Form 11 2015

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Form 11 Return Summary - For Year of Assessment 2015 (Approved under section 917K) Your PPS Number TAIN Remember to quote your PPS number in all correspondence or 2985049U when calling at your Revenue office

51867G

Ryszard Glowacki Return of Income, Charges and Capital Gains for the year ended 31 December 2015 Claim for Tax Credits, Allowances and Reliefs for the year ended 31 December 2015 This tax return should be completed and returned to the above address on or before 31 October 2016. On that date you must also pay any balance of Income Tax due for 2015. If you file the return on or before 31 August 2016, Revenue will calculate your Income Tax liability for you. This will assist you in paying the correct amount by the due date. Where this return is submitted after 31 October 2016 a surcharge (5% where the return is submitted within two months, otherwise 10%) will be added to your tax liability. Civil Penalties Criminal Prosecution - Tax law provides for both civil penalties and criminal sanctions for the failure to make a return, the making of a false return, facilitating the making of a false return, or claiming tax credits, allowances or reliefs which are not due. In the event of a criminal prosecution, a person convicted on indictment of an offence may be liable to a fine not exceeding 126,970 Euro and or to a fine of up to double the difference between the declared tax due and the tax ultimately found to be due and or to imprisonment.

YOU MUST SIGN THIS DECLARATION I DECLARE that, to the best of my knowledge and belief, this form contains a correct return in accordance with the provisions of the Taxes Consolidation Act 1997 of: - All the sources of my income and of the amount of income derived from each source in the year 2015, and - All disposals of chargeable assets and of the amount of chargeable gains that accrued to me in the year 2015. I DECLARE that, to the best of my knowledge and belief, all the particulars given as regards tax credits, allowances and reliefs claimed and as regards outgoings and charges are correctly stated. Signature Date Capacity of Signatory Main Residence Address Telephone No. Agent's Details: Tax Adviser Identification No. (TAIN)

51867G

Clients Ref.

6107

When completing this return you should read the appropriate Helpsheet. If you have not received a copy of the Helpsheet you can get one from Revenue's website www.revenue.ie (under 'Taxes and Duties' - 'Income Tax' 'Forms' - 'Tax Return Forms'), or from Revenue's Forms & Leaflets Service by phoning LoCall 1890 306 706 (ROI only), + 353 1 702 3050. This return is only to be used for the 2015 Income Tax year. A - PERSONAL DETAILS [1-22] 1. If you are completing this return on behalf of a deceased individual enter the date of death. (Note: in the case of a married person, only complete this section where the deceased was the assessable spouse in the period to which this return refers.) (DD/MM/YYYY) Enter the name of the personal representative (i.e. executor, administrator, etc) Enter the date grant of probate or letter of administration was obtained 2. Tick the box to indicate your marital status:

3. If your personal circumstances changed in 2015 tick the box to indicate your previous status and state date of change:

(a) Single

Single

(b) Married

X

Married

Widowed

(c) In a Civil Partnership (d) Married but living apart

Married but living apart

If wholly or mainly maintaining your spouse tick box (e) In a Civil Partnership but living apart

Divorced

In a Civil Partnership Surviving Civil Partner In a Civil Partnership but living apart Former Civil Partner

Date of Marriage or Civil

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If wholly or mainly maintaining your spouse tick box

Partnership (DD/MM/YYYY) Date of Separation/Divorce (DD/MM/YYYY) Spouse's or Civil Partners Date of Death (DD/MM/YYYY)

(f) Widowed (g) A Surviving Civil Partner (h) Divorced (i) A former Civil Partner 4. If married, tick the box to indicate basis of assessment applicable for 2015:

Joint Assessment

X Separate Assessment

Single Treatment

5. State the number of Dependent Children 6. If you wish to claim Widowed Parent Tax Credit state date of death of spouse (DD/MM/YYYY) 7. Your Date of Birth (DD/MM/YYYY)

21/12/1972

8. Please indicate whether you are deemed to be subject to the limitation on the use of Reliefs by High Income Individuals (i.e. under Chapter 2A of Part 15). Form RR1 2015 Should be completed and also Panel J 9. Spouse's Details (a) Spouse's PPS Number (b) Date of Birth (DD/MM/YYYY)

2985049UW

(Pre-marriage) Surname

OR, if unknown

First name(s)

13/08/1973

Dorota

Tick box(es) to indicate for the year 2015 if you and/or your spouse were: Self

Spouse

10. Permanently Incapacitated

Yes

No X

Yes

No X

11. A Proprietary Director i.e. owned/controlled more than 15% of the share capital of a company

Yes

No X

Yes

No X

12. A holder of a 'full' Medical Card

Yes

No X

Yes

No X

13. Entitled to an exemption from PRSI

Yes

No X

Yes

No X

Yes

No X

Yes

No X

Yes

No X

Yes

No X

(a) State reason - self (b) State reason - spouse 14. Entitled to an exemption from Universal Social Charge (a) State reason - self (b) State reason - spouse 15. A farmer

Residence status for the year 2015 [16-21] See Guide to Completing 2015 Pay and File Returns for more information on the "Extent of Liability to Income Tax" of individuals who are either not resident or not domiciled in Ireland. 16. If you are a citizen of Ireland, resident but not ordinarily resident in the State, tick the box Remittances There are no entries on this panel B - INCOME FROM TRADES, PROFESSIONS OR VOCATIONS [101 - 157] (INCLUDING FARMING & PARTNERSHIP INCOME)

" Trade No 1 (Construction) 101

102

103 104

Tick the box(es) to indicate to whom the income in each column refers. In Trade 3 column enter the number of trades for which information is being included, if applicable. Description of Trade, Profession or Vocation Do not submit accounts with this return. Instead you MUST give an extract of information from the accounts on pages 8 and 9. If you are employed by An Post as a subpostmaster/postmistress tick the box If this source of income ceased during the year 2015 state the date of cessation (DD/MM/YYYY)

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Self

Spouse

X Construction

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105

If you are an RCT Subcontractor for the purposes of this trade and have changed your Accounting Period in 2015, tick the box

Farmers 106 107 108 109 110

Tick the box if you are a partner in Registered Farm Partnership as defined by S 667C Tick the box if this trade relates in whole or in part to Share Farming If you wish to elect to income averaging for the year 2015 (and subsequent years) tick this box If the assessable profits for this year are computed in accordance with S657 - income averaging - tick this box If you wish to withdraw from income averaging for the year 2015 tick this box

Profit assessable in 2015 (a) Amount of adjusted net profit for accounting period 111

5658

(b) Amount of adjusted net loss for accounting period 112

(a) Enter the assessable profit even if this is the same as the adjusted net profit per line 106(a) - (if a loss show 0.00) This should include income assessable under Section 98A(4), (Reverse Premiums in trading situations)) where appropriate

5658

Start Your Own Business relief There are no items on this panel Balancing Charges (a) Amount arising from capital allowances which were 114 deductible in arriving at relevant income for USC (b) Amount arising from capital allowances which were not deductible in arriving at relevant income for USC Unused Capital Allowances from a prior year (a) Amount carried forward which is allowable as a deduction 115 for Universal Social Charge (USC), i.e. allowances under Sections 284(1), 272(3),658(2)(b) and 659(2)(a) determined in accordance with subsections (3A), (3AA), (3B) or (3BA) or Section 659 (b) Amount carried forward which is not allowable as a deduction for USC, i.e. allowances other than those claimed under the Sections specified in (a) above and are not specified relief capital allowances (as set out in Sch 25B) (c)Specified Relief Capital Allowances (as set out in Sch. 25B) (i) Specified property relief capital allowances, as defined in S. 531AAE (ii) All other specified relief capital allowances Capital Allowances for the year 2015 [116 - 119] Where a claim to tax relief on property based incentive 116 schemes is included below, tick the box and give details in Panel N on page 24 117

Machinery and Plant

Industrial Buildings and/or Farm Buildings Allowance (a) Amount which is allowable as a deduction for Universal 118 Social Charge(USC), i.e. allowances under Sections 272(3), 658(2(b) and 659(2)(a) determined in accordance with subsections (3A), (3AA), (3B) or (3BA) of Section 659 (b) Amount which is not allowable as a deduction for USC, i.e. allowances other than those claimed under the Sections specified in (a) above and are not specified relief capital allowances (as set out in Sch 25B) (c) Specified Relief Capital Allowances (as set out in Sch. 25B) (i) Specified property relief capital allowances, as defined in S531AAE (ii) Living city initiative (iii) All other specified relief capital allowances 119

Other

Losses [120 - 122]

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120

(a) If you wish to claim for relief under S. 381, to set any loss in this trade made in the year 2015 against your other income, enter the amount of the loss.Claim to be made on or before 31/12/2015 (b) If you wish to claim under S. 381 to set a relevant loss, as defined in S 381B, made in the year 2015 against your other income, enter the amount of the loss. Claim to be made on or before 31/12/2017(Note relief is restricted to a max of €31750) Amount of loss used (c) If there are no/insufficient profits, and you wish to claim to add any unused current year Capital Allowances to any loss made in the trade for this year (S. 392), enter the relevant amount of unused Capital Allowances. Claim to be made on or before 31/12/2015 (i) Non-specified relief capital allowances (i.e. not included in Sch. 25B) (ii) Specified Relief Capital Allowances (as set out in Sch 25B) (ii(I)) Specified property relief capital allowances, as defined in S. 531AAE (ii(II)) All other specified relief capital allowances (d) Total loss for offset against other income (by virtue of S.381 and/or S.392)

Unused losses from a previous year (a) Amount of unused losses from a prior year (S. 382) other 121 than residential development land losses where the relevant claim was not made to and received by Revenue before 7/4/2009 (b) In respect of unused residential development land losses from a prior year where the relevant claim was not made to and received by Revenue before 7/4/2009, state: (i) Amount of tax credit due in respect of these losses (S. 644AA(6) and (8)) (ii) Amount of tax payable on the profits or gains of the combined trade (S. 644AA(7)) Terminal loss relief There are no items on this panel Review of Income Tax Year 2014 (Only complete this section if a review of 2014 is required) There are no items on this panel Credit for Professional Services Withholding Tax Gross withholding tax in the basis period for 2015 on fees for 125 Professional Services. Do not include credit for Relevant Contracts paid PRSI paid 126

PPS NO.

If you are employed by An Post as a sub-postmaster/subpostmistress enter the amount of PRSI, if any, paid direct to An Post in respect of this income 2985049U

Trade No 1 (Construction)

EXTRACTS FROM ACCOUNTS [127 - 163] Accounts Information Period (must be completed) 127. (DD/MM/YYYY) From

24/08/2015

128. (DD/MM/YYYY) To

31/12/2015

Extracts From Accounts, pages 6 and 7 must be completed in all cases where you or your spouse are in receipt of trading or professional income 129. If you have previously submitted accounts information relating to this return state the income tax return to which accounts were submitted (YYYY) 130. (a) Where the income arises from a partnership, enter the tax reference of the partnership (b) Insert X in the box if you are choosing to submit your Financial Statements in iXBRL Format via ROS (c) Insert X in the box if you are a non-active partner within the meanaing of S. 409A Income [131-133] 131. Sales / Receipts / Turnover

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7460

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132. Receipts from Government Agencies (GMS, etc.)

0

133. Other Income including tax exempt income

0

Trading Account Items [134-135] 134. Purchases

201

135. Gross Trading Profits

7259

Expenses and Deductions [136-143] 136. Salaries / Wages , Staff costs

0

137. Sub-Contractors

0

138. Consultancy, Professional fees

246

139. Motor, Travel and Subsistence

480

140. Repairs / Renewals 141. Depreciation, Goodwill / Capital write off 142. Provisions including bad debts - positive 143. Other Expenses (Total)

875

Capital Account and Balance Sheet Items [144-155] 144. Cash / Capital introduced 145. Drawings (Net of Tax and Pension contributions)

5650

146. Closing Capital Balance (Indicate (+) or (-) opposite) 147. Stock, Work in progress, Finished goods 148. Debtors and Prepayments 149. Cash / Bank (Debit)

0

150. Bank / Loans /Overdraft (Credit)

0

151. Client Account Balances (Debit) 152. Client Account Balances (Credit) 153. Creditors and Accruals 154. Tax Creditors 155. Net Assets (Indicate (+) or (-) opposite) Extracts from Adjusted Profit Computation [156-157] Profit/Loss [156-157] 156. Net Profit per Accounts

5658

157. Net Loss per Accounts Adjustments made to Profit/Loss per Accounts [158-163] 158. Motor Expenses 159. Donations (Political + charitable)/Entertainment 160. Light, Heat and Phone 161. Net gain on sale of fixed / chargeable assets 162. Net Loss on sale of fixed / chargeable assets 163. (a) Stock Relief Claimed under S666 (b) Stock Relief Claimed under S667B (c) Stock Relief Claimed under S667C Notes to the Accounts C - IRISH RENTAL INCOME There are no entries on this panel D - INCOME FROM IRISH EMPLOYMENTS, OFFICES (INCL. DIRECTORSHIPS), PENSIONS, ETC. INCOME FROM FOREIGN OFFICES OR EMPLOYMENTS ATTRIBUTABLE TO THE DUTIES OF THOSE OFFICES AND EMPLOYMENTS EXERCISED IN THE STATE [212 - 240] Employers/Pension Providers PAYE Registered Number

Payment Frequency

Does the P60 for this Self employment indicate there were

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Spouse/Civil Partner

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53 pay days in 2015? 9831553H

Weekly

X

212. (a) Gross amount of income from Irish employments, offices and nonProprietary Directorships subject to PAYE

7986

218. Allowable Deductions incurred in Employment (a) Nature of employment(s)

General operatives (labourers etc. incl.

(b) Expenses

97

(c) Maximum Amount of Relief Available (d) Superannuation Contributions/AVC (where not deducted by Employer) (e) Allowable Superannuation Contributions/AVCs (f) Capital Allowances (g) Total

97

(h) Amount of total at (g) referring to Proprietary Directorship income/salary (i) Amount of total at (g) referring to Employment income/salary

97

Universal Social Charge - Gross Income from Employment/Pension Gross amount of all employment and occupational pension income, before any deduction for superannuation, other pension contributions, or permanent health benefit. This is the Gross Income for USC as shown on the P60, ap appropriate 2015. Enter the full amount for the year. 232. Gross income for USC for the year 2015

7986

233. Amount of USC deducted in 2015

140

234. Amount of USC refunded for the year 2015 235. If you have received a performance-related bonus from a specified institution in excess of 20,000 and have suffered USC at the rate of 45% on this payment insert x in the box 237. Directorships If you and/or your spouse held proprietary directorships in the year 2015, state each company's tax number and the percentage shareholding in each company. Tax Number

%

Tick if spouse

E - FOREIGN INCOME There are no entries on this panel F - INCOME FROM FEES, COVENANTS, DISTRIBUTIONS, ETC. There are no entries on this panel INCOME FROM SOURCES NOT SHOWN ELSEWHERE There are no entries on this panel G - EXEMPT INCOME There are no entries on this panel H - ANNUAL PAYMENTS, CHARGES AND INTEREST PAID [501-514] There are no entries on this panel I - CLAIM FOR TAX CREDITS, ALLOWANCES, RELIEFS AND HEALTH EXPENSES [515-544] Amount of Personal Tax Credit

3300

515. (a) Home Carer Tax Credit - Amount due for 2015 516. PAYE Tax Credit

X

526. Medical Insurance Relief There are no entries on this panel 528. Home Renovation Incentive - Tax credit due for 2015 based on your HRI online claim

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0

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J - HIGH INCOME INDIVIDUALS: LIMITATION ON USE OF RELIEFS There are no entries on this panel K - CAPITAL ACQUISITIONS IN 2015 There are no items on this panel L - CAPITAL GAINS - CAPITAL GAINS FOR THE YEAR 1 JANUARY 2015 - 31 DECEMBER 2015 [801 - 817] Tick box(es) to indicate: Self 802. If any disposal was between connected parties or otherwise not at arms length

Spouse

803. If any of the original acquisitions were between connected parties or otherwise not at arms length 804. If the market value has been substituted for the cost of acquisition of any assets disposed of If an election for CGT (rather than income tax) treatment on a return of value by Standard Life plc was received after the deadline set by the company, due to delays in the postal system (For audit purposes, the person concerned should retain the letter issued by Standard Life plc to the person, confirming the position) Double Taxation Relief 817. If you wish to claim relief for foreign tax in respect of a disposal that gives rise to a liability to capital gains tax shown above, provide the following information in respect of each such foreign disposal Amount of foreign tax for which relief is now Country Amount of gain claimed M - CHARGEABLE ASSETS ACQUIRED IN 2015 There are no entries on this panel N - PROPERTY BASED INCENTIVES ON WHICH RELIEF IS DUE IN 2015 There are no entries on this panel O - SELF ASSESSMENT MADE UNDER CHAPTER 4 OF PART 41A This return must include a Self-Assessment by the chargeable person to whom the return relates. An individual who fails to make a self-assessment will be liable to a penalty of 250 Euro. 934. Self Assessment - Income Tax 2015 Column A Column B Revenue Self-Assessment Calculation (a) Amount of income or profits arising for this period 13644.00 13644.00 (i) Amount of Income Tax chargeable for this period 2709.40 2709.40 (ii)(I) Amount of USC chargeable for this period self

237.30

237.30

(ii)(II) Amount of USC chargeable for this period spouse

0.00

0.00

(iii)(I) Amount of PRSI chargeable for this period self

226.32

226.32

(iii)(II) Amount of PRSI chargeable for this period spouse

0.00

0.00

(iv) Total amount of tax chargeable for this period

3173.02

3173.02

(c)(i) Amount of tax payable for this period before refund/offset at (c)(iii) below

323.62

323.62

(iii) Amount of refund (or offset) made out of tax wihheld at source

0.00

0.00

(d) Amount of tax payable for this period

323.62

323.62

(f) Amount of surcharge due under S 1084 because of late filing of this return

0.00

0.00

(g) Amount of surcharge due under S 1084 because of non-compliance with LPT requirements (h) Amount of tax paid directly to the Collector General for this period

0.00

0.00

0.00

0.00

(j)(i) Balance of Tax Payable for this period

323.62

323.62

(ii) Amount of tax overpaid for this period before refund/offset at (c)(iii) below

(e) Amount of tax overpaid for this period

(j)(ii) Balance of Tax Overpaid for this period I confirm agreement with the figures at (a) to (c)(ii) inclusive as computed above in column I declare the above to be my Self Assessment to Income Tax for the year 2015 Please indicate what you believe gives rise to your self assessment figures in column B differing from the indicative tax figures provided by ROS in column A

Yes

X

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No X

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Financial Accounts Declaration The Accounts information printed above is the information transmitted or to be transmitted in accordance with S917f(1) Taxes Consolidation Act 1997 and was prepared from the books, records and explanations provided by me. Signature: ___________________________________ Date: ________________ Time: ________________ Address where signed: _______________________________________________________________________________________ Capacity of signatory: ________________________________________________________________________________________

Declaration This declaration is for the purposes of Section 91K TCA 1997 only. It is a declaration confirming the information that is contained in the Form 11 that will be submitted electronically. This hard copy should be retained by you; it is not your return (but is a copy of what is contained in your tax return) and it should not be sent to Revenue. I declare that to the best of my knowledge and belief the information printed above is the information transmitted or to be transmitted in accordance with S917f(1) Taxes Consolidation Act 1997. The information is a correct return in accordance with the provisions of the Taxes Consolidation Act 1997 of: - All the sources of my income and the amount of income derived from each source in the year of assessment 2015 - All disposals of chargeable assets and of the amount of chargeable gains which accrued to me in the year of assessment 2015 (if any) The information correctly states: - All particulars as regards Allowances and reliefs claimed and - Outgoings and charges Signature: ___________________________________ Date: ________________ Time: ________________ Address where signed: _______________________________________________________________________________________ Capacity of signatory: ________________________________________________________________________________________

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