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Department of the TreasuryInternal Revenue Service

Income Tax Return for Single and


Joint Filers With No Dependents (99)

Form

1040EZ

Your first name and initial

2013

OMB No. 1545-0074


Your social security number

Last name

Rajagobalan

Sankaranarayanan

If a joint return, spouses first name and initial

869

Apt. no.

Home address (number and street). If you have a P.O. box, see instructions.

7926 Forest Pine Drive

319

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

Presidential Election Campaign

Foreign province/state/county

Income
Attach
Form(s) W-2
here.
Enclose, but do
not attach, any
payment.

Wages, salaries, and tips. This should be shown in box 1 of your Form(s) W-2.
Attach your Form(s) W-2.

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

Unemployment compensation and Alaska Permanent Fund dividends (see instructions).

4
5

Add lines 1, 2, and 3. This is your adjusted gross income.


If someone can claim you (or your spouse if a joint return) as a dependent, check
the applicable box(es) below and enter the amount from the worksheet on back.

42,329.

10,000.

6
7
8a

32,329.
7,717.

7,717.

10

4,403.

11a

3,314.

6
7
8a
b
9
10

Payments,
Credits,
and Tax

11a

Refund
Have it directly
deposited! See
instructions and
fill in 11b, 11c,
and 11d or
Form 8888.

You
Spouse
If no one can claim you (or your spouse if a joint return), enter $10,000 if single;
$20,000 if married filing jointly. See back for explanation.
Subtract line 5 from line 4. If line 5 is larger than line 4, enter -0-.
This is your taxable income.
Federal income tax withheld from Form(s) W-2 and 1099.
Earned income credit (EIC) (see instructions).
Nontaxable combat pay election.
8b
Add lines 7 and 8a. These are your total payments and credits.
Tax. Use the amount on line 6 above to find your tax in the tax table in the
instructions. Then, enter the tax from the table on this line.
If line 9 is larger than line 10, subtract line 10 from line 9. This is your refund.
If Form 8888 is attached, check here a

Routing number

0 5 3 0 0 0 1 9 6

Account number

2 3 7 0 2 8 0 4 7 3 4 2

12

Amount
You Owe

Make sure the SSN(s)


above are correct.

Check here if you, or your spouse if filing


jointly, want $3 to go to this fund. Checking
Foreign postal code a box below will not change your tax or
refund.
You
Spouse

Charlotte NC 28273
Foreign country name

34 3496

Spouses social security number

Last name

ac

Type:

Checking

42,329.

Savings

If line 10 is larger than line 9, subtract line 9 from line 10. This is
the amount you owe. For details on how to pay, see instructions.

12
Yes. Complete below.

Third Party
Designee

Do you want to allow another person to discuss this return with the IRS (see instructions)?

Sign
Here

Under penalties of perjury, I declare that I have examined this return and, to the best of my knowledge and belief, it is true, correct, and
accurately lists 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.
Daytime phone number
Your occupation
Your signature
Date

Designees
a
name

Joint return? See


instructions.
Keep a copy for
your records.

Paid
Preparer
Use Only

Phone
no.

Personal identification
number (PIN)

Consultant
Spouses signature. If a joint return, both must sign.

Print/Type preparers name

Firms name

Preparers signature

Self-Prepared

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.

If the IRS sent you an Identity Protection


PIN, enter it
here (see inst.)
PTIN
Check
if
self-employed

Date

Firm's EIN

Firms address a

(980)298-2636

Spouses occupation

Date

No

Phone no.

BAA

REV 03/03/14 Intuit.cg.cfp.sp

Form 1040EZ (2013)

D-400 (59)

Individual Income Tax Return 2013

10-3-13

< Staple All Pages of Your

North Carolina Department of Revenue

Return and W-2s Here

For calendar year 2013, or fiscal year beginning

and ending

13

Select box if you or your spouse were


out of the country on April 15 and a
U.S. citizen or resident.

RAJAGOBALAN
SANKARANARAYA
Your SSN: 869343496
7926 FOREST PINE DRIVE
319
Spouses SSN:
CHARLOTTE
NC 28273 MECKL
X 1. Single
2. Married Filing Jointly
3. Married Filing Separately
4. Head of Household
Filing Status

Select box if return is filed and signed


by Executor or Administrator.

Number of Exemptions Claimed:

You Spouse

Year spouse died:


Return for deceased taxpayer
Return for deceased spouse

Select box if you or your spouse were a nonresident of NC for the entire year.
Select box if you or your spouse moved into or out of NC during the year.

FS

SANK

EX

01

7926

PP

28273

RAJAGOBALAN

DT

OC

NRT N

PYT N

TD

DS

EA

NRS N

PYS N

SD

SANKARANARAYA

Date of death:
Date of death:

869343496
NC

7926 FOREST PINE DRIVE

319

28273

CHARLOTTE

42329

24A

31

45

07

24B

33

370

46A

09

24C

34

46B

11 S

3000

24D

35

46C

13

2500

25

36

46D

7020159015

06

01

5. Widow(er) with Dependent Child

16

00000

27A

37

46E

17

36829

27B

38

47A

2450

27C

40

47B

19

27D

41

47C

21

EU

42

48

51

23A

2820

28

43

49

53

23B

30

44

50

54

18

TN 9802982636
Sign Return Below

PN

PP

X Refund Due

370

I certify that, to the best of my knowledge, this return is accurate and complete.

Payment Due

If prepared by a person other than taxpayer, this certification is based on all information of
which the preparer has any knowledge.

Your Signature

Date

Spouses Signature (If filing joint return, both must sign.)

Date

SELF PREPARED
Paid Preparers Signature

Date

9802982636
Home Telephone Number (Include area code)

Paid Preparers FEIN, SSN, or PTIN

Paid Preparers Telephone Number

If you ARE NOT due a refund, mail return, any payment, and Form D-400V to: NCDOR, P.O. Box 25000, Raleigh, N.C. 27640-0640
If REFUND mail to: NCDOR, P.O. Box R, Raleigh, N.C. 27634-0001
REV 02/10/14 INTUIT.CG.CFP.SP

D-400 2013 Page 2

(59)

Last Name (First 10 Characters)

Your Social Security Number

SANKARANAR

869343496

D-400 Line-by-Line Information


Additions to Federal Adjusted Gross Income
6. Federal adjusted gross income

6.

7. Additions to federal adjusted gross income


8. Add Lines 6 and 7
9. Deductions from federal adjusted gross income

7.
8.

10. Subtract Line 9 from Line 8


11. Deduction Type
N.C. standard deduction
12.
13.
14.
15.
16.
17.
18.

9.
10.
11.

N.C. itemized deduction

11.

Subtract Line 11 from Line 10


N.C. personal exemption allowance
Subtract Line 13 from Line 12
Same as Line 14
Part-year residents and nonresidents
N.C. Taxable Income
N.C. Income Tax

12.
13.
14.
15.
16.
17.
18.

19. Tax Credits


20. Subtract Line 19 from Line 18

19.
20.

21. Consumer Use Tax

21.

22. Add Lines 20 and 21

22.

42329
0
42329
0
42329
S
3000
0
39329
2500
36829
36829
0.0000
36829
2450
0
2450
0
2450

North Carolina Income Tax Withheld


23a.

23b. Spouses Income Tax Withheld

23b.

2820
0

Other Tax Payments


24a. 2013 Estimated Tax
24b. Paid with Extension
24c. Partnership

24a.
24b.
24c.

24d. S Corporation
25. North Carolina Earned Income Tax Credit
26. Add Lines 23a through 25

24d.
25.
26.

27a. Tax Due - If Line 22 is more than Line 26,


subtract and enter the result
27b. Penalties

27a.
27b.

27c. Interest

27c.

EU Exception to underpayment of
estimated tax

EU

27d. Interest on the underpayment


of estimated income tax
28. Pay this Amount

27d.
28.
29.

0
0
0
0
0
2820
0
0
0

0
0

32. Add Lines 30 and 31


33. Amount to be Refunded

36.

Adjustments for section 179


expense deduction

37.
38.

Adjustments for tuition and fees deduction,


Form 1040, Line 34 or Form 1040A, Line 19
37.
Other federal adjusted gross income additions 38.

39.

Total additions

34.

35.

36.

39.

0
0
0

40.

41.

42.
43.

0
0
0
0

Deductions from Federal Adjusted


Gross Income
40.
41.

State or local income tax refund


Interest income from obligations of
US or US possessions

42.
43.
44.

Social Security and Railroad


Retirement Benefits
Bailey settlement retirement benefits
Other retirement benefits

45.

Severance wages

44.
45.

Adjustment for bonus depreciation added


back in 2008, 2009, 2010, 2011, and 2012
46a. 2008
46b. 2009

46a.
46b.

46c. 2010

46c.

46d. 2011
46e. 2012
46f. Add Lines 46a, 46b, 46c
46d and 46e and enter on 46f

46d.
46e.

0
0
0
0
0

46f.

47a. 2010
47b. 2011

47a.
47b.

47c. 2012

47c.

0
0
0
0

47.

50.

Adjustment for net business income that


is not considered passive income

51.

Other federal adjusted gross income


deductions
Total deductions

52.
30.
31.
32.
33.

Adjustment for section 179 expense deduction


added back in 2010, 2011, and 2012

47d. Add Lines 47a, 47b, and 47c and enter on 47d 47d.
48. Contributions to North Carolinas National
College Savings Program (NC 529 Plan)
(See instructions)
48.
49. Adjustment for absorbed NOL
added back in 2003, 2004, 2005, and 2006
49.

370

Amount of Refund to Apply to:


30. Amount of Line 29 to be applied to
2014 Estimated Income Tax
31. N.C. Nongame and Endangered
Wildlife Fund

Interest income from other states


Adjustment for bonus depreciation
(See instructions)

46.

23a. Your Income Tax Withheld

29. Overpayment - If Line 22 is less than


Line 26, subtract and enter the result

34.
35.

50.

51.

0
0

52.

0
Part-Year Residents and Nonresidents

0
0
370

53.
54.

All income while a part-year NC resident and


NC source income while a nonresident
Total income from all sources

53.
54.

55.

Divide Line 53 by Line 54

55.

N.C. Residency Dates for Part-Year Residents


Beginning

REV 02/10/14 INTUIT.CG.CFP.SP

This page must be filed with the first page of this form.

Taxpayer:
Spouse:

Ending

0
0
0.0000

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