Tax return (2)

Electronic Filing Instructions for your 2011 Federal Tax ReturnImportant: Your taxes are not finished until all required steps are completed.

Declaration Control Number: Accepted: 01/22/2012norma J buchanonp.o. box 501forreston, IL 61030

Page 1 of 1

|Balance | Your federal tax return (Form 1040A) shows a refund due to you in theDue/ | amount of $8,234.00. Applicable fees were deducted from your originalRefund | refund amount of $8,234.00. Your refund is now $8,176.10. Because you

| chose to have your TurboTax fees deducted from your refund, you will| receive e-mail from the University National Bank of Saint Paul, MN,| which handles this transaction. The IRS estimates that you can expect| your tax refund to be direct deposited into your account on or around| 02/01/2012. This is only an estimate. The account information you| entered - Account Number: 50002194 Routing Transit Number: 271184425.

______________________________________________________________________________________||

Where's My | Before you call the Internal Revenue Service with questions aboutRefund? | your refund, give them 7 to 14 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 Internal Revenue| Service directly at 1-800-829-4477. You can also check www.irs.gov| and select the "Where's my refund?" link.

______________________________________________________________________________________||

No | No signature form is required since you signed your returnSignature | electronically.Document |Needed |

______________________________________________________________________________________||

What You | Your Electronic Filing Instructions (this form)Need to | Printed copy of your federal returnKeep |

______________________________________________________________________________________||

2011 | Adjusted Gross Income $ 24,094.00Federal | Taxable Income $ 4,494.00Tax | Total Tax $ 0.00Return | Total Payments/Credits $ 8,234.00Summary | Amount to be Refunded $ 8,234.00

| Effective Tax Rate -21.20%______________________________________________________________________________________|

Hi norma,

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

With TurboTax Federal Free Edition: - Your filed return has 100% guaranteed accurate calculations* - You received a printed copy of your return with supporting documents for your records

Many happy returns from TurboTax.

Form

1040A 2011U.S. Individual Income Tax ReturnDepartment of the Treasury—Internal Revenue Service

IRS Use Only—Do not write or staple in this space. (99)

OMB No. 1545-0074Your first name and initial Last name

Your social security number

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

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

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

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Foreign country name Foreign province/county Foreign postal code

Presidential Election CampaignCheck here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund. You Spouse

Filing status Check only one box.

1 Single2 Married filing jointly (even if only one had income)3 Married filing separately. Enter spouse’s SSN above and

full name here. ▶

4 Head of household (with qualifying person). (See instructions.)If the qualifying person is a child but not your dependent, enter this child’s name here. ▶

5 Qualifying widow(er) with dependent child (see instructions)

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

b Spousec Dependents:

(1) First name Last name

(2) Dependent’s social security number

(3) Dependent’s relationship to you

(4) ✓ if child under age 17 qualifying for child tax credit (see

instructions)If more than six dependents, see instructions.

} Boxes checked on 6a and 6bNo. of children on 6c who: • lived with you

• did not live with you due to divorce or separation (see instructions)

Dependents on 6c not entered above

d Total number of exemptions claimed.

Add numbers on lines above ▶

Income Attach Form(s) W-2 here. Also attach Form(s) 1099-R if tax was withheld. If you did not get a W-2, see instructions. Enclose, but do not attach, any payment. Also, please use Form 1040-V.

7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7

8a Taxable interest. Attach Schedule B if required. 8ab Tax-exempt interest. Do not include on line 8a. 8b

9a Ordinary dividends. Attach Schedule B if required. 9ab Qualified dividends (see instructions). 9b

10 Capital gain distributions (see instructions). 1011 a IRA

distributions. 11a11b Taxable amount

(see instructions). 11b12 a Pensions and

annuities. 12a12b Taxable amount

(see instructions). 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 1314 a Social security

benefits. 14a14b Taxable amount

(see instructions). 14b

15 Add lines 7 through 14b (far right column). This is your total income. ▶ 15Adjusted gross income

16 Educator expenses (see instructions). 1617 IRA deduction (see instructions). 1718 Student loan interest deduction (see instructions). 18

19 Tuition and fees. Attach Form 8917. 1920 Add lines 16 through 19. These are your total adjustments. 20

21 Subtract line 20 from line 15. This is your adjusted gross income. ▶ 21For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040A (2011)

1

2

3

24,094.

24,094.

24,094.

buchanon 329-50-5462

p.o. box 501

norma J

xavier Z taylor 324-96-0331 Grandchildethan A watson 335-08-3033 Grandchild

forreston IL 61030

BAAREV 12/01/11 TTO

Form 1040A (2011) Page 2Tax, credits, and payments

22 Enter the amount from line 21 (adjusted gross income). 2223 a Check

if: { You were born before January 2, 1947, BlindSpouse was born before January 2, 1947, Blind }Total boxes

checked ▶ 23ab If you are married filing separately and your spouse itemizes

deductions, check here ▶ 23bStandard Deduction for— • People who check any box on line 23a or 23b or who can be claimed as a dependent, see instructions. • All others: Single or Married filing separately, $5,800 Married filing jointly or Qualifying widow(er), $11,600 Head of household, $8,500

24 Enter your standard deduction. 2425 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 2526 Exemptions. Multiply $3,700 by the number on line 6d. 2627 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.

This is your taxable income. ▶ 2728 Tax, including any alternative minimum tax (see instructions). 2829 Credit for child and dependent care expenses. Attach

Form 2441. 2930 Credit for the elderly or the disabled. Attach

Schedule R. 3031 Education credits from Form 8863, line 23. 3132 Retirement savings contributions credit. Attach

Form 8880. 3233 Child tax credit (see instructions). 3334 Add lines 29 through 33. These are your total credits. 3435 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. This is

your total tax. 3536 Federal income tax withheld from Forms W-2 and

1099. 3637 2011 estimated tax payments and amount applied

from 2010 return. 37If you have a qualifying child, attach Schedule EIC.

38a Earned income credit (EIC). 38ab Nontaxable combat pay

election. 38b39 Additional child tax credit. Attach Form 8812. 3940 American opportunity credit from Form 8863, line 14. 4041 Add lines 36, 37, 38a, 39, and 40. These are your total payments. ▶ 41

Refund Direct deposit? See instructions and fill in 43b, 43c, and 43d or Form 8888.

42 If line 41 is more than line 35, subtract line 35 from line 41. This is the amount you overpaid. 42

43a Amount of line 42 you want refunded to you. If Form 8888 is attached, check here ▶ 43a

▶ b Routing number

▶ c Type: Checking Savings

▶ d Account number

44 Amount of line 42 you want applied to your 2012 estimated tax. 44

Amount you owe

45 Amount you owe. Subtract line 41 from line 35. For details on how to pay, see instructions. ▶ 45

46 Estimated tax penalty (see instructions). 46

Third party designee

Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No

Designee’s name ▶

Phone no. ▶

Personal identification number (PIN) ▶

Sign here Joint return? See page 13. Keep a copy for your records.

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 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.▲ Your signature Date Your occupation Daytime phone number

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 here (see inst.)

Paid preparer use only

Print/type preparer's name Preparer’s signature DateCheck ▶ if self-employed

PTIN

Firm's name ▶

Firm's address ▶

Firm's EIN ▶

Phone no.

Form 1040A (2011)

24,094.

8,500.15,594.11,100.

4,494.448.

448.448.

0.

3,125.

3,557.

1,552.

8,234.

8,234.8,234.

cashier (815)742-2174

5 0 0 0 2 1 9 4

2 7 1 1 8 4 4 2 5

REV 12/01/11 TTO

SELF PREPARED

SCHEDULE EIC (Form 1040A or 1040)

Department of the Treasury Internal Revenue Service (99)

Earned Income CreditQualifying Child Information

Complete and attach to Form 1040A or 1040 only if you have a qualifying child.

1040A . . . . . . . . . .

1040

EIC

◀OMB No. 1545-0074

2011Attachment Sequence No. 43

Name(s) shown on return Your social security number

Before you begin: • See the instructions for Form 1040A, lines 38a and 38b, or Form 1040, lines 64a and 64b, to make sure that (a) you can take the EIC, and (b) you have a qualifying child.

• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child’s social security card is not correct, call the Social Security Administration at 1-800-772-1213.

▲!CAUTION

• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See page 2 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 If you have more than three qualifying children, you only have to list three to get the maximum credit.

First name Last name First name Last name First name Last name

2 Child’s SSN The child must have an SSN as defined in the instructions for Form 1040A, lines 38a and 38b, or Form 1040, lines 64a and 64b,unless the child was born and died in 2011. If your child was born and died in 2011 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.

3 Child’s year of birth Year

If born after 1992 and the child was younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5.

Year If born after 1992 and the child was younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5.

Year If born after 1992 and the child was younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5.

4 a Was the child under age 24 at the end of 2011, a student, and younger than you (or your spouse, if filing jointly)?

Yes.

Go to line 5.

No.

Go to line 4b.

Yes.

Go to line 5.

No.

Go to line 4b.

Yes.

Go to line 5.

No.

Go to line 4b.

b Was the child permanently and totally disabled during any part of 2011?

Yes.Go to line 5.

No.The child is not a qualifying child.

Yes.Go to line 5.


Yes.Go to line 5.


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

6 Number of months child lived with you in the United States during 2011

• If the child lived with you for more than half of 2011 but less than 7 months, enter “7.”

• If the child was born or died in 2011 and your home was the child’s home for the entire time he or she was alive during 2011, enter “12.”

months Do not enter more than 12 months.



For Paperwork Reduction Act Notice, see your tax return instructions.

Schedule EIC (Form 1040A or 1040) 2011

norma J buchanon 329-50-5462

xavier Z taylor

324-96-0331

1 9 9 9

Grandchild

12

ethan A watson

335-08-3033

2 0 0 8

Grandchild

12

BAA REV 11/22/11 TTO

Form 8812Department of the Treasury Internal Revenue Service (99)

Additional Child Tax Credit

Complete and attach to Form 1040, Form 1040A, or Form 1040NR.

1040A 1040

8812

◀

1040NR

OMB No. 1545-0074

2011Attachment Sequence No. 47

Name(s) shown on return Your social security number

Part I All Filers 1 1040 filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the

Instructions for Form 1040, line 51).1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the

Instructions for Form 1040A, line 33).

1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the Instructions for Form 1040NR, line 48).

If you used Pub. 972, enter the amount from line 8 of the Child Tax Credit Worksheet in the publication.

} 1

2 Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 48 . . . . . . 2 3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit . . . . . . . . . . . . . 3 4a Earned income (see instructions on back) . . . . . . . . . . . . 4a

b Nontaxable combat pay (see instructions on back) . . . . . . . . . . . . . 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 Multiply the amount on line 5 by 15% (.15) and enter the result . . . . . . . . . . . . . . 6 Next. Do you have three or more qualifying children?

No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of line 3 or line 6 on line 13.

Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on line 13. Otherwise, go to line 7.

Part II Certain Filers Who Have Three or More Qualifying Children 7 Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6.

If married filing jointly, include your spouse’s amounts with yours. If you worked for a railroad, see instructions on back . . . . . . . . . . 7

8 1040 filers: Enter the total of the amounts from Form 1040, lines 27 and 57, plus any taxes that you identified using code “UT” and entered on line 60.

1040A filers: Enter -0-.

1040NR filers: Enter the total of the amounts from Form 1040NR, lines 27 and 55, plus any taxes that you identified using code “UT” and entered on line 59.

} 8

9 Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . 9

10 1040 filers: Enter the total of the amounts from Form 1040, lines 64a and 69.

1040A filers: Enter the total of the amount from Form 1040A, line 38a, plus any excess social security and tier 1 RRTA taxes withheld that you entered to the left of line 41 (see instructions on back).

1040NR filers: Enter the amount from Form 1040NR, line 65.

} 10

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 III Additional Child Tax Credit 13 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . 13

1040A 1040

1040NR ◀

Enter this amount on Form 1040, line 65, Form 1040A, line 39, or Form 1040NR, line 63.

For Paperwork Reduction Act Notice, see your tax return instructions. Form 8812 (2011)

norma J buchanon 329-50-5462

2,000.

448.1,552.

24,094.

21,094.3,164.

1,552.

BAA REV 11/22/11 TTO

We Need Your Consent to Use Your Tax Information

The IRS requires that we obtain your consent to use specific information in your tax return to determine if you can use this payment method.

Protecting Your Privacy

Because you have selected this payment option, Intuit, the maker of TurboTax software, needs to check a few items in your return to determine whether you can pay your fees from your refund. For example, you must reside in the U.S. and your refund must be large enough to make the payment.

We’re asking your permission to perform these checks and providing some important information to you as required by the IRS. To agree, simply enter your name(s) and the date in the boxes below after reading the consent and select "I Agree".

I authorize Intuit, the maker of TurboTax, to use the information provided in this 2011 return to determine whether a portion of the refund can be used to pay for tax preparation.

IRS regulations require the following statements:

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

You are not required to complete this form. If we obtain your signature on this form by conditioning our 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."

Taxpayer’s First Name Taxpayer’s Last Name

Spouse’s First Name Spouse’s Last name(if applicable) (if applicable)

Please type the date below:

Date

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].

norma buchanon

01/22/2012

Finally, We Need Your Consent to Disclose Your Tax Information

Before we continue with processing your payment by transferring money from your tax refund, weneed to ask for your permission again, this time to forward certain of your information to University National Bank of St. Paul, MN (’BANK’) and to Santa Barbara Tax Processing Group, LLC, (’SBTPG’), the administrator and servicer of your tax refund transfer. To consent, type your first and last name and today’s date in the boxes below.

How this protects your privacy

Because you are choosing to pay for your tax preparation with money from your refund, Intuit, the maker of TurboTax software, needs to send a limited amount of personal information from your tax return information, (such as your identifying information, deposit information, and refund amount)to BANK and to SBTPG, the administrator and servicer of payment for tax preparation services from your tax refund. Your information is sent via a secure SSL encrypted transmission for the sole purpose of refund processing tax preparation service payment. BANK and SBTPG are contractually obligated to protect the confidentiality of your information.

We’re asking your permission to disclose that information, and also providing some important information to you as required by the IRS. To agree, simply enter your name(s) and the date in the boxes below after reading this consent and select "I Agree".

I authorize Intuit, the maker of TurboTax, to disclose to BANK and SBTPG that portion ofmy 2011 tax return information that is necessary to enable BANK and SBTPG to process my refund and pay for my tax preparation.

IRS regulations require the following statements:

"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose, without your consent, your tax return information to third parties for purposes other than the preparation and filing of your tax return. 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. If we obtain your signature on this form by conditioning our 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."

Please type the date below:

Date

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].

sbia1301.SCR 12/01/11

norma buchanon

01/22/2012

ELECTRONIC POSTMARK - CERTIFICATION OF ELECTRONIC FILING

Taxpayer:Primary SSN:

Federal Return Submitted:Federal Return Acceptance Date:

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 17, 2012. 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 17, 2012, your Intuit electronic postmark will indicate April 17, 2012, 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 17, 2012, and a corrected return is submitted and accepted before April 22, 2012. If your return is submitted after April 22, 2012, 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 15, 2012. 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 15, 2012, and the corrected return is submitted and accepted by October 20, 2012.

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.

norma J buchanon329-50-5462

January 22, 2012 04:48 PM PST01/22/2012

Electronic Filing Instructions for your 2011 Illinois Tax ReturnImportant: Your taxes are not finished until all required steps are completed.

norma J buchanonp.o. box 501forreston, IL 61030

Page 1 of 1

|Balance | Your Illinois state tax return (Form IL-1040) shows a refund due toDue/ | you in the amount of $442.00. Your tax refund should be directRefund | deposited into your account within 7 to 14 days after your return is

| accepted. The account information you entered - Account Number:| 50002194 Routing Transit Number: 271184425.

______________________________________________________________________________________||

Where's My | Before you call the Illinois Department of Revenue with questionsRefund? | about your refund, give them 7 to 14 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 Illinois| Department of Revenue directly at 1-217-782-3336. From outside of| Illinois use 1-800-732-8866. You can also visit the Illinois| Department of Revenue web site at www.ILtax.com.

______________________________________________________________________________________||

No | No signature form is required since you signed your returnSignature | electronically.Document |Needed |

______________________________________________________________________________________||

What You | Your Electronic Filing Instructions (this form)Need to | Printed copy of your state and federal returnsKeep | Copies of Forms W-2, W-2G, and 1099-R

| Copies of other states' tax returns, if applicable______________________________________________________________________________________|

|2011 | Taxable Income $ 18,094.00Illinois | Total Tax $ 905.00Tax | Total Payments/Credits $ 1,347.00Return | Amount to be Refunded $ 442.00Summary |

______________________________________________________________________________________|

Do not write above this line.

IL-1040 front (R-12/11)

2011 Form IL-1040

Step 1: Personal Information

1 Federal adjusted gross income from your U.S. 1040, Line 37; U.S. 1040A, Line 21; or U.S. 1040EZ, Line 4 1 .00 2 Federally tax-exempt interest and dividend income from your U.S. 1040 or 1040A, Line 8b; or U.S. 1040EZ 2 .00 3 Other additions. Attach Schedule M. 3 .00 4 Total income. Add Lines 1 through 3. 4 .00

5 Social Security benefits and certain retirement plan income received if included in Line 1. Attach Page 1 of federal return. 5 .00 6 Illinois Income Tax overpayment included in U.S. 1040, Line 10 6 .00 7 Other subtractions. Attach Schedule M. 7 .00 Check if Line 7 includes any amount from Schedule 1299-C. 8 Add Lines 5, 6, and 7. This is the total of your subtractions. 8 .00 9 Illinois base income. Subtract Line 8 from Line 4. 9 .00

10 a Number of exemptions from your federal return x $2,000 a .00 b If someone can claim you as a dependent, see instructions. x $2,000 b .00 c Check if 65 or older: You + Spouse = x $1,000 c .00 d Check if legally blind: You + Spouse = x $1,000 d .00 Exemption allowance. Add Lines a through d. 10 .00

11 Residents: Net income. Subtract Line 10 from Line 9. Skip Line 12. 11 .00 12 Nonresidents and part-year residents: Check the box that applies to you during 2011 Nonresident Part-year resident, and write the Illinois base income from Schedule NR. Attach Schedule NR. 12 .00

13 Residents: Multiply Line 11 by 5% (.05). Nonresidents and part-year residents: Write the tax from Schedule NR. 13 .00 14 Recapture of investment tax credits. Attach Schedule 4255. 14 .00 15 Income tax. Add Lines 13 and 14. Cannot be less than zero. 15 .00

16 Income tax paid to another state while an Illinois resident. Attach Schedule CR. 16 .00 17 Property tax and K-12 education expense credit amount from Schedule ICR. Attach Schedule ICR. 17 .00 18 Credit amount from Schedule 1299-C. Attach Schedule 1299-C. 18 .00 19 Add Lines 16, 17, and 18. This is the total of your credits. Cannot exceed the tax amount on Line 15. 19 .00 20 Tax after nonrefundable credits. Subtract Line 19 from Line 15. 20 .00

Sta

ple

W-2

an

d 1

099

form

s h

ere

or for fiscal year ending /

Illinois Department of Revenue

Individual Income Tax Return

Sta

ple

yo

ur

chec

k

(Whole dollars only)

tax.illinois.gov

Step 2:

Income

Step 3:

Base Income

Step 4:

Exemptions

Step 5:

NetIncome

Step 6:

Tax

Step 7:

Tax After Non-refundableCredits

C Filing status (see instructions)

Single or head of household Married filing jointly Married filing separately Widowed

D Check if same-sex civil union return (see instructions)

This form is authorized as outlined under the Illinois Income Tax Act. Disclosure of this information is required. Failure to provide information could result in a penalty.

p.o. box 501

forreston IL 61030

24,094

3 6,000

6,000

18,094

905

905

0905

24,094

329-50-5462

24,094

norma J buchanon

ID: 3WM REV 12/23/11 TTO

21 Tax after nonrefundable credits from Page 1, Line 20 21 .00

22 Household employment tax. See instructions. 22 .00

23 Use tax on internet, mail order, or other out-of-state purchases from UT Worksheet or UT Table in the instructions. Do not leave blank. 23 .00

24 Total Tax. Add Lines 21, 22, and 23. 24 .00

25 Illinois Income Tax withheld. Attach W-2 and 1099 forms. 25 .00 26 Estimated payments from Forms IL-1040-ES and IL-505-I, including overpayment applied from 2010 return 26 .00

27 Pass-through entity tax payments. Attach Schedule K-1-P or K-1-T. 27 .00

28 Earned Income Credit from Schedule ICR. Attach Schedule ICR. 28 .00

29 Total payments and refundable credit. Add Lines 25 through 28. 29 .00

30 Overpayment. If Line 29 is greater than Line 24, subtract Line 24 from Line 29. 30 .00

31 Underpayment. If Line 24 is greater than Line 29, subtract Line 29 from Line 24. 31 .00

32 Late-payment penalty for underpayment of estimated tax. 32 .00 a Check if at least two-thirds of your federal gross income is from farming.

b Check if you or your spouse are 65 or older and permanently living in a nursing home.

c Check if your income was not received evenly during the year and you annualized your income on Form IL-2210. Attach Form IL-2210.

33 Voluntary charitable donations. Attach Schedule G. 33 .00

34 Total penalty and donations. Add Lines 32 and 33. 34 .00

35 If you have an overpayment on Line 30 and this amount is greater than Line 34, subtract Line 34 from Line 30. This is your remaining overpayment. 35 .00

36 Amount from Line 35 you want refunded to you 36 .00

37 Complete to direct deposit your refund

Routing number Checking or Savings

Account number

38 Subtract Line 36 from Line 35. This amount will be applied to your 2012 estimated tax. 38 .00

39 If you have an underpayment on Line 31, add Lines 31 and 34. or If you have an overpayment on Line 30 and this amount is less than Line 34, subtract Line 30 from Line 34. This is the amount you owe. 39 .00

Under penalties of perjury, I state that I have examined this return, and, to the best of my knowledge, it is true, correct, and complete.

Your signature Date Daytime phone number Your spouse’s signature Date

Paid preparer’s signature Date Preparer’s phone number Preparer’s FEIN, SSN, or PTIN

IL-1040 back (R-12/11)

If no payment enclosed, mail to: If payment enclosed, mail to: ILLINOIS DEPARTMENT OF REVENUE ILLINOIS DEPARTMENT OF REVENUE PO BOX 1040 SPRINGFIELD IL 62726-0001 GALESBURG IL 61402-1040

DR AP RR DC

Step 8:

Other Taxes

Step 9:

Payments and Refundable Credit

Step 10:

Result

Step 11:

Underpayment of Estimated Tax Penalty and Donations

Step 12:

Refund or Amount You Owe

Step 13:

Sign and Date

Check, and complete below, if you want to allow another person to discuss this return with the Illinois Department of Revenue.

Designee’s Designee’s Name (please print) Phone number

Third PartyDesignee

Next year (in January 2013), we will no longer automatically mail 1099-G forms. Instead, we ask that you get this information from our website. Check the box if you still want us to mail you a paper Form 1099-G next year.

Form 1099-G Information

905

(815)742-2174

0

905

1,169

1,347

442

442

0

442

178

5 0 0 0 2 1 9 4

2 7 1 1 8 4 4 2 5


Self-Prepared

IL-1040 Schedule ICR (R-12/11)

You must complete IL-1040 through Line 15 and Schedule CR, if applicable, before completing this schedule.

The total amount of Illinois Property Tax Credit and K-12 Education Expense Credit cannot exceed tax. Only the Earned Income Credit may exceed tax.

ReadthisinformationfirstComplete this schedule only if you are eligible for the

IllinoisPropertyTaxCreditK-12EducationExpenseCreditEarnedIncomeCredit(EIC)

IllinoisDepartmentofRevenue

2011ScheduleICRIllinoisCredits AttachtoyourFormIL-1040

ContinuedonPage2

ILAttachmentNo.23

Step1:Providethefollowinginformation – –

Your name as shown on your Form IL-1040 Your Social Security number

Step2:Figureyournonrefundablecredit1 Write the amount of tax from your IL-1040, Line 15. 1 .00

2 Write the amount of credit for tax paid to other states from your IL-1040, Line 16. 2 .00

3 Subtract Line 2 from Line 1. 3 .00

SectionA-IllinoisPropertyTaxCredit(Seeinstructionsfordirectionsonhowtoobtainyourpropertynumber)

4 a Write the total amount of Illinois Property Tax paid during the tax year for the real estate that includes your principal residence. 4a .00 b Write the property number for the property listed above. 4b

c Write the property number for an adjoining lot, if included in Line 4a. 4c d Write the property number for another adjoining lot, if included in Line 4a. 4d e Write the portion of your tax bill that is deductible as a business expense on U.S. income tax forms or schedules, even if you did not take the federal deduction. 4e .00

f Subtract Line 4e from Line 4a. 4f .00 g Multiply Line 4f by 5% (.05). 4g .00

5 Compare Lines 3 and 4g, and write the lesser amount here. 5 .00

6 Subtract Line 5 from Line 3. 6 .00

SectionB-K-12EducationExpenseCredit

You must complete the K-12 Education Expense Credit Worksheet on the back of this schedule and attach any receipt you received from your student’s school.

7 a Write the total amount of K-12 education expenses from Line 13 of the worksheet on the back of this schedule. 7a .00

b You may not take a credit for the first $250 paid. 7b 250.00 c Subtract Line 7b from Line 7a. If the result is negative, enter “zero.” 7c .00

d Multiply Line 7c by 25% (.25). Compare the result and $500, and write the lesser amount here. 7d .008 Compare Lines 6 and 7d, and write the lesser amount here. 8 .00

SectionC-TotalNonrefundableCredit

9 Add Lines 5 and 8. This is your nonrefundable credit amount. Write this amount on Form IL-1040, Line 17. 9 .00

Page 1 of 4

norma J buchanon

905

905

0

905

0

3 2 9 5 0 5 4 6 2


IL-1040 Schedule ICR (R-12/11)

ScheduleICR—Page2

Step3:FigureyourrefundablecreditEarnedIncomeCredit

10a Write the amount of federal EIC as shown on your

U.S. 1040, Line 64a; U.S. 1040A, Line 38a; or

U.S. 1040EZ, Line 8a. 10a .00 b Multiply the amount on Line 10a by 5% (.05). 10b .00

c Illinoisresidents: Write 1.0.

Nonresidentsandpart-yearresidents: Write the decimal from

Schedule-NR, Line 48. 10c d Multiply Line 10b by the decimal on Line 10c. 10d .00

11Write the amount from Line 10d here. This is your Illinois

Earned Income Credit. Write this amount on Form IL-1040, Line 28. 11 .00

SectionBContinued-K-12EducationExpenseCreditWorksheet(continuedfromStep2,SectionB)

Youmustcompletethissectionandattachanyreceiptyoureceivedfromyourstudent’sschool.

12 Complete the following information for each of your qualifying students. If a student attended more than one qualifying school during the calendar year, please list separately. If you need more space, attach a separate piece of paper following this format.

A B C D E F Student’sname SocialSecuritynumber Grade Schoolname Schoolcity Totaltuition,

(K-12only) (ILK-12schoolsonlyorwrite (ILcitiesonly) book/labfees

“homeschool,”ifapplicable)

a - - b - - c - - d - - e - - f - - g - -

h - -

i - -

j - -

13 Add the amounts in Column F for Lines 12a through 12j (and the amounts from Column F of any additional pages you attached). This is the total amount of your qualified educationexpenses for

this year. Write this amount here and on Step 2, Line 7a of this schedule. 13 .00

Page 2 of 4This form is authorized as outlined under the Illinois Income Tax Act. Disclosure of this information is required. Failure to provide information could result in a penalty.

1.0000

3,557178

178

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Documents

Tax return (2)