Mitt and Ann Romney's 2011 estimated 1040 form

26.6 MB·English

by  mittromney.com

£1040

Department ofthe Treasuy-Inlemal Revenue Seniesa)
U.S. Individual Income Tax Return

20) he

2011, erg 2 ‘See separate instructions.

‘Your fst name and intel.

WILLARD M

Tasinane ‘Your social socufly number

ROMNEY

Tra fin retire, spouse a name ana aT Tastname

and on line 8 ae coe.

fr or pontameterteemn de core you hava Afoegn Sdleae, avo coilete space blow fue nahloreh Treat iaionGanoson
BELMONT MA 02478 fore lrrorsuad
Foreign cat wae Foreign provasa/enaiy Foam posi ade
USA
Filing Status + | Sinate 4 Ties of novsanci itn estas aon)
2 |X] atari ting jointly (even if only ene nad income) the ailing pene ew ia ye gendent, eter this
check only one 3 |_| Marri fling separately. Enter spouse's SSN above chs name ner,
box and fullname here. De 5 [J ovaiitying widower with depemaan? cil
Exemptions ¢ |X] Yes. sooo can clin yuo dpe donot hack boxe % \auese, Bie
POU al eee
© Dependents: (2) Dependent. (dmpencants ofa coal” 6" ined win you
fae tastnane | s2set secu number | editensinp to yoy Saarinen
pope te tem
‘irate ard Z pol enrad shove
o>
Total number of owempions chimed ea
Income 7 Wses, salaries, tos, ete, Alach Forms) W2 vay vg
Ba Taxable interest. Alach Schedule Bifrequiced = _ 4,099, 156.
Attach Form(s) Taxcexemptinteret. Do not include on line Ba
Where AIS 84 Ordinary dividends, Altech Schedule B if rei veeertete++-| 9a] 3,168, 867.
Wacsnd” ——b Qualified dividends... —_ - Le 11, 905, 753.
1089-8 ittex 40. Taxable refunds, credits, or offsets of salé and vee ee SPMD, 2.40 352, 905.
44 Alimony received é..g. eeeeer
42 Business income or ors) Aach Sebel or Gita 111! ‘ 12 110, 500
teaver: 13 Capital gsin or (oss), Atiach Schedule D Hegre. not quired, check here 13 | 10,700,179.
Eeomsivctos. 44 Other gains o (losses) Atach FOO" 47H... ve vv vv vp uve vveceeees 14 NONE
180 IRA distibutions . , asa | b Taxable amount»... , [18b.
16a Pensions and annuifés . . , 3, 18a bTexable amount... .. , [18b
nce, butde 17 Rental ral estat erships, S coporations, wusla te Atach Schedule... ,{ 47 | 2,830, 078.
hotatischany 18 Farm inconet6 se) tansScnedule F vee eee eee eee eee 18
bomen Aso, 49 Unemstoy ent ob BENSONON ee eee eee ence ees 48
Ferm Heiss. 208 Sociatseguilyboetis, , , , [208 bToxatio amount... , , [206
24 OtfBrincgine. Has type and amount _ 1 2 =352, 805.
22 _Cofibind!the amounts inthe far right column vough 21, Tiss vou total income | 22 | 20, 908, 680.
‘ PS nn
Adjusted 7%, certain isiness ‘expenses of reservists, performing artists, and
atoe asis government officials. Aaen Form 2108 or 108-62, | 24
Heath sevings account deduction, Attach Foem ase... . | 26
Moving expenses. Attach Form 3903 , ee -.. [26
Dedtuctible part of ee-employment tax Altach Schedule SE... || 27 7,805.
28 Self-employed SEP, SIMPLE, and qvalfieg plane... . +. [28
29° Self-employed hestth insurance deduction : 29
30° Penalty on early withdrawalof savings... - 2... .... | 30
31a Alimony pale b Rocisien’s SSN aa
32 IRAdeduCION. ee wares toon oS
43. Student loan intrest deduction, |. : oe Er
34 Tultion and foes, Attach Form 8917, 2. [se
35 Domestic production actives deduction. Attch Form 8903, . | , [36
36° Addlines 23 through 35 ee + NS es : 36 7,805.
37 _Subirac ine 36 from line 2, This is your adjusted gross a sz] 20, 901, 075.

For Disclosure, Privacy Act, and Pt

s

serwork Reduction Act Nof

Fom 1040 (2011)

a

Form prepared based on best available estimates, wnich will be appropriately updated prior to filing, See Statement A
Form ro4o20t1) WELLARD M ROMNEY & ANN D ROMNEY aoe 2

Tax and 38 Amount from ine 37 (adjusted gross income) ae onee 23.20 75.
Credits 39a Check { YYou were born before January 2, 1947, Blind. | Total Boxes
i ‘Spouse was born before Janvary 2, 1947, [| tind. J checked me 398

D It your spouse itemizes on a separate retun cx you were a dualsatusafen, check here De 390
Itemized deductions (trom Schedule A) or your standard deduction (see left margin) | |
41 Subliact tine 40 from EneS8 _
42 Exemptions. Multiply $3,700 by the number on tne 6d, | | | | | 42 7,400.
43° Taxable income. Subtract line 42 from line 41, If line 42 is more than line 41, enter ¥ . £431 15,205, 496,
44 Tax (see insteuctions). Check it any from: a[_] Forms) aaie bL_]rommaa72 e[ _]oezetecton [44 | 2, 988, 626.
45° Alternative minimum tax (see instructions). Attach Form 6251 | | | 224,425.
46 Addlines 44 and45 .. 3813, 051.
47 Foreign tex credit tach Form 11161 equred
48 Credit for child and depandent care expenses, A‘lach Form 2
43 Ecucalion credits from Form 8863, ne 23. , beset
50. Retirement savings contributions ered. Attach Ferm 8680. |,
51 Child tax-rodit (seeinsvvctions), |...
52 Residential energy credits. Alen Form 8695... ss sss
53. Other credits from Form: al_|asoo wl |ssor |

{401 5,688,179.
4115, 212, 896.

54 Addlines 47 through 53, These are your total credits... . NONE
55 Subtract line 54 from ine 48. I line $4 is more than line 45, enter 0. 3,213, 051,
56 Self-employment tax Attach Schadule SE, a 13,572.

57 Unreported social security and Medicare tax fom Form: a F

58. Asstonatxen Ras oer ui treme’ sas, le Ath FH en

59a Household employment taxes fram Sehecue H, a:

b Fitstaime homebuyer eredit repayment. Atach Form 5406 i rewuied ag

80 Other taxes. Enter coset) from instructions _ %

61_Ad lines 56 through 60, This is your total tax. vs as

Payments 62 Fedoral income tox withhels trom Farms Wie? and 1009, cng
83. 2071 estimated tax payments and amount appligg th 201a,euse | (63 | 3, 434, 441,

S4a Earned income credit (EIC) . d %

walt y Nontaxable combat pay election

Stilo #1] 66 Addtional child tax credit Altach Foon
86 American opportunity credit rom Fer

67 fo

68

_

st] 3, 226, 623.

ityoubaw a

a7 | 3,434, 441
Refund 73. Ivline 72is qare tea lng 61, subtract fine 61 fom line 72. Tiss the amount you overpaid... . | 73 207,818
1¢ 2g you wart refunded to you. If Form 8888 is allached, check here >) [ras
ic T]he tyre: [ Jehecking [| savings
Da Accouii.ngt I Lf I a
15,, Amount Hine 73 you want applied to your 2012 estimated tex > [78] 207, 618.
Amount 76 “Amount you owe. Subtract line 72 from Ine 61, For details on how to pay, sesinetructions . , , > | 76

See

You Owe <e77-.,Eslimatod tax penalty (sce instructions). Lar |
Third Paty @B0¥ Want Lo allow another person to cscuss ths rium vith the IRS (see mirucions) 71K ] Yes. Complete below No
D as roe Peso ie
ssionee “tyre DANIEL P,EEUSEEY ae soc |
Sign Set ey are tt ead, and corpo Declaration of pene foborbion pain c based a al hemmorsn onion pronase yee
iere Your sinh Das “Tou scepation Daye prove ember
Joie? Se ECU eiE
Spouses sijrawe Wa nt aah bow moe saa, Dae Spouse occupation Ia RAR RTT ROS
OME MAKE: [tenet
Prntliype prepare name Proper Sanatre Date col FIN
DANIEL P. PENELEY seisen
funsnane _) PRT CEWATERHOUS ECOOPERS LLP fans EN
Fervs tues 125 HIGH STREET Pore no
BOSTON ma 02110
sniee Fom 1040 (017)

Form prepared based on best available estimates, which will be appropriately updated prior to filing, See Statement A
SCHEDULE A i:
(Fema 1080) Itemized Deductions

OMB No. 1545.0074

2011

apace tie reas > attach to Form tue, > Soo nstructions for Schedule A (Farm 1040}, tach

Internat Revenue Serdoe,

Seeanoe he, 07

Name(s) shown on Form 1640
WILLARD M ROMNEY ¢ ANN D ROMNEY

Medical ‘Caution. D0 not include expenses rmburead or paid by cers,

41 Medial and dental expenses (seo nstucton 1
and 2 Enter smamtem Form oe
Dental a yi |

Expenses 3 Wout ine 2 by'7.5% (075)
4

aida

Taxes You § State and local (eneck only one box):

Paid a |X| income tes, oF 7 vee [Ss 1,323,094.
b ‘General sales taxes,
& Real estate taxes (see instucions) . 6... |B 226, 356.

Personal property taxes,
8 Other taxes. List ype and amount De

eee [Z 146. |

8 Add ines § through 8

596.

Interest 10 Home morigage interest snd points report ta you on Ferm 1098 [10
You Paid 11 Home morigageinterest not reported to you on Form 1088, I pal
to the person from whom you bought the nome, soo instruction

and show thal person's name, identiying ne, and aéess

Note.

4
Your morgane
intreot 12 Poin nt reported to you on Ferm 1098, See natuctongay
Gesveion may forspecalnios ssn
Belimtea (G50 413. engage nsurance prone ese nahucion)
Investment interest, Ailach Form 4952 if required. ‘Sexifli 46,033. STMT 4
45 Add lines 10 through 14... sae a 15 46,033.
Gifts to 18 Gis by cosh or chock Hfyou mos a
Charity noe sosinsivaine . . SEE, SERTERENDS. [16 100,000.
iyoumatea 17 Other than by ean or cheak. Hang gH
dentate _—_seoinstuctons, You mit otagFom 8280 [an 920,572. | | srw 4
Eenerke 43. Carryover tom pioryoor 18
88 instructions. 4g Add lines 16 through 18. pees 419 4,920, 572.
Casualty and Z
Theft Losses 20 veeeeee
dob Exponses 21 ge Change” joo wor ui oon,
and cert gg, 2108 a 21062 i equa Soe
Miscellaneous: A 2
Deductions 4, s
490,000.
ae Adi lines rouge 490, 000.
=Baornacentan
ce
2,2 tp Hin 35 by 2660) 418,022.
7 Subtract 26 from line 24. If line 26 is more than line 24, enter -O- ean 127. 71,378.
Biber 28 Other ro stm intratns List ype anc amount
Hiscetaneous
Deductions .
Total 29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount
Itemized ‘on Form 1040, line 40. — beeee wae [29 5,688,179.

Deductions 39 ir you clect to itemize deductions even though they are less than your standard

deduction, checkhere

For Paperwork Reduction Act Notice, see Form 1040 instructions,

158

‘Schedule A (Form 1040) 2011

Form prepared based on best available estimates, which will be appropriately updated prior to filing, See Statement A
(OMB Ne. 1545.

2011

Altochavert

SCHEDULE B
(Form 10404 or 1040)

Interest and Ordinary Dividends

> Attach to Form 40404 or 1040. mse

eportment ft asin Instructions on back.
[iba Revo Saree (9)

074

SqnencsN, 08

Hames} shown en velar
WILLARD M ROMNEY § ANN D ROMNEY

Part} 1 List name of payer. If any interest i from @ Selerfinanced mortgage and the
Interest buyer used the property as a personal residence, see instructions on back and list
interest ‘his interest frst, Also, show that buyer's social security number and address >

(See instructions
fon back and the
Instructions for
Form 1040A, or
Form 1040,

line 82.)

Note. If you
received a Form
1099-INT, Form
1099-010, or
substitute
statement from
a brokerage firm,
list the firm's
name as the
payer and enter

the total interest» 33 The amounis on 2 | 4,099.2

56.

shown on that
form. 3. Excludable interest on series EE and | U.S. savings ran

Attach Form 8815

4 Subtract line 3 from line
1040, fine 8a... = 4| 4,099,156.
Nate, fine 4 is over $1,500, you must complete Pail’ ‘Amount
Part 5 Listname of payer &

i A 172
Ordinary M 2,122.
Dividends M 579”
(See instructions — W 88
on back andthe 1,463, 483.
instructions for pie
Form 10404, or 415, 623.
Fou 1040, 2 5 [| 4.280, 800.
line 92.)

Note. Ifyou
received a Form
4098-DIV or
substitute

statement from
8 brokerage firm,

ft the f's
name as the
payer and enter
the ordinary
dividends shows 1049, 6 | 3,168,867.
"palatal ine 6 is over $1,500, you must complete Par i
“a You AVL comet spat t you te fas over 1,500 o ible wert o ordinary ddende HaTa YT
Part Ill %,, Y9ean account; of (e} received a distribution from, or were a grantor of, ora transferor to, aforeign trust. |¥€S| NO
Foreign“ 7a Atany time during 2011, did you have a financial interest in or signature authority over a financial
Accounts account (such as a bank account, securities account, or brokerage account located! in a foreign
country? Seoinstructions, 2... eerneees male
SPe TONS res" ote jou requted We Form 1D 90921 @ renee ine Kamael Reema oF smratue
vase ‘a authority? See Form TD F 90-22.1 and its instructions for filing requirements and exceptions to
feck) those requirements... voveeeae _ x
b If you are required to fle Form TD F 90-22.1, enler the name of the foreign country where the.
financial account is located > .
8 During 2011, did you receve a disivbution from, or were you the grantor of or tansteror to, a
foreign trust? It"Yes,” you may have to file Form 3520. See instructions on back . wee | [x
For Paperwork Reduction Aet Noll, see your tax return Instructions Schedule For totoa or Toa 2071

sayeoo ore * INCLUDES, 639,021. OF US TREAS OBLIGATION INT. FROM SCH K-1 SOURCES

Form prepared based on best available est

lates, which will be appropriately updated prior to filing, See Statement A
SCHEDULE C Profit or Loss From Business

(Form 1040) {Sole Proprietorship)
> For information on Schedule € and its instructions, go to www.irs.gow/schedulec

Department ofthe Treasury

Artachmont

Inveenal aovenue See 99) Attach to Form 1040, 1040NR, of 1041; partnerships generally must fe Form 1065. Sees. 09
‘Name of propretor on urban
WILLARD M_ ROMNEY

‘A Principal business or profession, Including preduct o: service (see instructions) a TE
LNDEPENDENT ARTISTS, WRITERS, PERFORMERS b> 711519
© “Business name. If no seperate business name, leave blank D_ einployeriD RumBerEDY), jes nary
AUTHOR/SPEAKING FEES

E Business adores (ncusing sutoorroemno) Pe

Cy. town oF post ofc, stale, and 219 code

F Accounting moves: (4) EX] Cash (2)[_] Accrust (3) [_] Other fepociid
S Did you "materially participate” inthe operation ofthis business ding 2011? Hf °No." see nstctons forint an
H—Hyou started or acquired this business during 2011, check here,

1 Did you make sry payments in 2011 that woutd require you to fle Form(s) 1088? (see inetuctions). .. . . ~ hy
Jat Ves," did you of will you file al eequired Eorme 10997.

Income

12 Merchant card and third pany payments For20\fenterO-.,.. ss cases
b Gross recsipts or sales nct entered online 1a (see instructions}... ss ss.
€ Income reported to you on Form W.2 ifthe "Statutory Emly” box on
that form was checked. Caution. Ses instr, before completing this ine, . ss.
4 Total gross receipt. Add lines ta through ©. 2... , 110, 500.
2 Retumns and allowances plus ary olher adjustments (¢0@ insiuctions)
3 Subiractline 2fromline 1d... ey 110,500.
4 Gost of goods sold (fem ne 42). |.
Gross profit Subtract ine 4 from lines. 110,500.
& Other income inclusing federal and state gasoline of fel tax ered a
7__cross income. Add ines 5 and6. cesses - 10, 500.
Expenses. Enter expenses for business use of your home only on line 30,
& Adwaising,....... 18. E_|a87%, Grice expense (eve inatuctons).... | 18 |
9 Gar and truck’ expenses (one "149.7 Pension and profitsharing lane... . | 49
instructions), , sonnet HO” Rentor lento (200 instructions)
40 Commissions andiecs | | || [ 40 A} Vehicles, machinery, and equipment .. | 200
11 Contract labor (see instructions) [14 E |b otner business property, , - [zon
12 Depletion, . , ...[ 22 24 Repairs and maintenance ||| ||| | 24
43° Depreciaian are” seston 178" Fo 22 Supplies (not induded in Party 22
expense deduction (net |. ae eee ete ve PE
Ineluded in Part oe
instructions) 24° Travel, meals, and entertainment
14 Employes benefit eS 71
{other than on tine 19), Deductible meats anc
15 Insurance (other tha entertsinment (see instructions)...
48 ntorot: tities
Other expenses (rom tne 48). , |
“5 bb _Reserved for future use
28 “Giponses betore expenses for business use afhame. AdG lines 8 twoush 27a... , veeee
23 ‘Vesprofit oF (loss). Subtract line 28 fromline 7... a 110, 500
30 Eigeliggs Terbusiness use of your home, tach Form 8829. De not report euch expenses elsewhere
31. Net profitor (loss). Subiact line 30 trom ine 28
+ Ifa profit. enter on both Form 1040, ine 12 (or Form 1040NR, line 13) and on Schedule SE, tne 2.
It you entered an amount on line 1, see inst. Estates and trusts, enter on Form 1041, line 3
4 If oss, you must go to line 32. 4 110, 500.

32 I youhave a loss, check the box that describes your investment in this actvly (see instructions)
'# Ifyou checked 32a, enter the loss on bath Form 1040, line 12, (ot Form 1040NR, line 43) and
‘on Schedule SE, line 2. If you entered an amount on line fc, see the insteuctlons for line 31 32a
Estates and truss, enter on Form 1041, line 3. 32b
+ Ifyou checked 32b, you must attach Form 6198. Your loss may belie.

For Paperwork Reduction Act Notice, see your tax return Instructions. ‘Scheaule © (Form 1040) 2071

Form prepared based on best avail = leest = which will be appropriately updated prior to filing,

See Statement 4
(Form 1040)2011 WLLLARD M ROMNEY ep:
Cost of Goods Sold (see instructions)

83 Mato) used Teor [Tower eostarmarct [J oter fattochexlontn)
24 Mate yee ain cuits cass whan eangantceungioeiny?
35 Inventory at beginning of veer. dierent fom lat you's clsinginverery, attach elaraon, [38

26 Purchases less costo temsithdrawn fr personause ceeeee a6

37. Cost of labor, Do not include any amounts paid to yourself

38 Materials and supplios |

39° Othercosts

40 Acdlines 25 through 29

41 Inventory at end of year ,

a

42 _ Cost of goods sold, Subtract line 41 from line 40. Enter the rocukhere andonlineé . sss hs « sin = «| 42

GEGEN Information on Your Vehicle. Complete this part only if you are claimffig Car or trick expenses on line 9
and are not required to file Form 4562 for this business. See the instquatfons for line 13 to find out if you must
file Form 4562. £

43. When old you ple your vehiclein senice fer business purposes? (month, cay, yest)“

44 Of the total number of miles you drove your vehicle during 2011, enter

4 me.
4s .. Caves Ene
3 _. Loves ne
474 Do you have evidence lo suppor your daaucton. BS wee - Clves Tne

tives isthemiimcewiior «fest, mae. wee [Tle [ne

‘Other Expenses. List below businéss expenses not included on lines 8-26 or line 30.

‘$8 Total other expenses. Enter here and on ine 27a 48

‘Schedule ¢ (Form 1040) 2077

Form prepared based on best available estimates, which will be appropriately updated prior to filing, See Statement A
SCHEDULE D Capital Gains and Losses | OM No. Teseso0rt —
(Form 7040) | PrAttach to Form 1040 or Form 1040NR. Dr See Instructions for Schedule D (Form 1040) 2011
Litera Rave Soe 9, D Use Form 8949 to list your transactions for lines 1, 2, 3.8, 8, and 10.

Name(s) shown on rem
WILLARD M ROMNEY & ANN D ROMNEY

Part Short-Term Capital Gains and Losses - Assets Held One Year or Less

Complete Form 8949 before completing fine 1, 2, or 3, Je) Sales price tom | (1) Costor other basis. | (g) Adjusiments to (h) Gain oF (loss)
This form may be easier to complete you round of cans to |? | Humromersee” | ASE | camer,
tho dor ene [os

1

Short-term totals from all Forms 8949 with box A

checked inPartl.... « ulna ( 1
2° Short-term totals trom all Fors 8949 with box 8
checked in Part I. eee wee ig i
3 Shorterm totals from all Forms 6949 with box C
checked inPartl. vs es sees seca esse Ci
4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6761, and 0624... <t. [4 166,224.
5 Net sortion gain or (ois) from partnerships, © covporatens, estes, ang wists tah
Schedule(s) K-1 se... sees ee + SEE. STATEMENTS “Ree, | 6 923, 858.
6 Shortterm captal loss carryover. Enler the amount, any. from line 8 of your C
Worksheet in the instructions. ren 6 )
7 Not short-term capital gain or inrough
long-term capital gains o losses, goto Part below. Otherwise, go to Part Iai 7 11,090, 082
EEE] Long-term Capital Gains and Losses - Assets Held More Than One-Year
Complete Form 8949 before completing line 6,9, oF 10. | (alse prewtom | up Gaatoreierbess | tghAdustraniso | _ (}aim or oss)
This form may be easier to complete it you round oft cents ta |! *™"LRhiency"es:| "i eritmrin | SPanmaeran | Combine cums a
whole doliars sige ef)
& Long-term totals from all Forms 8848 with box A
checked inPart essa vase ssiceass )
9 Long-term totals trom all Forms 8949 with box.
checked inPart se seve ee
10 Long-term totais trom all Forms 8949 wit
checked in Pare. : a
4 Gain rom Form 4787, Part long-term @aln fe fer Forms 2439 and 6252; and long-term gain oF (loss)
from Forms 4684, 6781, and 8824,.=: . nee ow wee ss ey SE 250, 247
g STMT 8
42 Net long-term gain or (loss) ot ares 1s, S corporations, estates, and trusts from Schedule(s) K-1 | 12 | 9, 320, 634
13 Capital gain cistibutionsiee. thecigstucions cesses STME. 9. [13 39, 216.
44 Long-term capital loss:serridver. Enier the amount, it any, from tine 13 of your Capital Loss Carryover
ee tenes vee [WE )
45 Net fong-term capitalain or (oss). Combine lines & through 14 in column (f). Then go to Part Il on
the back»... - eee pares sores 415 | 9,610,097,

"Setidule D (Form 1040) 2073

Form prepared based on best available estimates, which will be appropriately updated prior to filing, See Statement A.
WILLARD M ROMNEY & ANN D ROMNEY
‘Schedule D (Form 1040} 2011

Summary

48 Combine lines 7 and 15 and enter the result . 16 10700179.

'* If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1O40NR, line
14. Then go to line 17 betow.

‘If fine 16 is a loss, skip linas 17 through 20 below. Then go to line 21. Also be sure to complete
line 22.

If tine 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form |=
1040NR, line 14. Then go to line 22

417 Ase lines 15 and 16 both gains?
X] Yes. Go to line 18,
No. Skip tines 18 through 21, and go to tine 22.

18

19 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gai
instructions

20 Are lines 18 and 19 both zero or blank? é e
X] Yes. Complete Form 1040 through fine 43, of Form 1040NR thrdligh line.44. ‘then complete
the Qualified Dividends and Capital Gain Tax Workshect in tho instuctions fof Form 1040. line

No. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete the
Schedule D Tax Worksheet in the instructions. Do not complete lies 21 and 22 below.
e

24

Note. When figuring which amountisssmaliéy, treat both amounts as positive numbers.
22 Do you have qualified dividends @n Form 1040, ine db, or Form 1040NR, tine 1067

[7] Yes Complete Form 1041 ‘ucough tine 43, or Form 1040NR through line 41. Then complete
the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040
line 44 (or inthe ingtrucions for Form 1040NR, line 42)

No, Complete.the. reafof Form 1040 or Form 1040NR.

‘Schedule D (Form 1040) 2011

Form prepared based on best available estimates, which will be appropriately updated prior to filing, See Statement A
SCHEDULE E Supplemental Income and Loss | ove no. 1845-0674
(Form 1040) (From rentaf real estate, royalties, partnerships, 2011
epee ne rest 'S corporations, estates, trusts, REMICS, etc.) Pea
Breyaeteplavey BN > Attach to Form 1040, 1040NR, oF Form 1044, De-See separate instructions. ecnment yy

amet) show ene
WILLARD M ROMNEY & ANN D ROMNEY

‘A. Did you make any payments in 2011 that would require you to fle Form(s) 1099? (see instructions)
B If "Yes." did you or will you Tle all required Forms 1099?

Income or Loss From Rental Real Estate and Royalties N:
Schedule © or C.EZ (see instructions. If you are an individu, report farm rental income 0: loss from Form 4836

if you are in the business of renting personal property, use

on page 2, line 40,

Caution. For each rental property listed on line 1, check the box in the last column only if you owned that property as a member of a

qualified joint venture (QJV) reporting income not subject to set-employment tax.

1 | Physical address of each property-street,ciy, state, zip | Type-from It [2 For each renial eal Fair Rental]
‘below | estate property listed, Dae alt ov
report the number of pars
Alt YY 1995 FA days rented at fair rental [A |”
is ae value and days with ai
| personal use. Soe
= instructions,
Type of Property:
4 ‘Single Family Residence 3 Vacation/Short-Term Rental 5 Land 7 Sali-Rental
2_MultiFamily Residence 4 Commercial 8 Royalties 8 Other (dosefiley
Income: PT Prey
€
3a_Merchant card and third party payments. For 2011, enter-0- [3a
b Payments not reported to you online 3822. -sseess2s| 3b
4 Total not including amounts on line 3a thal are not Pr
income (se instructions) 4
Expenses:
5 Advertising. estar
6 Auto and travel (see insiuctions) .
7 Glening and maintenance
8 Commissions se aoe
9 Insurance...
10
"
12
13. Other interest
14 Repais |,
16 Supplies | |
16 Tees...
47 Utiiies | |
48 Depreciation exoense or de
419° Other dist) 49
20 Total expenses. Addsifies § Pr [ze
21 Sublract line 20 ‘foi,
instructions tafind out f Yau must le Form 6198... , . [2 6,848.
22 Deductible rerialreal estale loss afler limitation, if any,
Ic )
1 Total of ll aniBunts reported online 3a forall royaty prepares... '
¢ Total of allmounts reported online 4 for alrental properties... :
Total ofall amounts reported online 4 forall royaky properties... —_ 6, 648.
«© Total ofall amounts reported online 12 forall properties :
1 Tolal ofall amounts reported online 18 fora propertios :
{9 Total ofall amounts reported online 20 for al properties serene :
24 Income, Add positive amounts shown on line 21. Do notinclude any losses ok ee ee a G, 848.
25 Losses, Ads royalty losses from fine 24 and rental rest eslae losses fromline 22. Enter total lasses here... 2... [2B
26 Total rental real estate and royalty income or (loss). Combine lines 24 and 25, Enter the result here.
1 Parts HM, IW, and tine 40 on page 2 do not apply to you, also entar this amount en Ferm 1040, Ine
17, orForm 1040NR, tine 18. Otherwise, include this amountin the total on ine 44 on page 2 ...|2 6,848.
For Paperwork Reduction Act Noilse, see your tax return Instructions. ‘Schedule E (Form 1040) 2017

Form prepared based on best available estimates, which will be appropriately updated prior to filing, See Statement A
Schedule & Form 1040)2011 Altachenl Sequonca No. 13
Name(s) shown or reirn. Do nol enlername and sdal eazy number shown On Oe He ‘You soctal securiy num
WILLARD M ROMNEY & ANN D ROMNEY

Caution The IRS compares amounts reported on your tax return with amounts shown on Schedulb(s) K+

EEE income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for which
any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See instructions,

37 We ou reoerng ary lms ot alowed in = por yer on to Uw ai or bai misters @ pror yom
Uunallowed loss from 2 passive activity (if tnat loss was not repertes on Form 8582), or unreimbursed Lives [K] No
Darrsi Speses I you sneered Yas" seesrutens sere compltig he econ

(ear Pt BICReaT] —— rena wry
ra Name Mirwtee'’s ["lesr | Soames | Syancnta
eS spain | "ete

A|INTERCONTINENTAL REAL ESTATE INVEST -

BIROB ROM ENTERPRISES LLC P

7 r

o| Fa

STMT 10 Passive Income and Loss. Nonpassive Income and Loss.4°
cant Pormsee Frotneo) | AnEcwanores | Mm sthecuenct | alitowtameomg Wea &|, ty lon Sehecte a

A 1,429. #

B| NONE}

cl

289 Tota

0 rot

30 Add columns (g} and () of ine 298 | .. [30 1,429.

31 Add columns (1), {h), and {i} ofline 296 . pitt d

32 Total partnership and § corperstion income or oss}. Combine hnes 30 and 31 Enter he
resull here and include in the total on ling 41 below... - pee ee ee | 2 1,429.

Income or Loss From Estates and Trusts

memes,

33 (a) Name deniteation number

A|_SEE STATEMENT 17 a
B Z
STMT 12 Passive Income and Loss “ass Nonpassive Income and Loss STMT 13.
‘assive deduction or = Pabtldincome {9} Deduction artoss ther Income
(aca Form S582 Heegured) ergsenstute 1 ‘am Seneca Shed
A 2
7 a
34a Totals a 2,625, 388. 197,624.
b Totals fer

as] 2,823, 012.

36 Add columns (@) and (of We 34
“ 36 1( 1,211.)

36 Add columns (c) and (e}afur eb
37 Total estate and trustincoite or figss)

Include inthe total Gino below... .../37] 2,821, 801.
Income or Lags From Real Estate Mortgage Investment Conduits (REMICs) - Residual Holder

(c) Excess ndusion fom

(Enso ewuteen eae eaen FR) Tawi coe tke) anaes
y — See ne | Oe rmoraicene | scat as
39 Combiné.columas (¢) and (e) only. Enter the result here and include in te total on Ane 41 below... ET

fzuad Summary

40 Nelo reral inca ofa fon Form 835. Aso,conpeieine #7 blow - a

41 Total income or 1os9). canine ines 26,32, 37, 36,2 4. Entre reut nae aon Fou 1085, ns FoF YOUN, 1 ai | 2,830, 078.
42 Reconciliation of farming and ishing Income, Enter your gross
aiming and fishing income reported on Form 4835, line 7: Schedule K-t
(Form 1085), box 14, code B, Schedule K-t (Form 1120S), box 17, code
U; and Schedule K-1 (Form 1041} line 14, code F (se inettions) ws... 42
43. Reconellation for real estate professionals. If you were a real” estate
professional (see instructions), enter the net income or (loss) you reported
‘anywhere on Form 1040 of Form 1040NR from all rental real estate activities
In which you materially participated under the passive activly loss ules... a

‘Schedule & Form 1040) 2011,

Form prepared based on best av:

ble estimates, which will be appropriately updated prior to filing, See Statement A