FORM 1040

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Your Personal Information: Name:___________________________________

Address:_________________________________

Email:___________________________________

Income

7 Wages, salaries, tips, etc. Attach Form(s) W-2

8a Taxable interest. Attach Schedule B if required

8b Tax-exempt interest. Do not include on line 8a

9 a Ordinary dividends. Attach Schedule B if required

9b Qualified dividends

10 Taxable refunds, credits, or offsets of state and local income taxes

11 Alimony received

12 Business income or (loss). Attach Schedule C or C-EZ

13 Capital gain or (loss). Attach Schedule D if required. 

14 Other gains or (losses). Attach Form 4797

15a IRA distributions

15b Taxable amount

16a Pensions and annuities

16b Taxable amount

17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

18 Farm income or (loss). Attach Schedule F

19 Unemployment compensation

20a Social security benefits

20b Taxable amount

21 Other income. List type and amount

22 Combine the amounts in the far right column for lines 7 through 21.  This is your total income

Adjusted Gross Income

23 Educator expenses

24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ

25 Health savings account deduction. Attach Form 8889

26 Moving expenses. Attach Form 3903

27 Deductible part of self-employment tax. Attach Schedule SE

28 Self-employed SEP, SIMPLE, and qualified plans

29 Self-employed health insurance deduction

30 Penalty on early withdrawal of savings

31a Alimony paid

31b Recipient’s SSN ▶

32 IRA deduction

33 Student loan interest deduction

34 Tuition and fees. Attach Form 8917

35 Domestic production activities deduction. Attach Form 8903

36 Add lines 23 through 35

37 Subtract line 36 from line 22. This is your adjusted gross income

Taxes and Credits

38 Amount from line 37 (adjusted gross income)

39a Check if: You were born before January 2, 1949, Blind, Spouse was born before January 2, 1949, Spouse is Blind. Total checked ▶

39b If your spouse itemizes on a separate return or you were a dual-status alien, check here ▶

40 Itemized deductions (from Schedule A) or your standard deduction

41 Subtract line 40 from line 38

42 Exemptions.

If line 38 is $150,000 or less, multiply $3,900 by the number on line 6d. Otherwise, see instructions

43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-

44 Tax (see instructions). Check if any from:

44a Form(s) 8814

44b Form 4972

45 Alternative minimum tax (see instructions). Attach Form 6251

46 Add lines 44 and 45

47 Foreign tax credit. Attach Form 1116 if required

48 Credit for child and dependent care expenses. Attach Form 2441

49 Education credits from Form 8863, line 19

50 Retirement savings contributions credit. Attach Form 8880

51 Child tax credit. Attach Schedule 8812, if required

52 Residential energy credits. Attach Form 5695

53 Other credits from Form:

53a 3800

53b 8801

54 Add lines 47 through 53. These are your total credits

55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-

Other Taxes

56 Self-employment tax. Attach Schedule SE

57 Unreported social security and Medicare tax from Form: a 4137 b 8919

58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required

59a Household employment taxes from Schedule H

59b First-time homebuyer credit repayment. Attach Form 5405 if required

60 Taxes from:

60a Form 8959

60b Form 8960

60c Instructions; enter code(s)

61 Add lines 55 through 60. This is your total tax

Payments

62 Federal income tax withheld from Forms W-2 and 1099

63 2013 estimated tax payments and amount applied from 2012 return

64a Earned income credit (EIC)

64b Nontaxable combat pay election

65 Additional child tax credit. Attach Schedule 8812

66 American opportunity credit from Form 8863, line 8

67 Reserved

68 Amount paid with request for extension to file

69 Excess social security and tier 1 RRTA tax withheld

70 Credit for federal tax on fuels. Attach Form 4136

71 Credits from Form:

71a 2439

71b Reserved

71c 8885

72 Add lines 62, 63, 64a, and 65 through 71. These are your total payments

Refund

73 If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid

 

Signed:________________________

Dated:_________________________

 
 
 
 
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