Treasury Internal Revenue Service

Department of the Treasury Internal Revenue Service (99)Capital Gains and Losses Attach to Form 1040 or Form 1040NR. Information about Schedule D and its separate instructions is at www.irs.gov/scheduled. Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10. OMB No. 1545-00742016Attachment Sequence No. 12 Name(s) shown on return Your social security number

Part I Short-Term Capital Gains and Losses? ”Assets Held One Year or Less See instructions for how to figure the amounts to enter on the lines below. This form may be easier to complete if you round off cents to whole dollars.(d) Proceeds (sales price) (e) Cost (or other basis) (g) Adjustments to gain or loss from Form(s) 8949, Part I, line 2, column (g)(h) Gain or (loss) Subtract column (e) from column (d) and combine the result with column (g) 1a Totals for all short-term transactions reported on Form 1099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 1b .

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Totals for all transactions reported on Form(s) 8949 with Box A checked . . . . . . . . . . . . .2 Totals for all transactions reported on Form(s) 8949 with Box B checked . . . . . . . . . . . . .3 Totals for all transactions reported on Form(s) 8949 with Box C checked . . . . . . . . . . . . .4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . 4 5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . 6 ( )7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any long-term capital gains or losses, go to Part II below. Otherwise, go to Part III on the back . . . . . 7 Part II Long-Term Capital Gains and Losses”Assets Held More Than One Year See instructions for how to figure the amounts to enter on the lines below.

This form may be easier to complete if you round off cents to whole dollars.(d) Proceeds (sales price) (e) Cost (or other basis) (g) Adjustments to gain or loss from Form(s) 8949, Part II, line 2, column (g)(h) Gain or (loss) Subtract column (e) from column (d) and combine the result with column (g) 8a Totals for all long-term transactions reported on Form 1099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 8b .8b Totals for all transactions reported on Form(s) 8949 with Box D checked . . . . . . . . . . . . .9 Totals for all transactions reported on Form(s) 8949 with Box E checked . . . . . . . . . . . . .10 Totals for all transactions reported on Form(s) 8949 with Box F checked. . . . . . . . . . . . . .11 Gain from Form 4797, Part I

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