This tax document is provided courtesy of efile.com. Visit our homepage:

Transcription

1 This tax document is provided courtesy of efile.com. Visit our homepage: Discover the benefits of efiling: Learn more about income taxes in the US: For electronic filing support, click here: Please contact an efile.com customer tax support representative with any questions you might have:

2 File this return with Collector of Internal Revenue on or before March,. Any balance of tax due (item, below) must be paid in full with return. See separate Instructions for filling out return. FORM Treasury Department Internal Revenue Service U. S. INDIVIDUAL INCOME TAX RETURN FOR CALENDAR YEAR or scal year beginning.,, and ending., EMPLOYEES. Instead of this form, you may use your Withholding Receipt, Form W- (Rev.), as your return, if your total income was less than,, consisting wholly of wages shown on Withholding Receipts or of such wages and not more than of other wages, dividends, and interest. NAME. (PLEASE PRINT. If this return is for a husband and wife, use bath first names) Page Do not write in these spaces File Code Serial No. District (Cashier's Stamp) Exemptions ADDRESS. (PLEASE PRINT. Street and number or rural route) Social Security No. (if any)... (City or town, postal one number) (State).list your own name. If married and your wife (or husband) had no income, or if this is a joint return of husband and wife, list name of your wife (or husband). List names of other close relatives with incomes of less than who received more than one-half of their support from you. If this is a joint return of husband and wife, list dependent relatives of both. NAME (Please print) Relationship X X X X X X X XX NAME (Please print) Relationship r. Enter your total wages, salaries, bonuses, commissions, and other compensation received in, BEFORE PAY-ROLL DEDUCTIONS for taxes, d jes, insurance, bonds, etc. Members of armed forces and persons claiming traveling or reimbursed expenses, see Instruction. PRINT EMPLOYER'S NAME WHERE EMPLOYED (CITY AND STATE) AMOUNT Income How to figure Tax Tax Due or Refund Enter total here «>.Enter here the total amount of your dividends and interest (including interest from Government obligations unless wholly exempt from taxation). If you received any other income, give details on page and enter the total here.add amounts in items,, and, and enter the total here If item includes income of both husband and wife, show husband's income here, ; wife's income here, IF YOUR INCOME WAS LESS THAN,. You mayfindyour tax in the tax table on page. This table, which is provided by law, is based on the same tax rates as are used in the Tax Computation on page. The table automatically allows about percent of your total income for charitable contributions, interest, taxes, casualty losses, medical expenses, and miscellaneous expenses. If your expenditures and losses of these classes amount to more than percent, it will usually be to your advantage to itemize them and compute your tax on page. IF YOUR INCOME WAS, OR MORE. Disregard the tax table and compute your tax on page. You may either take a standard deduction of or itemize your deductions, whichever is to your advantage. HUSBAND AND WIFE. If husband and wife file separate returns, and one itemizes deductions, the other must also itemize deductions..enter'your tax from table on page, or from line, page.how much have you paid on your income tax? (A) By Withholding from your wages (Attach Withholdine Receipts. Form W-). (B) By payments on Declaration of Estimated Tax Enter total here»>.f your tax (item ) is larger than payments (item ), enter BALANCE OF TAX DUE here. If your payments (item ) are larger than your tax (item ), enter the OVERPAYMENT here... Check (l') whether you want this overpayment: Refunded to youq; or Credited on your estimated tax Q -. If you filed a return for a prior year, what was the latest year?. To which Collector's office was it sent? To which Collector's office did you pay amount claimed in item (B), above? Is your wife (or husband) making a separate return for?..... If "Yes," write below: ("Yes" or "No") Name of wife (or husband) Collector's office to which sent. I declare under the penalties of perjury that this return (including any accompanying schedules and statements) has been examined by me and to the best of my knowledge and belief is a true, correct, and complete return. (Signature of person (other than taxpayer or agent) preparing return) (Name of rm or employer, if any) (Date) (Signature of taxpayer) (Date) (If this is a joint return of husband and wife, it must be signed by both) (SEE TAX TABLE BELOW)

3 If you use this table, tear off his page and file only pages and Page TAX TABLE FOl /COMES UNDER, Read down the shaded columns below until youfindthe line cotering tl tal income you entered in item, page. Then read across to the column headed by the number corresponding to the number of persons listed in item I, page. Enter the tax you find there in item, page. Husband and wife see Special Rule at end of table. If total income in itean, pare, is At least ' -. So ; S,,, <,, *,,,,,.,,,,,,,,,,,,., urn,'«*,,,, ',,,*,,,, X,S,,,, : *., * :,,, suss,,,,#,,sse, BstJcss than. soo v - -,,,,., ', ;, *,,,,,,,,,,,, -,,,,,,,,, l,oo i;?,. -, ;,*,,,,,,,,,,,,, -»,,,,", -,, And therarobef &f pirmtejtrtetfni item Itp^ftl, i*-*«- K ---- l.'- loo -, - - -<*,' (.mere tax-j*-^ * ~ JO a J If total income in item,- page, is At least,,,; -,',,,, ;, -., ',,, *,«,,,,,,,,,,, ',,,,, x,, -,, -,,,,,, ',...' \,*,t>,.,,,, -, :'*, * \ * *>, *, -.,-, *,,, - AM,,,,., -, -, >,,,, ':, But less than,,,,--,,., ',,,,,,,,,,,,,,, * ',,,,,,,,,,,,,,,,,,, -.,,,,,,,, -,,,,,', ;ioe, * *',,, -,, <-,,, *,, *,'»., And t>c nuniher of persons Bst«in item i Jftgel, is - t. ' SPE< CIAL RULE FOR H (USBA NDM ID WI FE If it. :m, pag el, includes the ii uome of bol th hus band i and wi re. redt.d B the tax you found in the table by p o» two inc omes but not by more han ercent of thi smal w t parage: iph of page of In struct! on*.. F< >r an stamp le, * «' tax is-.' i,. ' - & C',. \ l;> L> or more,

4 Do not use this page if your income is wholly from salaries, wages, dividends, and interest Page Schedule A INCOME FROM ANNUITIES OR PENSIONS. Cost of annuity (total amount you paid in). Amount received tax-free in prior years.. Remainder of your cost (line I less line ) Total amount received this year. Excess, if any, of line over line. Enter line, or percent of line, whichever is greater... Kind of property Schedule B. INCOME FROM RENTS AND. Amount of rent or royalty. Depreciation or depletion (explain in Schedule F) ROYALTIES. Repairs (explain in Schedule G). Other expenses (itemize in Schedule G) Net profit (or loss) (col. less sum of cols.,, and ). Schedule C PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION. (Farmers should obtain Form F) (State () nature of business - ; () business name ) J. Total receipts. COST OF GOODS SOLD (To be used where inventories are an income-determining factor) (Enter the letters "C,** or "C or M," on line and- if inventories are valued at either cost, or cost or market whichever u lower). Inventory at beginning of year.. Merchandise bought for sale. Labor. Material and supplies. Other costs(explain in Schedule G). Total of lines to. Less inventory at end of year.. Net cost of goods sold (line less line ). Gross profit (line less line ). OTHER BUSINESS DEDUCTIONS Salaries and wages not included as "Labor". Interest on business indebtedness Taxes on business and business property.. Losses (explain in Schedule G) Bad debts arising from sales or services... Depreciation, obsolescence and depletion (explain in Schedule F) Rent, repairs, and other expenses (explain in Schedule G) Amortization of emergency facilities (attach statement) Net operating loss deduction (attach statement). Total of lines to. Total of lines and Net profit (or loss) (line less line ). Schedule P. CAINS AND LOSSES FROM SALES OR EXCHANGES OF CAPITAL ASSETS, ETC.. Net gain (or loss) from sale or exchange of capital assets (from separate Schedule D). Net gain (or loss) from sale or exchange of property other than capital assets (from separate Schedule D)._ Schedule E. INCOME FROM PARTNERSHIPS, ESTATES AND TRUSTS, AND OTHER Name and address of partnership, syndicate, etc Name and address of estate or trust Other sources (state nature) Total SOURCES Total income from above sources (Enter as item, page ). I. Kind of property (If buildings, state material of which constructed) Schedule F. EXPLANATION OF DEDUCTION FOR DEPRECIATION CLAIMED IN SCHEDULES B AND C. Date acquired. Cost or other basis (Do not include land or other nondepreciable property). Assets fully depreciated in use at end of year. Depreciation allowed (or allowable) in prior years. Remaining cost or other basis to be recovered. Estimated life used in accumulating depreciation. Estimated ren»ining life from beginning of year. Depreciation allowable this year Schedule G. EXPLANATION OF COLUMNS AND OF SCHEDULE B f AND LINES,, AND OF SCHEDULE C, Column or line No.. Explanation. Amount. Column or Line No.. Explanation. Amount

5 Do not itemize deductions if () You determine your tax from the tax table on page, or () total income is, or more and you claim the standard deduction. If husband and wife living together at end of year file separate returns and one itemizes deductions, the other must file his or her return on Form, and must also itemize deductions. Page DEDUCTIONS Describe deductions and state to whom paid. If more space is needed, list deductions on separate sheet of paper and attach to this return Amount Contr.uons Allowable Contributions (not in excess of percent of item, page ) Interest Taxes Losses from fire, storm, shipwreck, or other casualty, or theft Total Allowable Losses (not compensated by insurance or otherwise)... Medical and dental expenses Net Expenses (not compensates oy insurance or otherwise) Enter percent of item, page, and subtract from Net Expenses Miscellaneous (includingalimony.amorlizable bond premium, special deduction for the blind, etc) TOTAL DEDUCTIONS. TAX COMPUTATION FOR PERSONS NOT USING TAX TABLE ON PAGE. Enter amount shown in item, page. This is your Adjusted Cross Income. Enter DEDUCTIONS (if deductions are itemized above, enter the total of such deductions: if adjusted gross income (line, above) is, or more and deductions are not itemized, enter the standard deduction of ). Subtract line from line. Enter the difference here. This is your Net Income. Enter your Surtax Exemptions ( for each person listed in tern, page ). Subtract line from line. Enter the difference here. This is your Surtax Net Income. Use the Surtax Table in instruction sheet tofigureyour Surtax on amount entered on line. Enter the amount here. Copy thefigureyou entered on line, above. (If line includes partially tax-exempt interes Tax Computation Instructions)... Enter your Normal-Tax Exemption ( if return includes income of only one person; otherw Tax Computation Instructions)... Subtract line from line, and enter the difference here. Enter here percent of line. This is your Normal Tax. Add thefigureson lines and, and enter the total here. (If alternative tax computation is made on separate Schedule D, enter here tax from line of Schedule D) If you used the standard deduction in line, disregard lines,, &, and copy on line the samefigureyou entered on Ene. Enter here any income tax payments to a foreign country or U. S. possession (attach Form ). Enter here any income tax paid at source on tax-free covenant bond interest. Add thefigureson lines and and enter the total here. Subtract line from line. Enter the difference here and in item, page. This is your tax it a. S. GOVERNMENT PJHNTINtS OFFICE t M - _... -