Form

1040 Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

(99)
2015 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2015, or other tax year beginning , 2015, ending , 20 See separate instructions.
Your first name and initial Last name Your social security number

Inisha Jaramillo 548-81-8019

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

Jesse D Jaramillo, II 561-77-5402

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above
c
and on line 6c are correct.
4029 johnson st Apt 3
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
san bernardino CA 92407 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

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

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

Exemptions 6a
b
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
} Boxes checked
on 6a and 6b
No. of children
2
c Dependents: (2) Dependent’s (3) Dependent’s (4)  if child under age 17 on 6c who:
social security number relationship to you qualifying for child tax credit • lived with you 1
(1) First name Last name (see instructions) • did not live with
you due to divorce
Miranda M ysiano 613-79-9747 Daughter or separation
If more than four (see instructions)
dependents, see Dependents on 6c
instructions and not entered above
check here a Add numbers on
d Total number of exemptions claimed . . . . . . . . . . . . . . . . . lines above a 3
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
Income
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
Attach Form(s)
9a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
W-2 here. Also
attach Forms b Qualified dividends . . . . . . . . . . . 9b
W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
1099-R if tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12 10,700.
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here a 13
If you did not 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14
get a W-2,
see instructions. 15a IRA distributions . 15a b Taxable amount . . . 15b
16a Pensions and annuities 16a b Taxable amount . . . 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18
19 Unemployment compensation . . . . . . . . . . . . . . . . . 19
20a Social security benefits 20a b Taxable amount . . . 20b
21 Other income. List type and amount 21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income a 22 10,700.
23 Educator expenses . . . . . . . . . . . 23
Adjusted 24 Certain business expenses of reservists, performing artists, and
Gross fee-basis government officials. Attach Form 2106 or 2106-EZ 24
Income 25 Health savings account deduction. Attach Form 8889 . 25
26 Moving expenses. Attach Form 3903 . . . . . . 26
27 Deductible part of self-employment tax. Attach Schedule SE . 27 756.
28 Self-employed SEP, SIMPLE, and qualified plans . . 28
29 Self-employed health insurance deduction . . . . 29
30 Penalty on early withdrawal of savings . . . . . . 30
31a Alimony paid b Recipient’s SSN a 31a
32 IRA deduction . . . . . . . . . . . . . 32
33 Student loan interest deduction . . . . . . . . 33
34 Tuition and fees. Attach Form 8917 . . . . . . . 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 756.
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . a 37 9,944.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA REV 12/30/15 Intuit.cg.cfp.sp Form 1040 (2015)
Form 1040 (2015) Page 2
38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38 9,944.
Tax and
Credits
39a Check
if:
{ You were born before January 2, 1951,
Spouse was born before January 2, 1951,
Blind.
Blind.
} Total boxes
checked a 39a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here a 39b
Standard 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . 40 12,600.
Deduction -2,656.
for— 41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41
• People who 42 Exemptions. If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see instructions 42 12,000.
check any
box on line 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43 0.
39a or 39b or 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44 0.
who can be
claimed as a 45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45
dependent,
see 46 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . 46
instructions. 47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . a 47 0.
• All others:
48 Foreign tax credit. Attach Form 1116 if required . . . . 48
Single or
Married filing 49 Credit for child and dependent care expenses. Attach Form 2441 49
separately,
$6,300 50 Education credits from Form 8863, line 19 . . . . . 50
Married filing 51 Retirement savings contributions credit. Attach Form 8880 51
jointly or
Qualifying 52 Child tax credit. Attach Schedule 8812, if required . . . 52 0.
widow(er), 53 Residential energy credits. Attach Form 5695 . . . . 53
$12,600
Head of 54 Other credits from Form: a 3800 b 8801 c 54
household, 55 Add lines 48 through 54. These are your total credits . . . . . . . . . . . . 55 0.
$9,250
56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . a 56 0.
57 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 57 1,512.
Other 58 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 58
59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 59
Taxes 60a Household employment taxes from Schedule H . . . . . . . . . . . . . . 60a
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . 60b
61 Health care: individual responsibility (see instructions) Full-year coverage . . . . . 61
62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62
63 Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . a 63 1,512.
Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . 64
65 2015 estimated tax payments and amount applied from 2014 return 65
If you have a 3,359.
66a Earned income credit (EIC) . . . . . . . . . . 66a
qualifying
child, attach b Nontaxable combat pay election 66b
Schedule EIC. 67 Additional child tax credit. Attach Schedule 8812 . . . . . 67 1,000.
68 American opportunity credit from Form 8863, line 8 . . . 68
69 Net premium tax credit. Attach Form 8962 . . . . . . 69
70 Amount paid with request for extension to file . . . . . 70
71 Excess social security and tier 1 RRTA tax withheld . 71. . .
72 Credit for federal tax on fuels. Attach Form 4136 . 72. . .
73 Credits from Form: a 2439 b Reserved c 8885 d 73
74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . a 74 4,359.
Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75 2,847.
76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . a 76a 2,847.
a
bRouting number 0 3 1 1 0 1 1 6 9 a c Type: Checking Savings
Direct deposit?
See a dAccount number 8 5 1 3 6 3 5 3 3 0 2 0 3
instructions.
77 Amount of line 75 you want applied to your 2016 estimated tax a 77
Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions a 78
You Owe 79 Estimated tax penalty (see instructions) . . . . . . . 79
Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No
Designee’s Phone Personal identification
Designee name a no. a number (PIN) a

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

Joint return? See

instructions. Child care
Keep a copy for Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection
your records. PIN, enter it
Welder here (see inst.)
Print/Type preparer’s name Preparer’s signature Date PTIN
Paid Check if
self-employed
Preparer
Use Only Firm’s name a Self-Prepared Firm's EIN a

Firm’s address a Phone no.

www.irs.gov/form1040 REV 12/30/15 Intuit.cg.cfp.sp Form 1040 (2015)
Inisha Jaramillo 548-81-8019

child care 6 2 4 4 1 0

4029 johnson st , Apt. Apt 3

san bernardino, CA 92407

10,700.

10,700.

BAA REV 10/28/15 Intuit.cg.cfp.sp

SCHEDULE SE
Self-Employment Tax
OMB No. 1545-0074

2015
(Form 1040)
a Information about Schedule SE and its separate instructions is at www.irs.gov/schedulese.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040 or Form 1040NR. Sequence No. 17
Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) Social security number of person
Inisha Jaramillo with self-employment income a 548-81-8019
Before you begin: To determine if you must file Schedule SE, see the instructions.

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

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

Did you receive wages or tips in 2015?

No Yes
d d d
Are you a minister, member of a religious order, or Christian
Yes Was the total of your wages and tips subject to social security Yes
Science practitioner who received IRS approval not to be taxed a or railroad retirement (tier 1) tax plus your net earnings from a
on earnings from these sources, but you owe self-employment
self-employment more than $118,500?
tax on other earnings?

No
No
d d

Are you using one of the optional methods to figure your net Did you receive tips subject to social security or Medicare tax Yes
Yes a
earnings (see instructions)? a that you did not report to your employer?

No
No d
d
No Did you report any wages on Form 8919, Uncollected Social Yes
Did you receive church employee income (see instructions) Yes ` Security and Medicare Tax on Wages? a
reported on Form W-2 of $108.28 or more? a

No
d d
You may use Short Schedule SE below a You must use Long Schedule SE on page 2

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

1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form
1065), box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . 1a
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z 1b ( )
2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),
box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1.
Ministers and members of religious orders, see instructions for types of income to report on
this line. See instructions for other income to report . . . . . . . . . . . . . . 2 10,700.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . 3 10,700.
4 Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do
not file this schedule unless you have an amount on line 1b . . . . . . . . . . . a 4 9,881.
Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b,
see instructions.
5 Self-employment tax. If the amount on line 4 is:
• $118,500 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 57,
or Form 1040NR, line 55
• More than $118,500, multiply line 4 by 2.9% (.029). Then, add $14,694 to the result.
Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55 . . . . . . . 5 1,512.
6 Deduction for one-half of self-employment tax.
Multiply line 5 by 50% (.50). Enter the result here and on Form
1040, line 27, or Form 1040NR, line 27 . . . . . . . . 6 756.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 12/04/15 Intuit.cg.cfp.sp Schedule SE (Form 1040) 2015
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040A or 1040) 1040A `
Qualifying Child Information
2015
..........

a
1040
Complete and attach to Form 1040A or 1040 only if you have a qualifying child.
Department of the Treasury a EIC Attachment
Information about Schedule EIC (Form 1040A or 1040) and its instructions is at www.irs.gov/scheduleeic.
Internal Revenue Service (99) Sequence No. 43
Name(s) shown on return Your social security number
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019
• 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. Miranda M ysiano
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
2015. If your child was born and died in
2015 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.
613-79-9747
3 Child’s year of birth
Year 2 0 0 9 Year Year
If born after 1996 and the child is If born after 1996 and the child is If born after 1996 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

2015, 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 2015?
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
6 Number of months child lived
with you in the United States
during 2015

• If the child lived with you for more than

half of 2015 but less than 7 months,
enter “7.”
• If the child was born or died in 2015 and 12 months 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 2015, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax BAA REV 12/09/15 Intuit.cg.cfp.sp Schedule EIC (Form 1040A or 1040) 2015
return instructions.
SCHEDULE 8812 OMB No. 1545-0074
Child Tax Credit 1040
◀
(Form 1040A or 1040)
▶ Attach to Form 1040, Form 1040A, or Form 1040NR.
1040A
1040NR 2015
Department of the Treasury
▶ Information about Schedule 8812 and its separate instructions is at 8812 Attachment
Internal Revenue Service (99) www.irs.gov/schedule8812. Sequence No. 47
Name(s) shown on return Your social security number
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019
Part I Filers Who Have Certain Child Dependent(s) with an ITIN (Individual Taxpayer Identification Number)

▲
!
CAUTION
Complete this part only for each dependent who has an ITIN and for whom you are claiming the child tax credit.
If your dependent is not a qualifying child for the credit, you cannot include that dependent in the calculation of this credit.

Answer the following questions for each dependent listed on Form 1040, line 6c; Form 1040A, line 6c; or Form 1040NR, line 7c, who has an ITIN
(Individual Taxpayer Identification Number) and that you indicated is a qualifying child for the child tax credit by checking column (4) for that
dependent.
A For the first dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

B For the second dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

C For the third dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

D For the fourth dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

Note: If you have more than four dependents identified with an ITIN and listed as a qualifying child for the child tax credit, see separate instructions
and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

}
Part II Additional Child Tax Credit Filers
1 If you file Form 2555 or 2555-EZ stop here, you cannot claim the additional child tax credit.

If you are required to use the worksheet in Pub. 972, enter the amount from line 8 of the Child Tax
Credit Worksheet in the publication. Otherwise:
1040 filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the 1 1,000.
Instructions for Form 1040, line 52).
1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040A, line 35).
1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040NR, line 49).
2 Enter the amount from Form 1040, line 52; Form 1040A, line 35; or Form 1040NR, line 49 . . . . . 2 0.
3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit . . . . . . . . . . . . . 3 1,000.
4a Earned income (see separate instructions) . . . . . . . . . . . 4a 9,944.
b Nontaxable combat pay (see separate
instructions) . . . . . . . . . . . 4b
5 Is the amount on line 4a more than $3,000?
No. Leave line 5 blank and enter -0- on line 6.
Yes. Subtract $3,000 from the amount on line 4a. Enter the result . . . 5 6,944.
6 Multiply the amount on line 5 by 15% (.15) and enter the result . . . . . . . . . . . . . . 6 1,042.
Next. Do you have three or more qualifying children?
No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part III 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 III and enter the amount from line 3 on line 13.
Otherwise, go to line 7.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 12/09/15 Intuit.cg.cfp.sp Schedule 8812 (Form 1040A or 1040) 2015
Schedule 8812 (Form 1040A or 1040) 2015 Page 2
Part III Certain Filers Who Have Three or More Qualifying Children
7 Withheld social security, Medicare, and Additional Medicare taxes from
Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse’s
amounts with yours. If your employer withheld or you paid Additional

}
Medicare Tax or tier 1 RRTA taxes, see separate instructions . . . . . . 7
8 1040 filers: Enter the total of the amounts from Form 1040, lines
27 and 58, plus any taxes that you identified using code
“UT” and entered on line 62.
1040A filers: Enter -0-. 8
1040NR filers: Enter the total of the amounts from Form 1040NR,
lines 27 and 56, plus any taxes that you identified using
code “UT” and entered on line 60.

}
9 Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . 9
10 1040 filers: Enter the total of the amounts from Form 1040, lines
66a and 71.
1040A filers: Enter the total of the amount from Form 1040A, line
42a, plus any excess social security and tier 1 RRTA 10
taxes withheld that you entered to the left of line 46
(see separate instructions).
1040NR filers: Enter the amount from Form 1040NR, line 67.
11 Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 11
12 Enter the larger of line 6 or line 11 . . . . . . . . . . . . . . . . . . . . . . 12
Next, enter the smaller of line 3 or line 12 on line 13.
Part IV Additional Child Tax Credit
13 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . . . 13 1,000.
Enter this amount on
1040 Form 1040, line 67,
Form 1040A, line 43, or
1040A Form 1040NR, line 64.
1040NR ◀

REV 12/09/15 Intuit.cg.cfp.sp Schedule 8812 (Form 1040A or 1040) 2015

 8965
OMB No. 1545-0074
Health Coverage Exemptions
Form

Department of the Treasury

a Attach to Form 1040, Form 1040A, or Form 1040EZ. 2015
a Information about Form 8965 and its separate instructions is at www.irs.gov/form8965. Attachment
Internal Revenue Service Sequence No. 75
Name as shown on return Your social security number
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019
Complete this form if you have a Marketplace-granted coverage exemption or you are claiming a coverage exemption
on your return.
Marketplace-Granted Coverage Exemptions for Individuals. If you and/or a member of your tax household
Part I
have an exemption granted by the Marketplace, complete Part I.
(a) (b) (c)
Name of Individual SSN Exemption Certificate Number

6
Part II Coverage Exemptions Claimed on Your Return for Your Household

7a Are you claiming an exemption because your household income is below the filing threshold? . . . . . . Yes No

b Are you claiming a hardship exemption because your gross income is below the filing threshold? . . . . Yes No
Coverage Exemptions Claimed on Your Return for Individuals. If you and/or a member of your tax
Part III
household are claiming an exemption on your return, complete Part III.
(c) (d)
(a) (b) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p)
Exemption Full
Name of Individual SSN Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Type Year

10

11

12

13
For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions. BA REV 12/09/15 Intui Form 8965 (2015)
 ELECTRONIC POSTMARK - CERTIFICATION OF ELECTRONIC FILING

Taxpayer: Inisha Jaramillo & Jesse D Jaramillo, II

Primary SSN: 548-81-8019

Federal Return Submitted: January 26, 2016 09:11 AM PST

Federal Return Acceptance Date:

Your return has been rejected by the IRS

The Intuit Electronic Postmark shows the date and time Intuit received your federal tax return. The Intuit
Electronic Postmark documents the filing date of your income tax return, and the electronic postmark
information should be kept on file with your tax return and other tax-related documentation.

There are two important aspects of the Intuit Electronic Postmark:

1. THE INTUIT ELECTRONIC POSTMARK.

The electronic postmark shows the date and time Intuit received the federal return, and is deemed the
filing date if the date of the electronic postmark is on or before the date prescribed for filing of the
federal individual income tax return.

TIMELY FILING:
For your federal return to be considered filed on time, your return must be postmarked on or before
midnight April 18, 2016. Intuit’s electronic postmark is issued in the Pacific Time (PT) zone. If you are
not filing in the PT zone, you will need to add or subtract hours from the Intuit Electronic Postmark time
to determine your local postmark time. For example, if you are filing in the Eastern Time (ET) zone and
you electronically file your return at 9 AM on April 18, 2016, your Intuit electronic postmark will indicate
April 18, 2016, 6 AM. If your federal tax return is rejected, the IRS still considers it filed on time if the
electronic postmark is on or before April 18, 2016, and a corrected return is submitted and accepted
before April 23, 2016. If your return is submitted after April 23, 2016, a new time stamp is issued to
reflect that your return was submitted after the IRS deadline and, consequently, is no longer considered
to have been filed on time.

If you request an automatic six-month extension, your return must be electronically postmarked by
midnight October 17, 2016 If your federal tax return is rejected, the IRS will still consider it filed on time
if the electronic postmark is on or before October 17, 2016, and the corrected return is submitted and
accepted by October 20, 2015.

2. THE ACCEPTANCE DATE.

Once the IRS accepts the electronically filed return, the acceptance date will be provided by the Intuit
Electronic Filing Center. This date is proof that the IRS accepted the electronically filed return.
We need your consent to process with this payment option
This is an IRS requirement

The purpose of this agreement is to confirm that you are eligible for this payment option. By
agreeing, you allow Intuit, the maker of TurboTax software, to verify that your refund is enough
to cover total fees and applicable sales tax.

IRS regulations require the following statements:

"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use
your tax return information for purposes other than the preparation and filing of your tax return without
your consent.

You are not required to complete this form to engage our tax return preparation services. If we obtain
your signature on this form by conditioning our tax return preparation services on your consent, your
consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not
specify the duration of your consent, your consent is valid for one year from the date of signature."

If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at [email protected].

To agree, enter your name and date in the boxes below and select the "I Agree" button on the
bottom of the page.

I authorize Intuit, the maker of TurboTax, to use the information provided in this 2015 return to
determine whether a portion of the refund can be used to pay for tax preparation.

inisha Jaramillo
First Name Last Name

Please type the date below:

01/22/2016
Date

Jesse Jaramillo

01/25/2016
 CUSTOMER SERVICE: 877-908-7228
Civista Bank
Refund Processing Agreement ("Agreement")

Name Inisha Jaramillo & Jesse D Jaramillo, II

Social Security No. 548-81-8019

This Agreement contains important terms, conditions and disclosures about the processing of your refund by
Civista Bank, Member FDIC (’BANK’). Read this Agreement carefully before accepting its terms and
conditions, and print a copy and/or retain this information electronically for future reference. As used in this
Agreement, the words ’you’ and ’your’ refer to the applicant or both the applicant and joint applicant if the
2015 federal income tax return is a joint return (individually and collectively, ’Applicant’). The words ’we,’ ’us’
and ’our’ refer to BANK and Processor. The term ’Servicer’ or ’Processor’ refer to the third party processor,
Santa Barbara Tax Products Group, LLC.

1. NOTICE: No Requirement To Have BANK Process Your Refund In Order To File Electronically.
THE REFUND PROCESSING SERVICE IS A FREE OPTION INCLUDED WITH YOUR PURCHASE OF
EITHER TURBOTAX PREMIUM OR TURBOTAX MAX. YOU ARE NOT REQUIRED TO USE THE REFUND
PROCESSING SERVICE. IF YOU USE THE REFUND PROCESSING SERVICE, YOU CAN EXPECT TO
RECEIVE THE PROCEEDS FROM YOUR FEDERAL TAX REFUND WITHIN 21 DAYS FROM WHEN THE
IRS ACCEPTS YOUR RETURN UNLESS THERE ARE PROCESSING DELAYS BY THE IRS. THE
REFUND PROCESSING SERVICE WILL NEITHER SPEED UP NOR DELAY YOUR FEDERAL TAX
REFUND. THE COST OF PREPARING YOUR TAX RETURN IS NOT ANY MORE OR LESS IF YOU
RECEIVE THE REFUND PROCESSING SERVICE.

2. Authorization to Release Personal Information. You authorize the Internal Revenue Service (’IRS’) to
disclose any information to BANK and Processor related to the funding of your 2015 federal tax refund.
You also authorize Intuit, as the transmitter of your electronically filed tax return, to disclose your tax return
and contact information to BANK and Processor for use in connection with the refund processing services
being provided pursuant to this Agreement and BANK and Processor to share your information with Intuit.
None of Intuit, BANK or Processor will disclose or use your tax return information for any other purpose,
except as permitted by law. BANK and Processor will not use your tax information or contact information
for any marketing purpose. For more information concerning our privacy policy please see the disclosures
at the end of this Agreement describing how BANK may use or share your personal information.

3. Summary of Terms
Expected Federal Refund $ 2,847.00
Less TurboTax Premium or TurboTax MAX Fees $ 39.99
Less TurboTax Fees $ 79.99
Less Additional Products and Services Purchased $ 0.00
Expected Proceeds* $ 2,727.02
*These charges are itemized. This is only an estimate. The amount will be reduced by any applicable sales taxes, and if
applicable, a returned item and other processing fees paid to Processor as set forth in paragraphs 4 and 7 below.

4. Temporary Deposit Account Authorization. You hereby authorize BANK to establish a temporary deposit
account (’Deposit Account’) for the purpose of receiving your tax year 2015 federal tax refund from the IRS.
BANK or Servicer must receive an acknowledgement from the IRS that your return has been electronically
filed and accepted for processing before the Deposit Account can be opened. You authorize BANK
or Servicer to deduct from your Deposit Account the following amounts: (i) the fees for TurboTax
Premium or TurboTax MAX; (ii) the fees and charges related to the preparation, processing and
transmission of your tax return (TurboTax Fees); and (iii) amounts to pay for additional products
and services purchased plus applicable taxes. You also authorize BANK to deduct twenty dollars ($20)
as a returned item processing fee from your Deposit Account in the event that your deposit is returned
or you provide incorrect bank account or routing information, as set forth in the Note in paragraph 7
below. This fee shall be paid by BANK to Processor. You authorize BANK and Processor to disburse
the balance of the Deposit Account to you after making all authorized deductions or payments. If the
Deposit Account does not have sufficient funds to pay the TurboTax fees, fees for TurboTax Premium or
TurboTax MAX, and the fees for Additional Products and Services Purchased as set forth in Section 3, (a)
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019 Page 2
you authorize BANK and/or Processor to automatically deduct such fees (or any portion thereof) via ACH,
electronic check, or wire transfer directly from the account or card in which you authorized BANK to deposit
your Expected Proceeds as set forth in Section 7, and (b) if you made alternative arrangements with
TurboTax for payment of such fees, those arrangements will be attempted prior to any automatic deduction.

5. Acknowledgements. (a) You understand that: (i) neither BANK nor Processor can guarantee the amount
of your tax year 2015 federal tax refund or the date it will be issued, and (ii) neither BANK nor Processor is
affiliated with the transmitter of the tax return (Intuit) and neither warrants the accuracy of the software
used to prepare the tax return. (b) You agree that Intuit is not acting as your agent and is not under any
fiduciary duty with respect to the processing of your refund by BANK and Processor. (c) Your refund may
be held or returned to the IRS if it is suspected of fraud or identity theft.

6. Truth in Savings Disclosure. The Deposit Account is being opened for the purpose of receiving your
(both spouses if this is a jointly filed return) tax year 2015 federal tax refund. Processor and BANK will
deduct the fees set forth in Section 3. No other deposits may be made to the Deposit Account. No
withdrawals will be allowed from the Deposit Account except as provided in Section 4. No interest is
payable on the deposit; thus, the annual percentage yield and interest rate are 0%. The Deposit Account
will be closed after all authorized deductions have been made and any remaining balance has been
disbursed to you. We will also charge a Return Item Fee of $20 if the refund cannot be delivered as
directed in Section 4 of this application. An Account Research and Legal Processing fee of $25 may be
charged if we are required to provide additional processing to return the funds to the IRS. These fees
will be paid by Bank to the Processor. Questions or concerns about the Deposit Account should be
directed to: Civista Bank, c/o Santa Barbara Tax Products, Group, LLC, 11085 North Torrey Pines Road,
Suite 210, La Jolla, CA 92037 or via the Internet at http://sbtpg.com.

7. Disbursement Method: You agree that the disbursement method selected below will be used by
BANK to disburse funds to you.
a) Direct Deposit to Prepaid Debit Card: If you choose this option, you authorize BANK to transfer
the balance of your Deposit Account to the financial institution that supports your prepaid debit card,
so that the financial institution may deposit the balance of your refund, as directed by you, on the
respective prepaid debit card you have selected. Additional fees may be charged for the use of the
card. Please review the cardholder agreement associated with the use of your prepaid debit card
provided by the participating financial institution to learn of other fees, charges, terms and conditions
that will apply. Neither BANK nor Processor will be responsible for your funds once they have been
deposited with the respective financial institution.

b) X Direct Deposit to Checking or Savings Account: If you choose this option, the balance of your
Deposit Account will be disbursed to you electronically by ACH Direct Deposit to your personal bank
account designated below. If a joint return is filed, the bank account may be a joint account or the
individual account of either spouse.

DIRECT DEPOSIT ACCOUNT TYPE:

X Checking
Savings
RTN # 031101169
Account # 8513635330203
Note: To ensure that there are no delays in receiving your refund, please contact your financial
institution to confirm that you are using the correct RTN (routing) and account number. If you or your
representative enter your account information incorrectly and your deposit is returned to BANK, the
Deposit Account balance minus a $20 returned item processing fee will be disbursed to you via a
cashier’s check mailed to your physical address of record. The BANK, the Processor and Intuit are not
responsible for the misapplication of a direct deposit that results from error, negligence or malfeasance
on the part of you or your representative. In cases where the BANK has received your federal tax
refund but is unable to deliver the funds directly to you, funds may be held at the BANK until claimed,
or returned to the IRS or State of residency. Additional return item and processing fees may be
deducted from the Deposit Account for federal tax refunds that continue to be undeliverable and
unclaimed and must be returned to the IRS or State. The amount of additional processing fees will be
determined by the efforts required and the complexity of the transaction but will not exceed $25.
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019 Page 3

Processing fees will be paid by BANK to Processor.

You must notify BANK in writing 3 business days prior to the account being debited to revoke the
authorization for applicable fees agreed to in Section 4, and to afford BANK a reasonable opportunity
to act on your request. You may notify us in writing at: Civista Bank, c/o Santa Barbara Tax
Products Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037.

8. FEDERAL ELECTRONIC FUND TRANSFER ACT DISCLOSURES: In case of errors or questions about
electronic transfers into the Deposit Account, write Civista Bank, c/o Santa Barbara Tax Products
Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037 or telephone
(877) 908-7228 and provide your name, a description or explanation of the error, and the dollar amount of
the suspected error. We will determine whether an error occurred within 10 business days after we hear
from you and will correct any error promptly. If we need more time, however, we may take up to 45 days
to investigate your complaint or question. If we decide to do this, we will credit your Deposit Account
within 10 business days for the amount you think is in error, so that you will have the use of the money
during the time it takes us to complete our investigation. If we ask you to put your complaint or question
in writing and we do not receive it within 10 business days, we may not credit your Deposit Account.
For errors involving new accounts, we may take up to 90 days to investigate your complaint or question.
For new accounts, we may take up to 20 business days to credit your Deposit Account for the amount
you think is in error. We will tell you the results within three business days after completing our
investigation. If we decide that there was no error, we will send you a written explanation. You may ask
for copies of the documents that we used in our investigation.

Business Days: Our business days are Monday through Friday, excluding federal holidays. Saturday,
Sunday, and federal holidays are not considered business days, even if we are open.

Confidentiality: We will disclose information to third parties about your account or the transfers you make:

? To complete transfers as necessary;

? To verify the existence and condition of your account upon the request of a third party, such as a credit
bureau or merchant;
? To comply with government agency or court orders;
? If you give us your written permission; or
? As explained in the Privacy section of this disclosure

Our Liability: If we do not complete a transfer to your account on time or in the correct amount according
to this Agreement, BANK or Processor may be liable for your losses or damages. In addition to all other
limitations of liability set forth in this Agreement, we will not be liable to you if, among other things:
? Circumstances beyond our control (natural disasters, such as fire or flood) prevent the transfer, despite
reasonable precautions that have been taken.
? The funds in your account are subject to legal process or other claim restricting such transfer.

9. Governing Law. The enforcement and interpretation of this Agreement and the transactions
contemplated herein shall be governed by the laws of the United States, including the Electronic Signatures
in Global and National Commerce Act, and, to the extent state law applies, the substantive law of Ohio.
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019 Page 4

10. Arbitration Provision. This arbitration provision is made pursuant to a transaction involving interstate
commerce and shall be governed by the Federal Arbitration Act. You agree that any and all disputes which
in any way arise out of or relate to this Agreement, shall be resolved solely by binding arbitration before the
American Arbitration Association (’AAA’) before a single arbitrator in arbitration commenced as close as
possible to where you reside. Any and all disputes must be brought in the parties’ individual capacity, and
not as a plaintiff or class member in any purported class or representative proceeding. Judgment on the
award rendered by the arbitrator may be entered in any court having jurisdiction thereof. Each party to any
such arbitration shall bear its own separate costs and expenses of the arbitration and shall share equally in
the charges of the AAA, including the fee of the arbitrator. However, if you are unable to pay any fee of the
AAA or the arbitrator, BANK or Processor agrees to pay those fees for you. By agreeing to arbitration, you,
BANK, and Processor are waiving each of their respective rights to file a lawsuit and proceed in court and
to have a jury trial to resolve disputes. The word ’disputes’ is given its broadest possible meaning,
and includes all claims; disputes or controversies, including without limitation any claim or attempt to set
aside this arbitration provision.

11. USA Patriot Act Disclosure. To help the government fight the funding of terrorism and money laundering
activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies
each person who opens an account. What this means for you: When we open a Deposit Account for you for
the purpose of receiving your IRS federal tax refund or if you apply for one of our products, we will ask for
your name, address, date of birth, and other information that will allow us to identify you. We may also ask
for your driver’s license information or information from other identifying documents of yours.

YOUR AGREEMENT

BANK and Processor agree to all of the terms of this Agreement. By selecting the 'I Agree' button in
TurboTax: (i) You authorize BANK and Processor to receive your 2015 federal tax refund from the IRS
and to make the deductions from your refund described in the Agreement, (ii) You agree to receive all
communications electronically in accordance with the ’Communications’ section of the Tax Year 2015
TurboTax(R) User Agreement, (iii) You consent to the release of your 2015 federal tax refund
deposit information and application information as described in Section 2 of this Agreement;
and (iv) You acknowledge that you have reviewed, and agree to be bound by, the Agreement’s terms
and conditions. If this is a joint return, selecting 'I Agree' indicates that both spouses agree to be
bound by the terms and conditions of the Agreement.
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019

Civista Bank’s Privacy Policy

FACTS What does Civista Bank do with your personal information?

Why? Financial Companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you how
we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.

What? The types of personal information that we collect and share depend on the product or service
you have with us. This can include:

? Social Security number and account balances

? payment history and transaction history
? overdraft history and account transactions

When you are no longer our customer, we continue to share your information as described in
this notice.

How? All Financial Companies need to share customers’ personal information to run their everyday
business. In the section below we list the reasons financial companies can share their
customers’ personal information; the reasons Civista Bank chooses to share
and whether you can limit the sharing.

Reasons we can share your Does Civista Bank Can you limit this sharing?
personal information Share?

For our everyday business purposes

such as to process your transaction,
maintain your account(s), respond to court Yes No
orders and legal investigations, or report to
credit bureaus.

For our marketing purposes ' No We don’t share

to offer our products and services to you.

For joint marketing with other No We don’t share

financial companies.

For our affiliates’ everyday

business purposes ' No We don’t share
information about your transactions
and experiences.

For our affiliates’ everyday

business purposes ' No We don’t share
information about your creditworthiness.

For our affiliates to market to you. No We don’t share

For non affiliates to market to you. No We don’t share

Questions? Toll Free: 800-604-9368 or go to www.civistabank.com

Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019 Page 2

Who we are

Who is providing this notice? Civista Bank

What we do

How does Civista Bank To protect your personal information from unauthorized access
protect my and use, we use security measures that comply with federal law.
personal information? These measures include computer safeguards and secured files
and buildings.

How does Civista We collect personal information about you when you apply for a tax
collect my related product. This includes information in your application, such
personal information? as your name, address, social security number, income,
deductions, refund and the like. We also collect information about
your transactions with us., tax preparers and similar providers, such
as payment histories, balances due, and tax information. We may
also collect information concerning your credit history from a
consumer reporting agency.

Why can’t I limit all sharing? Federal law gives you the right to limit only:

? Sharing for affiliates everyday business purposes ' information

about your creditworthiness,
? Affiliates from using your information to market to you,
? Sharing for non affiliates to market to you.

State laws and individual companies may give you additional rights
to limit sharing.

Definitions

Affiliates Companies related by common ownership or control. They can be

financial and nonfinancial companies.

? Civista Bank does not share with our affiliates.

Non affiliates Companies not related by common ownership or control. They can
be financial or nonfinancial companies.

? Civista Bank does not share with non

affiliates so they can market to you.

Joint Marketing A formal joint marketing agreement between non affiliated financial
companies that together market financial products or services
to you.

? Civista Bank does not jointly market

Other Important Information

This Notice is adopted in recognition of our obligations under Title V of Gramm-Leach Bliley Act of 1999.
This Notice applies only to individuals who have applied for a tax-related bank product.

sbia2301.SCR 12/01/2015
Read and accept this Disclosure Consent
This is an IRS requirement

In order to finalize your request for this payment option, we need to send the following information to
Civista Bank of Sandusky, OH (’BANK’) and to Santa Barbara Tax Products Group, LLC (’SBTPG’),
the administrator and servicer of this payment option: your identifying information, your deposit
information and your refund amount.

We transmit this information so that you may use this payment option. BANK and SBTPG will use
your information in accordance with their applicable refund processing service agreement and
privacy policy.

IRS regulations require the following statements:

"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot
disclose your tax return information to third parties for purposes other than the preparation and filing of
your tax return without your consent. If you consent to the disclosure of your tax return information,
Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage our tax return preparation services. If we obtain
your signature on this form by conditioning our tax return preparation services on your consent, your
consent will not be valid. If you agree to the disclosure of your tax return information, your consent is
valid for the amount of time that you specify. If you do not specify the duration of your consent, your
consent is valid for one year from the date of signature."

If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at [email protected].

To agree, enter your name and date in the boxes below and select the "I Agree" button on the
bottom of the page.

I authorize Intuit, the maker of TurboTax, to disclose to BANK and SBTPG that portion of my
2015 tax return information that is necessary to enable BANK and SBTPG to process
my refund.

Sign this agreement by entering your name:

Inisha Jaramillo

Please type the date below:

01/26/2016
Date

Jesse Jaramillo

01/26/2016

sbia1301.SCR 12/17/15
 TAXABLE YEAR
FORM

2015 California Resident Income Tax Return 540

APE ATTACH FEDERAL RETURN
A
548-81-8019 JARA 561-77-5402 15 PBA 624410 R
INISHA JARAMILLO RP
JESSE D JARAMILLO II

4029 JOHNSON ST APT APT 3

SAN BERNARDINO CA 92407

02-08-1984 10-24-1983

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

2 m Married/RDP filing jointly. See inst. 5 m
Status

Qualifying widow(er) with dependent child. Enter year spouse/RDP died

Filing

3 m Married/RDP filing separately. Enter spouse’s/RDP’s SSN or ITIN above and full name here

If your California filing status is different from your federal filing status, check the box here . . . . . . . . . . . . . . . . m
6 If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See inst. . . . . . . . .  6 m
 For line 7, line 8, line 9, and line 10: Multiply the amount you enter in the box by the pre-printed dollar amount for that line. Whole dollars only

m
7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked
box 2 or 5, enter 2, in the box. If you checked the box on line 6, see instructions. .    7 2 X $109 =  $ 218

m X $109 =  $
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1;
if both are visually impaired, enter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     8

m X $109 =  $
9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1;
if both are 65 or older, enter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9
10 Dependents: Do not include yourself or your spouse/RDP.
Exemptions

Dependent 1 Dependent 2 Dependent 3

First Name
 MIRANDA  
Last Name
 YSIANO  
SSN
 613799747  
Dependent's
relationship  DAUGHTER  
to you

Total dependent exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 m

1 X $337 =  $
337

11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32 . . . . . . . . . . . . . . . . . . .  11 $ 555

REV 12/20/15 INTUIT.CG.CFP.SP

175 3101154 Form 540 C1 2015 Side 1

 Your name: J A R A M I L L O Your SSN or ITIN: 548-81-8019

12 State wages from your Form(s) W-2, box 16 . . . . . . . . . . . . . . . . . . . . . . .  12 . 00

13 Enter federal adjusted gross income from Form 1040, line 37; 1040A, line 21; or 1040EZ, line 4 . . . . . .  13 9944 . 00

14 California adjustments – subtractions. Enter the amount from Schedule CA (540), line 37, column B . . .  14 . 00
15 Subtract line 14 from line 13. If less than zero, enter the result in parentheses. See instructions . . . . . . . . . 15 9944 . 00
Taxable Income

16 California adjustments – additions. Enter the amount from Schedule CA (540), line 37, column C . . . . .  16 . 00
17 California adjusted gross income. Combine line 15 and line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  17

{ {
9944 . 00
18 Enter the Your California itemized deductions from Schedule CA (540), line 44; OR
larger of: Your California standard deduction shown below for your filing status:
• Single or Married/RDP filing separately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $4,044
• Married/RDP filing jointly, Head of household, or Qualifying widow(er) . . . . . $8,088
If Married/RDP filing separately or the box on line 6 is checked, STOP. See instructions . . . .  18 8088 . 00

19 Subtract line 18 from line 17. This is your taxable income. If less than zero, enter -0- . . . . . . . . . . . . . .  19 1856 . 00

31 Tax. Check the box if from:  Tax Table  Tax Rate Schedule
  FTB 3800     FTB 3803 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  31 19 . 00
32 Exemption credits. Enter the amount from line 11. If your federal AGI is more than $178,706,
see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  32 555 . 00
Tax

33 Subtract line 32 from line 31. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  33 0 . 00

34 Tax. See instructions. Check the box if from:   Schedule G-1   FTB 5870A . . . . . . . .  34 . 00
35 Add line 33 and line 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  35 0 . 00

40 Nonrefundable Child and Dependent Care Expenses Credit. See instructions. . . . . . . . . . . . . . . . . . . . . .    40 . 00
43 Enter credit name                  code       and amount . . .  43 . 00
Special Credits

44 Enter credit name                  code       and amount . . .  44 . 00

45 To claim more than two credits, see instructions. Attach Schedule P (540) . . . . . . . . . . . . . . . . . . . . . . .  45 . 00
46 Nonrefundable renter’s credit. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  46 . 00
47 Add line 40 through line 46. These are your total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  47 . 00
48 Subtract line 47 from line 35. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  48 0 . 00

61 Alternative minimum tax. Attach Schedule P (540) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  61 . 00

Other Taxes

62 Mental Health Services Tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  62 . 00

63 Other taxes and credit recapture. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  63 . 00
64 Add line 48, line 61, line 62, and line 63. This is your total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  64 0 . 00

REV 12/20/15 INTUIT.CG.CFP.SP

Side 2 Form 540 C1 2015 175 3102154

 Your name: J A R A M I L L O Your SSN or ITIN: 548-81-8019

71 California income tax withheld. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    71 . 00

72 2015 CA estimated tax and other payments. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    72 . 00
Payments

73 Withholding (Form 592-B and/or 593). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    73 . 00

74 Excess SDI (or VPDI) withheld. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    74 . 00
75 Earned Income Tax Credit (EITC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    75 . 00
76 Add lines 71 through 75. These are your total payments. See instructions . . . . . . . . . . . . . . . . . . . . . . . .  76 . 00
Use
Tax

91 Use Tax. This is not a total line. See instructions . . . . . . . . . . . . . . . . . . . . 91 . 00

92 Payments balance. If line 76 is more than line 91, subtract line 91 from line 76. . . . . . . . . . . . . . . . . . . .     92 . 00
93 Use Tax balance. If line 91 is more than line 76, subtract line 76 from line 91. . . . . . . . . . . . . . . . . . . . .     93 . 00
Overpaid Tax/

94 Overpaid tax. If line 92 is more than line 64, subtract line 64 from line 92 . . . . . . . . . . . . . . . . . . . . . . . .    94
Tax Due

. 00
95 Amount of line 94 you want applied to your 2016 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    95 . 00
96 Overpaid tax available this year. Subtract line 95 from line 94 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    96 . 00
97 Tax due. If line 92 is less than line 64, subtract line 92 from line 64. . . . . . . . . . . . . . . . . . . . . . . . . . . . .  97 0 . 00

REV 12/20/15 INTUIT.CG.CFP.SP

175 3103154 Form 540 C1 2015 Side 3

Your name: J A R A M I L L O Your SSN or ITIN: 548-81-8019

Code Amount

California Seniors Special Fund. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  400 . 00

Alzheimer’s Disease/Related Disorders Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  401 . 00
Rare and Endangered Species Preservation Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  403 . 00
California Breast Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  405 . 00
California Firefighters’ Memorial Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  406 . 00
Emergency Food for Families Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  407 . 00
California Peace Officer Memorial Foundation Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  408 . 00
California Sea Otter Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  410 . 00
Contributions

California Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  413 . 00

Child Victims of Human Trafficking Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  419 . 00
School Supplies for Homeless Children Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  422 . 00
State Parks Protection Fund/Parks Pass Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  423 . 00
Protect Our Coast and Oceans Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  424 . 00
Keep Arts in Schools Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  425 . 00
California Senior Legislature Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  427 . 00
Habitat for Humanity Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  428 . 00
California Sexual Violence Victim Services Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  429 . 00
State Children’s Trust Fund for the Prevention of Child Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  430 . 00
Prevention of Animal Homelessness & Cruelty Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  431 . 00
110 Add code 400 through code 431. This is your total contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  110 . 00

REV 12/20/15 INTUIT.CG.CFP.SP

Side 4 Form 540 C1 2015 175 3104154

 Your name: J A R A M I L L O Your SSN or ITIN: 548-81-8019

111 AMOUNT YOU OWE. If you do not have an amount on line 96, add line 93, line 97, and line 110. See instructions. Do not send cash.
Mail to: FRANCHISE TAX BOARD
You Owe
Amount

PO BOX 942867
SACRAMENTO CA 94267-0001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  111 , , . 00
Pay online – Go to ftb.ca.gov for more information.

. 00
Interest and

112 Interest, late return penalties, and late payment penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Penalties

113 Underpayment of estimated tax. Check the box:   FTB 5805 attached   FTB 5805F attached  113 . 00
114 Total amount due. See instructions. Enclose, but do not staple, any payment . . . . . . . . . . . . . . . . . . . . . . . 114 . 00
115 REFUND OR NO AMOUNT DUE. Subtract the sum of line 110, line 112 and line 113 from line 96. See instructions.
Mail to: FRANCHISE TAX BOARD
PO BOX 942840
SACRAMENTO CA 94240-0001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    115 , , 0 . 00
Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip. See instructions.
Refund and Direct Deposit

Have you verified the routing and account numbers? Use whole dollars only.
All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:
 Type
 Routing number  Checking  Account number  116 Direct deposit amount

 Savings , , . 00
The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:
 Type
 Routing number  Checking  Account number  117 Direct deposit amount

 Savings , , . 00

IMPORTANT: See the instructions to find out if you should attach a copy of your complete federal tax return.
To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to ftb.ca.gov
and search for privacy notice. To request this notice by mail, call 800.852.5711. Under penalties of perjury, I declare that I have examined this tax return,
including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Your signature Date Spouse’s/RDP’s signature (if a joint tax return, both must sign)

X   X
Your email address (optional). Enter only one email address. Daytime phone number (optional)

Sign (    )
Here Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)

It is unlawful
to forge a
spouse’s/RDP’s Firm’s name (or yours, if self-employed)  PTIN
signature.
SELF PREPARED
Joint tax return?
(See instructions) Firm’s address  FEIN

Do you want to allow another person to discuss this tax return with us? See instructions . . . .  m Yes m No
Print Third Party Designee’s Name Telephone Number

    

REV 12/20/15 INTUIT.CG.CFP.SP

175 3105154 Form 540 C1 2015 Side 5

 Form
1040 Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

(99)
2015 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2015, or other tax year beginning , 2015, ending , 20 See separate instructions.
Your first name and initial Last name Your social security number

Inisha Jaramillo 548-81-8019

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

Jesse D Jaramillo, II 561-77-5402

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above
c
and on line 6c are correct.
4029 johnson st Apt 3
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
san bernardino CA 92407 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

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

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

Exemptions 6a
b
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
} Boxes checked
on 6a and 6b
No. of children
2
c Dependents: (2) Dependent’s (3) Dependent’s (4)  if child under age 17 on 6c who:
social security number relationship to you qualifying for child tax credit • lived with you 1
(1) First name Last name (see instructions) • did not live with
you due to divorce
Miranda M ysiano 613-79-9747 Daughter or separation
If more than four (see instructions)
dependents, see Dependents on 6c
instructions and not entered above
check here a Add numbers on
d Total number of exemptions claimed . . . . . . . . . . . . . . . . . lines above a 3
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
Income
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
Attach Form(s)
9a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
W-2 here. Also
attach Forms b Qualified dividends . . . . . . . . . . . 9b
W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
1099-R if tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12 10,700.
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here a 13
If you did not 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14
get a W-2,
see instructions. 15a IRA distributions . 15a b Taxable amount . . . 15b
16a Pensions and annuities 16a b Taxable amount . . . 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18
19 Unemployment compensation . . . . . . . . . . . . . . . . . 19
20a Social security benefits 20a b Taxable amount . . . 20b
21 Other income. List type and amount 21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income a 22 10,700.
23 Educator expenses . . . . . . . . . . . 23
Adjusted 24 Certain business expenses of reservists, performing artists, and
Gross fee-basis government officials. Attach Form 2106 or 2106-EZ 24
Income 25 Health savings account deduction. Attach Form 8889 . 25
26 Moving expenses. Attach Form 3903 . . . . . . 26
27 Deductible part of self-employment tax. Attach Schedule SE . 27 756.
28 Self-employed SEP, SIMPLE, and qualified plans . . 28
29 Self-employed health insurance deduction . . . . 29
30 Penalty on early withdrawal of savings . . . . . . 30
31a Alimony paid b Recipient’s SSN a 31a
32 IRA deduction . . . . . . . . . . . . . 32
33 Student loan interest deduction . . . . . . . . 33
34 Tuition and fees. Attach Form 8917 . . . . . . . 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 756.
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . a 37 9,944.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA REV 12/30/15 Intuit.cg.cfp.sp Form 1040 (2015)
Form 1040 (2015) Page 2
38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38 9,944.
Tax and
Credits
39a Check
if:
{ You were born before January 2, 1951,
Spouse was born before January 2, 1951,
Blind.
Blind.
} Total boxes
checked a 39a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here a 39b
Standard 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . 40 12,600.
Deduction -2,656.
for— 41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41
• People who 42 Exemptions. If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see instructions 42 12,000.
check any
box on line 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43 0.
39a or 39b or 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44 0.
who can be
claimed as a 45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45
dependent,
see 46 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . 46
instructions. 47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . a 47 0.
• All others:
48 Foreign tax credit. Attach Form 1116 if required . . . . 48
Single or
Married filing 49 Credit for child and dependent care expenses. Attach Form 2441 49
separately,
$6,300 50 Education credits from Form 8863, line 19 . . . . . 50
Married filing 51 Retirement savings contributions credit. Attach Form 8880 51
jointly or
Qualifying 52 Child tax credit. Attach Schedule 8812, if required . . . 52 0.
widow(er), 53 Residential energy credits. Attach Form 5695 . . . . 53
$12,600
Head of 54 Other credits from Form: a 3800 b 8801 c 54
household, 55 Add lines 48 through 54. These are your total credits . . . . . . . . . . . . 55 0.
$9,250
56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . a 56 0.
57 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 57 1,512.
Other 58 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 58
59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 59
Taxes 60a Household employment taxes from Schedule H . . . . . . . . . . . . . . 60a
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . 60b
61 Health care: individual responsibility (see instructions) Full-year coverage . . . . . 61
62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62
63 Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . a 63 1,512.
Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . 64
65 2015 estimated tax payments and amount applied from 2014 return 65
If you have a 3,359.
66a Earned income credit (EIC) . . . . . . . . . . 66a
qualifying
child, attach b Nontaxable combat pay election 66b
Schedule EIC. 67 Additional child tax credit. Attach Schedule 8812 . . . . . 67 1,000.
68 American opportunity credit from Form 8863, line 8 . . . 68
69 Net premium tax credit. Attach Form 8962 . . . . . . 69
70 Amount paid with request for extension to file . . . . . 70
71 Excess social security and tier 1 RRTA tax withheld . 71. . .
72 Credit for federal tax on fuels. Attach Form 4136 . 72. . .
73 Credits from Form: a 2439 b Reserved c 8885 d 73
74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . a 74 4,359.
Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75 2,847.
76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . a 76a 2,847.
a
bRouting number 0 3 1 1 0 1 1 6 9 a c Type: Checking Savings
Direct deposit?
See a dAccount number 8 5 1 3 6 3 5 3 3 0 2 0 3
instructions.
77 Amount of line 75 you want applied to your 2016 estimated tax a 77
Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions a 78
You Owe 79 Estimated tax penalty (see instructions) . . . . . . . 79
Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No
Designee’s Phone Personal identification
Designee name a no. a number (PIN) a

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

Joint return? See

instructions. Child care
Keep a copy for Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection
your records. PIN, enter it
Welder here (see inst.)
Print/Type preparer’s name Preparer’s signature Date PTIN
Paid Check if
self-employed
Preparer
Use Only Firm’s name a Self-Prepared Firm's EIN a

Firm’s address a Phone no.

www.irs.gov/form1040 REV 12/30/15 Intuit.cg.cfp.sp Form 1040 (2015)
Inisha Jaramillo 548-81-8019

child care 6 2 4 4 1 0

4029 johnson st , Apt. Apt 3

san bernardino, CA 92407

10,700.

10,700.

BAA REV 10/28/15 Intuit.cg.cfp.sp

SCHEDULE SE
Self-Employment Tax
OMB No. 1545-0074

2015
(Form 1040)
a Information about Schedule SE and its separate instructions is at www.irs.gov/schedulese.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040 or Form 1040NR. Sequence No. 17
Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) Social security number of person
Inisha Jaramillo with self-employment income a 548-81-8019
Before you begin: To determine if you must file Schedule SE, see the instructions.

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

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

Did you receive wages or tips in 2015?

No Yes
d d d
Are you a minister, member of a religious order, or Christian
Yes Was the total of your wages and tips subject to social security Yes
Science practitioner who received IRS approval not to be taxed a or railroad retirement (tier 1) tax plus your net earnings from a
on earnings from these sources, but you owe self-employment
self-employment more than $118,500?
tax on other earnings?

No
No
d d

Are you using one of the optional methods to figure your net Did you receive tips subject to social security or Medicare tax Yes
Yes a
earnings (see instructions)? a that you did not report to your employer?

No
No d
d
No Did you report any wages on Form 8919, Uncollected Social Yes
Did you receive church employee income (see instructions) Yes ` Security and Medicare Tax on Wages? a
reported on Form W-2 of $108.28 or more? a

No
d d
You may use Short Schedule SE below a You must use Long Schedule SE on page 2

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

1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form
1065), box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . 1a
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z 1b ( )
2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),
box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1.
Ministers and members of religious orders, see instructions for types of income to report on
this line. See instructions for other income to report . . . . . . . . . . . . . . 2 10,700.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . 3 10,700.
4 Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do
not file this schedule unless you have an amount on line 1b . . . . . . . . . . . a 4 9,881.
Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b,
see instructions.
5 Self-employment tax. If the amount on line 4 is:
• $118,500 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 57,
or Form 1040NR, line 55
• More than $118,500, multiply line 4 by 2.9% (.029). Then, add $14,694 to the result.
Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55 . . . . . . . 5 1,512.
6 Deduction for one-half of self-employment tax.
Multiply line 5 by 50% (.50). Enter the result here and on Form
1040, line 27, or Form 1040NR, line 27 . . . . . . . . 6 756.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 12/04/15 Intuit.cg.cfp.sp Schedule SE (Form 1040) 2015
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040A or 1040) 1040A `
Qualifying Child Information
2015
..........

a
1040
Complete and attach to Form 1040A or 1040 only if you have a qualifying child.
Department of the Treasury a EIC Attachment
Information about Schedule EIC (Form 1040A or 1040) and its instructions is at www.irs.gov/scheduleeic.
Internal Revenue Service (99) Sequence No. 43
Name(s) shown on return Your social security number
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019
• 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. Miranda M ysiano
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
2015. If your child was born and died in
2015 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.
613-79-9747
3 Child’s year of birth
Year 2 0 0 9 Year Year
If born after 1996 and the child is If born after 1996 and the child is If born after 1996 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

2015, 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 2015?
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
6 Number of months child lived
with you in the United States
during 2015

• If the child lived with you for more than

half of 2015 but less than 7 months,
enter “7.”
• If the child was born or died in 2015 and 12 months 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 2015, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax BAA REV 12/09/15 Intuit.cg.cfp.sp Schedule EIC (Form 1040A or 1040) 2015
return instructions.
SCHEDULE 8812 OMB No. 1545-0074
Child Tax Credit 1040
◀
(Form 1040A or 1040)
▶ Attach to Form 1040, Form 1040A, or Form 1040NR.
1040A
1040NR 2015
Department of the Treasury
▶ Information about Schedule 8812 and its separate instructions is at 8812 Attachment
Internal Revenue Service (99) www.irs.gov/schedule8812. Sequence No. 47
Name(s) shown on return Your social security number
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019
Part I Filers Who Have Certain Child Dependent(s) with an ITIN (Individual Taxpayer Identification Number)

▲
!
CAUTION
Complete this part only for each dependent who has an ITIN and for whom you are claiming the child tax credit.
If your dependent is not a qualifying child for the credit, you cannot include that dependent in the calculation of this credit.

Answer the following questions for each dependent listed on Form 1040, line 6c; Form 1040A, line 6c; or Form 1040NR, line 7c, who has an ITIN
(Individual Taxpayer Identification Number) and that you indicated is a qualifying child for the child tax credit by checking column (4) for that
dependent.
A For the first dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

B For the second dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

C For the third dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

D For the fourth dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No

Note: If you have more than four dependents identified with an ITIN and listed as a qualifying child for the child tax credit, see separate instructions
and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

}
Part II Additional Child Tax Credit Filers
1 If you file Form 2555 or 2555-EZ stop here, you cannot claim the additional child tax credit.

If you are required to use the worksheet in Pub. 972, enter the amount from line 8 of the Child Tax
Credit Worksheet in the publication. Otherwise:
1040 filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the 1 1,000.
Instructions for Form 1040, line 52).
1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040A, line 35).
1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040NR, line 49).
2 Enter the amount from Form 1040, line 52; Form 1040A, line 35; or Form 1040NR, line 49 . . . . . 2 0.
3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit . . . . . . . . . . . . . 3 1,000.
4a Earned income (see separate instructions) . . . . . . . . . . . 4a 9,944.
b Nontaxable combat pay (see separate
instructions) . . . . . . . . . . . 4b
5 Is the amount on line 4a more than $3,000?
No. Leave line 5 blank and enter -0- on line 6.
Yes. Subtract $3,000 from the amount on line 4a. Enter the result . . . 5 6,944.
6 Multiply the amount on line 5 by 15% (.15) and enter the result . . . . . . . . . . . . . . 6 1,042.
Next. Do you have three or more qualifying children?
No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part III 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 III and enter the amount from line 3 on line 13.
Otherwise, go to line 7.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 12/09/15 Intuit.cg.cfp.sp Schedule 8812 (Form 1040A or 1040) 2015
Schedule 8812 (Form 1040A or 1040) 2015 Page 2
Part III Certain Filers Who Have Three or More Qualifying Children
7 Withheld social security, Medicare, and Additional Medicare taxes from
Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse’s
amounts with yours. If your employer withheld or you paid Additional

}
Medicare Tax or tier 1 RRTA taxes, see separate instructions . . . . . . 7
8 1040 filers: Enter the total of the amounts from Form 1040, lines
27 and 58, plus any taxes that you identified using code
“UT” and entered on line 62.
1040A filers: Enter -0-. 8
1040NR filers: Enter the total of the amounts from Form 1040NR,
lines 27 and 56, plus any taxes that you identified using
code “UT” and entered on line 60.

}
9 Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . 9
10 1040 filers: Enter the total of the amounts from Form 1040, lines
66a and 71.
1040A filers: Enter the total of the amount from Form 1040A, line
42a, plus any excess social security and tier 1 RRTA 10
taxes withheld that you entered to the left of line 46
(see separate instructions).
1040NR filers: Enter the amount from Form 1040NR, line 67.
11 Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 11
12 Enter the larger of line 6 or line 11 . . . . . . . . . . . . . . . . . . . . . . 12
Next, enter the smaller of line 3 or line 12 on line 13.
Part IV Additional Child Tax Credit
13 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . . . 13 1,000.
Enter this amount on
1040 Form 1040, line 67,
Form 1040A, line 43, or
1040A Form 1040NR, line 64.
1040NR ◀

REV 12/09/15 Intuit.cg.cfp.sp Schedule 8812 (Form 1040A or 1040) 2015

 8965
OMB No. 1545-0074
Health Coverage Exemptions
Form

Department of the Treasury

a Attach to Form 1040, Form 1040A, or Form 1040EZ. 2015
a Information about Form 8965 and its separate instructions is at www.irs.gov/form8965. Attachment
Internal Revenue Service Sequence No. 75
Name as shown on return Your social security number
Inisha Jaramillo & Jesse D Jaramillo, II 548-81-8019
Complete this form if you have a Marketplace-granted coverage exemption or you are claiming a coverage exemption
on your return.
Marketplace-Granted Coverage Exemptions for Individuals. If you and/or a member of your tax household
Part I
have an exemption granted by the Marketplace, complete Part I.
(a) (b) (c)
Name of Individual SSN Exemption Certificate Number

6
Part II Coverage Exemptions Claimed on Your Return for Your Household

7a Are you claiming an exemption because your household income is below the filing threshold? . . . . . . Yes No

b Are you claiming a hardship exemption because your gross income is below the filing threshold? . . . . Yes No
Coverage Exemptions Claimed on Your Return for Individuals. If you and/or a member of your tax
Part III
household are claiming an exemption on your return, complete Part III.
(c) (d)
(a) (b) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p)
Exemption Full
Name of Individual SSN Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Type Year

10

11

12

13
For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions. BA REV 12/09/15 Intui Form 8965 (2015)