John A. Kennedy, Jr., LLC
	Certified Public Accountant
	INCOME
Wages and Salaries
		Employer Name	Gross Wages	Taxable Wages	Federal Tax WH	State Tax WH	Fica WH	Medicare WH
	1
	2
	3
	4
	5
	6
Interest and Dividend Income
		Source	Interest Amount	Ordinary Dividends	CG Dividends	NT Dividends
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
Gains/Losses from Sales of Stocks, Securities and Other Capital Assets
		Property Sold	Date Acquired	Date Sold	Sales Price	Cost Basis
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
Other Income						Adjustments to Income
			Income Amount- Taxpayer	Income Amount- Spouse				Taxpayer Amount	Spouse Amount
	1	Taxable state tax refunds			1	Educator expenses
	2	Alimony received			2	IRA deduction
	3	Business income- Schedule C			3	Student loan interest
	4	Other gains (losses)- Form 4797			4	Moving expenses
	5	Total IRA distributions			5	SEP, SIMPLE, qualified plans
	6	Total pensions/annuities			6	Penalty on early withdrawal of savings
	7	Rents, royalties, trusts, S corps, partnerships- Schedule E			7	Alimony paid
	8	Farm income- Schedule F
	9	Unemployment compensation
	10	Total social security benefits
	11	Tips received
	12	Child care taxable benefits
	13	Prizes/awards
	14	Scholarships/fellowships
	15	All other income