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Form

8879
Control Number (DCN)

OMS No. 15450074

IRS e-fi/e Signature Authorization


~ Do not send to the IRS. This is not a tax return. ~ Keep this form for your records. See instructions.

Department of the Treasury Internal Revenue Service

2010
Social security number

Declaration

00-871154-18103-1 474-04-3631
Spouse's social security number

Taxpayer's name

JEREMIAH
Spouse's name

GRIFFITH

KIM SESSIONS lea.l~i#1Tax Return Information t


1 Adjusted

528-97-6647
- Tax Year Ending December 31, 2010 (Whole Dollars Only)
1
,

gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4). .................... 2 Total tax (Form 1040, line 60; Form 1040A, line 37; Form 1040EZ, line 11). ..... ... ... .. ,.,., . ...
,., , ,

32,432. 1,060. 4,899.

.. .

2
3 4

11.11Iii1 Taxpayer

3 Federal income tax withheld (Form 1040, line 61; Form 1040A, line 38; Form 1040EZ, line 7). 4 Refund(Form 1040,line 74a; Form 1040A,line 46a; Form 1040EZ,line 12a;Form 1040SS,Part I, line 12a) ....... . 5 Amount you owe (Form 1040, line 76; Form 1040A, line 48; Form 1040EZ, line 13). .......

. .. . . . .
"

. .. .

..... .. .

Declaration

and Signature

Authorization

5 (Be sure you get and keep a copy of your return)

Underpenaltiesof perjury, I declarethat I haveexamineda copy of my electronic individual incometax return and accompanyingschedulesand statementsfor the tax year ending December31, 2010,and to the best of my knowledgeand belief, it is true, correct, and complete.I further declarethat the amounts in Part I aboveare the amountsfrom my electronic incometax return, I consentto allow my intermediateservice provider, transmitter, or electronic return originator (ERO)to send my return to the IRSand to receivefrom the IRS(a) an acknowledgement f receipt or reasonfor rejection of the transmission, (b) the reasonfor any delay in processingthe return or refund, and (c) the date of any refund. If applicable, o I authorizethe U.S.Treasury and its designatedFinancialAgentto initiate an ACHelectronicfunds withdrawal (direct debit) entry to the financial institution accountindicated in the tax preparationsoftware for paymentof my Federaltaxes owed on this return and/or a paymentof estimatedtax, and the financial institution to debit the entry to this account.I further understandthat this authorizationmay apply to future Federaltax paymentsthat I direct to be debitedthroughthe ElectronicFederalTax PaymentSystem(EFTPS).In order for me to initiate future payments,I requestthat the IRSsend me a personalidentification number(PIN) to accessEFTPS.This authorizationis to remain in full force and effect until I notify the U.S.Treasury FinancialAgentto terminate the authorization.To revokea payment,I must contactthe U.S.Treasury FinancialAgentat 1-888-353-4537 later than 2 no businessdays prior to the payment(settlement) date. I also authorizethe financial institutions involvedin the processingof the electronic paymentof taxesto receiveconfidential information necessaryto answer inquiries and resolve issues related to the payment.I further acknowledgethat the personalidentification number(PIN) below is my signaturefor my electronic incometax return and, if applicable,my ElectronicFundsWithdrawalConsent.

Taxpayer's

PIN: check one box only

[K] I authorize

HAYNIE AND COMPANY CPA'S


ERO finn name

to enter or generate

my PIN

78905
Enter five numbers, but

do not enter all zeros

D I will

as my signature on my tax year 2010 electronically filed income tax return. enter my PIN as my signature on my tax year 2010 electronically filed income tax return. Check this box only if you are entering own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.

your

Your signature

Date ~

Spouse's

PIN: check one box only

[K] I authorize

HAYNIE AND COMPANY CPA'S


ERO firm name

to enter or generate filed income tax return.

my PIN

80240
Enter five numbers, but do not enter all zeros

D own PIN and your return issignatureusing the Practitioner2010 electronicallyThefiled income complete Part III below.box only I will enter my PIN as my on my tax year tax return. Check this filed PIN method. ERO must
Spouse's signature ~ Date ~

as my signature

on my tax year 2010 electronically

if you are entering

your

Practitioner

PIN Method Returns Only - Practitioner


by your five-digit

continue

below

(pitt. frO Certification


ERO's EFIN/PIN.

and Authentication
EFIN followed

PIN Method Only


self-selected PIN ...

Enter your six-digit

87115412345
do not enter all zeros

I certify that the above numeric entry is my PIN, which is my signature for the tax year 2010 electronically filed income tax return for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Publication 1345, Handbook for Authorized IRS e-tite Providers of Individual Income Tax Returns.
ERa's signature ~

LARRY R.

BERGHOUT, CPA
ERO Must Retain This Form - See Instructions . Do Not Submit This Form to the IRS Unless Requested

Date ~

To Do So Form 8879 (2010)

BAA

For Paperwork

Reduction

Act Notice, see your tax return instructions.


FDIA1701L 11119110

Form

1040A

Department of the Treasury -

Internal Revenue Service

U.S. Individual Income Tax Return


Your first name and initial Last name

(99)

2010

IRS Use Only -

Do not write or staple in this space OMS No. 15450074 Your social security number

Name, Address, and SSN


See separate instructions

JEREMIAH GRIFFITH
If a joint return, spouse's first name and initial
Last name

474-04-3631
Spouse's social security number

KIM SESSIONS
Home address (number and street). If you have a P.O. box, see instructions. Apartment no.

528-97-6647
.
address, see instructions.

1300 E 6125 S
City. town or post office. If you have a foreign

Make sure the SSN(s) above and on line 6c are correct.

State

ZIP code

SOUTH OGDEN, UT 84405-7116


Presi denti al Election Campaign ~ 1 2 3 Check here if you, or your spouse if filin ~
jointl

Checking a box belowwill not change your tax or refund ~ You Spouse

,want $3 to go to this fund (see instructions)., 4

Filing status
Check only one box.

Single Married filingjointly(evenif onlyonehadincome) Married filingseparately. spouse'sSN above Enter S and full name here ~

Head household of (withqualifying person). (Seeinstructions.) If thequalifying person a childbutnotyourdependent, is enterthischild'sname here ~ ----------------------Qualifying widow(er) with dependent child (see instructions)
" "" } Boxes checked on 6aand6b, , No. of children on 6c who: lived with you. ..

Exemptions

6a

[R] Yourself.

If someone can claim you as a dependent, do not check box 6a.

b Spouse . c Dependents:
(1)

[Xl

....

.0'

.....

. ... . .....

..

2 ------

. ...

. .......

If more than six dependents, see instructions.

First name

Last name

(2) Dependent's social security number

(3) Dependent's relationship to you

(4) t/ IT child under age 17 qual for child tax cr (see instrs)

ZACHARY GRIFFITH

646-90-8270

SON

Ix

did not live with you due to divorce or separation (see instructions) ... Dependents on 6c not entered above ...

.. -----1

-----------

d Total number of exemptions claimed .... , ..........

. ......

.....

... ...

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

. .

....

Add numbers .\ on lines above ~

31

Income
AttachForm(s) W-2 here.Also attachForm(s) 1099-R tax if waswithheld. 7 Wages, 'salaries, tips, etc. Attach Form(s) W-2 .. 8a Taxable interest. Attach Schedule B if required. b Tax-exemptnterest. onot include i D online8a ..... , . 9a Ordinary dividends. Attach Schedule B if required ... , .. , .... b Qualified dividends (see instructions), .. , 10 Capital gain distributions (see instructions) ... 11 a IRA distributions. ' 11 a 12a Pensions and annuities
If you did not get a W-2,
see irrstructiona.

7 __:=.8.::a 9a

32,432.
_

8b 9b 11 b Taxable amount, 12bTaxabie amount. 10 11 b 12b 13 14b 15

12a . , ., .

13 Unemployment compensation and Alaska Permanent Fund dividends


(see instructions). . . . . 14a Social security benefits. . . . ... , .... , ... , 14a 14b Taxable amount. 15 Add lines 7 through 14b (far right column). This is your total income, , . 16 Educator expenses (see instructions) ,. 17 IRA deduction (see instructions) .. , ,... 18 Student loan interest deduction (see instructions) .... , .... , 19 Tuition and fees. Attach Form 8917. 20 Add lines 16 through 19. These are your total adjustments. --'-16-=----'-17'---.:.18=---'-1.:..9 , . , .. , . -'-

Enclose, but do not attach. any payment. Also, please use Form 1040-V.

~
_ _ _ _

32,432.

Adjusted gross income

20 ~ 21

O. 32,432.
Form 1040A (2010)

21 Subtract line 20 from line 15. This is your adjusted gross income, BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

FDIA1312L

01108111

Form 1040A (2010)

JEREMIAH 22

GRIFFITH

AND

KIM

SESSIONS gross income).

Tax, credits, and payments

Enter the amount

23a Check If:

{D

from line 21 (adjusted

0 Spousewas born beforeJanuary2, 1946, 0 Blind


itemizes . deduction (see instructions). ..

You were born beforeJanuary2,1946,

................. Blind } Total boxes checked. deductions, . . . . . . . . .. ~ .

. . . . . . .. 23a 23 b .

D
D
~

474-04-3631 ,....:22==-

Page 2 --=3-=2'-',_4.::..3=-=.2-=-.

b If you are married filing separately and your spouse see instructions and check here. . 24 25 26 27 28 Enter your standard Subtract

24 25 26 27 28

11,400. 21,032_ 10,950. 10,082. 1,008.

line 24 from line 22. If line 24 is more than line 22, enter 0-.. Multiply $3,650 by the number on line 6d. ..

Exemptions.

Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is your taxable income. . . . . . Tax, including any alternative .. minimum tax (see instructions)

29 30 31 32

Creditfor child and dependentcare expenses.Attach Form 2441. . . . Credit for the elderly or the disabled. Education Retirement savings contributions Attach Schedule R.

_29 --=-30~ 31 __ 32 _ 192.

credits from Form 8863, line 23 . . . . . . . credit. Attach . . Form 8880.

----------------------=-33-=--

_ 34 1,008.

33
34 35 36 37 38 39 If you have a qualifying child, attach Schedule EIC.

Child tax credit (see instructions). Add lines 29 through Subtract Advance earned

8~1_=6~.

33. These are your total credits from Form(s)

line 34 from line 28. If line 34 is more than line 28, enter -0income credit payments W-2, box 9 . --=.38::....... --=-39~ Schedule M. . . . _ --"42=_4_3"-. _4...:.;0=---.:41=-=.a

s
.................

.
~

35 -=..:36=-37

0.
_

Add lines 35 and 36. This is your total tax Federal income tax withheld tax payments from Forms W-2 and 1099. and amount applied from

0.

-=1:..!.,....:0=-6~0-=-. _ -::-.-:8:,-0'-:0'-'--. --=2:::..,<-7-=-=2...:.7-=-. -='1..;:,8-,:4;...:..-. 1_2 8_. __ ~44 . 45 4,899. 4,899. 4::...<,-=8c.::.9-.::..9...:-.

2010 estimated 2009 return .

40

Making work pay credit. Attach income credit (EIC). bNontaxable combat

41 a Earned 42 43 44

pay election._4...:.1'-b"--

Additional American

child tax credit. Attach Form 8812... opportunity credit from Form 8863, line 14.

Add lines 38, 39, 40, 41a,42, and 43. Theseare your total payments.. If line 44 is more than line 37, subtract This is the amount you overpaid. of line 45 you want refunded 324377613 190001383024 to your 2011 47 to line 37 from line 44. .

Refund
Direct deposit? See instructions and fill in 46b, 46c, and 46d or Form 8888.

45

46a Amount

~ bRouting number ... ~ dAccount number .. 47

~0 _46=.=a
Savings

Amount of line 45 you want applied estimated tax . Amount you owe. Subtract see instructions. . Estimated tax penalty

Amount you owe


Third
party

48 49

line 44 from line 37. For details on how to pay, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . __ 48 .... 49

(see instructions}

Doyou want to allow anotherpersonto discussthis rsturn with the IRS (soo instructions)?

lID

Yes.

Complete

the following.

designee
~:~~nee's ~ LARRY R. BERGHOUT, CPA ~~~ne~ 801-972-4800

Personal identification . 12345 number(PIN)

Sign here
Joint return? Seeinstructions. Keepa copy for your records. ~

Underpenaltiesof perjury.I declarethat I haveexaminedthis returnand accompanying SChedules andstatements, nd to the bestof my knowledge belief,they a and are true,correct.andaccuratelylist all amountsandsourcesof incomeI received cunnq the tax year. Declaration preparer(otherthanthe taxpayer)IS basedon all of information whichthe preparerhasany knowledge. of Yoursignature Date Youroccupation OPERATOR Spouse's signature.If a joint return.both mustsign. Date
Spouse's occupation

PrintIType

preparer"s

name

Preparer's

signature

HOMEMAKER Date BERGHOUT, 2/07/11

Check~ P00439981 Firm'sEIN ~ Phoneno. 87-0325228 8

Paid preparer use only

LARRY

R.

BERGHOUT, AND

CPA 2300

LARRY

R. CPA
1

Firm'sname . HAYNIE Firm'saddress~ 1785

COMPANY

WEST

SOUTH
84119-2065

SALT LAKE CITY, DT

1- 97 2 - 4 8 0 0 Form 1040A (2010)

FDIA1312L

01/08/11

SCHEDULE EIC
(Form 1040A or 1040)
Department of the Treasury Internal Revenue Service Name(s) shown on return

Earned Income Credit


Qualifying Child Information
(99)

OMB No. 15450074

Complete and attach to Form 7040A or 7040 only if you have a qualifying child. AND KIM SESSIONS

Attachment Sequence No.


Your social security

201043
number

JEREMIAH

GRIFFITH

474-04-3631

Before you begin:

See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and
64b, to make sure that (a) you can take the EIC and (b) you have a qualifying child. Be sure the child's name on line 1 and social security number (SSN) on line 2 agree with the child's social security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child's social security card is not correct, call the Social Security Administration at 18007721213.

CAUTION!

If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.

It will take us longer to process your return and issue your refund if vou do not fill in all lines that apply for each qualifying child .

Qualifying Child Information


Child's name If you have more than three qualifying children, you only have to list three to get the maximum credit . . . . . ......... .........
,

Child 1
First name

Child 2
First name Last name First name

Child 3
Last name

Last name

. ZACHARY

GRIFFITH

BRYSON

SESSIONS

Child's SSN The child must have an SSN as defined in the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and 64b, unless the child was born and died in 201O. If your child was born and died in 2010 and did not have an SSN, enter 'Died' on this line and attach a copy of the child's birth certificate, death certificate, or hospital medical records ...

646-90-8270
Year

647-36-4901
Year

3 Child's year of birth

2006

1997

Year

If born after 7997 AND the child was

If born after 7997 AND the child was

*~~g%'i~P,:f to Ime5.

~~Yp?Mt!{a Sf~)N6; ~o ~

*~~g~~ntp,:f to Ime 5.

~~!f, sf,fJs,{f;;~o ~?~ls'l!a

*~~g~~'i~p,~~ ~~Ih ?~ls~~ ~ Sf~Js,{f;;bo i to Ime 5.

If born after 7997 AND the child was

4a Was the child under age 24 at the end of 2010, a student, and younger than you (or your spouse, if filing jointly)? ..............

DYes. DNo. Go to line 5. Continue.

DYes. DNo. Continue. Go to line 5.

DYes. DNo. Continue. Go to line 5.

bWas the child permanently and totally d;sabl",d dur:na !Ony D""{ 01 ~~1M ...

Dv--.
Continuo.

D ..~
The child is not a qualifying child.

n-.
Continue.

ONQ.
The child

O'G~'
Continue.

Orto.
The child

is not :l qualifying child.

is not a

qualifying child.

Child's relationship to you (for example, son, daughter, grandchild, niece, nephew, foster child, etc) ..... ........

SON

SON

Number of months child lived with you in the United States during 2010

If the child lived with you for more than half of 2010 but less than 7 months, enter 'T. If the child was born or died in 2010 and your home was the child's home for the entire time he or she was alive during 2010, enter '12:. . . . . . . . . . . . . . . ... .. ....
, ,

--

1-2

months

--

12

months

--

months

Do not enter more than 72 months. BAA For Paperwork Reduction Act Notice, see your tax return instructions.

Do not enter more than 72 months.

Do not enter more than 72 months.

Schedule EIC (Form 1040A or 1040) 2010

FDIA7401L 11/04110

Form

881 2
(99)
Complete

Additional Child Tax Credit


and attach to Form 7040, Form 7040A, or Form 7040NR.

OMS No. 1545-0074

2010
~~g~~~c~n~o. Your social security number

Department of the Treasury Internal Revenue Service Name(s) shown on return

47

KIM SESSIONS
1040 filers:

474-04-3631

Enter the amount from line 6 of your Child Tax Credit Worksheet (see the Instructions for Form 1040, line 51). . 1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the Instructions for Form 1040A, line 33). 1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the Instructions for Form 1040NR, line 48). . If you used Pub 972, enter the amount from line 8 of the worksheet on page 4 of the publication.

1,000.

2 Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 48 . 3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit ... 4a Earned income (see instructions) ... b Nontaxable combat pay (see instructions) ..... 5 Is the amount on line 4a more than $3,000? No. Leave line 5 blank and enter -0- on line 6. 4b

2 3

816. 184.

32,432.

o
[R]

29,432. ~ Yes. Subtract $3,000 from the amount on line 4a. Enter the result. Multiply the amount on line 5 by 15% (.15) and enter the result. . Next. Do you have three or more qualifying children? No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of line 3 or line 6 on line 13.

Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line

Otherwise, go to line 7.

3 on line 13.

Certain Filers Who Have Three or More Qualif in Children


7 Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6.
If married filing jointly, include your spouse's amounts with yours. If you worked for a railroad, see the instructions. . .......... ..............
8 1040 filers:

Enter the total of the amounts from Form 1040, lines 27 and 57, plus any taxes that you Identified usinq code 'UT' and entered on the dotted line next to line 60. 1040A filers: Enter -0-. 1040NR filers: Enter the total of the amounts from Form 1040NR, lines 27 and 55, plus any taxes that you Identified usmq code 'UT' and entered on the dotted line next to line 59. Add lines 7 and 8. .
1040 filers: 1040A filers:

1--7_1--

9
10

Enter the total of the amounts from Form 1040, lines 64a and 69.

Enter the total of the amount from Form 1040A, line 41a, plus any excess social security and tier 1 RRTA taxes withheld that you entered to the left of line 44 (see instructions). l040NR filers: Enter the amount from Form 1040NR, line 64. Subtract line 10 from line 9. If zero or less, enter -0-.

L....:..10-'--'--

11

11

12 Enter the larger of line 6 or line 11 .....


Next, enter the smaller of line 3 or line 12 on line 13.

12

13

This is your additional

child tax credit.

13 Enter this amount on Form 7040, line 65,

184.

Form 1040A, line 42, or


Form 7040NR, line 62.

BAA

For Paperwork

Reduction

Act Notice, see your tax return instructions.

FDIA300lL

07/08/10

Form 8812 (2010)

Form

8863
(99)

Education Credits (American Opportunity and Lifetime Learning Credits)


~ See separate instructions to find out if you are eligible to take the credits. ~ Attach to Form 1040 or Form 1040A. .
Your social security

OMB No. 1545-0074

Department of the Treasury Internal Revenue Service Name(s) shown on return

2010
Attachment Sequence No.
number

50

JEREMIAH GRIFFITH AND KIM SESSIONS


CAUTION!
same year.

474-04-3631

You cannot take both an education credit and the tuition and fees deduction (see Form 8977) for the same student for the

W.lII.'. American
Caution'

Opportunity Credit
(t) If column (d) is

You cannot take the American opportunity credit for more than 4 tax years for the same student (e) Multiply the 1 (a) Student's name (b) Student's (c) Qualified (d) Subtract $2,000 (as shown on page 1 social security expenses (see from the amount in amount in column (d) by 25% (.25) of your tax return) number (as shown instructions). Do column (c). If zero on page 1 of not enter more or less, enter -0your tax return) than $4,000 for First name each student. --------------Last name
---------------

zero, enter the amount from column (c). Otherwise, add $2,000 to the amount in column (e).

JEREMIAH GRIFFITH

474-04-3631

320.

320.

---------------

---------------

Tentative American

opportunity credit. Add the amounts on line 1, column (t). .If .you.are t~klng t.helifetime learning credit for a different student, go to Part II; otherwise, go to Part III ....

~I

320.

~arari:l.lLifetime
Caution:

Learning Credit.
You cannot take the Amencan opportunity credit and the lifetime learning credit for the same student In the same year. (c) Qualified (b) Student's social (a) Student's name (as shown on page 1 of your tax return) expenses security number (as (see instructions) shown on page 1 of your tax return) Last name

3 First name

Add the amounts on line 3, column (c), and enter the total ........... .... . .. . ....... 5 Enter the smaller of line 4 or $10,000. .......... 6
Tentative

_....
,

..
"

...

....

'

. . . . . . . . . .. ....
...
,

.....

. . . .......

.....

.. . ..

"

..... ...

5
6 Form 8863 (2010)

otherwise go to Part IV .

lifetime learning credit. Multiply line 5 by 20% (.20). If you have an entry on line 2, go to Part III; . .. , .. , ........ .......... . . . ... . .. . ... . .. . .. . ........ . . . ..... , . . .............
'

BAA For Paperwork

Reduction Act Notice, see your tax return instructions.

FDIA3601L

12131110

474-04-3631

Page 2

320.
8 Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er). . . . . . . . . 9 Enter the amount from Form 1040, line 38,* or Form 1040A, line 22 Subtract line 9 from line 8. If zero or less, stop; you cannot take any education credit. . . . . . . . . . . . Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er). If line 10 is: Equal to or more than line 11, enter 1.000 on line 12. . . . . .. Less than line 11, divide line 10 by line 11. Enter the result as a decimal (rounded to at least three places). . . . . . . . . . . .. 13 } .. .. 8 9
10

180,000. 32,432. 147,568. 20,000.

10 11
12

11

1. 000
. ... Df-'-13=--1-14
15

Multiply line 7 by line 12. Caution: If you were under age 24 at the end of the year and meet the conditions in the instructions, you cannot take the refundable American opportunity credit. Skip line 14, enter the amount from line 13 on line 15, and check this box..

3.:....:;.2...:.0--'-. 128. 192.

14

Refundable American opportunity credit. Multiply line 13 by 40% (.40). Enter the amount here and on Form 1040, line 66, or Form 1040A, line 43. Then go to line 15 below

tRait .l~
15

Nonrefundable

Education Credits

Subtract line 14 from line 13. Enter the amount from line 6, if any. If you have no entry on line 6, skip lines 17 through 22, and enter the amount from line 15 on line 6 of the Credit Limit Worksheet (see instructions). Enter: $120,000 if married filing jointly; $60,000 if single, head of household, or qualifying widow(er). Enter the amount from Form 1040, line 38,* or Form 1040A, line 22. Subtract line 18 from line 17. If zero or less, skip lines 20 and 21, and enter zero on line 22. Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er). . . . . . . . . . . . . . ..............
f-'-'7=-----1-_

16 17 18 19 20 21

16

f-=-18::......f-

19 r--~------<-=-20=--'-_

22

If line 19 is: Equal to or more than line 20, enter 1.000 on line 21 and go to line 22 Less than line 20, divide line 19 by line 20. Enter the result as a decimal (rounded to at least three places). . . . .......... ......... Multiply line 16 by line 21. Enter here and on line 1 of the Credit limit Worksheet (see instructions). Nonrefundable education credits. Enter the amount from line 11 of the Credit Limit Worksheet (see instructions) here and on Form 1040, line 49, or Form 1040A, line 31 . . .
If you are filing Form 2555, 2555-EZ, or 4563. or you are excluding income from Puerto Rico, see Pub 970 for the amount to-enter.

r=2'=--f-------f--=22=-t--------

23

23

192. Form 8863 (2010)

FDIA3601L 12131110

SCHEDULE M
(Form 1040A or 1040)
Department of the Treasury Internal Revenue Service Name(s) shown on return

OM8 No. 1545-0074

Making Work Pay Credit


(99) Attach to Form 1040A or 1040. See separate instructions.
Your social security

2010
Attachment Sequence No.
number

166

JEREMIAH GRIFFITH AND KIM SESSIONS


Caution:

474-04-3631

To take the making work pay credit, you must include your social security number (if filing a joint return, the number of either you or your spouse) on your tax return. A social security number does not include an identification number issued by the IRS. Only the Social Security Administration issues social security numbers. You cannot take the making work pay credit if you can be claimed as someone else's dependent or if you are a nonresident alien.

Caution:

Important: Check the 'No' box on line 1a and see the instructions if: (a) You have a net loss from a business, (b) You received a taxable scholarship or fellowship grant not reported on a Form W-2, (c) Your wages include pay for work performed while an inmate in a penal institution, (d) You received a pension or annuity from a nonqualified deferred compensation plan or a nongovernmental section 457 plan, or (e) You are filing Form 2555 or 2555-EZ. 1 a Doyou(andyourspouse filing jointly) have if 2010 wages more of than$6,451 ($12,903 if married filingjointly)?

!Kl Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly)

on line 4 and go to line 5. No. Enter your earned Income (see Instructions). . . . . . . . . . . . . . . . . . . . . . . . . . 1a 1b 2 3 .

b Nontaxable combat pay included on line 1a (see instructions) . 2 Multiply line 1a by 6.2% (,062). . 3 Enter $400 ($800 if married filing jointly). 4 5 6 7

Enter the smaller of line 2 or line 3 (unless you checked 'Yes' on line 1a) Enter the amount from Form 1040, line 38*, or Form 1040A, line 22 . Enter $75,000 ($150,000 if married filing jointly) Is the amount on line 5 more than the amount on line 6? .

800.

5
6

32,432. 150,000.

!Kl o

No. Skip line 8. Enter the amount from line 4 on line 9 below. Yes. Subtract line 6 from line 5 . .
. I-~+---------

8 9 10

Multiply line 7 by 2% (,02).

Subtract line 8 from line 4. If zero or less, enter -0-..... Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2010? You may have received this payment in 2010 if you did not receive an economic recovery payment in 2009 but you received social security benefits, supplemental security income, railroad retirement benefits, or veterans disability compensation or pension benefits in November 2008, December 2008, or January 2009 (see instructions).

800.

!Kl No. Ent~r -0- on line 10 and go to line 11.

Yes. Enter the total of the payments you (and your spouse, if filing jointly) received in 2010. Do not enter more than $250 ($500 if married filing jointly)

f---'-10"--f'---'-11-'---'--

...:..O-'-,

11

Making work pay credit. Subtract line 10 from line 9. If zero or less, enter -0-. Enter the result here and on Form 1040, line 63; or Form 1040A, line 40.... .

8-'--'-0...:..0-'

*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions. BAA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule M (Form 1040A or 1040) 2010

FDIA8501 L

09/2011 0

40001

Utah Individual Income Tax Return


All State Income Tax Dollars Fund Education

2010 TC-40
Intuit

1032
Your Social Security No.

Fiscal year end month/year (mm/yy) Amended Return - enter code

Form 8886 filed


X if deceased

474043631
Spouse's SSN

JEREMIAH KIM 1300 E 6125 S

GRIFFITH

528976647

SESSIONS

SOUTH OGDEN
Filing Status - enter code - 2 Exemptions - enter number a b 1 = Single 2= Married filing jointly 3= Married filingseparately 4= Head of Household 5= Qualifying widow(er) 4 5 6 7 8 9

UT
1 1
1
Yourself } Spouse Dependents

844057116
UTIA0112L 11/10110

3 Election Campaign Fund - enter code C = Constitution Yourself Spouse

- 2

fromfederal eturn r

o =

c
d

Democratic L = Libertarian R = Republican N = No contribution

- N

Total exemptions (add a through c)

Does not increase tax or reduce refund.

Federal adjusted gross income from federal return Additions to income from TC-40A, Part 1 (attach TC-40A, page 1) Total income (add lines 4 and 5) State tax refund included on federal Form 1040, line 10 Subtractions from income from TC-40A, Part 2 (attach TC-40A, page 1) Utah taxable income (subtract the total of lines 7 and 8 from line 6 (not less than zero

- 4 - 5 6

32432

32432

-7 -8 - 9 -10
- 11

32432 1622

10 Utah tax calculation - multiply line 9 by 5% (.05) 11 Exemption amount - multiply $2,738 by line 2d above 12 Enter your federal standard or itemized deductions

8214 11400
Filing electronically is quick, easy and free, and will speed up your refund.

13 Add lines 11 and 12 14 State income tax deducted on federal Schedule A, line 5 (see instructions) 15 Subtract line 14 from line 13 16 17 18 19 Multiply line 15 by 6% (.06) Enter amount based on filing status: if line 1 equals 1 or 3, enter $12,535; if line 1 equals 4, enter $18,802; if line 1 equals 2 or 5, enter $25,070 Subtract line 17 from line 9 (not less than zero) Multiply line 18 by 1.3% (.013)

13

19614

15

19614

f---------To learn more, go to

1177 25070
18

taxexpress. utah.gov

7362 96
- 20

20 Taxpayer tax credit (subtract line 19 from line 16 (not less than zero 21 If you are a qualified exempt taxpayer, enter 'X' (see worksheet in instructions) 22 Utah income tax (subtract line 20 from line 10 (not less than zero

1081 541

23 Apportionable nonrefundable credits from TC-40A, Part 3 (attach TC-40A, page 1)

24

Subtract line 23 from line 22 (not less than zero) Non or Part-Year Residents, complete TC-408 before continuing on page 2

24

541

--.J

r
25 26 27

40002

Utah Individual Income Tax Return - 2010


_L_as_t _na_m_e----'G_R_I_F_F_I_T_H-'--

TC-40

Intuit

Page 2

I SSN

474043631 541

Entertax (full-year resident,entertax from line 24; non or part-yearresident,entertax from TC-40B,line 37) Nonapportionable nonrefundable credits from form TC-40A, Part 4 (attach TC-40A, page 1)

Subtract

line 26 from line 25 (not less than zero) - add lines 28a through Wildlife 28d and enter total contributions on line 28 Code Account Account Account Amount Sch Dist Code

27

541

28

Contributions Code

Description Utah Nongame Pamela Atkinson

01

.28a

02 03
05 09
10

Homeless

Kurt Oscarson School

Children's

Organ Transplant

.28b .28c
.28d
Fund

District & Nonprofit Housing

School District Foundation Reconstruction refund

28

Cat & Dog Community Methamphetamine

Spay and Neuter Program & Rehabilitation

29

AMENDED

RETURN ONLY - previous

30
31

Recapture

of low-income

housing

credit

Utah use tax

32

Total tax, use tax and additions to tax (add lines 27 through

31)

32 page 1) to 2010

541 888

33 34

Utah income tax withheld

shown on TC-40W,

Part 1 (attach TC-40W,

Credit for Utah income taxes prepaid

from TC-546 and 2009 refund applied

35 36 37 38 39
40

Pass-through Mineral

entity withholding withholding

tax from TC-40W, tax from TC-40W, payments

Part 3 (attach TC-40W, Part 2 (attach TC-40W,

page 2) page 2)

production

AMENDED Refundable

RETURN ONLY - previous credits from TC-40A,

Part 5 (attach TC-40A,

page 2)

Total withholding

and refundable

credits (add lines 33 through

38)

39

888

TAX DUE - Subtrad Penalty and interest

line 39 from line 32 (not less than zero)

41
42 43 44 45

41
(add lines 40 and 41) line 32 from line 39 (not less than zero) to your 2011 taxes account information number .44
checking
savings

PAY THIS AMOUNT REFUND - Subtract

347 190001383024
(see instructions) Account type:

Enter the amount Routing number

of refund you want applied - provide

DIRECT DEPOSIT YOUR REFUND

324377613

Account

Check box if refund will go to an account

outside the United States

46 To deposit total refund to your Utah Educational Savings Plan account(s), enter 'X' (see instructions)
Under penalties of perjury, I declare to the best of my knowledge and belief, this return and accompanying schedules reflect my true tax status,

SIGN

Your signature

Date

I Spouse's signature
Desiqnee's telephone number Designee. PIN Date Preparer's telephone number Preparer's PTIN Preparer's EIN

Date

HERE
Third Party Name of designee (if any) you authorize to discuss this return Designee Paid Preparer's Section

PREPARER
Preparer's signature

2/07/11 LARRY R_ BERGHOUT, CPA Firm's name and address HAYNIE AND COMPANY CPA'S 1785 WEST 2300 SOUTH SALT LAKE CITY
UTIAOl12L 11110110

801-972-4800 UT 841192065

P0043998 1 87032522 8

40008

Part 1 - Utah Withholding Tax Schedule


=La=s~tn=a~m=e __

Intuit

TC-40W

Page 1

G=R~I=F~F~IT==H

I~s=sN~~4~7~4~-~0~4~-~3

Line Explanations:

IMPORTANT
Do not send your W-2s or 1099s with your return. Instead, enter W-2 or 1099 information below, but only if there is Utah withholding on the form.

1 2 3 4 5 6 7

Employer/payer 10 number from W-2 box 'b' or 1099 Utah withholding 10 number from W-2 box '15' or 1099 Employer/payer name and address from W-2 box 'c' or 1099 Enter 'X' if reporting Utah withholding from form 1099 Employee's Social Security number from W-2 box 'a' or 1099 Utah wages/income fromW-2 box '16' or 1099 Utah withholding tax from W-2 box '17' or 1099

Use additional forms TC40W if you have more than four W-2s and/or 1099s with Utah withholding tax. Enter mineral production withholding from TC-675R in Part 2 of TC-40W; enter pass-through entity withholding in Part 3 of TC-40W.

1 2 3

410215170 Z88464 TARGET CORPORATION MAILSTOP NCD-0280, PO BOX 9401 MINNEAPOLIS, MN 55440-9401
4

510391628
2 3

12251777-003-W URS FEDERAL TECHNICAL SERVICES 20501 SENECA MEADOWS PKW GERMANTOWN, MD 20876

4 5

474043631 9957 123

5 6 7

474043631 22475 765

6 7

1 2 3 2 3

4 5
6 7

4
5 6 7

Enter total Utah withholding lax from all lines 7 here and on TC-40, page 2, line 33

888

Submit this page ONLY if data entered.

UTIA0212L

11/1 1/10

Attach this form to your 2010 Utah Income Tax Return. Do not attach W-2s or 1099s to your Utah return.