2010 tax return documents: how poor i am, but so rich in faith !

8/7/2019 2010 TAX RETURN DOCUMENTS: HOW POOR I AM, but SO RICH IN FAITH !

http://slidepdf.com/reader/full/2010-tax-return-documents-how-poor-i-am-but-so-rich-in-faith- 1/15

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PRESORTED

FIRST -CLASS

U.S, POSTAGE

SACRAMENTO.

PERMIT NO_PO Box 826880, Sacramento, CA 94280-0001

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE $300

Important Tax Information

Keep for your records

'See Reverse Side for Easy Opening Instructions'

***********AUTO"'''5-DIGIT 90265

1 1 . 1 " I I " ! i I . I I I I I I I I ' I I . I I I I " I I I I I I . I . I I ' I I . I I I , I ' 1 1 1 , 1 , , 1 1 . 1

PHILIP A KOK

PO BOX 152

MALIBU CA 90265-0152

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OMS NO 1545-01COPYB FORM 1099G CERTAIN GOVERNMENT PAYMENTS

2010FOR RECIPIENT REPORTOFTAXABLEUNEMPLOYMENTCOMPENSA.nONPAYMENTSFROMTHESTATEOFCALIFORNIA

Form 1099G Rev

Employment 'Development Department Recipient's Name Social Security NuUnarnployment lnsursnceIntegrilyandAccountingDlvlslon . MICloA

PHILIP A KOK 368-76-3890r- .o, Bo, 2408RanchoCordova.CA95741-2408

Payer's Federal.ID No. 94-2650401 2. State or Local Income Tax 3. Box 2 Amount is For Tax Year 4. Federal Income

1, UnemploymMt Compensation (UC) Refunds, Credits, or Offsets Tax Withheld

$5,250 $464

Type of UC Payments 201 0 Benefits Repaid

Ul$ 5,250 (a) $0..00

Prior Year(s) Benefits Repaid

(b) $0.00

This is important tax information and is being fumlshed to the Internal Revenue Service (IRS). If you are required 10 f ile a return, a negligencepenalty Orother sanctlon may be imposed on you if this income istaxable and the IRSdetermines that i t has nOI been reported.

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FORM 1099G CERTAIN GOVERNMENT PAYMENTS OMB NO. 1545-01COPYB

FOR RECIPIENT REPORTOFTAXABLEUNEMPLOYMENTCOMPENSATION,PAIDFAMILYLEAVEPAYMENTSFROMTHE 2010STATEOFCAUFOR'N'A

Form 1.099G Rev

Employment Development Department Recipient's Name Social Security NuUn.employment tnsurance Integrity and Account3tlg

Div is lon - MIC16A

PHIUPA KOK 368-76-3890=.o. Box2408R.n"hoCordova.CA95741-2408

Payer's FederallD No. 94-2650401 2_Slate or Local Income Tax 3. Box.2 Amount is For Tax Year 4. Federal Income

1, Unemployment Compensalion-Paid FamilyRefunds, Credits, or Offsets Tax Withheld

Leave (UC-PFL) $0.00

$0.00 PFL Payments 2010 Benefits Repaid

$0..00 (a) $0.00

Prior Year(s) Benefits Repaid

I(b) $0.00

This is important lax informalion and is being furnished to theiRS. I fyou are required to fi le a return, a negligence penal ty or other sanctionbe imposed on you i f this income is taxable and the IRS determines that it has not b",enr-eported.

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CLIENT 63890K

YANG & COMPANY, CPA A PROF. CORP.

1300 E. MAIN ST., STE #205

ALHAMBRA, CA 91801

(626) 286-1618

February 14,2011PHILIP ANTHONY KOK

POBOX 152

MALIBU, CA 90265-0152

Dear Philip Anthony,

Your 20 I0 Federal IndividualIncome Tax return wi II be electronically filed with the Internal

Revenue Service upon receipt of a signed Form 8879 - IRS e-file Signature Authorization. No

tax is payable with the filing of this return. You will receive a refund of$633.

Your 201 0 California Individual Income Tax Return will be electronically filed with the State of

California upon receipt of a signed Form 8453. No tax is payable with the filing of this return.

You will receive a refund of$52.

Please be sure to call if you have any questions.

Sincerely,

CHRISTI HUANG YANG, CPA



YANG & COMPANY, CPA1300E. Main St. #205 .Alhambra, CA 91801Tel: (626) 286-1618 Fax: (626) 289-0678

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Feb 11,2011

PHILIP ANTHONY KOK

POBOX 152

MALffiU, CA 90265

YANG AND CO., CPA

A Professional Corp.

1300 E Main St. #205

Alhambra, CA 91801

Tel: 626-286-1618

Professional Service Rendered:

2010 Fed & CA Tax Returns -- 10 % off

Total Invoice

Payment Recei ved

TOT AL BALANCE

Invoice 35104

45.00

45.00

$ 45.00

- - ---------- -- ------ --



Feb 11, 2011

PI-llLIP ANTHONY KOK

POBOX 152

MALmu , CA 90265

YANG AND CO., CPAA Professional-Corp.

1300 E Main St. #205

Alhambra, CA 91801

Tel: 626-286-1618

Professional Service Rendered:

2010 Fed &CA Tax Returns -- 10 % off

Total Invoice

Payment Received

TOTAL BALANCE

Invoice 35104

45.00

G - - c . .

45.00

$ 45.00



059

DO NOT MAIL THIS FORM TO THE FT

D a t e A c c e t e d

T A X A B L E Y E A R

2010 California e-file ReturnAuthorization for IndividualsF O R M

8453

P O B O X 1 5 2

I Api ne.rste. no.

Spouse','RDP', SSN or ITIN

Your first name and initial Last name Your SSN or ITIN

P H I L I P A N T H O N Y K O K 3 6 8 - 7 6 - 3 8 9 0If jOint return, spo",e'sIRDP's first name and initial Last name

1\ddress (include number and street. PO Box or PM8 no.) Daytime telephone number

City

M A L I B U , C A 9 0 2 6 5 - 0 1 5 2

State ZIP Code

Part I Tax Return Information ( w h o le d o ll a rs o n ly )

1 C a li fo rn ia a d ju st e d g ro ss in c o m e . ( F o r m 5 4 0 , l in e 1 7 ; F o r m 5 4 0 2 E Z , l in e 1 6 ; L o n g F o r m 5 4 0 N R , l i n e 3 2 ; o r S h o rt F o r m 5 4 0 N R , l in e 3 2 ) . .

2 R e fu n d o r n o a m o u n t d u e . ( F o rm 5 4 0 , l in e 1 1 5 ; F o r m 5 4 0 2 E Z , l in e 2 8 ; L o n g F o r m 5 4 0 N R , l in e 1 2 5 ; o r S h o rt F o r m 5 4 0 N R , l in e 1 2 5 ) . . .

1 9 6 1 7 .

2

3 A m o u n t y o u o w e . ( F o rm 5 4 0 , j m e 1 1 1 ; F o r m 5 4 0 2El , l i n e 2 7 ; L o n g F o rm 5 t tO N R , l in e 1 2 1 ; o r S h o r t F o rm 5 4 0 N R , l in e 1 2 1 ) . . . . . . . . . . • . 3

5 2 .

Part II Settle Your Account Electronicall for Taxable Year 2010 ( D u e 041l51l1)

4 D i r e c t deposi t o f r e fu n d 5 D E l e c tr o n ic f un d s w i t h d ra w a l 5a A m o u n t 5b W i th d ra w a l d a te ( M M / D D /Y Y Y Y )

P rt III M k E' d T P t f T bl Y 2011a a e stimate ax aymen 5 or axa e ear T h e s e a re N O T in s t a llm e n t p a y m e n ts f o r t h e c u r r e n t a m o u n t y o u o w e .

F i r s t P a y m e n t D u e 4115111 S e c o n d P a y m e n t D u e 6fl5fl1 T h i r d P a y m e n t D u e 9115111 F o u r t h P a y m e n t D u e 111711

6 A m o u n t

7 W i th d ra w a l d a te

Part IV Bankmg Information ( H a v e y o u v e r i f ie d y o u r b a n k in g in f o r m a t io n ? )

o S a v i n g s

12 T h e r e m a in in g a m o u n t o f m yr e fu n d f o r d i r e c t d e p o s i t . . .

13 R o u t in g n um b e r

14 Account n u m b e r

15 T y p e o f a c c o u n t :

8 A m o u n t o f r e f u n d 10 b e d ir e c t lyd e p o s i t e d t o a c c o u n t b e lo w . .

9 R o u t in g n u m b e r

10 A c c o un t n u m b e r

11 T y p e o f a c c o u n t : 0 C h e c k i n g o C h e c k i n g D S a v i n g s

Part V Declaration of Taxpayer(s)

I a u t h o r iz e m y a c c o u n t b e s e t t le d a s d e s ig n a te d i n P a r t I I . I f I c h e c k P a rt I I , B o x 4 , I d e c la re t h a t t h e d ir e c t d e p o s it r e fu n d in fo rm a t io n in P a r t I V a g r e e s w it h t h e a u t h o r iz a t io n s t a te do n m y r e tu rn . I f I c h e c k P a rt I I , B o x 5 , I a u t h o r iz e a n e le c t r o n ic fu n d s w it h dr a w a l f o r t h e a m o u n t l is t e d o n S a a n d a n y e s t im a t e d p a y m e n t a m o u n ts l is t e d o n l in e 6 f r o m t h e a c c o u n tl is te d o n l in e s 9, 1 0 , a n d 1 1 . If I h a v e f i le d a jo in t r e tu rn , t h is is a n i r r e v o c a b le a p p o in tm e n t o f t h e o th e r s po u s e / R D P a s a n a g e n t t o r e c e iv e t h e r e fu n d o r a u t h o r iz e a n e le c t r o n ic f u n dw i t h d r a w a l .

U n d e r p e n a lt ie s o f p e r ju ry , I d e c la re t h a t t h e I n fo rm a t io n I p ro v id e d t o m y e le c tr o n ic r e tu rn o r ig in a to r ( E R O ) , t r a n sm i t t e r , o r in te rm e d ia te s e r v ic e p ro v id e r , in c lu d in g m y n a m e , a d dr e sa n d s o c ia l s e c u r i t y n u m b e r ( S S N ) o r i n d iv id u a l t a x p a y e r id e n t i f i c a tio n n u m b e r ( IT IN ) , a n d t h e a m o u n t s s h o w n in P a rt I a b o v e a g r e e s w it h t h e in fo rm a t i o n a n d a m o u n ts s ho w n o n t h e

c o rr e s p o n d in g l in e s o f m y 2 0 1 0 C a l i fo rn ia in c o m e t a x r e tu rn . T o t h e b e s t o f m y k n o w le d g e a n d b e l ie f, m y r e tu rn is t r u e , correct a n d c o m p le t e . If I a m f i l in g a b a la n c e d u e r e tu rn , Iu n d e r s ta n d t h a t i f t h e F ra n c h is e T a x B o a r d ( F T B ) d o e s n o t r e c e i v e fu ll a n d t im e l y p a y m e n t o f m y t a x l ia b i l i t y , I r e m a in l ia b le fo r t h e t a x l ia b i l i t y a n d a ll a p p li c a b le in t e re s t a n dp e n a lf ie s . I a u th o riz e m y r e tu rn a n d a c c o m p a n y in g s c h e d u le s a n d s ta t e m e n ts b e t r a n sm i t t e d t o t h e F T B b y m Y E R O , t r a n sm i t t e r , o r in t e rm e d ia te s e r v ic e p ro v id e r . I f t h e p ro c e s sin g om y r e tu rn or r e f u n d is d e la y e d , I a u t h o r iz e t h e F T B t o disclose t o m y E R O , in te n n e dia te s e r v ic e p ro v id e r , t h e r e a s o n (s ) fo r t h e d e la y o r t h e d a te w h e n t h e r e fu n d w a s s e n t

SignHere

~- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - -

Spouse'sIRDP's sig~atl"e. If fil ing jointly, both must sign. DateYour signature Date

It is unlawful to forge" SpousfJ"sIRDP's signature.

Part VI Declaration of Electronic Return Originator (ERO) and Paid Preparer. See i n s t r u c t i o n s .

I d e c la re t h a t I h a v e r e v ie w e d t h e a b o v e t a xp a y e r 's r e tu rn a n d t h a t t h e e n t r ie s o n fo rm F T B 8 4 5 3 a re c o m p le te a n d c o r r e c t t o t h e b e s t o f m y k n o w le d g e . ( I f I a m o n ly a n I n te rm e d ia teS e rv ic e P ro v id e r , I u n de rs ta n d t h a t I a m n o t r e s p o n s ib le fo r r e v ie w in g t h e t a x p a y e r's r e tu rn . I d e c la re , h o w e v e r , t h a t f o rm F T B 8 4 5 3 a c c u ra te ly r e f le c ts t h e d a t a o n t h e r e tu rn .) I h a v eo b t a in e d t h e t a x p a y e r 's s ig n a tu re o n fo rm F T B 8 4 5 3 b e fo re t r a n s m it t in g t h is r e tu rn t o t h e F T B ; I h a v e p ro v id e d t h e t a x p a y e r w it h a c o p y o f a ll f o rm s a n d in fo rm a t io n t h a t I w il l f i le w it h e F T B , a n d I h a v e f o llo w e d a ll o th e r r e q u ir e m e n t s d e s c r ib e d in F T B P u b . 1 3 4 5 , 2 0 1 0 e - f i le H a n d b o o k fo r A u t h o r iz e d e - f i le P ro v id e r s . I w il l k e e p fo rm F T B 8 4 5 3 o n f i l e f o r f o u r y e a rsf r o m t h e d u e d a te o f t h e r e tu r n o r f o u r y e a rs f r o m t h e d a t e t h e r e tu r n is f i le d , w h ic h e ve r is la te r, a n d I w il l m a ke a c o p y a va ila b le t o t h e F T B u p o n r e q u e s t . I f I a m a ls o t h e p a idp re p a r e r , u n d e r . p e n a lt ie s o f p e rju ry , I d e c la r e t h a t I h a v e e x a m i n e d t h e a b o v e t a x p a y e r's r e tu rn a n d a c c o m p a n y in g s c h e d u le s a n d s ta t e m e n ts , a n d t o t h e b e st o f m y k n o w le d g e a n db e lie f, t h e y a re t r u e , c o rr e c t, a n d c o m p le te . I m a k e t h is d e c la ra t io n b a s e d o n a ll in fo rm a t io n o f w h ic h I h a v e k n o w le d g e .

IDate I Check ~ I C ' l e c k IERO'S SSNIPTINERO's ..._ also paid r.:l if self- nsignature ,.. C H R I S T I H U A N G Y A N G , C P A preparer IX I employed P O 0 1 5 0 3 4 9

EROMustSign

A L H A M B R A , C A

6 8 - 0 5 3 6 0 7 8Firm's name (or yours ..._if sa lt- amployed) ,..and address

_ Y : : . : A ; . : , N : : . . ; . ; : : : G _ _ ; : & : , _ _ : C = - O : : . : M : . = _ PA : : . = . c N : _ : : y ' - ' , _ _ _ _ c C = - P = - A : . : : _ . : : _ : A : _ : : P : _ : : R _ ; _ O ; ; . ; F : : . . . . ; , . ._ _ ; : C . . . : O . . : ; R . . ; _ P - - , - ' - - ; FEIN

1 3 0 0 E . M A I N S T . , S T E # 2 0 5

ZIP C o d e 9 1 8 0 1Under penalties of perjury. I declare that I have examined the above taxpayer's return and accornpanymq schedules and statements. and to the best of my knowledge and bel ief. they are truecorrect. and complete. I make this declaration based on all information 01 which I have knowledge.

PaidPreparerMustSign

Paidpreparer's ..._signature ,...-

I Date

I n IPaid preparer's SSNIPTIN

Check ifselt-ernployec

ZIP C o d e

Ftrm's name(or yours i fse If -emp Ioyed)and address

__________________________________________________________ _,FEIN

For Privacy Notice, get form FTB 1131. CAIABlOl L 1211511a FTB 8453 C2 201



For Privacy Notice, get form FTB 1131. CAIA3912L 1212

California Resident FORM

Income Tax Return 2010 540 Cl Side

APE DO NOT ATTACH FED RETURN

P

368-76-3890 KOK 10 AC

PHILIP A KOK A

R

RP

POBOX 152MALIBU CA 90265-0152 01-20-1967

01 1 72 0 408 0 APE 0

06 0 73 0 410 0 FS 0

09 0 74 0 413 0 3800 0

10 0 75 0 415 0 3803 0

12 9617 76 0 416 0 SCHG1 0

14 5250 77 0 417 0 5870A 0

16 0 78 0 418 0 5805 5805F 0

17 9617 91 52 110 0 DESIGNEE 1

18 3670 92 0 111 0 TPIDP 00150349

31 74 93 52 112 0 FN 680536078

34 0 94 0 113 041 0 95 0 115 52

42 0 400 0 116 0

43 0 401 0 117 0

44 0 402 0

45 0 403 0

46 60 404 0

61 0 405 0

62 0 406 0

63 0 407 0

64 0

71 52

Your email address ( opt ional). Enter only one.

Paid preparer's s ignature (declarat ion 01 preparer is based on all information of which preparer has any knowledge)

CHRISTI HUANG YANG, CPA• FEIN

I t is unlawfu lto forge aspouse's/RDP'ssignature.

Joint return?(Seeinstructlons.)

• Paid Preparer's PTINISS

P00150349Firm's name (or yours, if selt-ernployec) Firm's address

YANG & COMPANY, CPA A PROF. CORP.

1300 E. MAIN ST., STE #205

ALHAMBRA, CA 91801 68-0536078

DD you want to allow another person to discuss this return with us (see instructions)? , .' , .. , .

CHRISTI HUANG YANG CPA

• ~ Yes No626-286-1618Telephone NumberPrin t Third Party De s igne a 's Nam e

059 3101106



Your Name: PHILIP ANTHONY KOK

1 ~S ing le2 Married lRD P f ilin g jo in t ly . (see ins truc tions )

3 Married /RD P f ilin g s epa ra te ly .En te r spouse 's /RDP 'sSSN or IT IN aboveand full n ame here ..

4 H ead of househo ld (w ith qua lify ing pe rson). (see ins truc t ions )

5 Q ua lify ing w idow (er) w ith dependen t ch ild . En le r year spouse lRDP d ied _

If y ou r C a l if or nia f ili ng s ta tu s i s d if fe re n t f ro m y ou r f ed e ra l f il in g s ta tu s, c h ec k th e b o x h e re .

F ilin g S ta tu s

Your SSN or inN: 368-76- 3890

•Exempt ions

• 66 I f s om e on ec an c la im y ou ( o r y ou r s p ou se /R D P )a s a d e pe n de n t ch oc k th e b o x here(see ins t ruc t ions ) .

1 1

T ax ab le In co me 1 2

1 3

1 4

1 5

1 6

1 7

1 8

1 9

Tax 31

32

33

34

35

S p ec ia l C re dit s 41

42

43

44

45

46

47

48

O th er Ta xe s 61

62

63

64

Payments 71

72

Whol e doll ars

99.

7 P ers on al: If y ou c he ck ed1 , 3 , or 4 above ,en te r 1 in t he b ox . If youchoc ked2 or 5 , en ter 2 in t he b ox .

I f y o u c h o c ke d th e b o x o n l in e 6 , see the in s truc tions . . . . . . . . .. . .8 B lin d : I f y ou ( o r y ou r s p ou se /R D P ) ar e v is ua lly i mp a ir ed , e nt er 1; i f b o t ha re v i sua l ly impa ir ed , en t e r2.

9 S e nio r: If y ou ( or y ou r s po us e/R D P )a re 6 5 o r o l de r, en t e r 1 ; if b o th a re 6 5 o r o ld e r, e n te r 2 . . •

1 0 Dep e n de n ts : En te r n amea n d r e la t io n sh ip . D o n o t i nc lu d e y o ur se lf o r y o ur s p ou s el RDP .

------------------------ To ta l dependen t________________________ exemptions.....• 1 0 Dx $99", $

Ex empt io n amoun t : A d d l in e 7 t h rough l ine 1 0 . Transf e r t h i s amoun t t o l in e 3 2 . . . . . . . . . . . . . . . . . . . 1 1 $

7

§x $99: $

8 x $99: $

9 x $99: $

99.

Sta t ewages f rom you r Fo rm(s) W · 2 , box 1 6 . . . . . . . . . . • 1 2 --- '9 "",< ....:: .6; : : : . 1 _ : _ 7 . . , : . _

En te r fede ra l ad j u s tedg ro s s i n come f rom Fo rm1040 , I in e 3 7 ; Fo rm l040A , l in e 2 1 ; Form 1 0 4 0 E Z , l ine 4 . 1 3 1 4 , 8 6 7 .

Ca l if o rn i aad jus tmen t s - s ub t ra c t io ns .En t e r the amoun t lr om Schedu le C A ( 5 40 ) , l ine 3 7 , co lumn B . . .. . .. . .• • 1 4

Subt rac t l ine 14 f rom l ine 13. If le ss th an z ero, en le r th e re su lt i n pa re nth ese s(se e in struc tion s). . . . . . . . 1 5

Ca l if o rn i aad jus tmen t s - add i ti o ns .En t e r the amoun t f rom Schedu leCA ( 5 4 0 ) , l ine 3 7 , co lumn C............• • 1 6

Ca l i fo rn ia ad jus tedgrass income.Combine l ine 1 5 and l in e 1 6 ' " . . . . . . . . • . . . . . . . • 1 7

Enterth e l a rge r o f y o u r G A s ta n d a rd deduc ti 0n O R y o ur CA i t em iz e d d e d uc ti 0 n s . . .. . . . . . . . . . . . . . . . . . . • , 8

Subt rac t l ine 18 f rom l in e 17 . Th is i s y o u r t a x a b le i nc ome . I f l es s t h a n z e r o, e n t er ·0·. . . . . . . . . . . . . . . , 9

5,250 .

9 ,617 .

9 , 6 1 7 .

3 ,670.

5 , 947 .

T a x. C h e c k b ox i f f rom : IR lTaxTab le 0 TaxRa teSchedu le 0 H B 3800 UHS 3803 . . . .. @ 31

Exemp t io nc red it s .En t e r t he amoun t fr om l ine 1 1 . I f y o ur f e de r al AG I is mo re t h a n $162,186 (see ins trs). . . . . . . . .. 32

74.

99.

Subt rac t l ine 3 2 f rom l ine 3 1 . I f l es s t h a n z e r o, e n t er · 0 - . ..

Tax . (see in stru c t io ns )Check b o x i f f rom : DSc he dule G - l

A d d l ine 33 a n d l in e 34 .

o ... ". 3 3

®34

..... 35

DForm F T B 5 8 7 0 A . . , . . , .

New jobs cred it, amoun t gene ra ted (see In struct ions ) . . . . . . . . . . . .• 41

N ew jobs c red it, amount c la imed (see i n s truc tions ) . . . . . . . . • 42 _

C red it C ode amoun t. . ...• .. ..• .....• .. . .. .. . ~ 43 ---------C red it C ode amount. . . . . • . . . ~ 44

--------

To cla im more than tw o c red its (see in s truc tions ). ........• ... .4 5 _

Nonre fundab le ren te r's c red it (see in struct ions). . . .

Add line 42 th ro ug h lin e 46. The se a re your to ta l c re dits ....

• 46 6: :

47 60

OSubt rac t l ine 47 f rom l ine 35 . If l e s s t han ze ro, en t e r ·0 · . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . 48

Alte rn ative m in im um la x. A tta ch S che dule P (540)............. • 61

M en ia l H ea lth S erv ices Tax (see in s truc tions } ..• 62

Other taxes a n d credit r e c a p t u r e

(see i n st ru c ti on s ) . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •.

A dd lin e 48, l in e 61 , line 62, a nd line 63. Th is is your to ta l ta x.• 63

• 64

• 71 52.

• 72

• 73

• 74 O

76

77

78

79

O ve rp aid Ta xi91

Tax D ue 92

93

94

U se Tax 95

C aliforn ia income lax w ithhe ld (see in s truc tions ) .

2010 C A e stim ate d la x a nd oth er p aym en ts (s ee in stru ctio ns ) ..........• .............

73 R ea l e s ta te and o ther W ithhold ing (see instructions). . . . . . . . . . . . . . .

74 Excess SD I ( o r VPD I) w ithhe ld (see in s truc tions ) . . .

C h ild and D ependen t C a re Expenses C red it (see ins truc t ions ). A tta ch form FTB 3506.

75 Qua lify ing pe rson 's soc ia l security numbe r. . . . . . . . ......• 7 5

Qua lify ing person 's soc ia l security numbe r. . . . . . .. . •.....• • • 76

En ter the amoun t from form FTB 3506, Pa r t III, l ine 8..... . ...• 77

C h ild and D ependen t C a re Expenses C red it f rom form FTB 3506, Par i III, l ine 12. . . .... • 78

Add line 71 , lin e 72, l ine 73, l ine 74, a nd line 78. These are your to la l paym en ts

(see ins truc tions ). . . . . . . . . . , . 7 9 5 2.

O ve rpa id tax . If lin e 79 is more than lin e 64 , s ub tra ct lin e 64 from lin e 7 9 ... 91

• 92• 93

52

Amount o f lin e 91 you want app lie d to your 2011 es tima ted tax .

O verpa id ta x ava ilab le th is year. Sub tra c t lin e 92 from line 91 . .

Tax due . If line 79 is le ss than lin e 64 , sub tra ct lin e 79 from line 64 ..

52.

94

Use Tax . Th is is no t a to ta l lin e (see in s truc tions ). . • 95

S ide2 Form 540 C1 2010 CAIA3912L 12127O ~9 I 3102106



Your Narne: PHILIP ANTHONY KOK Your SSN Or ITIN: 368 - 7 6 - 3 8 90

California Fund for Senior Citizens, . ,

Code Amount

• 400

• 401

• 402

• 403

• 404

• 405

• 406• 407

• 408

• 410

• 413

• 415

• 416

• 417

• 418

Contributions California Seniors Special Fund (see instructions). , ,

Alzheimer's Disease/Related Disorders Fund. , . , ... , , ..

Rare and Endangered Species Preservation Program, .....

Slate Children's Trust Fund for the Prevention of Child Abuse.

California Breast Cancer Rese'arch Fund,

California Firefighters' Memorial Fund .. , .. ' ............•................ , .Emergency Food For Families Fund, ,..... ' , , , ' " .

California Peace Officer Memorial Foundation Fund.

California Sea Otter Fund , .. , .. , .

California Cancer Research Fund. , , , .

Arts Council Fund, , , , .. , . , , .. , . , , , . , . . . , ' ,

California Police Activities League (CALPAL) Fund. , , , ,

California Veterans Homes Fund, , . . , . .. ".

Safely Surrendered Baby Fund.. , . , , .. , , . , , .

110 Add code 400 through code 418. This is your total contribution. • 110

Amount 111You Owe

Interest and 112

Penalties 113

114

AMOUNT YOUOWE. Add line 94, l ine 95, and line 110 (see instructions). Mail to:FRANCHISE TAX BOARD, POBOX 942867, SACRAMENTO CA 94267-0009Pay online - Go to ftb.ca.gov and search for web pay , .. , . , , .. , . , . • 111Interest, late return penalties, and late payment penalties , .. , .. , ' .

Underpaymentof estimatedtax.C h e c k box: D FTB5 8 0 5 attached D FTB5 8 0 5 F attached., .. ,

Total amount due (see instructions). Enclose, but do not staple, any payment, .. .. ,

112

• 113114

Refund and 115 REFUND OR NOAMOUNT DUE. Subtractline95 andline110fromline 93 (seeinstructions).Mailto:Direct Deposit FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0009 .. , .... ,' • 115 52

Fill in theinformationtoauthorizedirectdepositofyourrefundintooneor twoaccounts,Donotattachavoide\Jcheckora depositslip(seeinstructions).

Have you verified the routing and account numbers? Use whole dollars only.

Allor the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:

D Checking 0Savings

• Routing number • Type • Account number • 116 Direct deposit amount

The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:

DChecking Dsavings

• Routing number . • Type • Account number • 117 Direct deposit amount

Form 540 C1 2010 SideCAIA3912L 12127110 059 3103106



TAXABLE YEAR SCHEDULE

2010 California Adjustments Residents CA (540)

Part I IncomeAdjustment ScheduleSection A ~ Income

KOK

7 Wages, salaries, tips, etc. See instructions before making an

entry in column B or C .S Taxable interest (b) .

9 Ordinary dividends. See instructions (b) _

1 0 Taxable refun d s , credits, o f f s e ts o f s tate a n d local incometaxes.. .

A

7Sa

9a

1 0

11

12

13

14

1 5 b

1 6 b

1 7

18

19

20

c AdditionsSee instructions

Tl Alimony received ..

12 8 u s in e s s in c o m e o r ( lo s s ) . . .. . . . • . . . .

13 Capital gain or (loss). See instructions, .

14 Other gains or (tosses) . . .

15 IRA distributions. See instructions .. (a) _

1 6 Pensionsa n d a n n u i t ie s . S e e in s tr u c tio n s . . .. C a ) _

1 7 R e n t a l real e s t st e , r o y a lt ie s , partnerships,S c o rp o ra t io n s, t r u st s , e tc . . .

18 Farm income or (loss) .

19 Unemp loyment compensation .

20 Social security benefits (a) _

21 Other income.

a C a Iifornia lotterywin n in g s

b 0 i s a s t e r 10 $ s c a r r y ov e r from F T B 3 8 0 5 V

c FederalN O L (Form 1 0 4 0 , line 2 1 )

d N O L c a rryoverfrom F T B 3 ! ! 0 5 V

e N O L f r o m F T B 3 80 50 , 3 80 5Z ,

3 80 6 , 3 8 07 , or 3 8 0 9

O t h e r (describe) :

21

22 Total. Combine line 7 through line 21 in column A. Add line 7through line 21 f in column B and column C. Go to Section B.. 22 14 867. 5 250.

23 Educator expenses. CAUTION: See instructions . 23

24 Certain business expenses of reservists, performing artists,and fee-basis government officials. . . . . . . . . . . 24

25 Health savings account deduction. 25

26 Moving expenses. . . . . . . . . 26

27 One-half of self-employment tax.: 27

28 Self-employed SEP, SIMPLE, and qualified plans. 28

29 Selt-e mployed hee Ith insurance deduction. 29

3030 Penalty on early withdrawal of savings ... ... ... ... ... •.. ..• .

31 a Alimony paid.

b Recipient's:SSN

Last name.32 IRA deduction ..

31a _32

33

34

35

33 Student loan interest deduction .

34 Tuition and fees. CAUTION: See instructions. ..

35 Domestic production activities deduction .

S e e in s t r s . 36

3 6 A d d l in e 2 3 through l i n e 3 1 a a n d l in e 3 2 t h ro u g h l in e 3 5 in columasA , B, and C .

37 Total, Subtract line 36 from line 22 in columns A, B, and C.See instructions . 37 14 867. 5 250.

059 7731104For Privacy Notice, get form FTB 1131. CAIA4012L 12116110 S c h e d ule C A ( 5 4 0 ) 2 0 1 0 S id e



Department of the Treasury - lnternal Revenue Service

Form Income Tax Return for Single and1040EZ Joint Filers With No Dependents (99) 2010 OMS No. 1545-007

Name, Your fi,st name MI last name Your social security number

Address, PHILIP ANTHONY KOK 368-76-3890and SSN II a joint return, spouse's first name MI last name Spouse's social security number

See separateinstructions. Home address (number and street). If you nave a P.O. box. see instructions. Apt no.

A Make sure the SSN{s) AP 0 BOX 152 above are correct.

City, town or post office. If you have a fow,gn address, see instructions_ Slale ZIP codeChecking a box below will not

Presidential MALIBU , CA 90265-0152 change your tax or refund.ionElect

Campaign trr...(see instrs) ,. Check here if you, or your spouse if a Joint return, want $3 to go to this fund? 0You oSpouse

Income

AttachForm(s)W·2 here.Enclose,h'll rln n,,+

1 Wages, salaries, and tips. This should be shown in box 1 of your Formes) W-2.

Attach your Form(s) W-2 , _ ,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 1 9,617.

2 Taxable interest. If the total is over $1,500, you cannot useForm 1040EZ... . , . 2

250.n c i Jl ig E ! !1 l ;e p e n . a V or ( ; I E - : . a

2 F ed era l in co m e la x w i l hhe l d1 W a ge s, lip s, o th er c o m pe n sa lio n 367.

2010 \1 S o c i a l s e c u r i t y t i p s

9,617,27 322,012 W a g e a n d T a x S ta t e m e n t 4 S o cia l s e c u t i t y ta x w i t h h e l d

8 A l l o c a t e d t i ps3 S o c ia l s e c u ri ty w a g e s

s n am e , a dd re ss , a nd Z IP c od e6 M e d i c a re la x w i t h h e l d

ANGELES UNIFIED SCHOOL DISTRICT9 A dv a rlt e E IC p ay m en t

5 M ed ic are w ag e s a nd t i p s :50_& DISBURSEMENTS DIVISION 10,453.56 151.58

ROLL SERVICES BRANCH 1 1 N o nq ua r m a d p l a n s1 2 a S e e illS tJ u c lio n s lo r b o x 1 2

17,, BOX 513307, TERMINAL ANNEX

1 0 D e pe n da n t c a re b e ne fit sI~ r --

ANGELES, CA 90051-13071 4 0 l 1 1 e r

1 2 b

I86.

1 3 e~ U W V ~~~nt ~ f ~ r 1 V C

n am a , a dd r e ss a nd Z I P o o d e I X I! 00.

19950-.-

1 2 c

1b E m ~ oy er Id en tif ic a tio n n um b e r (E IN ) % --

•95-6001908 ·

ILIP A KOK00704195 1 2 d

a E m ~ ()y ee 's s oc ia l s ec ur it y n um b er ;\

36,0, BOX 152

,

368 76 3890 · J ;3,,CA 902651 9 lo ca l in co m e ta x

2 0 L o c a l i t y n a m e -1 6 S l a t e w i r , s , ~ s , e t c .

1 7 S ta te in co m e t a x1 8 L oc a l w a ge s, t ip s, e tc

e E m p lo y e r s s la te 1 .0 n o . 52.36 ·3.9,61 ,2 -

\800-9074-9

O M S N o . 1 5 4 5 - 00 0 8Dept . o f theTreasury· IRS

CFor EMPLOYEE'S RECORDS (See Notice to Employee on back of CO~~~ I

You Owe13 If line 11 is larger than line 10, subtract line 10 from line 11. This is the amou nt you owe,

For details on how to pay, see instructions. . . . . . . .. . , . .. 13 o .I . R J Yes. C o m p l e t e th e following.Third Party D o y ou w an t t o a llo w a no th er p er so n t o d is cu ss t his return w i t h the IR S ( s e e instructions)? .

Designee~:~~nee's .. CHRISTI H UANG YANG , CPA Personal ID 88888

no. (PIN) ..~2.one . . 626-286-1618

SignHere

Under penalties of perjury. I declare that Ihave examined this return, and to the best ofmy knowledge and belief, it is true, correct, and accurately lists all amounts andI SOurcesql income I received cjuring the tax ye~r. Declaration of preparer (other than the taxpayer) is based on all informat'ol1 of which the oreparer has any knowledge.

Your signature Date Your occupation Daytime phone no.Joint return7See instructions.

Keep trr...~----~--~--~----~---------------+~-----1~--~----.-----------------ba copy for ,. Spouse's signature. If a nt return, both must sign. Date Spouse's occupationyou r records,

PaidPreparerUse Only

PrinVType preparer's name Preparer's signature

BAA For Dlsclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. FDIA0201L 0\105111 Form l040EZ (2010)

2010 tax return documents: how poor i am, but so rich in faith !

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