IRS Releases Publication 584 (6/2012), Casualty, Disaster, and Theft Loss Workbook
Publication 584 (6/2012)
- Jurisdictions
- LanguageEnglish
What's New
Future developments. The IRS has created a page on IRS.gov for information about Publication 584, at http://www.irs.gov/pub584. Information about any future developments affecting Publication 584 (such as legislation enacted after we release it) will be posted on that page.
This workbook is designed to help you figure your loss on personal-use property in the event of a disaster, casualty, or theft. It contains schedules to help you figure the loss to your main home, its contents, and your motor vehicles. However, these schedules are for your information only. You must complete Form 4684, Casualties and Thefts, to report your loss.
You can use this workbook by following these five steps.
1. Read Publication 547 to learn about the tax rules for casualties, disasters, and thefts.
2. Know the definitions of cost or other basis and fair market value, discussed later.
3. Fill out Schedules 1 through 20.
4. Read the instructions for Form 4684.
5. Fill out Form 4684 using the information you entered in Schedules 1 through 20.
Use the chart below to find out how to use Schedules 1 through 19 to fill out Form 4684.
And enter it on
Take what's in each row of . . . Form 4684 . . .
Column 1 Line 1
Column 2 Line 2
Column 3 Line 3
Column 4 Line 4
Column 5 Line 5
Column 6 Line 6
Column 7 Line 7
Column 8 Line 8
Column 9 Line 9
Losses
Generally, you may deduct losses to your home, household goods, and motor vehicles on your federal income tax return. However, you may not deduct a casualty or theft loss that is covered by insurance unless you filed a timely insurance claim for reimbursement. Any reimbursement you receive will reduce the loss. If you did not file an insurance claim, you may deduct only the part of the loss that was not covered by insurance.
Amount of loss. You figure the amount of your loss using the following steps.
1. Determine your cost or other basis in the property before the casualty or theft.
2. Determine the decrease in fair market value (FMV) of the property as a result of the casualty or theft. (The decrease in FMV is the difference between the property's value immediately before and immediately after the casualty or theft.)
3. From the smaller of the amounts you determined in (1) and (2), subtract any insurance or other reimbursement you received or expect to receive.
Apply the deduction limits, discussed later, to determine the amount of your deductible loss.
Cost or other basis. Cost or other basis usually means original cost plus improvements. If you did not acquire the property by purchasing it, your basis is determined as discussed in Publication 551, Basis of Assets. If you inherited the property from someone who died in 2010, and the executor of the decedent's estate made the election to file Form 8939, refer to the information provided by the executor or see Publication 4895, Tax Treatment of Property Acquired From a Decedent Dying in 2010.
Fair market value. FMV is the price for which you could sell your property to a willing buyer, when neither of you has to sell or buy and both of you know all the relevant facts. When filling out Schedules 1 through 20, you need to know the FMV of the property immediately before and immediately after the disaster, casualty, or theft.
Separate computations. Generally, if a single casualty or theft involves more than one item of property, you must figure the loss on each item separately. Then combine the losses to determine the total loss from that casualty or theft.
Exception for personal-use real property. In figuring a casualty loss on personal-use real property, the entire property (including any improvements, such as buildings, trees, and shrubs) is treated as one item. Figure the loss using the smaller of the following.
• The decrease in FMV of the entire property.
• The adjusted basis of the entire property.
Deduction limits. After you have figured the amount of your loss, as discussed earlier, you must figure how much of the loss you can deduct. You do this on Form 4684, section A. If the loss was to property for your personal use or your family's, there are two limits on the amount you can deduct for your casualty or theft loss.
1. You must reduce each casualty or theft loss by $100 ($100 rule).
2. You must further reduce the total of all your losses by 10% of your adjusted gross income (10% rule).
More information. For more information about the deduction limits, see Publication 547.
When your loss is deductible. You can generally deduct a casualty or disaster area loss only in the tax year in which the casualty or disaster occurred. You can generally deduct a theft loss only in the year you discovered your property was stolen. However, you can choose to deduct disaster area losses on your return for the year immediately before the year of the disaster if the President has declared your area a federal disaster area. For details, see Disaster Area Losses in Publication 547.
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Schedule 1. Entrance Hall
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(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
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Example:
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Chair 350.00 200.00 .00 275.00
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Clock 90.00 .00 .00 60.00
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Chair
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Clock
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Curtains
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Draperies
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Lamp
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Mirror
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Picture
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Rug
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Table
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Umbrella stand
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Wall fixture
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[Table Continued]
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(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
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Example:
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Chair .00 275.00 275.00 75.00
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Clock .00 60.00 60.00 60.00
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Chair
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Clock
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Curtains
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Draperies
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Lamp
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Mirror
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Picture
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Rug
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Table
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Umbrella stand
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Wall fixture
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1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
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Schedule 2. Living Room
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(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
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Accessories
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Blinds
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Bookcase
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Book
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Chair
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Chest
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Clock
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Coffee table
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Curtains
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Desk
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Draperies
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Fireplace
hardware
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Lamp
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Magazine rack
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Mirror
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Piano
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Picture
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Pillow
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Radio
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Rug & pad
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Shades
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Shutters
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Sofa
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Stereo
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Television
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Wall fixture
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[Table Continued]
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(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
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Accessories
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Blinds
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Bookcase
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Book
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Chair
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Chest
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Clock
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Coffee table
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Curtains
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Desk
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Draperies
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Fireplace
hardware
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Lamp
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Magazine rack
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Mirror
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Piano
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Picture
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Pillow
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Radio
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Rug & pad
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Shades
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Shutters
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Sofa
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Stereo
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Television
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Wall fixture
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1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 3. Dining Room
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(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
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Buffet
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Chair
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China cabinet
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Chinaware
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Crystal
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Curtains
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Draperies
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Glassware
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Mirror
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Picture
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Rug & pad
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Silver flatware
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Silver tea set
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Silver items
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Table
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Tea cart
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Wall fixture
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[Table Continued]
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(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
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Buffet
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Chair
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China cabinet
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Chinaware
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Crystal
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Curtains
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Draperies
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Glassware
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Mirror
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Picture
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Rug & pad
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Silver flatware
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Silver tea set
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Silver items
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Table
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Tea cart
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Wall fixture
----------------------------------------------------------------------
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----------------------------------------------------------------------
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----------------------------------------------------------------------
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----------------------------------------------------------------------
----------------------------------------------------------------------
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1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 4. Kitchen
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(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
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Blender
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Broiler
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Canned goods
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Can opener
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Clock
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Coffee maker
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Curtains
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Cutlery
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Dishes
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Dishwasher
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Food processor
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Freezer
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Frozen food
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Glassware
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Ice crusher
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Microwave oven
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Mixer
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Pots and pans
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Radio
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Refrigerator
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Stove
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Table and chairs
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Telephone
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Toaster
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Trash compactor
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Utensils
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Wall accessory
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[Table Continued]
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(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
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Blender
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Broiler
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Canned goods
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Can opener
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Clock
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Coffee maker
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Curtains
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Cutlery
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Dishes
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Dishwasher
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Food processor
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Freezer
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Frozen food
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Glassware
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Ice crusher
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Microwave oven
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Mixer
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Pots and pans
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Radio
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Refrigerator
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Stove
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Table and chairs
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Telephone
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Toaster
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Trash compactor
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Utensils
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Wall accessory
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1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 5. Den
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(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
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Bookcase
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Book
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CD player
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Chair
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Computer
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Clock
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Curtains
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Desk
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Draperies
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DVD player
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Lamp
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Mirror
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Picture
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Pillow
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Radio
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CDs/Records
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Rug & pad
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Telephone
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Sofa
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Stereo
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Table
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Television
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VCR
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[Table Continued]
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(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
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Bookcase
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Book
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CD player
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Chair
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Computer
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Clock
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Curtains
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Desk
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Draperies
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DVD player
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Lamp
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Mirror
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Picture
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Pillow
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Radio
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CDs/Records
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Rug & pad
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Telephone
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Sofa
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Stereo
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Table
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Television
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VCR
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----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
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1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 6. Bedrooms
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(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
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Bed cover
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Bed
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Bedside table
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Bureau
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Chair
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Chest
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Clock
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Clothes hamper
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Desk
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Dresser
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Jewelry box
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Lamp
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Linens
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Mirror
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Picture
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Radio
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Rug & pad
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Telephone
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Television
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[Table Continued]
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(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
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Bed cover
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Bed
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Bedside table
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Bureau
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Chair
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Chest
----------------------------------------------------------------------
Clock
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Clothes hamper
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Desk
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Dresser
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Jewelry box
----------------------------------------------------------------------
Lamp
----------------------------------------------------------------------
Linens
----------------------------------------------------------------------
Mirror
----------------------------------------------------------------------
Picture
----------------------------------------------------------------------
Radio
----------------------------------------------------------------------
Rug & pad
----------------------------------------------------------------------
Telephone
----------------------------------------------------------------------
Television
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
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1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 7. Bathrooms
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(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
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Bath mat
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Clothes hamper
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Curtains
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Hair dryer
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Linens
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Mirror
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Picture
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Razor
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Scale
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Towel rack
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Wall fixture
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[Table Continued]
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(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
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Bath mat
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Clothes hamper
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Curtains
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Hair dryer
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Linens
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Mirror
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Picture
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Razor
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Scale
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Towel rack
----------------------------------------------------------------------
Wall fixture
----------------------------------------------------------------------
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----------------------------------------------------------------------
----------------------------------------------------------------------
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----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
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1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 8. Recreation Room
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Billiard table
-----------------------------------------------------------------
Book
-----------------------------------------------------------------
Card table
-----------------------------------------------------------------
CD player
-----------------------------------------------------------------
Chair
-----------------------------------------------------------------
Clock
-----------------------------------------------------------------
Curtains
-----------------------------------------------------------------
DVD player
-----------------------------------------------------------------
Game
-----------------------------------------------------------------
Lamp
-----------------------------------------------------------------
Picture
-----------------------------------------------------------------
Ping Pong table
-----------------------------------------------------------------
Pool table
-----------------------------------------------------------------
Radio
-----------------------------------------------------------------
CDs/Records
-----------------------------------------------------------------
Rug & pad
-----------------------------------------------------------------
Sofa
-----------------------------------------------------------------
Stereo
-----------------------------------------------------------------
Table
-----------------------------------------------------------------
Television
-----------------------------------------------------------------
VCR
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Billiard table
----------------------------------------------------------------------
Book
----------------------------------------------------------------------
Card table
----------------------------------------------------------------------
CD player
----------------------------------------------------------------------
Chair
----------------------------------------------------------------------
Clock
----------------------------------------------------------------------
Curtains
----------------------------------------------------------------------
DVD player
----------------------------------------------------------------------
Game
----------------------------------------------------------------------
Lamp
----------------------------------------------------------------------
Picture
----------------------------------------------------------------------
Ping Pong table
----------------------------------------------------------------------
Pool table
----------------------------------------------------------------------
Radio
----------------------------------------------------------------------
CDs/Records
----------------------------------------------------------------------
Rug & pad
----------------------------------------------------------------------
Sofa
----------------------------------------------------------------------
Stereo
----------------------------------------------------------------------
Table
----------------------------------------------------------------------
Television
----------------------------------------------------------------------
VCR
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 9. Laundry and Basement
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Chair
-----------------------------------------------------------------
Dryer
-----------------------------------------------------------------
Electric iron
-----------------------------------------------------------------
Food freezer
-----------------------------------------------------------------
Ironing board
-----------------------------------------------------------------
Ladder
-----------------------------------------------------------------
Luggage
-----------------------------------------------------------------
Table
-----------------------------------------------------------------
Tool
-----------------------------------------------------------------
Tub
-----------------------------------------------------------------
Washing machine
-----------------------------------------------------------------
Work bench
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Chair
----------------------------------------------------------------------
Dryer
----------------------------------------------------------------------
Electric iron
----------------------------------------------------------------------
Food freezer
----------------------------------------------------------------------
Ironing board
----------------------------------------------------------------------
Ladder
----------------------------------------------------------------------
Luggage
----------------------------------------------------------------------
Table
----------------------------------------------------------------------
Tool
----------------------------------------------------------------------
Tub
----------------------------------------------------------------------
Washing machine
----------------------------------------------------------------------
Work bench
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 10. Garage
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Bicycle
-----------------------------------------------------------------
Garden hose
-----------------------------------------------------------------
Garden tool
-----------------------------------------------------------------
Hedger
-----------------------------------------------------------------
Ladder
-----------------------------------------------------------------
Lawn mower
-----------------------------------------------------------------
Snow blower
-----------------------------------------------------------------
Sprayer
-----------------------------------------------------------------
Spreader
-----------------------------------------------------------------
Tiller
-----------------------------------------------------------------
Tool
-----------------------------------------------------------------
Wheelbarrow
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Bicycle
----------------------------------------------------------------------
Garden hose
----------------------------------------------------------------------
Garden tool
----------------------------------------------------------------------
Hedger
----------------------------------------------------------------------
Ladder
----------------------------------------------------------------------
Lawn mower
----------------------------------------------------------------------
Snow blower
----------------------------------------------------------------------
Sprayer
----------------------------------------------------------------------
Spreader
----------------------------------------------------------------------
Tiller
----------------------------------------------------------------------
Tool
----------------------------------------------------------------------
Wheelbarrow
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 11. Sporting Equipment
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Boat & motor
-----------------------------------------------------------------
Camera
-----------------------------------------------------------------
Camping
equipment
-----------------------------------------------------------------
Field glasses
-----------------------------------------------------------------
Fishing tackle
-----------------------------------------------------------------
Golf clubs
-----------------------------------------------------------------
Gun
-----------------------------------------------------------------
Lawn game
-----------------------------------------------------------------
Projector
-----------------------------------------------------------------
Tennis racket
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Boat & motor
----------------------------------------------------------------------
Camera
----------------------------------------------------------------------
Camping
equipment
----------------------------------------------------------------------
Field glasses
----------------------------------------------------------------------
Fishing tackle
----------------------------------------------------------------------
Golf clubs
----------------------------------------------------------------------
Gun
----------------------------------------------------------------------
Lawn game
----------------------------------------------------------------------
Projector
----------------------------------------------------------------------
Tennis racket
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 12. Men's Clothing
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Belt
-----------------------------------------------------------------
Boots
-----------------------------------------------------------------
Gloves
-----------------------------------------------------------------
Handkerchief
-----------------------------------------------------------------
Hat
-----------------------------------------------------------------
Overcoat
-----------------------------------------------------------------
Raincoat
-----------------------------------------------------------------
Shirt
-----------------------------------------------------------------
Shoes
-----------------------------------------------------------------
Shorts
-----------------------------------------------------------------
Slacks
-----------------------------------------------------------------
Socks
-----------------------------------------------------------------
Sport jacket
-----------------------------------------------------------------
Suit
-----------------------------------------------------------------
Sweater
-----------------------------------------------------------------
Tie
-----------------------------------------------------------------
Underwear
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Belt
----------------------------------------------------------------------
Boots
----------------------------------------------------------------------
Gloves
----------------------------------------------------------------------
Handkerchief
----------------------------------------------------------------------
Hat
----------------------------------------------------------------------
Overcoat
----------------------------------------------------------------------
Raincoat
----------------------------------------------------------------------
Shirt
----------------------------------------------------------------------
Shoes
----------------------------------------------------------------------
Shorts
----------------------------------------------------------------------
Slacks
----------------------------------------------------------------------
Socks
----------------------------------------------------------------------
Sport jacket
----------------------------------------------------------------------
Suit
----------------------------------------------------------------------
Sweater
----------------------------------------------------------------------
Tie
----------------------------------------------------------------------
Underwear
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 13. Women's Clothing
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Belt
-----------------------------------------------------------------
Blouse
-----------------------------------------------------------------
Boots
-----------------------------------------------------------------
Coat
-----------------------------------------------------------------
Dress
-----------------------------------------------------------------
Fur
-----------------------------------------------------------------
Gloves
-----------------------------------------------------------------
Hat
-----------------------------------------------------------------
Hosiery
-----------------------------------------------------------------
Jacket
-----------------------------------------------------------------
Lingerie
-----------------------------------------------------------------
Scarf
-----------------------------------------------------------------
Shirt
-----------------------------------------------------------------
Shoes
-----------------------------------------------------------------
Skirt
-----------------------------------------------------------------
Slacks
-----------------------------------------------------------------
Suit
-----------------------------------------------------------------
Sweater
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Belt
----------------------------------------------------------------------
Blouse
----------------------------------------------------------------------
Boots
----------------------------------------------------------------------
Coat
----------------------------------------------------------------------
Dress
----------------------------------------------------------------------
Fur
----------------------------------------------------------------------
Gloves
----------------------------------------------------------------------
Hat
----------------------------------------------------------------------
Hosiery
----------------------------------------------------------------------
Jacket
----------------------------------------------------------------------
Lingerie
----------------------------------------------------------------------
Scarf
----------------------------------------------------------------------
Shirt
----------------------------------------------------------------------
Shoes
----------------------------------------------------------------------
Skirt
----------------------------------------------------------------------
Slacks
----------------------------------------------------------------------
Suit
----------------------------------------------------------------------
Sweater
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 14. Children's Clothing
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Blouse
-----------------------------------------------------------------
Boots
-----------------------------------------------------------------
Coat
-----------------------------------------------------------------
Dress
-----------------------------------------------------------------
Gloves
-----------------------------------------------------------------
Hat
-----------------------------------------------------------------
Shirt
-----------------------------------------------------------------
Shoes
-----------------------------------------------------------------
Skirt
-----------------------------------------------------------------
Slacks
-----------------------------------------------------------------
Socks
-----------------------------------------------------------------
Sport jacket
-----------------------------------------------------------------
Stockings
-----------------------------------------------------------------
Suit
-----------------------------------------------------------------
Sweater
-----------------------------------------------------------------
Underwear
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Blouse
----------------------------------------------------------------------
Boots
----------------------------------------------------------------------
Coat
----------------------------------------------------------------------
Dress
----------------------------------------------------------------------
Gloves
----------------------------------------------------------------------
Hat
----------------------------------------------------------------------
Shirt
----------------------------------------------------------------------
Shoes
----------------------------------------------------------------------
Skirt
----------------------------------------------------------------------
Slacks
----------------------------------------------------------------------
Socks
----------------------------------------------------------------------
Sport jacket
----------------------------------------------------------------------
Stockings
----------------------------------------------------------------------
Suit
----------------------------------------------------------------------
Sweater
----------------------------------------------------------------------
Underwear
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 15. Jewelry
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Bracelet
-----------------------------------------------------------------
Brooch
-----------------------------------------------------------------
Earrings
-----------------------------------------------------------------
Engagement ring
-----------------------------------------------------------------
Necklace
-----------------------------------------------------------------
Pin
-----------------------------------------------------------------
Ring
-----------------------------------------------------------------
Watch
-----------------------------------------------------------------
Wedding ring
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Bracelet
----------------------------------------------------------------------
Brooch
----------------------------------------------------------------------
Earrings
----------------------------------------------------------------------
Engagement ring
----------------------------------------------------------------------
Necklace
----------------------------------------------------------------------
Pin
----------------------------------------------------------------------
Ring
----------------------------------------------------------------------
Watch
----------------------------------------------------------------------
Wedding ring
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 16. Electrical Appliances
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Air conditioner
-----------------------------------------------------------------
Blanket
-----------------------------------------------------------------
Dehumidifier
-----------------------------------------------------------------
Fan
-----------------------------------------------------------------
Floor polisher
-----------------------------------------------------------------
Grill
-----------------------------------------------------------------
Heating pad
-----------------------------------------------------------------
Humidifier
-----------------------------------------------------------------
Sewing machine
-----------------------------------------------------------------
Sun lamp
-----------------------------------------------------------------
Vacuum cleaner
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Air conditioner
----------------------------------------------------------------------
Blanket
----------------------------------------------------------------------
Dehumidifier
----------------------------------------------------------------------
Fan
----------------------------------------------------------------------
Floor polisher
----------------------------------------------------------------------
Grill
----------------------------------------------------------------------
Heating pad
----------------------------------------------------------------------
Humidifier
----------------------------------------------------------------------
Sewing machine
----------------------------------------------------------------------
Sun lamp
----------------------------------------------------------------------
Vacuum cleaner
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 17. Linens
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Bath mat
-----------------------------------------------------------------
Bedsheet
-----------------------------------------------------------------
Bedspread
-----------------------------------------------------------------
Blanket
-----------------------------------------------------------------
Comforter
-----------------------------------------------------------------
Mattress pad
-----------------------------------------------------------------
Napkins
-----------------------------------------------------------------
Pillow
-----------------------------------------------------------------
Pillowcase
-----------------------------------------------------------------
Placemat
-----------------------------------------------------------------
Quilt
-----------------------------------------------------------------
Tablecloth
-----------------------------------------------------------------
Towel
-----------------------------------------------------------------
Washcloth
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Bath mat
----------------------------------------------------------------------
Bedsheet
----------------------------------------------------------------------
Bedspread
----------------------------------------------------------------------
Blanket
----------------------------------------------------------------------
Comforter
----------------------------------------------------------------------
Mattress pad
----------------------------------------------------------------------
Napkins
----------------------------------------------------------------------
Pillow
----------------------------------------------------------------------
Pillowcase
----------------------------------------------------------------------
Placemat
----------------------------------------------------------------------
Quilt
----------------------------------------------------------------------
Tablecloth
----------------------------------------------------------------------
Towel
----------------------------------------------------------------------
Washcloth
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 18. Miscellaneous
-----------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
or or casualty value
other other or before
Item basis reimbursement theft1 casualty
-----------------------------------------------------------------
Barbeque
-----------------------------------------------------------------
Lawn furniture
-----------------------------------------------------------------
Musical
instrument
-----------------------------------------------------------------
Outdoor shed
-----------------------------------------------------------------
Picnic set
-----------------------------------------------------------------
Porch furniture
-----------------------------------------------------------------
Sport equipment
-----------------------------------------------------------------
Swing set
-----------------------------------------------------------------
Toy
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
-----------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
value Column column (2) loss (column
after (5) minus or column (8) minus
Item casualty column (6) (7) column (3))2
----------------------------------------------------------------------
Barbeque
----------------------------------------------------------------------
Lawn furniture
----------------------------------------------------------------------
Musical
instrument
----------------------------------------------------------------------
Outdoor shed
----------------------------------------------------------------------
Picnic set
----------------------------------------------------------------------
Porch furniture
----------------------------------------------------------------------
Sport equipment
----------------------------------------------------------------------
Swing set
----------------------------------------------------------------------
Toy
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 19. Motor Vehicles
---------------------------------------------------------------------
(1) (2) (3) (4) (5)
Cost Insurance Gain from Fair market
Vehicle or or casualty value
(year, make other other or before
and model) basis reimbursement theft1 casualty
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
---------------------------------------------------------------------
[Table Continued]
----------------------------------------------------------------------
(1) (6) (7) (8) (9)
Fair market Smaller of Casualty/Theft
Vehicle value Column column (2) loss (column
(year, make after (5) minus or column (8) minus
and model) casualty column (6) (7) column (3))2
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
1 If column (3) is greater than column (2), enter the difference here
and skip columns (5) through (9) for that item.
2 If zero or less, enter -0-.
======================================================================
Schedule 20. Home (Excluding Contents)
----------------------------------------------------------------------
Note. If you used the entire property as your home, fill out only
column (a). If you used part of the property as your home and part
of it for business or to produce rental income, you must allocate
the entries on lines 2-9 between the personal part (column (a)) and
the business/rental part (column (b)).
----------------------------------------------------------------------
1. Description of property (Show (a) (b)
location and date acquired.)
______________________________________ Personal Business/
______________________________________ Part Rental Part
----------------------------------------------------------------------
2. Cost or other (adjusted) basis of
property (from Worksheet A)
----------------------------------------------------------------------
3. Insurance or other reimbursement
Note. If line 2 is more than line 3,
skip line 4. If line 3 is more than
line 2, you exclude gain, and the gain
is more than you can exclude, see the
instructions for line 3 in the
Instructions for Form 4684 for the
amount to enter.
----------------------------------------------------------------------
4. Gain from casualty. If line 3 is more
than line 2, enter the difference here
and skip lines 5 through 9. But see
Next below line 9.
----------------------------------------------------------------------
5. Fair market value before casualty
----------------------------------------------------------------------
6. Fair market value after casualty
----------------------------------------------------------------------
7. Decrease in fair market value. Subtract
line 6 from line 5.
----------------------------------------------------------------------
8. Enter the smaller of line 2 or line 7
Note for business/rental part. If the
property was totally destroyed by
casualty, enter on line 8, column (b)
the amount from line 2, column (b).
----------------------------------------------------------------------
9. Subtract line 3 from line 8. If zero
or less, enter -0-.
----------------------------------------------------------------------
Next: Transfer the entries from line 1 and lines 2-9, column (a),
above to the corresponding lines on Form 4684, Section A. Transfer the
entries from line 1 and lines 2-9, column (b), to the corresponding
lines on Form 4684, Section B.
----------------------------------------------------------------------
Worksheet A. Cost or Other (Adjusted) Basis
Keep for Your Records
Caution. See the Worksheet A Instructions before you use this
worksheet.
----------------------------------------------------------------------
(a) (b)
Personal Business/
Part Rental Part
----------------------------------------------------------------------
1. Enter the purchase price of the home
damaged or destroyed. (If you filed
Form 2119 when you originally
acquired that home to postpone gain
on the sale of a previous home
before May 7, 1997, enter the
adjusted basis of the new home from
that Form 2119.) 1. _________ _________
2. Seller paid points for home bought
after 1990. Do not include any
seller-paid points you already
subtracted to arrive at the amount
entered on line 1 2. _________ _________
3. Subtract line 2 from line 1 3. _________ _________
4. Settlement fees or closing costs.
(See Settlement costs in
Publication 551.) If line 1
includes the adjusted basis of
the new home from Form 2119, skip
lines 4a-4g and 5; go to line 6.
a. Abstract and recording fees 4a. _________ _________
b. Legal fees (including fees for title
search and preparing documents) 4b. _________ _________
c. Survey fees 4c. _________ _________
d. Title insurance 4d. _________ _________
e. Transfer or stamp taxes 4e. _________ _________
f. Amounts that the seller owed that
you agreed to pay (back taxes or
interest, recording or mortgage
fees, and sales commissions) 4f. _________ _________
g. Other 4g. _________ _________
5. Add lines 4a through 4g 5. _________ _________
6. Cost of additions and improvements.
(See Increases to Basis in
Publication 551.) Do not include
any additions and improvements
included on line 1 6. _________ _________
7. Special tax assessments paid for
local improvements, such as streets
and sidewalks 7. _________ _________
8. Other increases to basis 8. _________ _________
9. Add lines 3, 5, 6, 7, and 8 9. _________ _________
10. Depreciation allowed or allowable,
related to the business use or
rental of the home 10. 0 _________
11. Other decreases to basis (See
Decreases to Basis in
Publication 551.) 11. _________ _________
12. Add lines 10 and 11 12. _________ _________
13. Cost or other (adjusted) basis of
home damaged or destroyed. Subtract
line 12 from line 9. Enter here and
on Schedule 20, line 2 13. _________ _________
----------------------------------------------------------------------
Worksheet A Instructions.
Keep for Your Records
If you use Worksheet A to figure the cost or other (adjusted) basis
of your home, follow these instructions. DO NOT use this worksheet to
determine your basis if you acquired an interest in your home from a
decedent who died in 2010 and whose executor filed Form 8939.
----------------------------------------------------------------------
IF . . . THEN . . .
----------------------------------------------------------------------
you inherited your home from 1 skip lines 1-4 of the worksheet.
a decedent who died either ----------------------------------------
before or after 2010 or from 2 find your basis using the rules under
a decedent who died in 2010 Inherited Property in Publication 551.
and whose executor did not Enter this amount on line 5 of the
file Form 8939. worksheet.
----------------------------------------
3 fill out lines 6-13 of the worksheet.
----------------------------------------------------------------------
you received your home as a 1 read Property Received as a Gift in
gift Publication 551 and enter on lines 1
and 3 of the worksheet either the
donor's adjusted basis or the home's
fair market value at the time of the
gift, whichever is appropriate.
----------------------------------------
2 if you can add any federal gift tax
to your basis, enter that amount on
line 5 of the worksheet.
----------------------------------------
3 fill out the rest of the worksheet.
----------------------------------------------------------------------
you received your home as a 1 enter on line 1 of the worksheet the
trade for other property fair market value of the other
property at the time of the trade.
(But if you received your home as a
trade for your previous home before
May 7, 1997, and had a gain on the
trade that you postponed using
Form 2119, enter on line 1 of the
worksheet the adjusted basis of the
new home from that Form 2119.)
----------------------------------------
2 fill out the rest of the worksheet.
----------------------------------------------------------------------
you built your home 1 add the purchase price of the land and
the cost of building the home. Enter
that total on line 1 of the worksheet.
(However, if you filed a Form 2119 to
postpone gain on the sale of a
previous home before May 7, 1997,
enter on line 1 of the worksheet the
adjusted basis of the new home from
that Form 2119.)
----------------------------------------
2 fill out the rest of the worksheet.
----------------------------------------------------------------------
you received your home from 1 skip lines 1-4 of the worksheet.
your spouse after July 18, ----------------------------------------
1984 2 enter on line 5 of the worksheet your
spouse's cost or other (adjusted)
basis in the home just before you
received it.
----------------------------------------
3 fill out lines 6-13 of the worksheet,
making adjustments to basis only for
events after the transfer.
----------------------------------------------------------------------
you owned a home jointly fill out one worksheet, making
with your spouse, who adjustments to basis for events both
transferred his or her before and after the transfer.
interest in the home to you
after July 18, 1984
----------------------------------------------------------------------
you received your home from 1 skip lines 1-4 of the worksheet.
your spouse before July 19, ----------------------------------------
1984 2 enter on line 5 of the worksheet the
home's fair market value at the time
you received it.
----------------------------------------
3 fill out lines 6-13 of the worksheet,
making adjustments to basis only for
events after the transfer.
----------------------------------------------------------------------
you owned a home jointly 1 fill out a worksheet, lines 1-13,
with your spouse, and your making adjustments to basis only for
spouse transferred his or events before the transfer.
her interest in the home to ----------------------------------------
you before July 19, 1984 2 multiply the amount on line 13 of that
worksheet by 50% (0.50) to get the
adjusted basis of your half-interest
at the time of the transfer.
----------------------------------------
3 multiply the fair market value of the
home at the time of the transfer by
50% (0.50). Generally, this is the
basis of the half-interest that your
spouse owned.
----------------------------------------
4 add the amounts from steps 2 and 3
and enter the total on line 5 of a
second worksheet.
----------------------------------------
5 complete lines 6-13 of the second
worksheet, making adjustments to basis
only for events after the transfer.
----------------------------------------------------------------------
you owned your home jointly 1 fill out lines 1-13 of the worksheet.
with a nonspouse ----------------------------------------
2 multiply the amount on line 13 by your
percentage of ownership to get the
adjusted basis of your part-interest.
----------------------------------------------------------------------
you owned your home jointly 1 fill out a worksheet, lines 1-13,
with your spouse who died including adjustments to basis only
before 2010 and before the for events before your spouse's death.
casualty ----------------------------------------
2 multiply the amount on line 13 of that
worksheet by 50% (0.50) to get the
adjusted basis of your half-interest
on the date of death.
----------------------------------------
3 figure the basis for the half-interest
owned by your spouse. This is one-half
of the fair market value on the date
of death (or later alternate valuation
used for estate or inheritance tax).
(The basis in your half will remain
one-half of the adjusted basis
determined in step 2.)
----------------------------------------
4 add the amounts from steps 2 and 3 and
enter the total on line 5 of a second
worksheet.
----------------------------------------
5 complete lines 6-13 of the second
worksheet, making adjustments to basis
only for events after your spouse's
death.
----------------------------------------------------------------------
you owned your home jointly 1 skip lines 1-4 of the worksheet.
with your spouse who died ----------------------------------------
before 2010 and before the 2 enter the amount of your basis on line
casualty, and your permanent 5 of the worksheet. Generally, this is
legal home is in a community the fair market value of the home at
property state the time of death. (But see Community
Property in Publication 551 for
special rules.)
----------------------------------------
3 fill out lines 6-13 of the worksheet,
making adjustments to basis only for
events after your spouse's death.
----------------------------------------------------------------------
you owned your home jointly 1 fill out lines 1-13 of the worksheet,
with a nonspouse who died including adjustments to basis only
before 2010 and before the for events before the co-owner's
casualty death.
----------------------------------------
2 multiply the amount on line 13 by your
percentage of ownership to get the
adjusted basis of your part-interest
on the date of death.
----------------------------------------
3 multiply the fair market value on the
date of death (or later alternate
valuation used for estate or
inheritance tax) by the co-owner's
percentage of ownership. This is the
basis for the co-owner's
part-interest.
----------------------------------------
4 add the amounts from steps 2 and 3 and
enter the total on line 5 of a second
worksheet.
----------------------------------------
5 complete lines 6-13 of the second
worksheet, including adjustments to
basis only for events after the
co-owner's death.
----------------------------------------------------------------------
your home was ever 1 on line 8 of the worksheet, enter any
damaged as a result of a amounts you spent to restore the home
prior casualty to its condition before the prior
casualty.
----------------------------------------
2 on line 11 enter:
any insurance reimbursements
you received (or expect to
receive) for the prior loss,
and
any deductible casualty losses
from prior years not covered
by insurance.
----------------------------------------------------------------------
the person who sold you your on line 2 enter the seller-paid points
home paid points on your only if you deducted them as home
loan and you bought your mortgage interest in the year paid
home after 1990 but before (unless you used the seller-paid
April 4, 1994. points to reduce the amount on line
1).
----------------------------------------------------------------------
the person who sold you your on line 2 enter the seller-paid points
home paid points on your even if you did not deduct them
loan and you bought your (unless you used the seller-paid
home after April 3, 1994 points to reduce the amount on line
1).
----------------------------------------------------------------------
you used part of the you must allocate the entries on
property as your home and Worksheet A between the personal part
part of it for business or (column (a)) and the business/rental
to produce rental income part (column (b)).
----------------------------------------------------------------------
none of these items apply fill out the entire worksheet.
----------------------------------------------------------------------
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