Text extracted via OCR from the original document. May contain errors from the scanning process.
4
651112
Schedule K-1
(Form 1065)
A or caliwidar rm.?
Department of the treasury
„„,,54.5.5,..4
internal Revenue Service
,,,,,,,
Partner's Share of Income, Deductions,
Credits, etc.
2012
2012. or ins
[-M
Final K-1
(---i Amended K-I
OMB No. 1545-0099
Part ill Partner's Share of Current Year Income.
Deductions, Credits, and Other Items
I Ordinary business income (loss)
I
<100,000.>
15 Credits
so. See separate Instructions.
2 Newts Mg *SU inmost (Win
I
16 Foreign transactions
Part I
Information About the Partnership
3 Other net rental income (loss)
I
A Partnersne s eimuouet identification number
4 Guaranteed payments
iiimpplillress. city. state and ZIP code
86 HIDDEN RIDGE DRIVE
SYOSSET, NY
11791
5 Interest income
I
es Ordinary dividends
I
17 Alternative min lax (AMT) items
60 Oualthed dividends
I
C IRS Centre where partnership hied return
CINCINNATI,
OH
7 Royalties
I
D i -I Check A this is a publicly traded partnership (PTP)
IS
nondeductible
ax-exempt income and
expenses
0 Net short-term capital gain (loss)
Part II
Information About the Partner
9a Net long-term capital gain (loss)
I
90 Collectibles (28%) gain (loss)
I
19 Distributions
number
F Partners I Lim e. address. city. state, and ZIP code
329 SEABREEZE AVENUE
PALM BEACH, FL 33480
9e Unrecaplured sec 1250 gain
[
20 Other information
10 Net section 1231 gain (lesS)
11 Other income (loss)
0 L._..! General partner or LLC
member-manager
II FL Domestic partner
II What type of entity is this partner? PARTNERSHIP
I X I Limited partner or other LLC
member
0
Foreign partner
I
12 Section 179 deduction
12 II this partner is a retirement plan (IRIVSEPiKeoghretc.).
J Partner's share of profit, loss, and capital:
Beginning
Prole
0.0000000%
check here
LI
Ending
0.0000000%
13 Other deductions
Loss
0.0000000%
0.0000000%
Capital
0.0000000%
0 . 0 0 0 0 0 0 0%
14 Seff
A
I
employment earnings Coss)
K Partners share of liabilities at year end:
Nonrecoutse
Qualified norwecourse financing
Recourse
0.
$
If
$
'See attached statement for additional in ormation.
$
0 .
.2.
2
5,
G:
I. Partners capital account analysis:
Beginning capital account
Capital contributed during the year
Cul f ent year inoease (decreaSe)
Withdrawals & distributions
Ending capital account
Iii
Tax basis
CI GMP
S
$
100,000.8
$
<100,000.7g
S
)
$
0 .
LI] Section 704(b) book
gain or loss?
Li
Other (explain)
M Did the partner contribute property with a built-in
LI Yee
DC No
II Yes', attach statement (see instructions)
a I.cui.ii I_FIA For Paperwork Reduction Act Notice. see lestructIons for Form 1065.
IRS.00vilorm1065
Schedule K- I (Form 10651 2012
4
18060814 146773 ELK0020 cciRritirKrnsArt
ELK00202
SDNY_GM_00033012
EFIA_001 43625
EFTA01280181
83-0514382
SCHEDULE K-1
DESCRIPTION
AMOUNT
TOTALS
-100,000.
SCHEDULE K-1 INCOME SUBTOTAL
-100,000.
NET INCOME (LOSS) PER SCHEDULE K-1
-100,000.
TOTAL TO SCHEDULE K-1, ITEM L
-100,000.
PARTNER NUMBER 4
18060814 146773 ELK0020 cdN ribtinsAtc
s:::
2:
3013
EFTA 00143626
EFTA01280182
4
Schedule K-1 (Form 1065) 2012
Pacie 2
Tlili litt Maneli., the codes used on Schedule K-1 for all partnera and provides summarized reporting information lor partner‚ who file
Form 1040. For detalled reportiag and tilina informallow see the separate Partnera Instructiona for Schedule K-1 and the inetructions
for your income raa return.
CoCe
Nepot on
t. Ctøterry krewna tecorro Werk Danam,. Pkin!. Mb rewio 4-wel
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Ncnpaa kra
4~2~1
inaptrl•
2
Noi rental rcyl Nyp InComo (km)
3
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Fel patena
Nerka.
Civeremeed lavyments
5
venrep morce
Sa
Cebery dnedreelle
Fn
Ovatted areeleetz
nu)aduce$
e.
N49 sne91,e9rm cepra, gen ton{)
98.
Net Iong-term racmi gen !Ø!
90 OcalecteRte War% cont dowl
•
Llreacep Wed ~Ww 1293 gap
10
Net eptc. 1231 pae~
w
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Dale
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tl nvokertsy comwelone
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13.
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A Car. creettutions 60%;
•
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C Nercash cceveatioes 60141
O
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E
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Ii
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NON
79. 98.9 e 94C1Kon 179 00.9.KOOK Of any psalrer.99.99 09auchena, we
Me Partnera le*Instircee bobo crokne0 Suwne.%
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Net emnes POPI Porn
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C Gem nontrarm PCW%
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4
ELK00202
SDNY_GM 00033014
EFTA 00143627
EFTA01280183
56 BRYANT AVENUE
EDISON, NJ 08820
AUGUST 14, 2013
329 SEABREEZE AVENUE
PALM BEACH, FL 33480
DEAR MEMBER:
ATTACHED IS YOUR COPY OF THE 2012 PARTNERSHIP FORM 1065
SCHEDULE K-1. THIS SCHEDULE SUMMARIZES YOUR INFORMATION FROM
INCOME, FORM 1065.
SCHEDULE K-1, PAGE 2. IF YOUR RETURN WILL BE PREPARED BY
INFORMATION.
CONFIDENTIAL
SDNY_GM_00033015
EFTA_00 143628
EFTA01280184
New York State Department of Taxation and Fiance
2012
New York Partner's Schedule K-1
Tax Law - Article 22 (Personal Income Tax)
IT-204-IP
Et
4
Final K-1
For calendar year 2012 or tax year beginning
and ending
Amended K-1
Partners: Before completing your income tax return, see Form IT.204.1P.1, Partner's lnstructons for Form IT. 204'IP (available I www.tax.ny.gov).
Partnership's information (see anstruCtions)
Partnership's name (as shown on Form 1T-204)
A Mark an X in the box il either applies to your entity
B Tax shelter registration number. If any
C Business allocation percentage
Publicly traded partnership
El
Portfolio investment partnership
8
C
Partner's information (see ',initiator's)
Partners name
Partner's address
329 SEABREEZE AVENUE
City
stale
PALM BEACH
FL
ZIP code
33480
Partner's dent
number
D The partner Is
n X
V* 190, 0170.110 004
C
General partner or LEG member manager
al
Lir:tett partner or other LLC member
E what is the tax fang status of the partner? f.nrk an X it me a0PrOOSSIO bon. /km,.
Individual El Estate/trust [XI Partnership
F If the partner's a disregarded entity or grantor trust.
enter the tax ID of the entity or ndwectuW reporting the income. if known
0
DM the partner sell its entire interest during the tax year?
G
Yes Q
No DO
H Partner's shared profit loss. and capital
Beginning
Ending
1) Profit
HI
0.0000
%
0.0000
%
2) Loss „ .
H2
0.0000
%
0.0000
,
3) Capital .
H3
0.0000
%
0.0000
yr,
i
Partner's share of kibilltiss at the end of the year
1) Nonrecourse
II
2) Qualified nonrecourse financing
12
3) Recourse
. .
13
J Partner's capital account analysis
1) Beginning capital account
J1
2) Capital contributed during the year • cash .
J2
100,000.
3) Capital contributed during the year' property
J3
4) Current year increase (decrease)
J4
100,000.
5) Withdrawals and distributions - cash
J5
6) Withdrawals and distributions • property
J6
7) Ending capital account
J7
8) Method of accounting (mark an x in the appropriate box)
CE
Tax basis
C
GAAP
Iji
Book
Other (submit expianaeore
K Resident status (mark an x in all boxes that levy)
C
NYS fultyear resident
I
I
Yonkers full-year resident
=I
NYS part-year resident
L_I Yonkers part•year resident
MI
NYS nonresident
El
Yonkers nonresident
L
If the partner was included n a group retUrn, enter the Special NYS identification number, if known
L
118001121019
O
NYC fufiyear resident
NYC part-year resident
288151
11.19- 12
CONFIDENTIAL
SDNY_GM_00033016
EFTA_00143629
I I
EFTA01280185
Par 2 of 4
IT-204-IP (2012)
M 1) Was Form IT 2658•E fled with the partnership?
2) Was Form h1TA 405E filed with the partnership?
N NYS estimated tax paid on behalf of partner (from Form IT-26581
1) First installment
N1
2) Second installment
N2
3) Third installment
N3
4) Fourth installment
144
Total NYS estimated tax paid on behalf of partner (000 tries NI through N4)
O Estimated MCTMT paid on behalf of partner (from Form MTA-405)
1) First installment
01
2) Second installment
02
3) Third installment
03
4) Fourth installment
04
Total estimated MCTMT paid on behalf of partner (add tines 01 through CA)
0
Partner's share of income, deductions, etc.
A - Partners clistnbutive share items
B - Federal K-1 amount
C - Now York State amount
1 Ordinary business income (loss)
1
- 100,000.
1
- 100,000.
2 Net rental real estate income (loss)
2
2
3 Other net rental income floss)
3
3
4 Guaranteed payments
4
4
5 Interest income
5
5
8 Ordinary dividends
6
6
7 Royalties
7
7
8 Net short4enn capital gain (loss)
8
8
9 Net long-term capital gain (loss)
9
9
10 Net section 1231 gun (loss)
10
10
11 Other income (loss) Identify:
11
11
12 Section 179 deduction
12
12
13 Other deductions Identify:
13
13
14 Tax preference items for minimum tax
14
14
Identify,
15 Net earnings (lass) from self employment
15
15
18 Tax•exempt income and nondeductible expenses
16
16
17 Distributions - cash and marketable securities
17
17
18 Oistnbutlons • other property
18
18
19 Other items not included above that are required to be
reported separateN to partners
19
19
Identify
Date
N
Date
M1 Yes C
No 0
M2 Yes C
No ED
Amount
Amount
Partner's share of New York modifications (see ostructrons)
20 Nt,w York Stale addit>onf.
Number
A - Total amount
B - New York State allocated amount
20a EA-
200 EA-
20c EA-
20d EA-
20e EA-
20f EA-
21 Total addition modifications (total of column A. linen 20a through 20t)
21
118002121019
7864,52
•
CONFIDENTIAL
SDNY_GM_00033017
EFTA_00143630
EFTA01280186
IT-204-IP 12012)
Page 3 of 4
Partner's share of New York modificationsicentinuech
22 New York State subtractions
Number
A - Total amount
22a ES-
226 ES-
22c ES-
22d ES-
22e ES-
221 ES-
B - New York State allocated amount
23 Total subtraction modifications (total of column A. hoes 22a through 22*
23
20 Additions to federal itemized deductions
Letter
Amount
24a
24b
24c
24d
244
29(
25 Total additions to federal itemized deductions (add hoes 24a through 240
25
26 Subtractions from federal itemized deductions
Letter
Amount
28a
28b
26c
26d
26e
26f
27 Total subtractions from federal itemized deductions (add Imes 26a through 260
28 New York adjustments to tax preference dens
Partner's other information
29a Partners share of Now York source gross income
2% MCTD atlocatron percentage (see inStructrons)
Partner's credit information
Part 1 - Flow-through credit bases and factors
Brownfield redevelopment tax credit !Form!(-61 I or IT-611.1)
27
28
29a
2%
A Form IT-811
8 - Form IT-811.1
30 Site p•epa'atan credit component
30
30
31 Tangible property credit component
31
31
32 On.srte groundwater remediation credit component
32
32
118 0 0 312 1019
lIIINIIIIIIIINIIIIIIIHIIIII
CONFIDENTIAL
SDNY_GM_00033018
EFTA _00143631
EFTA01280187
Page 4 of 4
IT-204.417 (2012)
Partner's credit information (continued)
U capital tax credit (Form17-602)
33 Contributions of money to EZ community development projects
33
34 Recapture c4 credit for investments in certified EZ businesses
34
35 Recapture of credit for contributions of money to EZ community development projects
35
QEZE tax reduction credit (Form I7-604)
38 QEZE employment increase facto
38
37 QEZE zone allocation factor
37
38 QEZE benefit period facto
38
Excelsior jobs program tax credit (Forma-607)
39 Excelsior jobs tax credit component
.
39
40 Excelsior investment tax credit component
. ,
40
41 Excelsior research and development tax credit component
41
42 Excelsior real property tax credit component
42
Farmers' school tax credit (Form 17-217)
43 Acres of qualified agricdtural property
43
44 Acres of qualified conservation property
44
45 Elgible school district property taxes paid
45
46 Acres of qualified agricultural property converted to nonqualdred use
48
Other flow-through credit bases and factors
Credit bases
Code
Amount
Code
Amount
47a
47d
47b
47e
47c
471
Credit factors
Code
Factor
Cods
Factor
Cods
Factor
47q
471
47k
47h
47i
471
Part 2 - Flow-through credits, addbacks and recaptures
48 Longterm care insurance credit (Form 17-249)
48
49 Investment Credit (including employment incentive credit and historic barn rehabilitation credit; Form 17-212)40
50 Research and development • Investment credit (Form IT-212)
80
51 Other flow through credits
Code
Amount
Code
Amount
51a
51e
51b
51f
51c
51g
51d
51h
52 Addbacks of credits and recaptures
Cods
Amount
Cods
Amount
52a
52d
526
52e
52c
521
118004121019
288862
i'.19.12
CONFIDENTIAL
SontGfa_000aaotti
EFTA 00143632
EFTA01280188