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
16b Taxable amount
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
18 Farm income or (loss). Attach Schedule F
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
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 â–¶
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 â–¶
39b If your spouse itemizes on a separate return or you were a dual-status alien, check here â–¶
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:_________________________