Revised 5/25/2010
From Worksheet Last Name First Name Middle Name (page 3) $60,000 INCOME LIMIT ... Taxable & Tax Exempt Veterans Disability Benefits Dividends Alimony Debt Write-Off Business Profit/Loss Rents/Royalties Capital Gains/losses State Tax Refund Pension Annuities (Gross Amt. less rollover) Gambling Winnings IRA (Gross distribution less rollover) List Other Income: IF YOU DID NOT FILE A … ................
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