File by Mail Instructions for your 2009 Federal Tax Return

Important: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
Dorothy Gibbs
230 Peachtree St
Henderson, NC 27536
|
Balance | Your federal tax return (Form 1040) shows you owe a balance due of
Due/ | $1,282.00.
Refund |
| You are paying by check.
|
______________________________________________________________________________________
|
What You | Your tax return - The official return for mailing is included in
Need to | this printout. Remember to sign and date the return.
Mail |
| Your payment - Mail a check or money order for $1,282.00, payable
| to "United States Treasury". Write your Social Security number and
| "2009 Form 1040" on the check. Mail the return and check together.
|
| Attach the first copy or Copy B of Form(s) W-2 to the front of your
| Form 1040.
|
| Mail your return, attachments and payment to:
| Department of the Treasury
| Internal Revenue Service Center
| Atlanta, GA 39901-0102
|
| Deadline: Postmarked by Thursday, April 15, 2010
|
| Note: Your state return may be due on a different date. Please
| review your state filing instructions.
|
| Don’t forget correct postage on the envelope.
|
______________________________________________________________________________________
|
What You | Keep these instructions and a copy of your return for your records.
Need to | If you did not print one before closing TurboTax, go back to the
Keep | program and select Print & File tab, then select the Print for Your
| Records category.
|
______________________________________________________________________________________
|
2009 | Adjusted Gross Income $ 39,283.00
Federal | Taxable Income $ 26,361.00
Tax | Total Tax $ 3,539.00
Return | Total Payments/Credits $ 2,282.00
Summary | Payment Due $ 1,257.00
| Penalty/Interest $ 25.00
| Balance Due With Penalty/Interest $ 1,282.00
| Effective Tax Rate 9.01%
|
______________________________________________________________________________________
|
Payments | Estimated Payments for 2010 - This printout includes your estimated
You Need to | tax vouchers for your federal estimated taxes (Form 1040-ES).
Make |
|
______________________________________________________________________________________

Page 1 of 2
File by Mail Instructions for your 2009 Federal Tax Return
Important: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
Dorothy Gibbs
230 Peachtree St
Henderson, NC 27536
|
Payments | Mail payments according to the schedule below:
You Need to |
Make | Voucher Number Due Date Amount
(Continued) | 1 04/15/2010 $ 315.00
| 2 06/15/2010 $ 315.00
| 3 09/15/2010 $ 315.00
| 4 01/18/2011 $ 315.00
|
| Include a separate check or money order for each payment, payable to
| "United States Treasury". Write your social security number and "Form
| 1040-ES" on each check.
|
| Mail payments to:
| Internal Revenue Service
| P.O. Box 105225
| Atlanta, GA 30348-5225
|
______________________________________________________________________________________
|
Changed | You can still file electronically. Just go back to TurboTax, select
Your Mind | the Print & File tab, then select the E-file category. We’ll walk
About | you through the process. Once you file, we will let you know if your
e-filing? | return is accepted (or rejected) by the Internal Revenue Service.
|
______________________________________________________________________________________

Page 2 of 2
 I Detach Here and Mail With Your Payment I

Department of the Treasury Calendar Year '

Internal Revenue Service Due 4/15/2010 2010 Form 1040-ES Payment Voucher 1
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the ’United States Treasury.’ Write Amount of estimated tax
you are paying by check
315.
your social security number and ’2010 Form 1040-ES’ on your check or money order. Do not
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order
FDIA1901 06/15/09 1030

244-13-5250
DOROTHY GIBBS INTERNAL REVENUE SERVICE
PO BOX 105225
230 PEACHTREE ST ATLANTA GA 30348-5225
HENDERSON NC 27536

244135250 JO GIBB 30 0 201012 430

 I Detach Here and Mail With Your Payment I

Department of the Treasury Calendar Year'

Internal Revenue Service Due 6/15/2010 2010 Form 1040-ES Payment Voucher 2
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the ’United States Treasury.’ Write Amount of estimated tax
you are paying by check
315.
your social security number and ’2010 Form 1040-ES’ on your check or money order. Do not
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order
FDIA1902 06/15/09 1030

244-13-5250
DOROTHY GIBBS INTERNAL REVENUE SERVICE
PO BOX 105225
230 PEACHTREE ST ATLANTA GA 30348-5225
HENDERSON NC 27536

244135250 JO GIBB 30 0 201012 430

 I Detach Here and Mail With Your Payment I

Department of the Treasury Calendar Year'

Internal Revenue Service Due 9/15/2010 2010 Form 1040-ES Payment Voucher 3
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the ’United States Treasury.’ Write Amount of estimated tax
you are paying by check
315.
your social security number and ’2010 Form 1040-ES’ on your check or money order. Do not
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order
FDIA1904 06/15/09 1030

244-13-5250
DOROTHY GIBBS INTERNAL REVENUE SERVICE
PO BOX 105225
230 PEACHTREE ST ATLANTA GA 30348-5225
HENDERSON NC 27536

244135250 JO GIBB 30 0 201012 430

 I Detach Here and Mail With Your Payment I

Department of the Treasury Calendar Year'

Internal Revenue Service Due 1/18/2011 2010 Form 1040-ES Payment Voucher 4
File only if you are making a payment of estimated tax by check or money order. Mail this
voucher with your check or money order payable to the ’United States Treasury.’ Write Amount of estimated tax
you are paying by check
315.
your social security number and ’2010 Form 1040-ES’ on your check or money order. Do not
send cash. Enclose, but do not staple or attach, your payment with this voucher. or money order
FDIA1905 08/20/09 1030

244-13-5250
DOROTHY GIBBS INTERNAL REVENUE SERVICE
PO BOX 105225
230 PEACHTREE ST ATLANTA GA 30348-5225
HENDERSON NC 27536

244135250 JO GIBB 30 0 201012 430

To pay your taxes due by check, mail this form to the address listed below.

Form 1040-V (2009)

I Detach Here and Mail With Your Payment and Return I

Department of the Treasury

Internal Revenue Service (99) 2009 Form 1040-V Payment Voucher
G Use this voucher when making a payment with Form 1040.
G Do not staple this voucher or your payment to Form 1040.
G Make your check or money order payable to the ’United States Treasury.’ Enter the amount
G Write your social security number (SSN) on your check or money order. of your payment 1,282.
FDIA8601 06/15/09 1030

DOROTHY GIBBS
DEPARTMENT OF THE TREASURY
230 PEACHTREE ST INTERNAL REVENUE SERVICE CENTER
HENDERSON NC 27536 ATLANTA GA 39901-0102

244135250 JO GIBB 30 0 200912 610

 Department of the Treasury ' Internal Revenue Service
Form 1040 U.S. Individual Income Tax Return 2009 (99) IRS Use Only ' Do not write or staple in this space.

For the year Jan 1 - Dec 31, 2009, or other tax year beginning , 2009, ending , 20 OMB No. 1545-0074
Your first name MI Last name Your social security number
Label
(See instructions.) Dorothy Gibbs 244-13-5250
If a joint return, spouse’s first name MI Last name Spouse’s social security number
Use the
IRS label. 241-08-8690
Otherwise, Home address (number and street). If you have a P.O. box, see instructions. Apartment no. You must enter your
please print social security
or type. 230 Peachtree St
City, town or post office. If you have a foreign address, see instructions. State ZIP code J number(s) above. J
Checking a box below will not
Presidential Henderson NC 27536 change your tax or refund.
Election
Campaign A Check here if you, or your spouse if filing jointly, want $3 to go to this fund? (see instructions) You Spouse
1 Single 4 Head of household (with qualifying person). (See
Filing Status instructions.) If the qualifying person is a child
2 Married filing jointly (even if only one had income) but not your dependent, enter this child’s
Check only 3 X Married filing separately. Enter spouse’s SSN above & full name here
one box. name here James H Gibbs 5 Qualifying widow(er) with dependent child (see instructions)
Boxes checked
Exemptions 6a X Yourself. If someone can claim you as a dependent, do not check box 6a on 6a and 6b 1
b Spouse No. of children
(2) Dependent’s (3) Dependent’s b
(4) if on 6c who:
c Dependents: social security relationship qualifying ? lived
number to you child for child with you 1
tax credit ? did not
(1) First name Last name (see instrs) live with you
due to divorce
Tia R Gibbs 241-65-6664 Daughter or separation
If more (see instrs)
than four Dependents
dependents, on 6c not
see instructions entered above
and check here Add numbers
on lines
d Total number of exemptions claimed above 2
7 Wages, salaries, tips, etc. Attach Form(s) W-2 7 39,283.
Income 8 a Taxable interest. Attach Schedule B if required 8a
b Tax-exempt interest. Do not include on line 8a 8b
Attach Form(s) 9 a Ordinary dividends. Attach Schedule B if required 9a
W-2 here. Also b Qualified dividends (see instrs) 9b
attach Forms 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) 10
W-2G and 1099-R
if tax was withheld. 11 Alimony received 11
12 Business income or (loss). Attach Schedule C or C-EZ 12
If you did not
get a W-2, 13 Capital gain or (loss). Att Sch D if reqd. If not reqd, ck here 13
see instructions. 14 Other gains or (losses). Attach Form 4797 14
15 a IRA distributions 15 a b Taxable amount (see instrs) 15 b
16 a Pensions and annuities 16 a b Taxable amount (see instrs) 16 b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
Enclose, but do 18 Farm income or (loss). Attach Schedule F 18
not attach, any 19 Unemployment compensation in excess of $2,400
per recipient (see instructions) 19
payment. Also,
please use 20 a
Social security benefits 20 a b Taxable amount (see instrs) 20 b
Form 1040-V. 21
Other income 21
22
Add the amounts in the far right column for lines 7 through 21. This is your total income 22 39,283.
23
Educator expenses (see instructions) 23
Adjusted 24
Certain business expenses of reservists, performing artists, and fee-basis
Gross government officials. Attach Form 2106 or 2106-EZ 24
Income 25 Health savings account deduction. Attach Form 8889 25
26 Moving expenses. Attach Form 3903 26
27 One-half of self-employment tax. Attach Schedule SE 27
28 Self-employed SEP, SIMPLE, and qualified plans 28
29 Self-employed health insurance deduction (see instructions) 29
30 Penalty on early withdrawal of savings 30
31 a Alimony paid b Recipient’s SSN 31 a
32 IRA deduction (see instructions) 32
33 Student loan interest deduction (see instructions) 33
34 Tuition and fees deduction. Attach Form 8917 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 - 31a and 32 - 35 36
37 Subtract line 36 from line 22. This is your adjusted gross income 37 39,283.
BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. FDIA0112 09/17/09 Form 1040 (2009)
Form 1040 (2009) Dorothy Gibbs 244-13-5250 Page 2
Tax and 38 Amount from line 37 (adjusted gross income) 38 39,283.
Credits 39 a Check You were born before January 2, 1945, Blind. Total boxes
if: Spouse was born before January 2, 1945, Blind. checked 39 a
Standard b If your spouse itemizes on a separate return, or you were a dual-status alien, see instrs and ck here 39 b X
Deduction
for ' 40 a Itemized deductions (from Schedule A) or your standard deduction (see left margin) 40 a 5,622.
? People who b If you are increasing your standard deduction by certain real estate taxes, new motor vehicle taxes, or
check any box a net disaster loss, attach Schedule L and check here (see instructions) 40 b
on line 39a, 39b, 41 Subtract line 40a from line 38 41 33,661.
or 40b or who
can be claimed 42 Exemptions. If line 38 is $125,100 or less and you did not provide housing to a Midwestern displaced
as a dependent, individual, multiply $3,650 by the number on line 6d. Otherwise, see instructions 42 7,300.
see instructions. 43 Taxable income. Subtract line 42 from line 41.
If line 42 is more than line 41, enter -0- 43 26,361.
? All others: 44 Tax (see instrs). Check if any tax is from: a Form(s) 8814
Single or Married b Form 4972 44 3,539.
filing separately, 45 Alternative minimum tax (see instructions). Attach Form 6251 45
$5,700 46 Add lines 44 and 45 46 3,539.
47 Foreign tax credit. Attach Form 1116 if required 47
Married filing
jointly or 48 Credit for child and dependent care expenses. Attach Form 2441 48
Qualifying 49 Education credits from Form 8863, line 29 49
widow(er), 50 Retirement savings contributions credit. Attach Form 8880 50
$11,400
51 Child tax credit (see instructions) 51
Head of 52 Credits from Form: a 8396 b 8839 c 5695 52
household,
$8,350 53 Other crs from Form: a 3800 b 8801 c 53
54 Add lines 47 through 53. These are your total credits 54
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- 55 3,539.
56 Self-employment tax. Attach Schedule SE 56
Other 57 Unreported social security and Medicare tax from Form: a 4137 b 8919 57
Taxes 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 58
59 Additional taxes: a AEIC payments b Household employment taxes. Attach Schedule H 59
60 Add lines 55-59. This is your total tax 60 3,539.
Payments 61 Federal income tax withheld from Forms W-2 and 1099 61 1,882.
62 2009 estimated tax payments and amount applied from 2008 return 62
63 Making work pay and government retiree credit. Attach Schedule M 63 400.
If you have a
qualifying 64 a Earned income credit (EIC) 64 a
child, attach b Nontaxable combat pay election 64 b
Schedule EIC. 65 Additional child tax credit. Attach Form 8812 65
66 Refundable education credit from Form 8863, line 16 66
67 First-time homebuyer credit. Attach Form 5405 67
68 Amount paid with request for extension to file (see instructions) 68
69 Excess social security and tier 1 RRTA tax withheld (see instructions) 69
70 Credits from Form: a 2439 b 4136 c 8801 d 8885 70
71 Add lns 61-63, 64a, & 65-70. These are your total pmts 71 2,282.
Refund 72 If line 71 is more than line 60, subtract line 60 from line 71. This is the amount you overpaid 72
Direct deposit? 73 a Amount of line 72 you want refunded to you. If Form 8888 is attached, check here 73 a
See instructions G b Routing number XXXXXXXXX G c Type: Checking Savings
and fill in 73b, G d Account number XXXXXXXXXXXXXXXXX
73c, and 73d or
Form 8888. 74 Amount of line 72 you want applied to your 2010 estimated tax 74
Amount 75 Amount you owe. Subtract line 71 from line 60. For details on how to pay, see instructions 75 1,282.
You Owe 76 Estimated tax penalty (see instructions) 76 25.
Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. X No
Designee’s Phone Personal identification
Designee name G no. G number (PIN) G
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation Daytime phone number
Joint return?
See instructions. A Manager
Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation
Keep a copy
for your records. A
Date Preparer’s SSN or PTIN

Paid
Preparer’s
signature A Check if self-employed

Preparer’s Firm’s name Self-Prepared

Use Only
(or yours if
self-employed),
address, and
A EIN

ZIP code Phone no.

Form 1040 (2009)

FDIA0112 09/17/09
 OMB No. 1545-0074
SCHEDULE A Itemized Deductions
(Form 1040)

Department of the Treasury

2009
Attachment
Internal Revenue Service (99) G Attach to Form 1040. G See Instructions for Schedule A (Form 1040). Sequence No. 07
Name(s) shown on Form 1040 Your social security number

Dorothy Gibbs 244-13-5250

Medical Caution. Do not include expenses reimbursed or paid by others.
and 1 Medical and dental expenses (see instructions) 1 2,451.
Dental
Expenses 2 Enter amount from Form 1040, line 38 2 39,283.
3 Multiply line 2 by 7.5% (.075) 3 2,946.
4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- 4 0.
Taxes You 5 State and local (check only one box):
Paid a X Income taxes, or
b General sales taxes 5 2,122.
6 Real estate taxes (see instructions) 6
7 New motor vehicle taxes from line 11 of the worksheet on page
(See 2. Skip this line if you checked box 5b 7
instructions.) 8 Other taxes. List type and amount G
8
9 Add lines 5 through 8 9 2,122.
Interest 10 Home mtg interest and points reported to you on Form 1098 10
You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person
from whom you bought the home, see instructions and show that person’s name,
identifying number, and address G

11
12 Points not reported to you on Form 1098. See instrs for spcl rules 12
Note.
Personal 13 Qualified mortgage insurance premiums (see instructions) 13
interest 14 Investment interest. Attach Form 4952 if required.
is not
deductible. (See instrs.) 14
15 Add lines 10 through 14 15
Gifts to 16 Gifts by cash or check. If you made any gift of $250 or
Charity more, see instrs 16 3,500.
If you made 17 Other than by cash or check. If any gift of $250 or
a gift and more, see instructions. You must attach Form 8283 if
got a benefit
for it, see over $500 17
instructions. 18 Carryover from prior year 18
19 Add lines 16 through 18 19 3,500.
Casualty and
Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) 20
Job Expenses 21 Unreimbursed employee expenses ' job travel, union dues,
and Certain job education, etc. Attach Form 2106 or 2106-EZ if
Miscellaneous required. (See instructions.) G
Deductions
21
22 Tax preparation fees 22 200.
(See 23 Other expenses ' investment, safe deposit box, etc. List
instructions.) type and amount G
23
24 Add lines 21 through 23 24 200.
25 Enter amount from Form 1040, line 38 25 39,283.
26 Multiply line 25 by 2% (.02) 26 786.
27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- 27 0.
28 Other ' from list in the instructions. List type and amount G
Other
Miscellaneous
Deductions 28
Total 29 Is Form 1040, line 38, over $166,800 (over $83,400 if
Itemized married filing separately)?
Deductions
X No. Your deduction is not limited. Add the amounts in the far right column
for lines 4 through 28. Also, enter this amount on Form 1040, line 40a. G 29 5,622.
Yes. Your deduction may be limited. See instructions for the amount to enter.
30 If you elect to itemize deductions even though they are less than your standard deduction, check here G

BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. FDIA0301 11/20/09 Schedule A (Form 1040) 2009
SCHEDULE M OMB No. 1545-0074
Making Work Pay and Government
(Form 1040A or 1040)

Department of the Treasury

Retiree Credits 2009
Attachment
Internal Revenue Service (99) G Attach to Form 1040A, 1040, or 1040NR. G See separate instructions. Sequence No. 166
Name(s) shown on return Your social security number

Dorothy Gibbs 244-13-5250

1 a Important: See the instructions if you can be claimed as someone else’s dependent or are filing Form
1040NR. Check the ’No’ box below and see the instructions if (a) you have a net loss from a business, (b) you
received a taxable scholarship or fellowship grant not reported on a Form W-2, (c) your wages include pay
for work performed while an inmate in a penal institution, (d) you received a pension or annuity from a
nonqualified deferred compensation plan or a nongovernmental section 457 plan, or (e) you are filing Form
2555 or 2555-EZ.

Do you (and your spouse if filing jointly) have 2009 wages of more than $6,451 ($12,903 if married
filing jointly)?

X Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly) on line 4 and go to line 5.
No. Enter your earned income (see instructions) 1a

b Nontaxable combat pay included on line 1a

(see instructions) 1b
2 Multiply line 1a by 6.2% (.062) 2

3 Enter $400 ($800) if married filing jointly) 3

4 Enter the smaller of line 2 or line 3 (unless you checked ’Yes’ on line 1a) 4 400.

5 Enter the amount from Form 1040, line 38*, or Form 1040A, line 22 5 39,283.

6 Enter $75,000 ($150,000 if married filing jointly) 6 75,000.

7 Is the amount on line 5 more than the amount on line 6?

X No. Skip line 8. Enter the amount from line 4 on line 9 below.
Yes. Subtract line 6 from line 5 7

8 Multiply line 7 by 2% (.02) 8

9 Subtract line 8 from line 4. If zero or less, enter -0- 9 400.

10 Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2009? You may have
received this payment if you received social security benefits, supplemental security income, railroad
retirement benefits, or veterans disability compensation or pension benefits (see instructions).
X No. Enter -0- on line 10 and go to line 11.
Yes. Enter the total of the payments received by you (and your spouse, if filing jointly). 10 0.
Do not enter more than $250 ($500 if married filing jointly)

11 Did you (or your spouse, if filing jointly) receive a pension or annuity in 2009 for services performed as an
employee of the U.S. Government or any U.S. state or local government from work not covered by social
security? Do not include any pension or annuity reported on Form W-2.
X No. Enter -0- on line 11 and go to line 12.
Yes. ? If you checked ’No’ on line 10, enter $250 ($500 if married filing jointly and the
answer on line 11 is ’Yes’ for both spouses) 11 0.
? If you checked ’Yes’ on line 10, enter -0- (exception: enter $250 if filing jointly
and the spouse who received the pension or annuity did not receive an
economic recovery payment described on line 10)

12 Add lines 10 and 11 12 0.

13 Subtract line 12 from line 9. If zero or less, enter -0- 13 400.
14 Making work pay and government retiree credits. Add lines 11 and 13. Enter the result here and on Form
1040, line 63, Form 1040A, line 40; or Form 1040NR, line 60 14 400.

*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions.
BAA For Paperwork Reduction Act Notice, see Form 1040A, 1040, or 1040NR instructions. Schedule M (Form 1040A or 1040) 2009

FDIA8501 10/27/09
 Tax Payments Worksheet 2009
G Keep for your records

Name(s) Shown on Return Social Security Number

Dorothy Gibbs 244-13-5250

Estimated Tax Payments for 2009 (If more than 4 payments for any state or locality, see Tax Help)

Federal State Local

Date Amount Date Amount ID Date Amount ID

1 04/15/09 04/15/09 04/15/09

2 06/15/09 06/15/09 06/15/09

3 09/15/09 09/15/09 09/15/09

4 01/15/10 01/15/10 01/15/10

Tot Estimated
Payments

Tax Payments Other Than Withholding Federal State ID Local ID

(If multiple states, see Tax Help)

6 Overpayments applied to 2009

7 Credited by estates and trusts
8 Totals Lines 1 through 7
9 2009 extensions

Taxes Withheld From: Federal State Local

10 Forms W-2 1,882. 2,038.

11 Forms W-2G
12 Forms 1099-R
13 Forms 1099-MISC and 1099-G
14 Schedules K-1
15 Forms 1099-INT, DIV and OID
16 Social Security and Railroad Benefits
17 Form 1099-B St Loc
18 a Other withholding St Loc
b Other withholding St Loc
c Other withholding St Loc
19 Total Withholding Lines 10 through 18c 1,882. 2,038.
20 Total Tax Payments for 2009 1,882. 2,038.

Prior Year Taxes Paid In 2009 State ID Local ID

(If multiple states or localities, see Tax Help)

21 Tax paid with 2008 extensions

22 2008 estimated tax paid after 12/31/08
23 Balance due paid with 2008 return 84. NC
24 Other (amended returns, installment payments, etc)
 Schedule A State and Local Tax Deduction Worksheet 2009
Line 5 G Keep for your records

Name(s) Shown on Return Social Security Number

Dorothy Gibbs 244-13-5250

State and Local Income Taxes

State income taxes:

1 State income tax withheld 1 2,038.
2 2009 state estimated taxes paid in 2009 2
3 2008 state estimated taxes paid in 2009 3
4 Amount paid with 2008 state application for extension 4
5 Amount paid with 2008 state income tax return 5 84.
6 Overpayment on 2008 state income tax return applied to 2009 tax 6
7 Other amounts paid in 2009 (amended returns, installment payments, etc.) 7
8 State estimated tax from Schedule(s) K-1 (Form 1041) 8
Local income taxes:
9 Local income tax withheld 9
10 2009 local estimated taxes paid in 2009 10
11 2008 local estimated taxes paid in 2009 11
12 Amount paid with 2008 local application for extension 12
13 Amount paid with 2008 local income tax return 13
14 Overpayment on 2008 local income tax return applied to 2009 tax 14
15 Other amounts paid in 2009 (amended returns, installment payments, etc.) 15
16 Local estimated tax from Schedule(s) K-1 (Form 1041) 16
Other:
17 17
18 Total Add lines 1 through 17 18 2,122.
19 State and local refund allocated to 2009 19
20 Nondeductible state income tax from line 28 20
21 Total reductions Add lines 19 and 20. 21
22 Total state and local income tax deduction Line 18 less line 21 22 2,122.

Nondeductible State Income Tax (Hawaii Only)

23 Nontaxable federal employee cost of living allowance 23

24 Adjusted gross income 24
25 Add lines 23 and 24 25
26 Nondeductible percent. Line 23 divided by line 25 26 %
27 Hawaii state income tax included in line 18 27
28 Nondeductible Hawaii state income tax. Multiply line 26 by line 27. 28
 Charitable Contributions Summary 2009
G Keep for your records
Name(s) Shown on Return Social Security Number
Dorothy Gibbs 244-13-5250
Part I Cash Contributions Summary
(a) (b) (c) (d)
Name of Charitable Organization Total 50% 30% 100%
Limit Limit Limit
(Sch. K-1)

Church 3,500. 3,500.

Totals: 3,500. 3,500.

Part II Non-Cash Contributions Summary
Total Other Property Capital Gain Property

(a) (b) (c) (d) (e)

Name of Charitable Organization Total 50% 30% 30% 20%
Limit Limit Limit Limit

Totals:
Part III Contribution Carryovers to 2010
Total Cash and Other Capital Gain
Non-Capital Gain Property Property
(a) (b) (c) (d) (e) (f)
Total 100% 50% 30% 30% 20%
Limit Limit Limit Limit Limit
1 2009 contributions 3,500. 3,500.
2 2009 contributions
allowed 3,500. 0. 3,500. 0. 0. 0.
3 Carryovers from:
a 2008 tax year
b 2007 tax year
c 2006 tax year
d 2005 tax year
e 2004 tax year
4 Carryovers
allowed in 2009 0. 0. 0. 0. 0.
5 Carryovers
disallowed in 2009 0. 0. 0. 0. 0.
6 Carryovers to 2010:
a From 2009 0. 0. 0. 0. 0.
b From 2008
c From 2007
d From 2006
e From 2005
f From 2004 (expired)

Part IV Special Situations in Your Return for Current Year Donations

1 Was the entire interest given for all property donated to all charities? X Yes No
2 Were restrictions attached to any charities’s right
to use or dispose of any property donated to any charity? Yes X No
3 Did you give to anyone other than the charity the right to income from any
of the donated property or to possession of any of the donated property? Yes X No
4 Was any charity other than a 50% charity? Yes X No
 Federal Carryover Worksheet 2009
G Keep for your records

Name(s) Shown on Return Social Security Number

Dorothy Gibbs 244-13-5250

2008 State and Local Income Tax Information (See Tax Help)

(a) (b) (c) (d) (e) (f) (g)

State or Paid With Estimates Pd Total With- Paid With Total Over- Applied
Local ID Extension After 12/31 held/Pmts Return payment Amount
NC 1,978. 84.

Totals 1,978. 84.

Other Tax and Income Information 2008 2009

1 Filing status 1 3 MFS 3 MFS

2 Number of exemptions for blind or over 65 (0 - 4) 2
3 Itemized deductions after limitation 3 2,891. 5,622.
4 Check box if required to itemize deductions 4 X
5 Adjusted gross income 5 39,229. 39,283.
6 Tax liability for Form 2210 or Form 2210-F 6 3,274. 3,139.
7 Alternative minimum tax 7
8 Federal overpayment applied to next year estimated tax 8

QuickZoom to the IRA Information Worksheet for IRA information

Excess Contributions 2008 2009

9a Taxpayer’s excess Archer MSA contributions as of 12/31 9a

b Spouse’s excess Archer MSA contributions as of 12/31 b
10 a Taxpayer’s excess Coverdell ESA contributions as of 12/31 10 a
b Spouse’s excess Coverdell ESA contributions as of 12/31 b
11 a Taxpayer’s excess HSA contributions as of 12/31 11 a
b Spouse’s excess HSA contributions as of 12/31 b

Loss and Expense Carryovers 2008 2009

12 a Short-term capital loss 12 a

b AMT Short-term capital loss b
13 a Long-term capital loss 13 a
b AMT Long-term capital loss b
14 a Net operating loss available to carry forward 14 a
b AMT Net operating loss available to carry forward b
15 a Investment interest expense disallowed 15 a
b AMT Investment interest expense disallowed b
16 Nonrecaptured net Section 1231 losses from: a 2009 16 a
b 2008 b
c 2007 c
d 2006 d
e 2005 e
f 2004 f
Federal Carryover Worksheet page 3 2009

Dorothy Gibbs 244-13-5250

Charitable Contribution Carryovers

26 2008 Carryover of Other Property Capital Gain

charitable contributions
from: (a) 50% (b) 30% (c) 30% (d) 20%

a 2008
b 2007
c 2006
d 2005
e 2004

27 2009 Carryover of Other Property Capital Gain

charitable contributions
from: (a) 50% (b) 30% (c) 30% (d) 20%

a 2009
b 2008
c 2007
d 2006
e 2005

28 Amount overpaid less earned income credit 0.

2008 State Capital Loss Carryovers (For users not transferring from the prior year)

State Short-term AMT Short-term Long-term AMT Long-term Capital Loss AMT Capital Loss
ID Capital Loss Capital Loss Capital Loss Capital Loss (combined) (combined)
for State for State for State for State for State for State
File by Mail Instructions for your 2009 North Carolina Tax Return
Important: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
DOROTHY GIBBS
230 PEACHTREE ST
HENDERSON, NC 27536
|
Balance | Your North Carolina state tax return (Form D-400) shows you owe a
Due/ | balance due of $10.00.
Refund |
| You are paying by check.
|
______________________________________________________________________________________
|
What You | Your tax return - The official return for mailing is included in
Need to | this printout. Remember to sign and date the return.
Mail |
| Your payment - Mail a check or money order for $10.00, payable to
| "North Carolina Department of Revenue". Write your Social Security
| number and "2009 Form D-400" on the check. Mail the return and check
| together.
|
| Attach your Form W-2, 1099 statements, or other statements to your
| return.
|
| Mail your return, attachments and payment to:
| North Carolina Department of Revenue
| P.O. Box 25000
| Raleigh, NC 27640-0640
|
| Deadline: Postmarked by April 15, 2010
|
| Don’t forget correct postage on the envelope.
|
______________________________________________________________________________________
|
What You | Keep these instructions and a copy of your return for your records.
Need to | If you did not print one before closing TurboTax, go back to the
Keep | program and select Print & File tab, then select the Print for Your
| Records category.
|
______________________________________________________________________________________
|
2009 | Taxable Income $ 30,783.00
North Carolina | Total Tax $ 2,048.00
Tax | Total Payments/Credits $ 2,038.00
Return | Payment Due $ 10.00
Summary |
|
______________________________________________________________________________________
|
Special | Your printed state tax forms may have special formatting on them,
Formatting | such as bar codes or other symbols. This is to enable fast
| processing. Don’t worry, these forms have been approved by your
| taxing authority and are acceptable for printing and mailing.
|
______________________________________________________________________________________

Page 1 of 2
File by Mail Instructions for your 2009 North Carolina Tax Return
Important: Your taxes are not finished until all required steps are completed.

(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
DOROTHY GIBBS
230 PEACHTREE ST
HENDERSON, NC 27536
|
Changed | You can still file electronically. Just go back to TurboTax, select
Your Mind | the Print & File tab, then select the E-file category. We’ll walk
About | you through the process. Once you file, we will let you know if your
e-filing? | return is accepted (or rejected) by the state taxing agency.
|
______________________________________________________________________________________

Page 2 of 2
 Instructions for Form D-400V, Payment Voucher
What Is Form D-400V and ? Enter ’2009 Form D-400,’ Important Reminders
Why Should You Use It? your daytime phone
number, and your SSN
It is a statement you send on your check or money ? Do not staple, tape, paper
with your payment of any order. If you are filing a clip or otherwise attach
balance due on your 2009 joint return, enter the your check or money order
Form D-400. Using Form SSN shown first on to the voucher
D-400V allows us to your return.
process your payment more ? Do not fold the voucher
accurately and efficiently. What if You File or check
We strongly encourage you Electronically?
to use Form D-400V. ? Do not use the voucher to
If you choose to file pay quarterly estimated tax
Preparing and Sending electronically and have a
Your Payment balance due, follow your ? Do not use a photocopy of
transmitter’s or preparer’s the voucher
? Make your check or instructions for making
money order payable in your payment. ? Do not use another
U.S. dollars to the NC person’s voucher
Department of Revenue. Other Payment Methods
Note: The Department will ? Do not send cash
not accept a check, In lieu of using the payment
money order, or cashier’s voucher below, you may
check unless it is drawn pay your tax online by
on a U.S. (domestic) bank draft, or debit or
bank and the funds are credit card using Visa or
payable in U.S. dollars. Mastercard. For details, go
to our website at
? Make sure your name and www.dornc.com and click
address appear on your on Electronic Services.
check or money order.

Do not use this payment voucher if you pay your tax on-line.

Cut Here
B B
NCIA1701 11/03/09

D-400V (50) Individual Income Payment Voucher

9-16-08 North Carolina Department of Revenue

244135250 GIBB 230 27536

DOROTHY GIBBS

230 PEACHTREE ST For Calendar Year 2009 AMOUNT OF THIS PAYMENT

This must match the amount shown on
HENDERSON NC 27536 your check or money order.

Taxpayer/Paid Preparer: $ 10 .00

Date: Phone: 7270150006

Mail to:
NCDOR, PO Box 25000,
20095 2441352509 0000000 06408 Raleigh, NC 27640-0640
D-400 (50) 9-14-09 Individual Income Tax Return 2009
< Staple All Pages of Your North Carolina Department of Revenue
Return and W-2s Here
For calendar year 2009, or fiscal year beginning 09 and ending NC Public Campaign Fund
Select ’Yes’ if you want to designate $3 of
taxes to this special Fund for voter
education materials and for candidates who
accept spending limits. Selecting ’Yes’ does
DOROTHY GIBBS not change your tax or refund.
230 PEACHTREE ST Your SSN: 244135250 You Yes X No
Spouse’s
HENDERSON NC 27536 VANCE SSN: Your Spouse Yes No
Filing Status Year spouse died: Number of Exemptions Claimed: 02 NC Political Parties Financing Fund
Select box if you or your spouse Select appropriate box if you want to
1 Single were out of the country on April 15 Return for deceased taxpayer designate $3 to this fund. Your tax
and a U.S. citizen or resident. remains the same whether or not you
2 Married Filing Jointly Date of death: make a designation.
Select box if return is filed and
X 3 Married Filing Separately signed by Executor or Return for deceased spouse
Administrator.
4 Head of Household Date of death: You Your Spouse
5 Widow(er) with Dependent Child You Spouse Democratic Democratic
Select box if this is an Select box if you or your spouse were a nonresident of NC for the entire year. Republican Republican
Amended 2009 return. Select box if you or your spouse moved into or out of NC during the year. Unspecified Unspecified

FS 3 EX 02 PP N DT N DS N OC N EA N

GIBB 230 27536 NRT N NRS N PYT N PYS N

DOROTHY GIBBS 244135250 PCT N PFT 0

PCS PFS 0

230 PEACHTREE ST HENDERSON NC 27536

AGI 39283 22B 0 31 0 43 0 55 0

06 26361 22C 0 32 5622 44 0

07 4422 22D 0 33 0 45 0

09 0 23 0 35 2122 46 0
7
0
15 0 25A 10 36 2122 47 0 2
0
17 0 25C 0 37 2300 48 0 1
5
19 0 EU 38 0 49 0 0
0
1
21A 2038 26 10 39 0 50 0 1

21B 0 28 0 40 0 51 0

22A 0 29 0 41 0 52 0

TN PN PP 54 0 NCDOR Use Only

Sign Return Below Refund Due 0 X Payment Due 10

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

SELF PREPARED
Spouse’s Signature (If filing joint return, both must sign.) Date Paid Preparer’s Signature Date

Home Telephone Number (Include area code) Paid Preparer’s FEIN, SSN, or PTIN Paid Preparer’s Telephone Number

If you ARE NOT due a refund, mail return, any payment, and Form D-400V to: NCDOR, P.O. Box 25000, Raleigh, NC 27640-0640
If REFUND mail to: NCDOR, P.O. Box R, Raleigh, NC 27634-0001 NCIA0312 11/03/09 A
D-400 2009 Page 2 (50)
Last Name (First 10 Characters) GIBBS Your Social Security Number 244135250
D-400 Line-by-Line Information

AGI Federal Adjusted Gross Income AGI 39283 Additions to Federal Taxable Income
6 Taxable Income from Federal Return 6. 26361 32 Itemized deductions or standard
7 Additions to Federal Taxable Income 7. 4422 deduction from your federal return 32. 5622
8 Add Lines 6 and 7 8. 30783 33 N.C. standard deduction
9 Deductions from Federal Single $3,000; Head of household $4,400;
Taxable Income 9. 0 Qualifying widow(er) $6,000; Married filing jointly $6,000;
10 Line 8 minus Line 9 10. 30783 Married filing separately:
11 Same as Line 10 11. 30783 If your spouse does NOT claim itemized deductions $3,000;
12 Part-year residents If your spouse claims itemized deductions $0
and nonresidents 12. 0.0000 NOTE: If 65 or older or blind or if someone can claim
13 N.C. Taxable Income 13. 30783 you as a dependent, see worksheet 33. 0
14 N.C. Income Tax 14. 2048 34 Line 32 minus 33 ' Amount cannot be
15 Surtax 15. 0 less than zero 34. 5622
16 Total North Carolina Income Tax 16. 2048 35 State, local, and foreign taxes 35. 2122
17 Tax Credits 17. 0
36 If standard deduction, enter amount
18 Line 16 minus Line 17 18. 2048 from Line 34. If itemizing, enter Line
19 Consumer Use Tax 19. 0 34 or 35, whichever is less. 36. 2122
20 Add Lines 18 and 19 20. 2048 37 Personal exemption adjustment 37. 2300
38 Interest income from other states 38. 0
North Carolina Income Tax Withheld 39 Adjustment for domestic production
activities (See instructions) 39. 0
21 a Your Income Tax Withheld 21 a. 2038 40 Adjustment for bonus depreciation 40. 0
21 b Spouse’s Income Tax Withheld 21 b. 0 41 Other federal taxable income additions 41. 0
42 Total additions 42. 4422
Other Tax Payments
Deductions from Federal Taxable Income
22 a 2009 Estimated Tax 22 a. 0 43 State or local income tax refund 43. 0
22 b Paid with Extension 22 b. 0 44 Interest income from obligations of
22 c Partnership 22 c. 0 US or US’ possessions 44. 0
22 d S Corporation 22 d. 0 45 Social Security and Railroad
23 North Carolina Earned Income Tax Credit 23. 0 Retirement Benefits 45. 0
24 Add Lines 21a through 23 24. 2038 46 Bailey settlement retirement benefits 46. 0
25 a Tax Due ' If Line 20 is more than Line 24, 47 Other retirement benefits 47. 0
subtract and enter the result 25 a. 10 48 Severance wages 48. 0
25 b Penalties and interest 25 b. 0 49 Adjustment for additional first-year
EU Exception to underpayment of depreciation added back in 2002, 2003,
estimated tax EU and 2004 (See instructions) 49. 0
25 c Interest on the underpayment of 50 Adjustment for bonus depreciation
estimated income tax 25 c. 0 added back in 2008 50. 0
51 Contributions to North Carolina’s
26 Pay this Amount 26. 10 National College Savings Program
(NC 529 Plan) (See instructions) 51. 0
27 Overpayment ' If Line 20 is less
than Line 24, subtract and enter 52 Other federal taxable income deductions 52. 0
the result 27. 0 53 Total deductions 53. 0

Amount of Refund to Apply to: Part-Year Residents and Nonresidents

54 All income while a part-year NC resident

28 Amount of Line 27 to be applied to and NC source income while a nonresident 54. 0
2010 Estimated Income Tax 28. 0 55 Total income from all sources 55. 0
29 N.C. Nongame and 56 Divide Line 54 by Line 55 56. 0.0000
Endangered Wildlife Fund 29. 0
30 Add Lines 28 and 29 30. 0 N.C. Residency Dates for Part-Year Residents
Beginning Ending
31 Amount to be Refunded 31. 0 Taxpayer:
Spouse:
This page must be filed with the first page of this form. NCIA0312 11/03/09
 Form D400, ln 33 North Carolina Standard Deduction Worksheet 2009
G Keep for your records ' Do not file

Name(s) Shown on Return Social Security Number

DOROTHY GIBBS 244-13-5250

STANDARD DEDUCTION FOR THIS RETURN

Standard deduction based on the tables shown below. Enter on Form D400
line 33. 0.
(*If married filing separately and spouse itemized deductions check here X )

Table A: STANDARD DEDUCTION FOR MOST TAXPAYERS

1 Standard deduction based on filing status:

Single $3,000
Married Filing Jointly $6,000
Married Filing Separately $3,000
Head of Household $4,400
Qualifying Widow(er) $6,000 1 3,000.

2 Additional deductions: Taxpayer Spouse

65 or Over
Blind
If age 65 or older or blind, multiply the number of boxes checked above
by $600 if married (filing as joint or separate*) or qualifying widow; OR
by $750 if single or head of household 2 0.

3 Add lines 1 and 2. 3 3,000.

Table B: STANDARD DEDUCTION FOR DEPENDENTS

1 Enter your earned income plus $250. Total 1

2 Minimum standard deduction 2 500.
3 Enter the larger of line 1 or line 2 3
4 NC standard deduction from Table A, line 1, above 4
5 Standard deduction.
a Enter the smaller of line 3 or line 4. 5a

b NC additional deduction from Table A, line 2, above b

c Add lines 5a and 5b. c

nciw2901.SCR 10/02/09
 Personal Exemption Adjustment Worksheet 2009
G Keep for your records

Name as Shown on Return Social Security Number

DOROTHY GIBBS 244135250

If your federal adjusted gross income (Form 1040, line 37; Form 1040A, line 21; or Form 1040EZ, line 4) is
less than the amount shown for your filing status in the chart, complete line 1. Otherwise, Skip line 1 and
complete line 2.
Filing Status Adjusted Gross Income
Married, filing jointly/Qualifying widow(er) $ 100,000
Head of Household $ 80,000
Single $ 60,000
Married, filing separately $ 50,000

1 1040 or 1040A filers

? Multiply the number of exemptions claimed on line 6d of 1040 or 1040A
by $ 1150 and enter the result
1040EZ Single filers
? Enter $ 1150 if you cannot be claimed as a dependent by
someone else
? Enter zero if you can be claimed as a dependent by
someone else
1040EZ Married Filing Jointly filers
? Enter $2,300 if neither spouse can be claimed as a dependent by
someone else
? Enter $ 1150 if one spouse can be claimed as a dependent by
someone else
? Enter zero if both spouses can be claimed as dependents by
someone else
Stop Here and enter this amount on Form D-400, line 37 1 2300

2 1040 or 1040A filers

? Multiply the number of exemptions claimed on line 6d of 1040
or 1040A by $1,650 and enter the result
1040EZ Single filers
? Enter $1,650 if you cannot be claimed as a dependent by
someone else
? Enter zero if you can be claimed as a dependent by
someone else
1040EZ Married Filing Jointly filers
? Enter $3,300 if neither spouse can be claimed as a dependent by
someone else
? Enter $1,650 if one spouse can be claimed as a dependent by
someone else
? Enter zero if both spouses can be claimed as dependents by
someone else
Important: If you were not required to complete the Deduction for
Exemptions Worksheet in the instructions for federal Form 1040 or 1040A,
Stop Here and enter this amount on line 37 of Form D-400. 2 0

If you were required to complete the Deduction for Exemptions Worksheet

and you answered "No" on line 6 of the federal worksheet, complete Lines 3
through 6 below. If you answered "Yes" on line 6 of the federal worksheet,
skip lines 3 through 6 and complete line 7 below.

3 Enter the amount from line 9 of the Deduction for Exemptions Worksheet
in the Federal program 3 0
4 Enter the amount from line 1 of the Deduction for Exemptions Worksheet
in the Federal program 4 0
5 Line 3 divided by Line 4 entered as a decimal amount 5 0.00
6 Multiply line 2 by line 5 and enter the result here and on Form D-400, Line 37 6 0
7 Multiply line 2 by .6666 and enter the result here and on Form D-400, Line 37 7 0

NCIW2101.SCR 09/28/09