1 n40 ri:-,:11.

;;:',-i ;1:: l':: ;^- ,nna

For the year Jan I - qlc 3! 2!m, m othef lr{ y@r beqiiii[q ,2009,endiiq ,20
Label
@E!
f
B,
rdrn.
POl,LAK 386-66-6787
a iohi spoue!rEi nans sedu*ssocbl3ecudlynmber

kne adr43 (n!.i&r ad*@t. f Ap"d@ * Younust enter your

935a{. KosnYER . sociaLsecuih
cib,, iM pod ofire
or
l iumbe(s) abo;e A
rl-h's; bnffi,rL,,'
IKOKIE. IL 600 76
> lXlYou
check ioF d ibu, or y0dr spoose i Jilmo iohtly, rarl 93 1o qo io this iuidt ($s ti t1l Ise"*"
Filing Status 1 Head ofhoLsehold (wirh q!. lynq person),
(See
2 N{erid lirinsjomlrGuen it@lyde had iieme)
nsrru.l om,) lJ lhe qlailinq
p€rson ls z.hid
b!lnottolr dependent, enler this chlds
3 Mdried iilliq separaiely. Enhr spouset SSN above & Ju

Exemplions Yourself, Lf someono dan claim you as a dependenl, tto nor check box 6a.....

14,
1
!(

d -old, nLnoer o oe nptons c a,ned

7 Waqes, saiaries, iips, etc. Attach Form(s) W-2 _ I8 699_
8a laeble inlerest, Aitach Schedute B it.equted.
bTd-exemFl nlerFsl. Do nor In( Lda on.ne 8a...
9a Ordinary dvidends. Altach.schedute B il.eqlted
b Cualiiied dividmds (se iisr6) ST.2 l9b
10 Tabble Elunds, dedib, 0r oiisek ot si?te aid ocat inlone tals G@ inshmibN) , , , , . . . . . . . . . _
1l Alimonyreceived....
12 Business income or (loss). Altach Schedute C or C-EZ
13 kpiialqanm(los).AnS.hDtJrqd.ffior@d,*hse...... ........ .n
14 Olherqa I > o. (o<s6), Att.ch lod 47c7
15a RA dishbulons... t5a .lh iaxabLe amolni (see instrs).
16a Penslors and annuiies,, .. b TaxabLe amount (se6 insts) .
17 Rentai realesiate. royaittes, parrrershiFs, S corporaiions, irusts, 6tc, Attach ScheduL6 E
18 Farm incohe or (oss). Aiia.h Schedlt€ E....

23 Educalor erperses (see inslruc0ons) .. ..

Adiusted Zt Caidi br..-. e\Dd-6 d eea.sts per'orriq fl6 s, ano -k.bal
Gtoss mJs' rnl 0'lr 6lc. Ar4h FoT'lC6 tr 2106.Ll
25 Heallh savnqs accouni ded!.iion. Aitach Form 8889.. ....
26 Mov n! "\paFes. Anaca forr 3903.
27 One-hali of seti emp oyrnont lax, Attach ScheduLe SE.
2a Sal-enpo/eo SLP SlMPtF. aad quc ieo p da^
29 '.ll..rpo@dte,h :a,nre@dr.1otr !e rr(rcn,/
30 Penalry on aarly ,rora,ato sdrnqs
3l a Ci oaL pdid b es pL rr -Srr.. . >
32 rPA oeo I -io1 6rrL.r F,, -:l
'see
33 S LdF r oal.r"resldeouronrseeirk.don\,.
34 niior ar €es oeoL. ho-. Alta(i t_o m B9'
35 Domestic producrioi actvit * dBductiod. Altaclr Form 8903. . .
35 Add lin* 23,3laand32 3t
37 Subtra.l line 36 iiom line 22, Thts is vour
BAA Fo. Disclosuro; Pdva.y Act, and PaFe ork Reduction Act Notic., see instruciions. Forn 10rr0 (2008)
 JOEI, B, POLI-AX 386-66- 6787 p
Tax and 3a aTo. nr t m tr )7 (adjJsr.d Aro:s r(or ej
3ra.red f Eyouw*ebd-bero,e-oL4y2 !o?r4. !e,o. 6o"",
> f
Credits ,' 1*s
Ll lspouse €s bot oe.ore talJat,2, cAa, I lB r. check€d 39dl
blf}!urspouseltemizsonassparaiercUh,orF!wrcaduatsiabrsaien,seiisirsaid*tri. > 39b
c Cli$k iislaidard deduliioi lncLud6 rcalaslateim d disaster oss Ge instructions) .. ... > 39c
rO liefriad dedrcii06 (l.om S.heduleA) oilof st nddd dsdudion G@ leJt mdqii). ..,. ..... .....: 450.
slbtracl rne a0'or ne 38
42 Ii :r " i8 i o@ t 9 9 5 o ro. p!\{e "oni4q b d ir dtrsren dNold$.no v o"at s* nilrd m
0'4 e r rlliply$.rm by lhe blalr.rbe o' *iDlrns c dmd oir tne od . 500
li& 42 iren line41.
Tarable imome. SublE.r
'B l' rel?Bn0r'nr 'E{l.enF.0. .. 965.
Tax (see iclrs). check ll any tax is iromr a EFom(s) p,sia
bJF6n4972._... 508.
45 An rnatve hinimum tax (s6e insirucUons). Attach Fam 62b1.. ..... ...., ... .... 0.
.16 Add iines {4 and 45 . . .
08.
$5,450 47 Foreign ld credit. Atiach Fom lt16ii.equired ...... | 47
4 Cd'tar rn.d,! @@-od e " expea*. a1r' fo.- 2dl
'
49 Credil lor ihe e derly or lhe disabed. Attach S.hedut6 F,...,
50 Fducafo I (rsrls. Attacl- lorm 88bt...
$r0,900 Retirement savings conlrtbltioG.redft , Altach Fo.r. 88S0...
F'ldd ne,llse n.l mons) rrL. o r 8q0 , ro! !:q
ctu.Fo- oh r flang .l-lrogs
53
"[lrm o!amr
" [-
$4,0o0 o,b|csiro-,om:
55 Add ne! !7 !n ouo "Imo
r 5r'. Tness a,e tor.totctdedhs 508.
56 Line 55 trom line46. li line 55 ts nore than line 46
0.
Other

62 Federa income lax witlhetd ircm FormsW.i and iO99

@ '003 e- i ar6 d prqFB,r0 arounllppti@ t@ AO/ jar.tr.
6rta Eahed in@he crudit (Etc)
b Noni&ble coobai pay ,.. > 54
ehciioi
L(a. r. alrsu.r/ zad (. RF.A r4 * Fhetd (sF !fDt
6 '
Addiloaalch o l-r'qeol lttacf corm 88 2
A,nount pd d w rh requFl 1or erle$ oi lo rh (se in5tuchons). .
6a
69
&"obin. roa: a [?1e b n,," . n8s;;'d d8;
Fi^t iFe lomebLrer cred L Arta.f Fo. . 5405 ...
70 Re.overy rebate credli (s6e worksheei)

819.
Refund /z F .e BtuTtla. tre6 -LbLJa.t Fe6 font'ot. ti( s EamoL.ryoumerid I79.
73. ! noml o, he // .oL {+9ry194u. ri l orr BB88 is a(qched. che- h::" ' ! 879.
: lill;Jll1T,11l lf,ffiffiLS--:rue.-EE"*"s
649238
Is"*ei
01100 0138

74 Anouit oi lhE 72 Fu trni applied ro your2009 estimied tar,,.. . . -l j

Amounl 75 Amunt yo! ow€. &bhlci line /1 ifon line 6t. Fd delatts on how ro pa, s@ iisiructioi!
You Owe
Third Party Do Fu wff] io airow ano$er peBoi to dtsu$ iiis rctum w tr jhe lRs Gee instrucdn'' Y€s, Complor€ ihe ioLowing_
i33*' ' 1g9a F6RMAN cpA lF* '
Sign
Here

WRlTER/ STI'DENT I4l-',t67-6

Keep a copy

Paid 0049621s
PreFare/s
use Only OO DA ST STE 812 eN 36-4337942
EVANSTON rL 60 201- 4655 847) 316 1040
Form 10r{t (2008)
 2008
Nam<t drM r Fofu i@
JOEL B, POIIAK 386-66-6781
Schedule B -
Interest and Ordinary Dividends
Part I I Lrsl ra-6 o pdlAr l'arv irerss s ror a se 6rrrai-pd norlqaAe ara b.- bL/er u.eo
rrr o,_oDeny as a peKo% re.idel(e se6rhe:shr(ronsard s,ths 1!er*||F.a.o
lnlerest choi thai buyar < so.alsecu -' rlnb* ano aooreis

2 Add lhe amoLnts on line 1

3 Exclldabie inie.esi Dn series EE and I U.S. savinqs bonds isued atier 1989,
Aha.l- -o'm 88_5 .. .....
2, Enier the resui here and on Form 1 0.
Note.lf line 4 is ov€r $l u musl comDlete Part t.
5 List nafle oi payer .>
Pad ll ItrBRJ=Lt,r!\cl1 387.
Ordinary
Dividenas

5 Add the amolnts on line 5. Ente.lire ioiathere and on Form lO4O 38i.
Not€. ll ]ine 6 is over$l
Part lll You mlsr codpele rlis pa'l I yoL (a) t ad over $ ,r00 o, LcrabtF r,e.est o. o,. ndr? a vioenos or tb) h"da
:orc,qn ac.oLnrior{.) .cened siributiol lom o.dereaqr. orof.o.ar.an,iarorro.aro,eo,iir,sl
Foreign "
d

and 7a Al any 1 me dlring 2003, did you hrve an nteresr In or a signaiure or oiher aulhority over a finanalat accohl
n a bre0n counEyi such as a bank accourr, seclrjties accolnt, or other financiat;ccounl? See instructilrb
Trusls ro' e<-o, or. and Fl:19 reqle r enrj oi | .m -D E 90.2Z 1. . . .
b li'Yes, 6nter the nanre of the forcign cohtry.. >
a Durnq Ooti. dra you er.ea JskibLror ?om. o.4ere lol Fe q€4ro, o- or traN€-or ro, d oreion Fust;
' "e<, /ou tral t-are'eio ie Form 3520. See insLr-cr,ons
BAA For PapdNork R.duction Act Notice, see Foft ! OrO instru.rions. Schedule B (Form 1040) 2008
SCHEDULE D
capital cains and Losses
>Attach rofom orForm torl0t{R. >See Insrhl.tio[s {or Schedute D (Form 1040).
1040 2008
htr*naltuvgne swd 09) > U$ Sa:he.lub Dn to Ist addidonal thnsa.rionE tor ti.es 1 and 8.

B 386-66-6787
lffi-r€rffi Short-Term Capilal cains and Losses - Asseis Held One year or Less

2 Enler yolr shon,iem ioia s, fi any, irom S.hedut€ D-t , ne 2 . .

3 Totd short-tom sls prtc

4 Shod.terri qain f.om Form 62? and shorl-ieftt gain or (loss) fron Foms 4684, 6781 , and 8924 . . , , , . .
5 Net shorl.term qzin or (ossJ fr.m padneBhips, S coQol"tions, estates, andhusbnoh schedule(s) K-i ...
6 Sron.rer h .aprta oss larryovc'. Enier he ar ounr , t anv, tror I,16 8 or yo,r Crpitat Loss Carryowr
worKned n $e Instructions ..

ffi Long-Term Capital Gains and Losses

- Assets Held More Than One year

I 306.419 Slt. A_I{ERTCAN

645.
434 SH..AMERICtrN
9/O4/0 13,179. 11

Enier yolr longnem biats, ii ay, from Schedute D,t, lihe 9....
ra Totallonqitern eles pricb amounts. Add tires 8 and 9 in
co Lmn 'd\ .. 21,395.
Conirotr-'or4?n/ Parr:.onq.termga'ntonIofs243qand6252:2od rernoarno. foss) tro.
-orms 4644. 6/81 ano 8824 ... .... - ...
11 onS

12 Net lona-lei.r gain or (loss) irom parLerships, S corpo.arions, esiares, and Vusts trorn schedue(s) K.1..

13 6pita qah dist buhoN. See iNls,

14 LonC.ren, cqo ldl l6s canyove.. Fnrer '- e arouni, ir a1r', non ..ne _ 5 o yo rr Crpitlt Loss Carryover
YYorkeh€dt n the insrn ,lionr.
Net l.n+t6im capital gain or 0osi), Cdmbine tires 8 through t4 in column (0. Then qo to part lll on
527 .
BAA For PapoMo* Rodrction r* ltoii.., see rom tolo
"iiorml&6 Flnstru.tions.- schedu e D (Fom loaq 2008
 C6nb:re in* I ard 5 a' o enp' 16 .es. t

. A Sa!!, eni€. he amounl tom tine t6 on Fom 1040, tine 13, or Fonn ]O4ONR, tine 14. Then go io
. A loss.st p ines 7 rr rouql 20 beotr rre, .. -o n4 2r. A'5o oe s re lo omptete ne 22.
. z.rc.s'ipii16 rTtrrousF2t oeoaa1d"nei 0.on ormlo4!,,"iir,oi;JHroadNn_, ne q.
Then to qo lne 22

17 Are Ines 15 and l6 both qans?

E Ye!. co io rine 18.

n No. Skip lines te ttvouqh 21, and qo to ltne 22.

18 Enler he amolnt, ii any, iroft tine 7 oi ihd 2a% Rate cain Wo*6hset in the imt.uctions 0.

C4e' lhe aho nl, iI ary. rror ,re tB o..rp Unrecaptured Section 1250 cain Wortcheet n

Are lnes lA and 19 boit' zero or blank?

lI] Yes,,Co rp er. lom to4o lh,oLqn tine,l3. or Fof o4!NR t-rougt- tine 4!. fhercompete Ee Quatifbd
-om lMo (or nthe crrucions ot
- Dlvidehdsand
'o'n LAUNR). CaFitalGaln Tar-WortGhe*
Donor (omp.". r", r,
rn lhe
r.
I
"nc'or
".0 "Jlltil"
L iii"tr8li:i*ilx I'y":xi:fli;lix3;iii,i{,TiYf#5'!ii'isig".#.J*'-'p,"te,he s.h6du,e

li li.6 16ls a loss, enter here and on Form 1040, tine 13, or Fom to4!NR, lire 14, ihe snalts of:

. 'lhe ross on tin€ t6 or

. ($3 000), or irmafttedtiling sepabtet, (gt,SOO)

Not€, When iiglring whch adolnt is srna|er, treat both amounts as posirive r!6bers,

Z Do you have qlaliiied dividends on Fo.n 1040, tine 9b, or Form t04!NF, ltne tob?
! 1"..Cor p,ere ro,n Oal tnrougn l.ne 43, ortorm 04oNRlh.ough.e,E.-t-en.omoetetleeuat,fiod
.DMdehds.ndcaP|ta|Gaintax'1or[she.tirlhelnst'
Foin 1040NR),
n No. Complote the restofFom tOzO orForm i040rJR,

schedlte D (Foh 1040) 2008

 Educaiion Credits
,,,.8863 (Hope and Lifetime Leaming Credits)
> Se€ instiuction3 to lind our it vou aE etiqibte-to t3re h6 .;€dns.
> Attach to Form 1040 dr Fo;n r 0.oa
2008
50

B. POI],AK 386-66-6787
Cavnon:.'arcnnot,arF'nch.pp.tpdrandhctitcineteait.actqdo.thesamelttudehtinrhe>dtuerc.t
. Ya' cadnot a].e bath an adu, at:an. .di' drd te ) )han a.d tees dpdJcLaF (see ratd 89,-) ,ot tic sme studnt'o. u.e

Ho Caunont You camot lake A1e iedil far note than 2tax

$l,200*

;.-f;ft6lker"!,kydne ".",ag.F.".es1u,n",nr';ai..a:._1,,1@.inL.
crcdit ?Add rhe af o.16 0n l ne . ro rmr (f), I voL a e Grinq -e r,4tm- teqrr ne creo l
r.nl, qo io Pa.l ll: ol!e4!*, qo Ld P.rl .
Lifetime Leamino Credit
(a) Student s nafre {as shown on page I of your rax reurnl

JOEI, B- POLLAK 386-66-5787 28 370,

4 Add th6 amounls on ine 3, cotlnn (.), and enter ine rolar 28 370.
10 000.
broslLde.6'hoaneno-eod,eiqbteeorai:onains'rtu,onilaMdw6([.rno.sastdar.a,,rLer e:na
rpe rsd I clJded on |.rc ! (see spec a rut6 r rl. nrirrc.,oirsj "
c Slblracl line 5b lrom line 5 10 000.
6a Mulilply llne 5b by 4070 (.40)
b Mulilply lne 5c by 20% {.20) 000.
.rediL Add nes 6a and 6b and 000.
owable Education Credits
7 Tenrzlrve edu.aiion credrls. Add L,nes 2 and 6c
000.
I Erte- ,$1r€ 000 r orn €d. nqjo.,tJ4$5a,0oof,lqte,h.ado!hoLsahod
or quaL woow(Pr)
ryrnq . 58 000.
9 Enter lhe ahouni noo Form t040,line 381, !r Form ]O4OA, tne22. .. ... L4,915 .
10 S6i€ci line 9 trom lne 8 lf zero or tess, stopi yoL cannoi lake any
43,085
tl En e-:$20,000 i me(ed. nqtonl/,$to,Ooo,rs4g.e h"aoo to, cet-otd,
o_ ala,w/no wido'(eo . 10,000.
12 i'lhe 0 ! eq ir b a n o€ than |r ' I, en'er tf e omoLa hor ne 7 or t.ne t3 ano oo ro ne t4

Mullply ine 7 by ne l2
14 Enier lie anout irom Form 1040, line 46, or Farm I O4OA, tine 2g 508.
Enlerihe lota. irany, ofyo,rcredjt ifom Form 1040, ltnes 47 throuqh 49, oiFom t O40A, lides 29 and 30.
16 Slblract Line 15 from Line 14, lf ze.o or ess, stop. you cannot iak6 any educaUon credits
508.
17 Edlcalio. cr€dits. Enier tne smafer of tine ]3 or Line t6 hore and on Fom 1040, une 50, or Foim tO40A!
508.
BAA For P6peMork Reduciion Act Nottca s€e initruqrons. Form 8863 (2008)
 llllnols Dep!rtn€nt ot R€lenu€ E tr_E- 36218018061
Declaration Contro Number @CN)
-@-E
lL-8453 tllinois 2008 tndividual Income Tax Electronic Filinq Declaration
not maLlForm L-8453 to lh6 lltinois ot Revenue un ess it s redre.l-.d 16r r.Ji.; \
Step 1: Provide laxpaye! information
JOEI B, PO],LAK 3 8 6-6 6-518 7
spoFds 6Et mns (and si i:ms

8852 N. KOSTNER
spw3ss@d $frdv nlnb8r
S(oKIE, 1r, 6007 6 847-76?-6655

Step 2: Complete infomration trom tax ieturn

1 Nel income liom Form lL- 1040, Lne I I, or Sdredute NR, Steo 5, Line 51, I T2 915. 00
2 T", fior Form L . 0!O, I ip 13 2 387. 00
3 lllinois lncome Tax wiltrheld rrom Fom L- 1040, Llne 22 on9 (ent6r'0 ii none) ........ 3 0, 00
Overpaymerl lrom Form 11.1040, Line 32 00
Totalamounidue troh Form L.]04!, Li.e 36 5 387. 00
6 Fling slatus: X Single/head orhousehotd _Manied iijn! jo ntly _Mared ilino sepa€tely lvidowed

Slep 3:Complete direct deposit.of refund orelectronic fundswithdrawal information (oprjonal)

Note: To initiale a paymeni d retund iran.aclion,lhB information in this Siep nust be incuded wtthin ihe etech.onjc lransriss on,
7 Roufinq nudber (RN)....... ...
8 Acco"nlnrmber(ArD. ....
Type oI accoLnl _CheckinS _Savi.gs
10 Date lhe paymenl is to be etectrorica ty wirhdEwn:
1l Eleclronl. lunds wthd/awal amolnt: 00
12

SteP 4: TaxPayer declahlion and signature (siqn 6ty attef steF 2 and step 3 (ir appticable) is .omp|eted)

l] --on."nr."" ry,"r'n".aj,lr-s.san
o. drectyoepo5r-d as derqnareo n jrep3an..le.ro,e.1e ino,har,oi on Ines / rroLah e <.ore^l
nevoczbe4opoinlientoilheolherspoL)easanaaerItor"cF!e.here..no.
LJas Lil-orize ih" Ino.s Depa-h.nr o Reverue DoD aro caesqn.reo hnaiura acenrronralednAcrebd.o|crlndswrfd.aaal
oosrgn.red n ,ie ecron c oo4.on or ry z00a |]i:nois ;1 ome ra\.etjn,
-a q
auhoJ /e I dn" nnilLtrotu,nvoNeo n bre
'he I lo answer
proc$s ng or an erectronrc overPaynerf ol {a,eslo recelve coniidentlal informatis necessary inquirles and lesolv€
issues related to the paymenl.
E do notwani dir6.l deposii ofmy relund, or an elec?onrctunds wiridrawa (direcr debil) oi my batance d!e,
|-]ndnl6aisoipen!r|d6clacthefhrnationonnielt|rnic|L1c40Elumandi]icinjonati0n|prwidedlonyeL*onid!hoii0iiaio!(
Fi 0r r tr\n0hr000q n/ 16 ud \ lae, corel a d dmpr6 e lmadl llt ny "u-, di oec arar o" ar d map."ymq ht0rr .l01r.ibE *1ito Doc b,/ m tRO. I
d'!l4usbNd-an/Liurd/0,,1rfan\mrqNi'rPrFtLnt.b6d(sledorriqr"dt. l*€d, a_tore Doc ro dp. \ n" "3r., $.Ei.antray@
(( "-ra '

!ign
spoLac s silEb'e af ld ir eln, bodr mEr sron)

Slep 5: Electronic rclurn originalor(ERO) and paid preparer d€claration and signalure
ld-clae'hdl lhc/ee,arlnaolhsrdipaJe-see-to1ctL. O4O.erua rferorqatolo. s Form -8453 ano
rlotmrl.t lrore'olodAddilreoLiretellsollhsproq!Faroc-.rare.rroer pena,les o'peq' r, Brarrorhebe-.o
"ccoflDdnrino
riJ r<iroi,ecqe rte
'dxoaver's retLrn a.d arcompanr' ng ilformar.on.re l!a. -oreLl, ano .omp eie

!IqDA FORMAN CPA ch*kil paid preparer:

tr G-,""^.'.')
ERO
L]NDA FORMAN CPA, P. C. P00496215
blr ssdiv n!n6s
Ydu. (ssN) or P'LN

OO DAV]S 51 STE 812 36-433',]942

F&Er 8mdrys idanHhdon no. (FEL|9

ov-..'_'.-'' rt 60201-4655 _
IVANSTON. (847) 316-1040

Step 6: Allach required documenls (e,9., Forfis W-2, W-2c, 1099-G, 1099.R, tL-1310, out-of.state retums, eic)
Forn ll{rui.:l (R- l I /08) D: 2BN