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£1040 Us individual income Tax Rute | 2014 ose ease ey eer iO he dye beg Bri er = [See separate instructions Your rs name ad a Tear our soca eur amber ll eee pauses sora SeCUT PIS ROMNEY ta ae mac i — Mircenme seen ice, state, Taw sgn ads, dso conplleopacs buon (ee BERGA) eet ane ne MA 02478 ——[Famign peau] rn soe ey Foret cane ne faint) Rar areas) ne eet USA J ES yeu [x] spain Filing Status * |_|Snae 4 [Tiss ot oanahad (oan eating pas) (eae ‘nstuctors) it 2 [arid fing jointy (event ony ene ha nce) the suing pen ht tt your gears, eae van enecr criyono 2 [_] Maries ting sepratay Ener spovees Sou cone ches tomate Bn — Soe and faloanehre, 5 [7] uativng wouter wih depose ED Exemptions 6 | Yourstf someone can claim you as a dependant, donot check boxéa sivee ] etaoneee ——b 1x] spouse =eeeetereees pote I Begun © Dependents: 2) Dependents ydereane [OLrowceran Sindh you oo stm | eels | ona, | 2 oma £0 an (eCieuctons) Sl] — Add mambers on Tota number of eager dined moa ie Income 7 Wages, salaes, io, ts Attaon Fama aeneaee Se Tenable inerestAtach SchesueBHreqined 210210222 2° DTITEIIT 3.012.775, Smee O Tetexamtinerst oo notinaudeontrooe 222) Law [3 395"| Watere A> 98, Ordinary didende. Aeon Sched reuted ttpescvcecesees [Qa] 3,649,567, woes" © Qualified dividends |, STM. 1. . Lee | 2,221) 956. rw, 10 Terabe refunes, cre, o oct fate and ical cots [10 | 352,905. a ‘Pha 450, 740) > oO 1 Aimonyrectied vse essen 12 Susiesincomear ts) Ach ShnniecenCed 22ST! SEQHETS 19. Captat gon creme) tach Sone rege rte Re ‘Feeinsuctons. 44 Other gains or (losses), ‘toch Fo 4797, 152 iRAdistibutens. [ Taxable amont || 163 Pensions and annuities | ° (16 Taxable amount [as | 6810176. Lm tae 17 Reval nm yates, Soren, Scapaaans He an , Sree 18 Feminconeor om) Also areas? a farmehes 49 Unamplomen conperecan BaSoneseee acer aaae Forviion. 208 soda enue [20a grange cent — 21 Obe nee Us gp andanont___SER_STAtEuENE 3 5. 22-coniete ana nt ie snes aunt Ts tdancaes BPE So 23 EeuaO ORME vere eens ee ES Geese 4 Cara taeus epeacteacniin eariy ste a Gross ‘fee-basis government officials. Attach Form 2106 or 2106-EZ [24 Income 25 Health savings account deduction. Attach Form 8889... 25 20° Movog pou Asch Fom i002 S 27nd par of empress Seaade oF 28. Setempoyd SEP. Sue me unre 2 20 Sel-ompoye esi nsusten dicen 20. Punayen ery wincowtofoaingn 310 Almony pdb Recs San Bie 1 acne eee ere 33. swcentcen mires don | ee 24. TutlonanetensatacnFomsoi7s 0S LDTLTTES 35 Sameera aces ceva. ntuohFom eis” “Lae —————| 36 Aides BONS ee vv vvve sevens sll oT ge 12.657, Sr cigs nea i dan acme) the FaEDE Hania, Py At ana Paper React med eo (OMB No. 1548-0074 Application for Automatic Extension of Time To File U.S. Individual Income Tax Return ram 4868 [rebral Revsrue Sanne ey ‘There are three ways to request an automatic extension of tine to file a U.S. individual Income tax return 1. You can file Form 4868 electronically by accessing IRS e-fle. Using your home computer or by using a tax professional who uses one 2. You can pay ail or part of your estimate of income tax due Using a creditor debit card or by using the Electronic Federal ‘TaxPayment System (EFTPS). 3. You can fle @ paper Form 4868, am It's Convenient, Safe, and Secure IRS e-fipis the IRS's electronic fing program. You can get an ‘utamatic extension of time to fle your tax return by fling Form 4868 electronical. You will receive an electronic acknowledgment ‘once you complete the transaction. Keep it with your records. Da ‘not send in Form 4884 if you file electronically, unless you are ‘making @ payment with a check or mony order (see page 3) Complete Form 4868 to use es a worksheet, ifyou think you may ‘owe tax when you fie your return, you wil need to estimate your total tax lability and subtract how much you have already pid (nes 4,5, and 6 below). ‘Several companies offer free e-fiing of Form 4868 through the Free File program. For more deta, 90 to IRS .gov and click on treet 2011 Efile Using Your Personal Computer or Through a Tax Professional Refer to your tax software package or tax preparer for ways to fle electronically. Be sure to have a copy of your 2010 tax elu - you will be asked to provide information from the return for texpayer verification. f you wish to make a payment, you can pay by ‘lectroni funds withdrawal or send your chack or money order to the address shown in the middle column under Where To Filo @ Paper Form 4868 (see page 4) Pay by Credit or Debit Card or EFTPS You can get an extension it you pay part oral of your estimate of income tax due by using a crecit or debit card. Your payment must be at least $1. You can also gat an extension witen you pay par or allof your estimate of income tax due using EFTPS. You can pay by hone or over the internet (see page 3). File a Paper Form 4868, If you wish to fle on paper instead of electronically, itn the Form 4888 below and mailitto the address shown on page 4 For information on using @ private delvery service, oe page 4 Note. Ifyou are a fiscal year taxpayer, you must fie a paper Form 4860, General Instructions Purpose of Form Use Form 4868 to apply for more months (4i*out of the ‘country” (defined on page 2) and a U.S ctizen or residons to fle Form 1080, 10408, 104082, 1040NR, i040NRAEZ, 1040. PR or 1040-85. Gift and genoration-skipping transfer (GST) tax return (Form 709), ‘An extension of time to fle your 2011 ealendar year income ax, return also extends the time to fle Form 709 for 2011, However, it does nol extend the time to pay any gift and GST tax you may ue for 2017, To make a payment of git and GST tax. soe Porm G302, you! do not pay the amount cue by the regular dub date for Form 708, you will owe interest and may also be charged psnaties, the donor died duting 2011, see the instructions for Forms 703 and 8892, Qualifying for the Extension To get the extra time you must ram 4868 Deparment ne rst internal RovanaSevee bo Identification 11 Your names) (600s ucons) WILLARD M ROMNEY ANN_D_ROMNEY ‘Aditess (sonarus) Appi To File U.S. Individu: BELMONT "2 Your soci securly number ation for Automatic Extension of Time ec 1. Property estimate your 2011 tax lablity using the information available to you. 2. Enter your foal tax ability on tine 4 of Form 4868, and 3. Fle Form 4868 by the regular due date of your rotun, Although you are not required to make a payment of the tax {You estimate as due, Form 4868 doos nat extend the tine fo bay faxes. I you do nt pay the amount due by tho, regular due date, you will owe intorest. You ray algo be charged ‘onalios. For more details, see Interest and Late Payment Snally {n page 2. Any romnitance you make with your appleaton fer ‘extension wil be treated as @ payment of tax ‘You do not have to explain why you are asking forthe extension \We will contact you only your request is deniod Do rat fle Form 4868 if you want the IRS fo figure your tax or you are under @ court order to file your return by ths Paulas coe date, REY ‘OWE No. 1648-0074 2011 fal Income Tax Return Individual Income Tax 4 Estimate of total tex sity for 2011 5 Total 2011 payments 6 Balance duo. Subiract fine § from line 4 (Gee instructions)... 2... ‘Amount you are paying eee havucions) De ~ $3,226, 623 3 441 1 le winicidag terse erst eye ee] ‘3 Spouse's social security number | ae a Fam 4868 (2071), ey GOLDMAN SACHS HEOGE FUND PARTNERS H.LLC PARTNER SCHEDULE K-1 SUPPORTING SCHEDIRES R.ERADFORD MALT TTEE THE ANN O ROPESE GRAY ULF 80X15, CODE P OTHER eREDITS Us.wwTHHoLoING TAK TOTALOTHER CREDITS —— Page 5 of 22

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