Electronic Filing Instructions for your 2016 Federal Tax Return

Important: Your taxes are not finished until all required steps are completed.

Isaac L Ramer, Jr & Jody D Ramer

14 Clifford Road
Selinsgrove, PA 17870
|
Balance | Your federal tax return (Form 1040A) shows a refund due to you in the
Due/ | amount of $7,271.00. Your tax refund will be direct deposited into
Refund | your account. The account information you entered - Account Number:
| 3740437359 Routing Transit Number: 031302955.
|
______________________________________________________________________________________
|
When Will | The IRS issued more than 9 out of 10 refunds to taxpayers in less
You Get | than 21 days last year. The same results are expected in 2017. To
Your | get your estimated refund date from TurboTax, log into My TurboTax at
Refund? | www.turbotax.com. If you do not receive your refund within 21 days,
| or the amount you get is not what you expected, contact the Internal
| Revenue Service directly at 1-800-829-4477. You can also check
| www.irs.gov and select the "Where's my refund?" link.
|
______________________________________________________________________________________
|
What You | Your Electronic Filing Instructions (this form)
Need to | Printed copy of your federal return
Keep |
|
______________________________________________________________________________________
|
2016 | Adjusted Gross Income $ 46,069.00
Federal | Taxable Income $ 17,269.00
Tax | Total Tax $ 328.00
Return | Total Payments/Credits $ 7,599.00
Summary | Amount to be Refunded $ 7,271.00
| Effective Tax Rate -1.17%
|
______________________________________________________________________________________

Page 1 of 1
Hi Isaac and Jody,

We just want to thank you for using TurboTax this year! It's our goal to make
your taxes easy and accurate, year after year.

With TurboTax Deluxe:

Your Head Start On Next Year:
When you come back next year, taxes will be so easy! We'll have all
your information saved and ready to transfer in to your new return.
We'll ask you questions about what changed since we last talked, and
we'll be ready to get you the credits and deductions you deserve, no
matter what life throws at you.

Here's the final wrap up for your 2016 taxes:

Your federal refund is: $ 7,271.00

You qualified for these important credits:

- Child Tax Credit
- Earned Income Credit

Your Guarantee of Accuracy:

Breathe easy. The calculations on your return are backed with our
100% Accuracy Guarantee.
- We double checked your return for errors along the way.
- We helped with step-by-step guidance to get your answers on the right
IRS forms.
- We made sure you didn't miss a deduction even if something in your life
changed, like a new job, new house - or more kids!

Also included:
- We provide the Audit Support Center free of charge, in the unlikely
event you get audited.

Many happy returns from TurboTax.

Form Department of the Treasury—Internal Revenue Service
1040A U.S. Individual Income Tax Return (99) 2016 IRS Use Only—Do not write or staple in this space.
Your first name and initial Last name OMB No. 1545-0074
Your social security number
Isaac L Ramer, Jr 203 60 5574
If a joint return, spouse’s first name and initial Last name Spouse’s social security number
Jody D Ramer 196 64 3502
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above
c
14 Clifford Road 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
Selinsgrove PA 17870 Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign country name Foreign province/state/county Foreign postal code a box below will not change your tax or
refund. You Spouse

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

status 2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent,
Check only 3 Married filing separately. Enter spouse’s SSN above and enter this child’s name here. a
one box. full name here. a 5 Qualifying widow(er) with dependent child (see instructions)

}
Exemptions 6a Yourself. If someone can claim you as a dependent, do not check Boxes
checked on
box 6a. 6a and 6b 2
b Spouse No. of children
on 6c who:
c Dependents: (4)  if child under
(2) Dependent’s social (3) Dependent’s • lived with
age 17 qualifying for
If more than six security number relationship to you child tax credit (see
you 2
dependents, see (1) First name Last name instructions) • did not live
instructions. with you due to
Izabel P Ramer 205-78-3218 Daughter divorce or
Sophia C Ramer 159-82-2734 Daughter separation (see
instructions)
Dependents
on 6c not
entered above

Add numbers
on lines
d Total number of exemptions claimed. above a 4
Income
7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7 46,069.
Attach
Form(s) W-2 8a Taxable interest. Attach Schedule B if required. 8a
here. Also b Tax-exempt interest. Do not include on line 8a. 8b
attach
Form(s) 9a Ordinary dividends. Attach Schedule B if required. 9a
1099-R if tax b Qualified dividends (see instructions). 9b
was 10 Capital gain distributions (see instructions). 10
withheld. 11a IRA 11b Taxable amount
If you did not distributions. 11a (see instructions). 11b
get a W-2, see 12a Pensions and 12b Taxable amount
instructions.
annuities. 12a (see instructions). 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 13

14a Social security 14b Taxable amount
benefits. 14a (see instructions). 14b

15 Add lines 7 through 14b (far right column). This is your total income. a 15 46,069.
Adjusted
gross 16 Educator expenses (see instructions). 16
income 17 IRA deduction (see instructions). 17
18 Student loan interest deduction (see instructions). 18

19 Tuition and fees. Attach Form 8917. 19

20 Add lines 16 through 19. These are your total adjustments. 20

21 Subtract line 20 from line 15. This is your adjusted gross income. a 21 46,069.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040A (2016)
BAA REV 01/25/17 TTO
Form 1040A (2016) Page 2
Tax, credits, 22 Enter the amount from line 21 (adjusted gross income). 22 46,069.
and
payments
23a Check
if: {
You were born before January 2, 1952,
Spouse was born before January 2, 1952,
Blind Total boxes
Blind checked a 23a }
b If you are married filing separately and your spouse itemizes
Standard deductions, check here a 23b
Deduction
for— 24 Enter your standard deduction. 24 12,600.
• People who 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25 33,469.
check any
box on line 26 Exemptions. Multiply $4,050 by the number on line 6d. 26 16,200.
23a or 23b or
who can be 27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
claimed as a This is your taxable income. a 27 17,269.
dependent,
see 28 Tax, including any alternative minimum tax (see instructions). 28 1,728.
instructions.
29 Excess advance premium tax credit repayment. Attach
• All others:
Single or Form 8962. 29 600.
Married filing 30 Add lines 28 and 29. 30 2,328.
separately,
$6,300 31 Credit for child and dependent care expenses. Attach
Married filing Form 2441. 31
jointly or
Qualifying 32 Credit for the elderly or the disabled. Attach
widow(er),
$12,600 Schedule R. 32
Head of 33 Education credits from Form 8863, line 19. 33
household,
$9,300 34 Retirement savings contributions credit. Attach Form 8880. 34
35 Child tax credit. Attach Schedule 8812, if required. 35 2,000.
36 Add lines 31 through 35. These are your total credits. 36 2,000.
37 Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-. 37 328.
38 Health care: individual responsibility (see instructions). Full-year coverage 38 0.
39 Add line 37 and line 38. This is your total tax. 39 328.
40 Federal income tax withheld from Forms W-2 and 1099. 40 6,731.
If you have
41 2016 estimated tax payments and amount applied
a qualifying from 2015 return. 41
child, attach 42a Earned income credit (EIC). 42a 868.
Schedule
EIC. b Nontaxable combat pay election. 42b
43 Additional child tax credit. Attach Schedule 8812. 43
44 American opportunity credit from Form 8863, line 8. 44
45 Net premium tax credit. Attach Form 8962. 45
46 Add lines 40, 41, 42a, 43, 44, and 45. These are your total payments. a 46 7,599.
47 If line 46 is more than line 39, subtract line 39 from line 46.
Refund This is the amount you overpaid. 47 7,271.
Direct 48a Amount of line 47 you want refunded to you. If Form 8888 is attached, check here a 48a 7,271.
deposit?
See a b
Routing a c Type: Checking Savings
instructions number 0 3 1 3 0 2 9 5 5
and fill in
48b, 48c, a d
Account
and 48d or number 3 7 4 0 4 3 7 3 5 9
Form 8888. 49 Amount of line 47 you want applied to your
2017 estimated tax. 49
Amount 50 Amount you owe. Subtract line 46 from line 39. For details on how to pay,
you owe see instructions. a 50
51 Estimated tax penalty (see instructions). 51
Third party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No
Designee’s Phone Personal identification
designee name a no. a number (PIN) a

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other
than the taxpayer) is based on all information of which the preparer has any knowledge.
here Your signature Date Your occupation Daytime phone number
F

Joint return?
See instructions. laborer (570)259-4613
Keep a copy Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection
PIN, enter it
for your records.
homemaker here (see inst.)
Print/type preparer’s name Preparer’s signature Date PTIN
Paid Check a if
self-employed
preparer Firm's name a Firm's EIN a
Self-Prepared
use only Firm's address a Phone no.
REV 01/25/17 TTO Form 1040A (2016)
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040A or 1040) 1040A `
a
Qualifying Child Information
Complete and attach to Form 1040A or 1040 only if you have a qualifying child.
..........

1040 2016
Department of the Treasury a
Information about Schedule EIC (Form 1040A or 1040) and its instructions is at www.irs.gov/scheduleeic.
EIC Attachment
Internal Revenue Service (99) Sequence No. 43
Name(s) shown on return Your social security number
Isaac L Ramer, Jr & Jody D Ramer 203-60-5574
• See the instructions for Form 1040A, lines 42a and 42b, or Form 1040, lines 66a and 66b, to make
Before you begin: 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 1-800-772-1213.

F
!
CAUTION
• You can't claim the EIC for a child who didn't live with you for more than half of the year.
• 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 you do not fill in all lines that apply for each qualifying child.

Qualifying Child Information Child 1 Child 2 Child 3

1 Child’s name First name Last name First name Last name First name Last name
If you have more than three qualifying
children, you have to list only three to get
the maximum credit. Izabel P Ramer Sophia C Ramer
2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040A, lines 42a
and 42b, or Form 1040, lines 66a and 66b,
unless the child was born and died in
2016. If your child was born and died in
2016 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.
205-78-3218 159-82-2734
3 Child’s year of birth
Year 2 0 0 0 Year 2 0 0 3 Year
If born after 1997 and the child is If born after 1997 and the child is If born after 1997 and the child is
younger than you (or your spouse, if younger than you (or your spouse, if younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b;
go to line 5. go to line 5. go to line 5.

4 a Was the child under age 24 at the end of

2016, a student, and younger than you (or Yes. No. Yes. No. Yes. No.
your spouse, if filing jointly)?
Go to Go to line 4b. Go to Go to line 4b. Go to Go to line 4b.
line 5. line 5. line 5.

b Was the child permanently and totally

disabled during any part of 2016? Yes. No. Yes. No. Yes. No.
Go to The child is not a Go to The child is not a Go to The child is not a
line 5. qualifying child. line 5. qualifying child. line 5. qualifying child.

5 Child’s relationship to you

(for example, son, daughter, grandchild,
niece, nephew, foster child, etc.) Daughter Daughter
6 Number of months child lived
with you in the United States
during 2016

• If the child lived with you for more than

half of 2016 but less than 7 months,
enter “7.”
• If the child was born or died in 2016 and 12 months 12 months months
your home was the child’s home for more
than half the time he or she was alive Do not enter more than 12 Do not enter more than 12 Do not enter more than 12
during 2016, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax BAA REV 01/25/17 TTO Schedule EIC (Form 1040A or 1040) 2016
return instructions.
Form 8962 Premium Tax Credit (PTC)
OMB No. 1545-0074

2016
a Attach to Form 1040, 1040A, or 1040NR.
Department of the Treasury Attachment
Internal Revenue Service a Information about Form 8962 and its separate instructions is at www.irs.gov/form8962. Sequence No. 73
Name shown on your return Your social security number
Isaac L Ramer, Jr & Jody D Ramer 203-60-5574
You cannot claim the PTC if your filing status is married filing separately unless you qualify for an exception (see instructions). If you qualify, check the box.

Part I Annual and Monthly Contribution Amount

1 Tax family size. Enter the number of exemptions from Form 1040 or Form 1040A, line 6d, or Form 1040NR, line 7d 1 4
2a Modified AGI. Enter your modified b Enter the total of your dependents'
AGI (see instructions) . . . . . 2a 46,069. modified AGI (see instructions) . . . 2b
3 Household income. Add the amounts on lines 2a and 2b . . . . . . . . . . . . . . . . . 3 46,069.
4 Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3 (see instructions). Check the
appropriate box for the federal poverty table used. a Alaska b Hawaii c Other 48 states and DC 4 24,250.
5 Household income as a percentage of federal poverty line (see instructions) . . . . . . . . . . . . 5 189 %
6 Did you enter 401% on line 5? (See instructions if you entered less than 100%.)
No. Continue to line 7.
Yes. You are not eligible to take the PTC. If advance payment of the PTC was made, see the instructions for
how to report your excess advance PTC repayment amount.
7 Applicable Figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions . . 7 0.0590
8a Annual contribution amount. Multiply line 3 by b Monthly contribution amount. Divide line 8a
8a 2,718.
line 7. Round to nearest whole dollar amount by 12. Round to nearest whole dollar amount
8b 227.
Part II Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit
9 Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage (see instructions)?
Yes. Skip to Part IV, Allocation of Policy Amounts, or Part V, Alternative Calculation for Year of Marriage. No. Continue to line 10.
10 See the instructions to determine if you can use line 11 or must complete lines 12 through 23.
Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12–23 No. Continue to lines 12–23. Compute
and continue to line 24. your monthly PTC and continue to line 24.
(b) Annual applicable (d) Annual maximum
(a) Annual enrollment (c) Annual (e) Annual premium tax (f) Annual advance
Annual SLCSP premium premium assistance
premiums (Form(s) contribution amount credit allowed payment of PTC (Form
Calculation (Form(s) 1095-A, (subtract (c) from (b), if
1095-A, line 33A) (line 8a) (smaller of (a) or (d)) (s) 1095-A, line 33C)
line 33B) zero or less, enter -0-)
11 Annual Totals 3,804. 3,804. 2,718. 1,086. 1,086. 1,692.
(c) Monthly
(a) Monthly enrollment (b) Monthly applicable (d) Monthly maximum (f) Monthly advance
contribution amount (e) Monthly premium tax
Monthly premiums (Form(s) SLCSP premium (Form premium assistance payment of PTC (Form(s)
(amount from line 8b credit allowed
Calculation 1095-A, lines 21–32, (s) 1095-A, lines 21–32, (subtract (c) from (b), if 1095-A, lines 21–32,
or alternative marriage (smaller of (a) or (d))
column A) column B) zero or less, enter -0-) column C)
monthly calculation)

12 January
13 February
14 March
15 April
16 May
17 June
18 July
19 August
20 September
21 October
22 November
23 December
24 Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here 24 1,086.
25 Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here 25 1,692.
26 Net premium tax credit. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and on Form
1040, line 69; Form 1040A, line 45; or Form 1040NR, line 65. If line 24 equals line 25, enter zero. Stop here. If line 25 is greater
than line 24, leave this line blank and continue to line 27 . . . . . . . . . . . . . . . . . . . 26
Part III Repayment of Excess Advance Payment of the Premium Tax Credit
27 Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here 27 606.
28 Repayment limitation (see instructions) . . . . . . . . . . . . . . . . . . . . . . 28 600.
29 Excess advance premium tax credit repayment. Enter the smaller of line 27 or line 28 here and on Form 1040, line
46; Form 1040A, line 29; or Form 1040NR, line 44 . . . . . . . . . . . . . . . . . . . 29 600.
For Paperwork Reduction Act Notice, see your tax return instructions. BA REV 01/25/17 TTO Form 8962 (2016)
Form 8962 (2016) Page 2
Part IV Allocation of Policy Amounts
Complete the following information for up to four shared policy allocations. See instructions for allocation details.
Allocation 1
30 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC

(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 2
31 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC

(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 3
32 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC

(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 4
33 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC

(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

34 Have you completed all policy amount allocations?

Yes. Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and non-
allocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on
lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24.
No. See the instructions to report additional policy amount allocations.

Part V Alternative Calculation for Year of Marriage

Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9.
To complete line(s) 35 and/or 36 and compute the amounts for lines 12–23, see the instructions for this Part V.
(a) Alternative family size (b) Alternative monthly (c) Alternative start month (d) Alternative stop month
35 Alternative entries contribution amount
for your SSN

(a) Alternative family size (b) Alternative monthly (c) Alternative start month (d) Alternative stop month
36 Alternative entries contribution amount
for your spouse's
SSN
REV 01/25/17 TTO Form 8962 (2016)
 Tax History Report 2016
G Keep for your records

Name(s) Shown on Return

Isaac L Ramer, Jr & Jody D Ramer

Five Year Tax History:

2012 2013 2014 2015 2016

Filing status MFJ

Total income 46,069.

Adjustments to income

Adjusted gross income 46,069.

Tax expense 2,413.

Interest expense 4,955.

Contributions

Miscellaneous
deductions

Other Itemized
Deductions 0.

Total itemized/
standard deduction 12,600.

Exemption amount 16,200.

Taxable income 17,269.

Tax 2,328.

Alternative min tax

Total credits 2,000.

Other taxes 0.

Payments 7,599.

Form 2210 penalty

Amount owed

Applied to next
year’s estimated tax

Refund 7,271.

Effective tax rate % -1.17

**Tax bracket % 10.0

**Tax bracket % is based on Taxable income.

 Form 1095-A Health Insurance Marketplace Statement 2016
G Keep for your records

QuickZoom to Form 1095-A, Health Insurance Marketplace Statement

QuickZoom to Form 8962, Premium Tax Credit (PTC)

Name(s) Shown on Return Your Social Security No.

Isaac L Ramer, Jr & Jody D Ramer 203-60-5574
Owned by: (See tax help if recipient is a dependent)
Taxpayer Spouse Spouse is covered by plan
Part I Recipient Information

1 Marketplace identifier 2 Marketplace-assigned pol. no. 3 Policy issuer’s name

PA 29172322
4 Recipient’s name 5 Recipient’s SSN 6 Recipient’s DOB

7 Recipient’s spouse’s name 8 Spouse’s SSN 9 Spouse’s DOB

10 Policy start date 11 Policy termination date 12 Street address (including apartment no.)
14 Clifford Road
13 City or town 14 State or province 15 Country and ZIP or foreign postal code
Selinsgrove PA 17870

Part II Covered Individuals

Check this box to populate the Name, SSN, and DOB for everyone listed on the return in Part II.
Note: Checking this box again will repopulate the information below and overwrite existing entries.

A. Covered individual name B. Covered C. Covered D. Coverage E. Coverage

First individual SSN individual start date termination
Last date of birth date
16

17

18

19

20

Part III Coverage Information

Month Copy Feature A. Monthly enrollment B. Monthly second lowest C. Monthly advance payment
See help for premiums cost silver plan (SLCSP) of premium tax credit
more info. premium
21 JANUARY 317.38 317.38 141.00
22 FEBRUARY 317.38 317.38 141.00
23 MARCH 317.38 317.38 141.00
24 APRIL 317.38 317.38 141.00
25 MAY 317.38 317.38 141.00
26 JUNE 317.38 317.38 141.00
27 JULY 317.38 317.38 141.00
28 AUGUST 317.38 317.38 141.00
29 SEPTEMBER 317.38 317.38 141.00
30 OCTOBER 317.38 317.38 141.00
31 NOVEMBER 317.38 317.38 141.00
32 DECEMBER 317.38 317.38 141.00
33 Annual Totals 3,804. 3,804. 1,692.
 Healthcare Entry Sheet 2016
G Keep for your records

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

Yes No/Partial
Everyone on the tax return was covered by health insurance all year.

If everyone on the return was covered and there was no Market Place coverage (Form 1095-A) then check the YES box
above - no other action is required. The 1095-B or 1095-C can be used to verify coverage but you do not need to enter
the information if everyone on the return was covered.

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

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

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

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

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

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

If applicable enter Market Place exemptions (ECNs) or Request exemptions on form 8965

Note: Do not enter the name, SSN, or date of birth directly on the table below. Instead, enter the information at the bottom of the
Personal Information Worksheet or Dependent and Nondependent Information Worksheet.
Or if you check the box at the top "Yes" that "Everyone on the tax return was covered by health insurance all year." the covered
all 12 months box will be marked for all the individuals below regardless of what is entered on the Personal Information or
Dependent and Nondependent Information Worksheet.

Short Gap
Eligible*
Yes No
a. Name of covered individual(s) Covered all
b. SSN c. DOB 12 months Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Isaac Ramer Short gap: Yes X No
203-60-5574 04/24/75 X X X X X X X X X X X X X T
2 Jody Ramer Short gap: Yes X No
196-64-3502 07/14/74 X X X X X X X X X X X X X S
3 Izabel Ramer Short gap: Yes X No
205-78-3218 04/06/00 X X X X X X X X X X X X X 1
4 Sophia Ramer Short gap: Yes X No
159-82-2734 08/29/03 X X X X X X X X X X X X X 2
5 Short gap: Yes No

6 Short gap: Yes No

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

To review the detail of each person listed on the return (covered, not covered, exempt) and to see any penalty calculation go to the
Health Care Individual Responsibility Smart Worksheet on Form 8965
Completion checkbox:
X Check this box once you are finished with all the healthcare related entries.
 Tax Payments Worksheet 2016
G Keep for your records

Name(s) Shown on Return Social Security Number

Isaac L Ramer, Jr & Jody D Ramer 203-60-5574

Estimated Tax Payments for 2016 (If more than 4 payments for any state or locality, see Tax Help)

Federal State Local

Date Amount Date Amount ID Date Amount ID

1 04/18/16 04/18/16 04/18/16

2 06/15/16 06/15/16 06/15/16

3 09/15/16 09/15/16 09/15/16

4 01/17/17 01/17/17 01/17/17

Tot Estimated
Payments

Tax Payments Other Than Withholding Federal State ID Local ID

(If multiple states, see Tax Help)

6 Overpayments applied to 2016

7 Credited by estates and trusts
8 Totals Lines 1 through 7
9 2016 extensions

Taxes Withheld From: Federal State Local

10 Forms W-2 6,731. 1,414. 967.

11 Forms W-2G
12 Forms 1099-R
13 Forms 1099-MISC, 1099-K and 1099-G
14 Schedules K-1
15 Forms 1099-INT, DIV and OID
16 Social Security and Railroad Benefits
17 Form 1099-B St Loc
18 a Other withholding St Loc
b Other withholding St Loc
c Other withholding St Loc
d Positive Adjustment St Loc
e Negative Adjustment St Loc
f Additional Medicare Tax
19 Total Withholding Lines 10 through 18f
6,731. 1,414. 967.
20 Total Tax Payments for 2016 6,731. 1,414. 967.

Prior Year Taxes Paid In 2016 State ID Local ID

(If multiple states or localities, see Tax Help)

21 Tax paid with 2015 extensions

22 2015 estimated tax paid after 12/31/2015
23 Balance due paid with 2015 return
24 Other (amended returns, installment payments, etc)
 Federal Carryover Worksheet 2016
G Keep for your records

Name(s) Shown on Return Social Security Number

Isaac L Ramer, Jr & Jody D Ramer 203-60-5574

2015 State and Local Income Tax Information (See Tax Help)

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

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

Totals

Other Tax and Income Information 2015 2016

1 Filing status 1 2 MFJ

2 Number of exemptions for blind or over 65 (0 - 4) 2
3 Itemized deductions 3 7,368.
4 Check box if required to itemize deductions 4
5 Adjusted gross income 5 46,069.
6 Tax liability for Form 2210 or Form 2210-F 6 0.
7 Alternative minimum tax 7
8 Federal overpayment applied to next year estimated tax 8

QuickZoom to the IRA Information Worksheet for IRA information

Excess Contributions 2015 2016

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

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

Loss and Expense Carryovers 2015 2016

Note: Enter all entries as a positive amount

12 a Short-term capital loss 12 a

b AMT Short-term capital loss b
13 a Long-term capital loss 13 a
b AMT Long-term capital loss b
14 a Net operating loss available to carry forward 14 a
b AMT Net operating loss available to carry forward b
15 a Investment interest expense disallowed 15 a
b AMT Investment interest expense disallowed b
16 Nonrecaptured net Section 1231 losses from: a 2016 16 a
b 2015 b
c 2014 c
d 2013 d
e 2012 e
f 2011 f
Electronic Filing Instructions for your 2016 Pennsylvania Tax Return
Important: Your taxes are not finished until all required steps are completed.

Isaac L & Jody D Ramer Jr

14 CLIFFORD ROAD
Selinsgrove, PA 17870
|
Balance | Your Pennsylvania state tax return (Form PA-40) shows a refund due to
Due/ | you in the amount of $4.00. Your tax refund will be direct deposited
Refund | into your account. The account information you entered - Account
| Number: 3740437359 Routing Transit Number: 031302955.
|
______________________________________________________________________________________
|
Where's My | Before you call the Pennsylvania Department of Revenue with questions
Refund? | about your refund, give them 21 days processing time from the date
| your return is accepted. If then you have not received your refund,
| or the amount is not what you expected, contact the Pennsylvania
| Department of Revenue directly at 1-717-787-8201. You can also visit
| the Pennsylvania Department of Revenue web site at
| http://www.revenue.state.pa.us/.
|
______________________________________________________________________________________
|
What You | Sign and date Form PA-8453 within 1 day of acceptance. Since you are
Need to | married filing jointly, your spouse must also sign and date the form.
Sign |
|
______________________________________________________________________________________
|
Do Not | Do not mail a paper copy of your tax return. Since you filed
Mail | electronically, the Pennsylvania Department of Revenue already has
| your return.
|
______________________________________________________________________________________
|
What You | Your Electronic Filing Instructions (this form)
Need to | - Form PA-8453 and attachment(s)
Keep | Printed copy of your state and federal returns
|
______________________________________________________________________________________
|
2016 | Taxable Income $ 45,931.00
Pennsylvania | Total Tax $ 1,410.00
Tax | Total Payments/Credits $ 1,414.00
Return | Amount to be Refunded $ 4.00
Summary |
|
______________________________________________________________________________________

Page 1 of 1
 Declaration Control Number/Submission ID

PA DEPARTMENT OF REVENUE USE ONLY – DO NOT WRITE OR STAPLE IN THIS SPACE

Form PA-8453 PENNSYLVANIA INDIVIDUAL INCOME TAX 2016

DECLARATION FOR ELECTRONIC FILING
For the year Jan. 1 – Dec. 31, 2016
Primary Taxpayer’s Social Security Number Secondary Taxpayer’s Social Security Number

Print Last Name

203-60-5574 196-64-3502
Primary Taxpayer’s Name, Initial; Secondary Taxpayer’s First Name, Initial; Secondary Taxpayer’s Last Name (only if different)

or RAMER JR, ISAAC L & JODY D

Type 14 CLIFFORD ROAD
Home Address (Number and Street including Rural Route or P.O. Box)

City, Town or Post Office State ZIP Code

SELINSGROVE PA 17870
Check
The above information must match that on the electronic return exactly.

➧
Proper S £ Single J X
£ Married, Filing Jointly D £ Deceased Daytime Telephone Number

P
Filing Status M £ Married, Filing Separately F £ Final Return (570)259-4613
Tax Return Information (Enter whole dollars only.)

E
Part I
1. Adjusted PA taxable income (Form PA-40, Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 45,931
2. PA tax liability (Form PA-40, Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

N
1,410
3. Total PA tax withheld (Form PA-40, Line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 1,414
4. Amount to be refunded (Form PA-40, Line 30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.

N
4
5. Total payment (tax due) (Form PA-40, Line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.

Direct Deposit of Refund or Electronic Funds Withdrawal of Tax Due (Optional – See instructions.)

S
Part II
The first two numbers of the RTN must
6. Routing transit number (RTN) be 01 through 12 or 21 through 32.
STATE W-2(s), W-2G
and 1099(s) HERE
STAPLE COPY OF

0 3 1 3 0 2 9 5 5

Y
7. Depositor account number (DAN) 3 7 4 0 4 3 7 3 5 9
8. Type of account: £
X Checking £ Savings
9 . Debit date
L
V
Part III Declaration of Taxpayers (Sign only after Part I is complete.)
10. X a.
£ I consent for my refund to be directly deposited as designated in Part II and declare all information shown on Lines 6 through 8 is correct. I certify the ultimate

A
destination of the funds is within the U.S. or one of its territories. If I have filed a joint return, this is an irrevocable appointment of the other Taxpayer as
an agent to receive the refund.
£ b. I am not receiving a refund or I do not want direct deposit of my refund.

N
£ c. I authorize the Pennsylvania Department of Revenue and its designated financial agents to initiate an electronic funds withdrawal entry to my designated
account for Pennsylvania taxes owed. I also authorize my financial institution to debit the entry to my account and the financial institutions involved in
the processing of my electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to
my payment. I certify the funds for this withdraw are originating from an account within the U.S. or one of its territories. I may revoke this authorization by

I
notifying the Pennsylvania Department of Revenue no later than two business days prior to the payment (settlement) date. I understand notification must
be made in writing by email to [email protected] or fax to 717-772-9310.
If I have filed a balance-due return, I understand that if the PA Department of Revenue does not receive full and timely payment of my tax liability, I will remain liable for the tax and all

A
applicable interest and penalties. If I have filed a joint federal and state tax return and there is an error on my state return, I understand my federal return will be rejected.
I declare under penalties of perjury that I have compared the information on my return with the information I provided to my electronic return originator and the amounts match those
on my 2016 PA Tax Return (PA-40). To the best of my knowledge, my return is true and complete. I authorize my electronic return originator to send my return and accompanying schedules
and statements to the Internal Revenue Service (IRS) and the IRS to subsequently send them to the PA Department of Revenue. In addition, by using a computer system and software to
prepare and transmit my return electronically, I consent to the disclosure of all information pertaining to my use of the system and software and to the transmission of my tax return
electronically to the PA Department of Revenue. If I am filing from a home computer, I understand that I am required to keep this form and supporting documents for three years.

Sign
Here ➧ Primary Taxpayer Date ➧ Secondary Taxpayer Date

Part IV Declaration of Electronic Return Originator (ERO) and Paid Preparer (See instructions.)
I declare that I have received the above-named taxpayer’s return and that the entries on this form are complete and correct to the best of my knowledge. I obtained the taxpayer’s
signature on this form before submitting this return to the PA Department of Revenue. I provided the taxpayer with a copy of all forms and information to be filed with the IRS and the
PA Department of Revenue and followed all other requirements specified by the PA Department of Revenue and described in the IRS Publication 1345, Handbook for Electronic Filers
of Individual Tax Returns (Tax Year 2016). If I am the preparer, under penalty of perjury, I declare that I examined the above-named taxpayer’s return and accompanying schedules and
statements, and to the best of my knowledge, they are true and complete. I understand that I am required to keep this form and supporting documents for three years.

Check if
ERO’s ERO’s signature Date Check if also
£ self-employed £
EIN/SSN or PTIN
Use ➧ paid preparer

Only
➧
Firm’s name (or yours,
if self-employed) and
address Daytime Telephone Number
Preparer’s signature Date Check if also Check if EIN/SSN or PTIN
➧ SELF-PREPARED paid preparer £ self-employed £
Paid

➧
Preparer’s Firm’s name (or yours,
if self-employed) and
Use Only address
Daytime Telephone Number

KEEP THIS FORM AND THE REQUIRED ATTACHMENTS FOR THREE YEARS. 1555 Please DO NOT mail this form.
REV 01/25/17 TTO
 1600112245

PA-40 - 2016
Pennsylvania Income Tax Return
ENTER ONE LETTER OR NUMBER IN EACH BOX (05-16)

N Extension. N Amended Return.

Residency Status.
203605574 196643502
PA Resident/Nonresident/Part-Year Resident
R
from to
RAMER JR
Occupation Single, Married/Filing Jointly,
Married/Filing Separately, Final Return
ISAAC L LABORER J
Occupation
Deceased
JODY D HOMEMAKER
N
Taxpayer Date of Death
RAMER
N

N Spouse Date of Death

Farmers.
14 CLIFFORD ROAD
School District Name SELINSGROVE
________________________
N
SELINSGROVE PA 17870 AR

570-259-4613 55710

1a Gross Compensation. Do not include exempt income, such as combat zone pay and
qualifying retirement benefits. See the instructions.
1a 46069

1b Unreimbursed Employee Business Expenses.

1c Net Compensation. Subtract Line 1b from Line 1a.
1b 138
1c 45931

2 Interest Income. Complete PA Schedule A if required.

3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required.
2 0
4 Net Income or Loss from the Operation of a Business, Profession or Farm.
3 0
4 0

5 Net Gain or Loss from the Sale, Exchange or Disposition of Property.

6 Net Income or Loss from Rents, Royalties, Patents or Copyrights.
5 0
7 Estate or Trust Income. Complete and submit PA Schedule J.
6 0
8 Gambling and Lottery Winnings. Complete and submit PA Schedule T.
7 0
9 Total PA Taxable Income. Add only the positive income amounts from Lines 1c,
8 0
2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6.
9 45931

10 Other Deductions. Enter the appropriate code for the type of deduction.
See the instructions for additional information.
N 10 0
11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9. 11 45931

1555 REV 01/25/17 TTO

Page 1 of 2
EC OFFICIAL USE ONLY FC

1600112245
 PA-40 - 2016
1600212250
Social Security Number

203605574 Name(s) ISAAC L & JODY D RAMER JR

12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307).

13 Total PA Tax Withheld. See the instructions.
12 1410
13 1414

14 Credit from your 2015 PA Income Tax return.

15 2016 Estimated Installment Payments. REV-459B included.
14 0
16 2016 Extension Payment.
N 15 0
17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only)
16 0
18 Total Estimated Payments and Credits. Add Lines 14, 15, 16 and 17.
17 0
18 0
Tax Forgiveness Credit. Submit PA Schedule SP.
19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased
19b Dependents, Part B, Line 2, PA Schedule SP
19a 00
20 Total Eligibility Income from Part C, Line 11, PA Schedule SP.
19b 00
21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP.
20 0
21 0

22 Resident Credit. Submit your PA Schedule(s) G-L and/or RK-1.

23 Total Other Credits. Submit your PA Schedule OC.
22 0
24 TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22 and 23.
23 0
25 USE TAX. Due on internet, mail order or out-of-state purchases. See instructions.
24 1414
26 TAX DUE. If the total of Line 12 and Line 25 is more than line 24, enter the difference here.
25 0
27 Penalties and Interest. See the instructions. Enter Code:
26 0
If including form REV-1630/REV-1630A, mark the box.
27 0
N
28 TOTAL PAYMENT DUE. See the instructions.
29 OVERPAYMENT. If Line 24 is more than the total of Line 12, Line 25 and Line 27, enter
28 0
the difference here.
29 4
The total of Lines 30 through 36 must equal Line 29.
30 Refund – Amount of Line 29 you want as a check mailed to you. REFUND
31 Credit – Amount of Line 29 you want as a credit to your 2017 estimated account.
30 4
31 0

32 Refund donation line. Enter the organization code and donation amount. See instructions.
33 Refund donation line. Enter the organization code and donation amount. See instructions.
32

34 Refund donation line. Enter the organization code and donation amount. See instructions.
33

35 Refund donation line. Enter the organization code and donation amount. See instructions.
34

36 Refund donation line. Enter the organization code and donation amount. See instructions.
35
36

Signature(s). Under penalties of perjury, I (we) declare that I (we) have examined this return, including all
accompanying schedules and statements, and to the best of my (our) belief, they are true, correct, and complete.
Your Signature Spouse’s Signature, if filing jointly

Preparer’s Name and Telephone Number Date E-File Opt Out N

Firm FEIN
SELF-PREPARED
Preparer’s PTIN

Page 2 of 2
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1600212250 1600212250
 1601910027
PA SCHEDULE W-2S
Wage Statement Summary
PA-40 Schedule W-2S
(08-16) (I) 2016 OFFICIAL USE ONLY

Summary of PA-Taxable Employee, Non-employee and Miscellaneous Compensation

Name shown first on the PA-40 (if filing jointly) Social Security Number (shown first)
ISAAC L RAMER JR 203-60-5574
Use this schedule to list and calculate your total PA-taxable compensation and PA tax withheld from all sources.
Part A Instructions: List each federal Form W-2 for you and your spouse, if married, received from your employer(s). In the first column enter T for the taxpayer’s Social
Security Number that appears first on the PA tax return and enter S for the second or spouse SSN. From the Form(s) W-2, enter each employer’s federal identification number.
Enter the amounts from the Forms W-2 in each column. IMPORTANT: You do not have to submit a copy of your Form W-2 if you earned all your income in Pennsylvania and
your employer reported your PA wages correctly and withheld the correct amount of PA income tax. You must submit a copy of your Form W-2 in certain circumstances. See
the PA Schedule W-2S instructions for a list of when a copy of a W-2 is required.
Part B Instructions: List each source of income received during the taxable year on a form or statement other than a federal Form W-2. Enter each payer’s name. List the
payment type that most closely describes the source of your non-employee compensation. Enter the amount of other compensation that you earned. If the form or statement
does not have separately stated amounts, enter the amount shown in both federal and PA columns.
IMPORTANT: You must submit a copy of each form and statement that you list in Part B, whether or not the payer withheld any PA income tax and regardless of whether or
not the income was taxable in PA. CAUTION: The federal and Pennsylvania (state) wages may be different in Part A and Part B.
If you need more space, you may photocopy this schedule or make your own schedules in this format.
Part A - Federal Forms W-2 SEE THE INSTRUCTIONS FOR WHEN TO SUBMIT FORM(S) W-2
Federal wages Medicare wages PA compensation PA income tax
T/S Employer’s identification number from Box b
from Box 1 from Box 5 from Box 16 withheld from Box 17
T 23-6000224 46,069 46,069 46,069 1,414

Total Part A- Add the Pennsylvania columns 46,069 1,414

Part B - Miscellaneous and Non-employee Compensation from federal Forms 1099-R, 1099-MISC and other statements
YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART
A. B. C. D. E. F. G. H.
T/S Type Payer name 1099R code Total federal amount Adjusted plan basis PA compensation PA tax withheld

Total Part B - Add the Pennsylvania columns

TOTAL - Add the totals from Parts A and B 46,069 1,414

Enter the TOTALS on your PA tax return on: Line 1a Line 13

Payment type: A. Executor fee B. Jury duty pay C. Director’s fee D. Expert witness fee
E. Honorarium F. Covenant not to compete G. Damages or settlement for lost wages, other than personal injury
H. Other nonemployee compensation. Describe:
I. Distribution from employer sponsored retirement, pension or qualified deferred compensation plan
J. Distribution from IRA (Traditional or Roth) K. Distribution from Life Insurance, Annuity or Endowment Contracts
L. Distribution from Charitable Gift Annuities M. Distribution from Employee Stock Ownership Plan
Describe:

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 1601710021
PA SCHEDULE UE
Allowable Employee
Business Expenses
PA Schedule UE (08-16)
PA DEPARTMENT OF REVENUE 2016 (I) OFFICIAL USE ONLY
Name of taxpayer claiming expenses Social Security Number (shown first)
ISAAC L RAMER JR 203-60-5574
Employer’s Name Employer’s address Employer Identification Number
PENN TOWNSHIP SUPERVISORS 228 CLIFFORD ROAD SELINSGROVE PA 17870 23-6000224
Describe the duties of the job in which you incurred these expenses Employer’s Telephone Number
WORK BOOTS
CAUTION: You must complete a separate schedule for each job or position. Spouses may not file joint PA Schedule(s) UE.
Part A. Direct Employee Business Expenses.

1. Union dues. List union name(s) and amount(s) paid. Enter the total. Submit additional sheets, if needed.
Name of union(s) and amount(s). 1. 0
2. Work clothes and uniforms. Needed for your employment and not suitable for everyday use.
Description: BOOTS 2. 138
3. Small tools and supplies. Needed for your employment and not provided by your employer.
Description: 3. 0
4. Professional license fees, malpractice insurance and fidelity bond premiums. Required as a
condition of your employment.
Description: 4. 0
5. Total Direct Employee Business Expenses. Add Lines 1 through 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 138
Part B. Business Travel Expenses. You may only use the amounts from Line 1 of federal Forms 2106 or 2106EZ. CAUTION: You may not
use the vehicle expense amounts from federal Forms 2106 or 2106-EZ if you include commuting miles between jobs for different employers.
Vehicle Expenses: Standard Mileage Rate.
6. Enter the amount from your Form 2106 or 2106-EZ, OR
Enter your total business miles and multiply by the federal standard mileage rate. 6. 0
Vehicle Expenses: Actual Travel and Mileage Expenses.
7. Enter the amount from your Form 2106. Make the following adjustments: . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 0
8. Add back the “Inclusion Amount” from Form 2106. This adjustment does not apply for PA purposes. . . . . . 8. 0
9. Optional Depreciation. You may use any generally accepted method. If not using your Form 2106, enter
your allowable depreciation expenses and the method you use . 9. 0
10. Actual Travel and Mileage Expenses for PA Purposes. Total Lines 7 through 9. . . . . . . . . . . . . . . . . . . . 10. 0
Other Business Travel Expenses.
11. Parking fees, tolls and transportation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 0
12. Travel expenses while away from home overnight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 0
13. Meals and entertainment expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 0
14. Total Business Travel Expenses. Add Lines 6 or 10 and Lines 11, 12 and 13. . . . . . . . . . . . . . . . . . . . . . 14. 0
Part C. Miscellaneous Expenses. Itemize your additional expenses.

15. Total Miscellaneous Expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 0

Total Allowable PA Employee Business Expenses. You must account for reimbursements, if any.
A. Direct Expenses from Line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A. 138
B. Business Travel Expenses from Line 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. 0
C. Miscellaneous Expenses from Line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C. 0
D. Office or Work Area Expenses from Line 16, on Side 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D. 0
E. Moving Expenses from Line 19, on Side 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E. 0
F. Education Expenses from Line 23, on Side 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F. 0
G. Total Depreciation Expenses from Line 24, on Side 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. 0
H. Total Allowable Employee Business Expenses. Add Lines A through G. . . . . . . . . . . . . . . . . . . . . . . . . . H. 138
I. Reimbursements. Enter payments that your employer DID NOT include in box 16 of your Form W-2. . . . I. 0
J. Net expense or reimbursement. Subtract Line I from Line H. Enter the difference, and: . . . . . . . . . . . . . . J. 138
If Line H is MORE than Line I, include on Line 1b, on your PA-40.
If Line I is MORE than Line H, include the excess on Line 1a, on your PA-40.
Nonresidents and part-year residents may also need to complete PA Schedule NRH. See instructions.
Side 1 1555
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1601710021 1601710021
 1601810029
PA SCHEDULE UE
Allowable Employee
Business Expenses
PA Schedule UE (08-16)
PA DEPARTMENT OF REVENUE 2016 (I) OFFICIAL USE ONLY
Name of taxpayer claiming expenses Social Security Number (shown first)
ISAAC L RAMER JR 203-60-5574
Part D. Office or Work Area Expenses. You must answer ALL three questions or the Department will disallow your expenses.
D1. Does your employer require you to maintain a suitable work area away from the employer’s premises? Yes No
D2. Is this work area the principal place where you perform the duties of your employment? Yes No
D3. Do you use this work area regularly and exclusively to perform the duties of your employment? Yes No
If you answer YES to ALL three questions, continue. If you answer NO to ANY question, you may not claim office or work area expenses.
Actual Office or Work Area Expenses. Enter expenses for the entire year and then calculate the business portion.
a. Depreciation expense (homeowners only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a. 0
b. Real estate taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. 0
c. Mortgage interest (homeowners only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. 0
d. Utilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. 0
e. Property insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e. 0
f. Property maintenance expenses from statement. See the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f. 0
g. Other apportionable expenses from statement. See the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g. 0
h. Rent (renters only). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h. 0
i. Total. Add Lines a through h. Enter the total here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i. 0
j. Business percentage of property. Divide the total square footage of your work area by the total square footage
of your entire property. Round to 2 decimal places. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j. %
k. Apportioned expenses. Multiply Line i by the percentage on Line j. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k. 0
l. Total office supplies from statement. See the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l. 0
16. Total Office or Work Area Expenses. Add Lines k and l. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. 0
Part E. Moving Expenses.
Distance Test.
E1. Enter the number of miles from your old home to your new workplace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . miles
E2. Enter the number of miles from your old home to your old workplace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . miles
E3. Subtract Line E2 from Line E1 and enter the difference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . miles
If Line E3 is 35 miles or more, continue. If it is not at least 35 miles, you may not claim any moving expenses.
17. Transportation expenses in moving household goods and personal effects. . . . . . . . . . . . . . . . . . . . . . . . . . 17. 0
18. Travel, meals, and lodging expenses during the actual move from your old home to your new home. . . . . 18. 0
19. Total Moving Expenses. Add Lines 17 and 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 0
Part F. Education Expenses. You must answer ALL three questions or the Department will disallow your expenses.
F1. Did your employer (or law) require that you obtain this education to retain your present position or job? YES NO
If you answer YES, continue. If you answer NO, you may not claim education expenses.
F2. Did you need this education to meet the entry level or minimum requirements to obtain your job? YES NO
F3. Will this education, program or course of study qualify you for a new business or profession? YES NO
If you answer NO to questions F2 and F3, continue. If you answer YES to either question, you may not claim education expenses.
Name of college, university or educational institution: Course of study:
20. Tuition or fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. 0
21. Course materials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. 0
22. Travel expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. 0
23. Total Education Expenses. Add Lines 20 through 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. 0
Part G. Depreciation Expenses. PA law does not allow any federal bonus depreciation and limits IRC Section 179 expensing to $25,000.
(a) Description of property (b) Date acquired (c) Cost or other basis (d) Depreciation method (e) Section 179 expense (f) Depreciation expenses

24. Total Depreciation Expenses. Add the amounts from columns (e) and (f). . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. 0

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REV 01/25/17 TTO
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