.

PLEASESIGN

Officer's signature Title Date Telephone number of person to contactHERE

PAIDPREPARER

Firm addressPreparer's signature (If other than taxpayer) Date Firm nameONLYIf you want to allow the preparer to discuss this returnPreparer's PTIN

with the Office of Tax and Revenue, mark here

Rev. 10/17 DCIZ3112L 10/16/17

RESIDENTIAL RENTAL

*********

117204X

X 117204

117204X1.000000

X 117204

117204X

X 117204

117204X250

156933

250

250X

XPREPARER 8584610115

X*********

D-30 FORM, PAGE 3

Taxpayer Name:

*170303S31032*




$Inventory at beginning of year (if different from last year's closing inventory, attach an explanation). . . . . . . . . . . . 1

$Purchases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

$Minus cost of items withdrawn for personal use. . . . . . Enter result here O

Cost of Labor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Material and supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Other costs (attach statement) ' (Additional 30% and 50% federal5bonus depreciation and additional IRC §179 expenses are not allowed.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$Total of lines 1 through 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

$Inventory at end of year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

$Cost of goods sold (Line 6 minus Line 7). Enter here and on D-30, Line 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8



$ $

TOTAL (Limited to 15% of net income ' also$enter on D-30, Line 18.). . . . . . . . . . . . . . . . . . . .



$ $

$TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



$ $

$TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Rev. 10/17

DCIZ3134L 10/16/17

27,407.

*********

RESIDENTIAL RENTAL

26,964.


MORTGAGE INT - BANKS (S 26,964.

D-30 PAGE 4

Taxpayer Name:

*170303S41032*


Schedule F ' DC apportionment factor (See instructions)

Round cents to the nearest dollar. If an amount is zero, leave the line blank. Carry all factors to six decimal places


(Column 2 divided by$ $.00 .00other than gross receipts from items of non-business income. . . . . Column 1)


For Combined Reporters

Enter the number of members in the combined group

Complete Schedule 1 from the DC Combined Reporting Schedule A1 Designated Agent

Schedule 1 ' Combined Report Tax Due

Tax Due Tax Due Tax Due Tax Due Tax DueCombined Group Report Intercompany Eliminations Total Before Eliminations Designated Agent Member 1

Tax Due Tax Due Tax Due Tax DueMember 2 Member 3 Member 4 Member 5




(claimed as nontaxable)Schedule H ' Income not reported(See instructions.)


TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Rev. 10/17

DCIZ3134L 10/16/17

66,388.

1.000000

*********

RESIDENTIAL RENTAL

156,933156,933

ASSOCIATION DUES (SCH. E) 52,005.INSURANCE (SCH. E) 7,509.MANAGEMENT FEES (SCH. E) 6,000.PLUMBING & ELECTRICAL (SCH. E) 874.

D-30 FORM, PAGE 5

Taxpayer Name:




Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1



Inventories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3














TOTAL ASSETS. . . . . . . . . . . . . . . . . . . . . . . . . 13






Capital stock. . . . . . . . . . . . . . . . . . . . . . . . . . . . 19



Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7 Col. 8Percentage Salary Claimed Exemption Net Income Total Income (or Loss) NotPercentage Net Loss

of (or Loss) Taxable to theof Time DC SourcesClaimedOwnership from UnincorporatedDevoted toName and Address of Taxpayer

Outside DC Business (Add Columns 4this BusinessOwner(s)/ Member(s) Identificationthrough 7)Number

% % $ $ $ $ $

$ $ $ $ $TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


' Any loss amount from Line 31 of D-30.Col. 6Net income of Unincorporated Business from both within' Enter the difference between Line 25 and Line 31 of D-30.Col. 7 $and outside DC (from Line 25 of D-30). . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RESIDENTIAL RENTAL

*********

-117,204. -117,204.

-117,204.

-117,204.

STATEMENT 2

D-30 FORM, PAGE 6

Taxpayer Name:






If 'Yes', submit separately an amended FormTYPE OF OWNERSHIP (sole proprietor, partnership, etc)6D-30 and a detailed statement, concerning










Is income from any other business or business14 Yes Nointerest owned by the proprietors of this businessbeing reported in a separate return?(If yes, list names and addresses of theother businesses.)


Yes No


Yes No


Rev. 10/17

DCIZ3105L 10/13/17

X

X

X

X

X

X

SOLE PROPRIETOR

X

*********

RESIDENTIAL RENTAL

X

RESIDENTIAL RENTAL

X

X




RESIDENTIAL RENTAL2029 CONNECTICUT AVE NW #41, WASHINGTON, DC 20008-6142 . . . . . . . . . . . . . . . . . . . . . . . . . . $ 156,933.

TOTAL $ 156,933.



SARA J. JACOBSC/O 13974 BOQUITA DRIVEDEL MAR, CA 92014***-**-**** 100% 100% $ 0. $ 0. $ -117,204. $ 0. $ -117,204.

$ 0. $ 0. $ -117,204. $ 0. $ -117,204.



InstructionsUse the D-30P Payment Voucher to make any payment due on your D-30 return.




Notes:


For electronic filers, in order to comply with banking rules, you will be asked the question 'Will the funds for this payment come from an?account outside of the United States?' If the answer is yes, you will be required to pay by money order (US dollars) or credit card. Pleasenotify this agency if your response changes in the future.




*17030PS11032*Amount of Payment $ .00(dollars only)


Mark if SSN VENDOR ID# 1032Business or Designated Agent Name Tax period ending (MMYY)




Rev. 10/17 DCIZ9601L 10/12/17

250

********* X



1

DEL MAR CA 92014

2017 TAX RETURN

Client:

Prepared for:

Prepared by:

Date:

Comments:

Route to:

FDIL2001L 07/05/17

NEW YORK INDIVIDUAL

1178K3

SARA J. JACOBSC/O 13974 BOQUITA DRIVE DEL MAR, CA 92014

OCTOBER 2, 2020

Department of Taxation and Finance NYIA6101L 12/14/17

New York State E-File Signature Authorization for Tax Year 2017 ForForms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210

Electronic return originator (ERO): Do not mail this form to the Tax Department. Keep it for your records.2017

Taxpayer's name: Spouse's name:

(jointly filed return only)Purpose

Form TR-579-IT must be completed to authorize an ERO to e-file a EROs must complete Part C prior to transmitting electronicallypersonal income tax return and to transmit bank account information filed income tax returns (Forms IT-201, IT-201-X, IT-203, IT-203-X,for the electronic funds withdrawal. IT-214, NYC-208, and NYC-210).

Both the paid preparer and the ERO are required to sign Part C.General instructionsHowever, if an individual performs as both the paid preparer and the

Taxpayers must complete Part B before the ERO transmits the ERO, he or she is only required to sign as the paid preparer. It is nottaxpayer's electronically filed Form IT-201, Resident Income Tax necessary to include the ERO signature in this case. Please note thatReturn, IT-201-X, Amended Resident Income Tax Return, IT-203, an alternative signature can be used as described in Publication 58,Nonresident and Part-Year Resident Income Tax Return, IT-203-X, Information for Income Tax Return Preparers. Go to our website atAmended Nonresident and Part-Year Resident Income Tax Return, www.tax.ny.gov to view this document.IT-214, Claim for Real Property Tax Credit, NYC-208, Claim for

Do not mail Form TR-579-IT to the Tax Department. EROs mustNew York City Enhanced Real Property Tax Credit, or NYC-210,keep this form for three years and present it to the Tax DepartmentClaim for New York City School Tax Credit.upon request.

For returns filed jointly, both spouses must complete and signThis form is not required for electronically filed Form IT-370,

Form TR-579-IT.Application for Automatic Six-Month Extension of Time to File forIndividuals. See Form TR-579.1-IT, New York State TaxpayerAuthorization for Electronic Funds Withdrawal for Tax Year 2017Form IT-370 and Tax Year 2018 Form IT-2105.

Part A ' Tax return information

1 Federal adjusted gross income (from applicable line). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

Refund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2.

Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3.

4.Financial institution routing number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5.Financial institution account number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Account type:6 Personal checking Personal savings Business checking Business savings

Part B ' Declaration of taxpayer and authorizations for Forms IT-201, IT-201-X, IT-203, IT-203-X, IT-214, NYC-208, and NYC-210

Under penalty of perjury, I declare that I have examined the information on my 2017 New York State electronic personal income tax return,including any accompanying schedules, attachments, and statements, and certify that my electronic return is true, correct, and complete. TheERO has my consent to send my 2017 New York State electronic return to New York State through the Internal Revenue Service (IRS). Inaddition, by using a computer system and software to prepare and transmit my form electronically, I consent to the disclosure to New YorkState of all information pertaining to the transmission of my tax form electronically. I understand that by executing this Form TR-579-IT, I amauthorizing the ERO to sign and file this return on my behalf and agree that the ERO's submission of my personal income tax return to the IRS,together with this authorization, will serve as the electronic signature for the return and any authorized payment transaction. If I am paying myNew York State personal income taxes due by electronic funds withdrawal, I certify that the account holder has authorized the New York StateTax Department and its designated financial agents to initiate an electronic funds withdrawal from the financial institution account indicated onmy 2017 electronic return, and authorized the financial institution to withdraw the amount from that account. As New York does not supportInternational ACH Transactions (IAT), I attest the source for these funds is within the United States. I understand and agree that I may revokethis authorization for payment only by contacting the Tax Department no later than five (5) business days prior to the payment date.

Taxpayer's signature: Date:

Spouse's signature: Date:


Part C ' Declaration of electronic return originator (ERO) and paid preparer

Under penalty of perjury, I declare that the information contained in this 2017 New York State electronic personal income tax return is theinformation furnished to me by the taxpayer. If the taxpayer furnished me a completed paper 2017 New York State return signed by a paidpreparer, I declare that the information contained in the taxpayer's 2017 New York State electronic return is identical to that contained in thepaper copy of the return. If I am the paid preparer, under penalty of perjury I declare that I have examined this 2017 New York State electronicpersonal income tax return, and, to the best of my knowledge and belief, the return is true, correct, and complete. I have based this declarationon all information available to me.

ERO's signature: Date:

Print name:

Paid preparer's signature: Date:

Print name:

1032TR-579-IT (12/17)

SARA J. JACOBS

4,068,290.47,738.

NYIA2701L 07/26/17Department of Taxation and Finance IT-370Application for Automatic Six-Month(with instructions)Extension of Time to File for Individuals2017



an automatic six-month extension of time to file Form IT-201, • June 15, 2018, if you are a U.S. nonresident alien for federalResident Income Tax Return, or Form IT-203, Nonresident and income tax purposes and you qualify to file your federal andPart-Year Resident Income Tax Return . New York State income tax returns on June 15, 2018, and you











Department of Taxation and Finance IT-370Application for Automatic Six-Month Extension of Time to File for Individuals2017


Enter your 2-character special condition code Spouse's full SSN (only if filing a joint return)Your full social security number (SSN) if applicable (see instructions) . . . . . . . . . . . . . . . . . . ?



Dollars Cents



E-mail:

3701171032

X

609248638

SARA J. JACOBS X

CA 92014

************


DEL MAR

Page 2 of 3 IT-370 (2017)






return is late, up to a maximum of 25%. However, if your return Name and address box – Enter your name (both names ifis not filed within 60 days of the time prescribed for filing a return filing a joint application), address, and entire social security(including extensions), this penalty will not be less than the number(s). Failure to provide the entire social security numberlesser of $100 or 100% of the amount required to be shown as may invalidate this extension or result in monies not being properlytax due on the return reduced by any tax paid and by any credit credited to your account. If you do not have a social securitythat may be claimed. The penalty will not be charged if you can number, enter do not have one . If you do not have a socialshow reasonable cause for filing late. security number, but have applied for one, enter applied for.




condition code, E3, E4 , or D9 on Form IT-201 or Form IT-203we will send a separate bill for $50 for each return or other taxdocument associated with the returned payment. when you file your return.



IT-370 (2017) Page 2 When completing this section, enter your New York tax preparer registrationidentification number (NYTPRIN) if you are required to have one. If you arePayment options ' Full payment must be made by check or money order of not required to have a NYTPRIN, enter in the NYTPRIN excl. code box oneany balance due with this automatic extension of time to file. Make the checkof the specified 2-digit codes listed below that indicates why you are exemptor money order payable in U.S. funds to New York State Income Tax andfrom the registration requirement. You must enter a NYTPRIN or an exclusionwrite the last four digits of your social security number and 2017 Income Taxcode. Also, you must enter your federal preparer tax identification numberon it. For online payment options, see our website (at www.tax.ny.gov).(PTIN) if you have one; if not, you must enter your social security number.








E-mail:

3702171032

CA 92014 0 3

************

NYIA1612L 11/27/17Department of Taxation and Finance IT-203Nonresident and Part-Year ResidentNew York State ? New York City ? Yonkers ? MCTMTIncome Tax Return2017 17For the year January 1, 2017, through December 31, 2017, or fiscal year beginning .

and ending . . . . .

For help completing your return, see the instructions, Form IT-203-I.Your social security numberYour first name and middle initial Your last name (for a joint return, enter spouse's name on line below) Your date of birth (mmddyyyy)

Spouse's social security numberSpouse's first name and middle initial Spouse's last name Spouse's date of birth (mmddyyyy)



Apartment no. City, village, or post officeTaxpayer's permanent home address (see instr.) (no. and street or rural route)School districtcode number


E New York City part-year residents only (see instrs)Single1A Filingstatus Number of months you lived in NY City in 2017. . . (1)(mark an Married filing joint return2 (2)X in one Number of months your spouse lived(enter both spouses' social security numbers above)box): in NY City in 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Married filing separate return3 F Enter your 2-character special condition(enter both spouses' social security numbers above)code(s) if applicable (see instructions). . . .

Head of household (with qualifying person)4 G New York State part-year residents (see instructions)Enter the date you moved intoor out of NYS (mmddyyyy) . . . . . . . . . . . . . . . . Qualifying widow(er) with dependent child5On the last day of the tax year (mark an X in one box):B Did you itemize your deductions on your 20171) Lived in NYS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . federal income tax return?. . . . . . . . . . . . . . . . . . . . . . . Yes No2) Lived outside NYS; received income fromC Can you be claimed as a dependent on another NYS sources during nonresident period. . . . . . . . . . . . . . taxpayer's federal return? NoYes3) Lived outside NYS; received no income fromD1 Did you have a financial account located in a NYS sources during nonresident period. . . . . . . . . . . . . . foreign country? (see instructions). . . . . . . . . . . . . . . . Yes NoNew York State nonresidents (see instructions)HD2 Yonkers part-year residents only:Did you or your spouse maintainYes NoDid you receive a property tax relief credit? (see instrs)(1)living quarters in NYS in 2017?. . . . . . . . . . Yes No(if Yes, complete Form IT-203-B).00Enter the amount. . (2)

Were you required to report, under P.L. 110-343, Div. C,D3§801(d)(2), any nonqualified deferred compensation

NoYeson your 2017 federal return? (see instructions). . . . . . .

I Dependent exemption information (see instructions)

First name and middle initial Last name Relationship Social security number Date of birth (mmddyyyy)


203001171032For office use only

*********

X

X

NY

MANHATTAN

369

92014CADEL MAR


JACOBSSARA

X

J 02011989

X

11012017

X

X

NYIA1612L 07/25/17Enter your social security numberPage 2 of 4 IT-203 (2017)



3 3 3 .00.00Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



Business income or loss (submit a copy of federal Sch. C or C-EZ, Form 1040) . . . . 6 66 .00 .00Capital gain or loss (if required, submit a copy of federal Sch. D, Form 1040). . . . . . 7 7 7.00 .00


9 99 .00Taxable amount of IRA distributions. Beneficiaries: mark X in box .00Taxable amount of pensions/annuities. Beneficiaries: mark X in box10 10 10.00 .00

11 Rental real estate, royalties, partnerships, S corporations,trusts, etc. (submit a copy of federal Schedule E, Form 1040). . . .00.0011 11Rental real estate included12


.00 .00Farm income or loss (submit a copy of federal Sch. F, Form 1040) . . . . . . 13 1313

.00 .0014 1414 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Taxable amount of social security benefits (also enter on line 26). . . .00 .0015 15 15Identify: .00 .0016 1616 Other income (see instrs)

.00 .0017 1717 Add lines 1 through 11 and 13 through 16 . . . . . . . . . . . . . . . . . .

Total federal adjustments to income (see instructions)18Identify: .00 .0018 18Federal adjusted gross income (subtract line 18 from line 17). . .00 .0019 1919


20 Interest income on state and local bonds and obligations(but not those of New York State or its localities). . . . . . . . . . . . . . 20 20.00 .00

21 21 21Public employee 414(h) retirement contributions . . . . . . . . . . . . . . .00 .0022 22 22Other (Form IT-225, line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0023 Add lines 19 through 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 23.00 .00


Taxable refunds, credits, or offsets of state and local income24taxes (from line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0024 24Pensions of NYS and local governments and the federal25government (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0025 25

.00 .0026 26 26Taxable amount of social security benefits (from line 15). . . . . . .


28 Pension and annuity income exclusion. . . . . . . . . . . . . . . . . . . . . . . .00 .0028 28.00 .0029 29 29Other (Form IT-225, line 18). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .0030 30 30Add lines 24 through 29. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 .003131 New York adjusted gross income (subtract line 30 from line 23). . . . . . . 31



33 Enter your standard deduction (table in instructions) or your itemized deduction (from Form IT-203-D).Mark an X in the appropriate box: 33 .00Standard - or - Itemized

3434 Subtract line 33 from line 32 (if line 33 is more than line 32, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0035 35Dependent exemptions (enter the number of dependents listed in Item I; see instructions) . . . . . . . . . . . . . . . 000.0036 36New York taxable income (subtract line 35 from line 34). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

203002171032


4068290

X 80004060290

4060290

4068290 1212677

4068290 1212677

86731 8673111884 11884

329185 118195

3640490 995867

4068290 1212677

4068290 1212677

Name(s) as shown on page 1 Enter your social security number IT-203 (2017) Page 3 of 4NYIA1634L 11/27/17

Tax computation, credits, and other taxes37 37New York taxable income (from line 36 on page 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0038 38New York State tax on line 37 amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0039 39New York State household credit (see instructions, table 1, 2, or 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0040 40Subtract line 39 from line 38 (if line 39 is more than line 38, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

4141 New York State child and dependent care credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0042 42Subtract line 41 from line 40 (if line 41 is more than line 40, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0043 43 .00New York State earned income credit (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Base tax (subtract line 43 from line 42; if line 43 is more than line 42, leave blank) . . . . . . . . . . . . . . . . . . . . . . 44 44 .00


46 46 .00Allocated New York State tax (multiply line 44 by the decimal on line 45). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 47 .00New York State nonrefundable credits (Form IT-203-ATT, line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

48 48 .00Subtract line 47 from line 46 (if line 47 is more than line 46, leave blank). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4949 .00Net other New York State taxes (Form IT-203-ATT, line 33). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50 50Total New York State taxes (add lines 48 and 49). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00


City and Yonkers taxes,child and dependent care credit. . . . . . . . . . . . . . . . . . . . . . . . . 52 .00credits, and surcharges, and52a Subtract line 52 from 51 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52a .00MCTMT.MCTMT netb52

earnings base. . . . 52b .00MCTMT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52c .0052c

53 53 .00Yonkers nonresident earnings tax (Form Y-203) . . . . . . . . . . . . .

54 Part-year Yonkers resident income tax surcharge54 .00(Form IT-360.1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55 55 .00Total New York City and Yonkers taxes / surcharges and MCTMT (add lines 52a, and 52c through 54) . . . . .

56 56Sales or use tax (See the instructions. Do not leave line 56 blank.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

(see instructions)Voluntary contributions

a5757 .00a Return a Gift to Wildlife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

57 bb 57 .00Missing/Exploited Children Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c57c 57 .00Breast Cancer Research Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

57 dd 57 .00Alzheimer's Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

57 e .00e 57Olympic Fund ($2 or $4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0057 ff 57Prostate and Testicular Cancer Research and Education Fund . . . . . . . . .

g5757g .009/11 Memorial. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 hh 57 .00Volunteer Firefighting & EMS Recruitment Fund. . . . . . . . . . . . . . . . . . . . . . . 57 57 .00i iTeen Health Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j57 57j .00Veterans Remembrance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5757 kHomeless Veterans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k .0057 l 57lMental Illness Anti-Stigma Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00

57 mWomen's Cancers Education and Prevention Fund. . . . . . . . . . . . . . . . . . . . m 57 .00Autism Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n n57 57 .00Veterans' Homes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57o 57o .00

57 .00Total voluntary contributions (add lines 57a through 57o). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5758 Total New York State, New York City, Yonkers, and sales or use taxes, MCTMT,

.00and voluntary contributions (add lines 50, 55, 56, and 57) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

203003171032


4060290358118

358118

358118

358118

1212677 4068290 0.2981

106755

106755

106755

0

106755

Enter your social security numberPage 4 of 4 IT-203 (2017)NYIA1634L 11/03/17

59 Enter amount from line 58. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0059


If applicable, completePart-year NYC school tax credit (fixed amount) (also complete E on front)60 .0060Form(s) IT-2 and/or IT-1099-R60a 60aNYC school tax credit (rate reduction amount) . . . . . . . . . . . . . . . . .00 and submit them with your

.0061 61Other refundable credits (Form IT-203-ATT, line 17). . . . . . . . . . . . return (see page 12).

.0062 Total New York State tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Do not send federal

.0063 Total New York City tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Form W-2 with your return.

.0064 Total Yonkers tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6465 Total estimated tax payments/amount paid with Form IT-370. . . . 65 .0066 Total payments and refundable credits (add lines 60 through 65). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0066

(see instructions)Your refund, amount you owe, and account information67 Amount overpaid (if line 66 is more than line 59, subtract line 59 from line 66). . . . . . . . . . . . . . . . . . . . . . . 67 .0068 Amount of line 67 to be refunded direct deposit to checking or paper

- or -savings account (fill in line 73) check. . . . 68 .00Mark one refund choice:

69 Amount of line 67 that you want appliedRefund? Direct deposit is the69 .00to your 2018 estimated tax (see instructions). . . . . . . . . . . . . . . easiest, fastest way to get your

69a Amount of line 67 that you want as a NYS 529 refund.69aaccount deposit (submit Form IT-195). . . . . . . . . . . . . . . . . . . . . . .00 See page 37 for payment

70 Amount you owe (if line 66 is less than line 59, subtract line 66 from line 59). To pay by electronic options.funds withdrawal, mark an X in the box and fill in lines 73 and 74. If you pay by checkor money order you must complete Form IT-201-V and mail it with your return. . . . . . . . . . . . . . . . . . . . . . 70 .00

71 Estimated tax penalty (include this amount on line 70,See page 40 for the proper71 .00or reduce the overpayment on line 67; see instructions). . . . . . .assembly of your return.72 Other penalties and interest (see instructions). . . . . . . . . . . . . . . . . 72 .00




Account number73c73b Routing number

74 Electronic funds withdrawal (see instructions) . . . . . . . . . . . . . . . . . Date Amount .00

Designee's phone number Personal identificationThird-party designee? number (PIN)(see instructions) ( )

E-mail:Yes NoPreparer's NYTPRINI Paid preparer must complete I NYTPRIN Taxpayer(s) must sign hereI I(see instructions) excl. code

Your signaturePreparer's signature

Your occupationPreparer's PTIN or SSN

Spouse's signature and occupation (if joint return)Employer identification number

Date Daytime phone numberDate ( )E-mail:E-mail:


203004171032


106755

49731247

148273154493

47738

X 47738

Print designee's name

858 461-0115X 92014

0 3

********* GOVERNMENT

Preparer's printed name


Address

NYIA6601L 10/13/17Department of Taxation and Finance IT-2Summary of W-2 StatementsNew York State @ New York City @ Yonkers2017



Box b Employer identification number (EIN) (if not United States)CountryCity State ZIP code


.00 .00.00Box 14b AmountCodeBox 8 Allocated tips DescriptionBox 12b Amount

.00.00.00Box 10 Dependent care benefits DescriptionCode Box 14c AmountBox 12c Amount

.00 .00.00DescriptionBox 12d AmountBox 11 Nonqualified plans Box 14d AmountCode

.00.00.00











.00 .00.00Box 14c AmountCode DescriptionBox 12c AmountBox 10 Dependent care benefits


.00 .00.00




.00 .00other state



102001171032

PIROJECT CONNECT, INC.

********* P.O. BOX 76

NH 03755814567214 HANOVER

86731

86731 4973

86731 1247 NYC

NYIA9712L 09/15/17Department of Taxation and Finance IT-182Passive Activity Loss LimitationsFor Nonresidents and Part-Year Residents2017




.001 Prior years unallowed losses from Worksheet 1, column (c) (see instructions). . . . . . . c 1c1d Add lines 1a, 1b, and 1c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .001d



All other passive activities.003a 3aActivities with net income from Worksheet 3, column (a). . . . . . . . . . . . . . . . . . . . . . . . . . .003b 3bActivities with net loss from Worksheet 3, column (b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .003c 3c(see instructions)Prior years unallowed losses from Worksheet 3, column (c)









.00(If married filing separately, filing status '3', see instructions)9 Multiply line 8 by 50% (.5). Do not enter more than 25,000. 9




.0013 13Subtract line 10 from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





182001171032


750969307

-76816

34826

-34826

-111642

76816150000

1212677

NYIA9712L 09/11/17Page 2 of 3 IT-182 (2017)



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


.00 .00 .00.00 .00

.00 .00.00 .00 .00

.00 .00.00 .00 .00

.00 .00.00 .00 .00

.00 .00 .00 .00.00




.00 .00 .00

.00 .00 .00

.00 .00 .00



(d) (e)(c)(a) (b)Date ofName of activity/property Date of Net loss UnallowedNet income





.00 .00 .00

.00 .00 .00

.00 .00 .00

.00 .00 .00

.00 .00 .00Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00

182002171032

34826

693077509



MASS PATHWAYS TO E 0 34826 0 0 34826

NYIA9703L 09/11/17 IT-182 (2017) Page 3 of 3



Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00.00 .00

' Allowed losses (see instructions)Worksheet 6(b)(a) (c)Form or schedule


.00.00 .00

.00.00 .00

.00.00 .00

.00.00 .00

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00.00 .00













Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00.00 .00 .00

182003171032

111642111642

111642111642


RESIDENTIAL RENTAL SCH E LN 22 76816 0.688056 76816MASS PATHWAYS TO ECON ADVA SCH E LN 28 34826 0.311944 34826

RESIDENTIAL RENTAL SCH E LN 22 76816 76816 0MASS PATHWAYS TO ECON ADVA SCH E LN 28 34826 34826 0




BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 73,245 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 73,245 76,419



6 LAMP 1/01/16 734 734 105 200DB HY 7 .24490 180

7 STOOL 1/01/16 1,101 1,101 157 200DB HY 7 .24490 270

10 TV CABINETS 1/01/16 9,819 9,819 1,403 200DB HY 7 .24490 2,405




8 LIGHTING 1/01/16 13,857 13,857 1,980 200DB HY 7 .24490 3,394

9 DRAPES 1/01/16 3,512 3,512 502 200DB HY 7 .24490 860


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0














BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 73,245 S/L MM 27.5 .03636 76,419 76,419 0

TOTAL BUILDINGS 2,101,726 73,245 76,419 76,419 0 0 0 0



6 LAMP 1/01/16 734 79 150DB HY 7 .19130 140 180 40 0

7 STOOL 1/01/16 1,101 118 150DB HY 7 .19130 211 270 59 0

10 TV CABINETS 1/01/16 9,819 1,052 150DB HY 7 .19130 1,878 2,405 527 0




8 LIGHTING 1/01/16 13,857 1,484 150DB HY 7 .19130 2,651 3,394 743 0

9 DRAPES 1/01/16 3,512 376 150DB HY 7 .19130 672 860 188 0


LAND____

2 LAND 1/01/16 900,740 0 0 0

TOTAL LAND 900,740 0 0 0 0 0 0 0











PAGE 2




BUILDINGS_________

1 BUILDING 1/01/16 2,101,726 2,101,726 73,245 S/L MM 27.5 .03636 76,419

TOTAL BUILDINGS 2,101,726 0 0 0 0 0 2,101,726 73,245 76,419



6 LAMP 1/01/16 734 734 105 200DB HY 7 .24490 180

7 STOOL 1/01/16 1,101 1,101 157 200DB HY 7 .24490 270

10 TV CABINETS 1/01/16 9,819 9,819 1,403 200DB HY 7 .24490 2,405




8 LIGHTING 1/01/16 13,857 13,857 1,980 200DB HY 7 .24490 3,394

9 DRAPES 1/01/16 3,512 3,512 502 200DB HY 7 .24490 860


LAND____

2 LAND 1/01/16 900,740 900,740 0

TOTAL LAND 900,740 0 0 0 0 0 900,740 0 0













ERO Declaration




CAIA9701L 07/13/17


ERO Signature


ERO's PIN

Documents

8453 U.S. Individual Income Tax Transmittal for an IRS 2019 · Form 2848, Power of Attorney and Declaration of Representative (or POA that states the agent is granted authority to