1040
Páginas: 7 (1540 palabras)
Publicado: 14 de junio de 2012
Form
1040
2011
(99)
Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return
For the year Jan. 1–Dec. 31, 2011, or other tax year beginning
OMB No. 1545-0074
, 2011, ending
IRS Use Only—Do not write or staple in this space.
See separate instructions.
, 20
Your first name and initial
Last name
Your social security numberJohn
Rivera
03
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
Mary Font
Castro
03
Apt. no.
Home address (number and street). If you have a P.O. box, see instructions.
▲
Oklahoma 1025 North Orlando Florida 123896
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (seeinstructions).
Foreign country name
Filing Status
Check only one
box.
Exemptions
6a
b
Presidential Election Campaign
Head of household (with qualifying person). (See instructions.) If
child’s name here. ▶
5
Qualifying widow(er) with dependent child
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse
.
Dependents:
(1) First name
..
.
.
.
.
.
.
.
.
.
(2) Dependent’s
social security number
Last name
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
}
(4) ✓ if child under age 17
qualifying for child tax credit
(see instructions)
(3) Dependent’s
relationship to you
Dependents on 6c
not entered above
d
Adjusted
Gross
Income
.
.
..
.
.
.
8b
..
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
10
11
.
.
.
.
.
.
.
.
.
.
.
.
10
11
12
13
14
Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . .
Capital gain or (loss). Attach Schedule D if required. If not required, check here ▶
Other gains or (losses). Attach Form4797 . . . . . . . . . . . . .
.
12
13
14
15a
16a
17
IRA distributions .
15a
b Taxable amount
...
Pensions and annuities 16a
b Taxable amount
...
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
15b
16b
17
18
19
20a
Farm income or (loss). Attach Schedule F .
Unemployment compensation . . . .
Social security benefits 20a18
19
20b
21
22
Other income. List type and amount
Combine the amounts in the far right column for lines 7 through 21. This is your total 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
.
24
25Moving expenses. Attach Form 3903 . . . . . .
Deductible part of self-employment tax. Attach Schedule SE .
Self-employed SEP, SIMPLE, and qualified plans
..
26
27
28
Self-employed health insurance deduction
Penalty on early withdrawal of savings . .
.
.
.
.
.
.
.
.
Alimony paid b Recipient’s SSN ▶
IRA deduction . . . . . . .
Student loan interest deduction . .Tuition and fees. Attach Form 8917 .
29
30
31a
.
.
.
.
.
.
.
.
.
.
.
.
32
33
34
Domestic production activities deduction. Attach Form 8903
35
Add lines 23 through 35 . . . . . . . . . . . . .
Subtract line 36 from line 22. This is your adjusted gross income
b
.
.
.
.
Wages, salaries, tips, etc. Attach Form(s) W-2
.
Taxable interest. AttachSchedule B if required .
Tax-exempt interest. Do not include on line 8a .
Ordinary dividends. Attach Schedule B if required
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
......
......
b Taxable amount
.
.
.
.
.
.
.
.
.
.
▶
.
.
2
9a
Qualified dividends . . . ....
1040
2011
(99)
Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return
For the year Jan. 1–Dec. 31, 2011, or other tax year beginning
OMB No. 1545-0074
, 2011, ending
IRS Use Only—Do not write or staple in this space.
See separate instructions.
, 20
Your first name and initial
Last name
Your social security numberJohn
Rivera
03
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
Mary Font
Castro
03
Apt. no.
Home address (number and street). If you have a P.O. box, see instructions.
▲
Oklahoma 1025 North Orlando Florida 123896
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (seeinstructions).
Foreign country name
Filing Status
Check only one
box.
Exemptions
6a
b
Presidential Election Campaign
Head of household (with qualifying person). (See instructions.) If
child’s name here. ▶
5
Qualifying widow(er) with dependent child
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse
.
Dependents:
(1) First name
..
.
.
.
.
.
.
.
.
.
(2) Dependent’s
social security number
Last name
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
}
(4) ✓ if child under age 17
qualifying for child tax credit
(see instructions)
(3) Dependent’s
relationship to you
Dependents on 6c
not entered above
d
Adjusted
Gross
Income
.
.
..
.
.
.
8b
..
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
10
11
.
.
.
.
.
.
.
.
.
.
.
.
10
11
12
13
14
Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . .
Capital gain or (loss). Attach Schedule D if required. If not required, check here ▶
Other gains or (losses). Attach Form4797 . . . . . . . . . . . . .
.
12
13
14
15a
16a
17
IRA distributions .
15a
b Taxable amount
...
Pensions and annuities 16a
b Taxable amount
...
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
15b
16b
17
18
19
20a
Farm income or (loss). Attach Schedule F .
Unemployment compensation . . . .
Social security benefits 20a18
19
20b
21
22
Other income. List type and amount
Combine the amounts in the far right column for lines 7 through 21. This is your total 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
.
24
25Moving expenses. Attach Form 3903 . . . . . .
Deductible part of self-employment tax. Attach Schedule SE .
Self-employed SEP, SIMPLE, and qualified plans
..
26
27
28
Self-employed health insurance deduction
Penalty on early withdrawal of savings . .
.
.
.
.
.
.
.
.
Alimony paid b Recipient’s SSN ▶
IRA deduction . . . . . . .
Student loan interest deduction . .Tuition and fees. Attach Form 8917 .
29
30
31a
.
.
.
.
.
.
.
.
.
.
.
.
32
33
34
Domestic production activities deduction. Attach Form 8903
35
Add lines 23 through 35 . . . . . . . . . . . . .
Subtract line 36 from line 22. This is your adjusted gross income
b
.
.
.
.
Wages, salaries, tips, etc. Attach Form(s) W-2
.
Taxable interest. AttachSchedule B if required .
Tax-exempt interest. Do not include on line 8a .
Ordinary dividends. Attach Schedule B if required
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
......
......
b Taxable amount
.
.
.
.
.
.
.
.
.
.
▶
.
.
2
9a
Qualified dividends . . . ....
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