EFTA01222546.pdf

Form Department of the Treasury—Internal Revenue Service 1040A U.S. Individual Income Tax Return (99) 2017 IRS Use Only—Do not write or staple in this space. Vow first name and rubel Last name OMB No. 1545-0074 Your social security number If a mint return. spouse's first name and initial Last name Spouse's social security number Home address (number and skeet). If you have a P.O. box. see instructions. Apt no- Make are the SSN(s) above a and on line 6c we correct. City. town or post office. state. and LP code. If you have a foreign address. also complete spaces below (see instruct's:en). Presidential Election Campaign Check here d you. or your sparse II filingpinny. want 33 to go notNohs to t fund Feign country name Foreign province/state/county Fang' postal code baeobng a bas rge y2uf t MI tax Of wend. D you El Spouse Filing 1 ❑ Single 4 ❑ Head of household (with qualifying person). (see Indrucbons.) status 2 O Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, Check only 3 O Married filing separately. Enter spouse's SSN above and enter this child's name here. lo one box. full name here. lio 5 O Qualifying widow(er) (see instructions) Exemptions 6a U Yourself. If someone can claim you as a dependent, do not check Boxes checked on box 6a. 6a and 6b b O Spouse No. of children on 6c who: c Dependents: 121 Dependent's social (3) Dependent's (4)1 if chid wider • kved with age 17 qualifying for If may than six security number relationship to you chid tax credit (see you dependents, see (1) First name Last name nstructions) • did not live mstructions. with you due to divorce or I separation (see instructions) ■ Dependents on 6c not entered above Add numbers ri on lines d Total number of exemptions claimed. above e Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7 Attach Form(s) W-2 8a Taxable interest. Attach Schedule B if required. 8a here. Also b Tax-exempt interest. Do not include on line 8a. 8b attach Form(s) 9a Ordinary dividends. Attach Schedule B if required. 9a 1099-R if b Qualified dividends (see instructions). 9b tax was 10 Capital gain distributions (see instructions). 10 withheld. 11a IRA 11b Taxable amount If you did not distributions. 11a (see instructions). 11b get a W-2. see 12a Pensions and 12b Taxable amount instructions. annuities. 12a (see instructions). 12b 13 Unemployment compensation and Alaska Permanent Fund dividends. 13 14a Social security 14b Taxable amount benefits. 14a (see instructions). 14b 15 Add lines 7 through 14b (far right column). This is your total income. P. 15 Adjusted gross 16 Educator expenses (see instructions). 16 income 17 IRA deduction (see instructions). 17 18 Student loan interest deduction (see instructions). 18 19 Tuition and fees. Attach Form 8917. 19 20 Add lines 16 through 19. These are your total adjustments. 20 21 Subtract line 20 from line 15. This is your adjusted gross income. ► 21 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040A (2017) EFTA01222546 Form 1040A (2017) Page 2 Tax, credits, 22 Enter the amount from line 21 (adjusted gross income). 22 and 23a Check I 0 You were born before January 2, 1953, 0 Blind iTotal boxes payments if: OSpouse was bom before January 2,1953, OBlind 1r:tweeted lo 23a ■ b If you are married filing separately and your spouse itemizes Standard deductions, check here ► 23b 0 Deduction for — 24 Enter your standard deduction. 24 • People who 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25 check any box on line 26 Exemptions. Multiply $4,050 by the number on line 6d. 26 23a or 23b or 27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. who can be claimed as a This is your taxable income. P. 27 dependent, see 28 Tax, including any alternative minimum tax (see instructions). 28 instructions. 29 Excess advance premium tax credit repayment. Attach • All others: Single or Form 8962. 29 Married filing separately, 30 Add lines 28 and 29. 30 $6.350 31 Credit for child and dependent care expenses. Attach Married filing Form 2441. 31 pntly or Qualifying 32 Credit for the elderly or the disabled. Attach widow(er). $12,706 Schedule R. 32 Heed of 33 Education credits from Form 8863, line 19. 33 household, $9. 350 34 Retirement savings contributions credit. Attach Form 8880. 34 35 Child tax credit. Attach Schedule 8812, if required. 35 36 Add lines 31 through 35. These are your total credits. 36 37 Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-. 37 38 Health care: individual responsibility (see instructions). Full-year coverage 0 38 39 Add line 37 and line 38. This is your total tax. 39 40 Federal income tax withheld from Forms W-2 and 1099. 40 41 2017 estimated tax payments and amount applied If you have a qualifying from 2016 retum. 41 child attaah 42a Earned income credit (EIC). 42a Schedule EIC. b Nontaxable combat Dav election. 42b 43 Additional child tax credit. Attach Schedule 8812. 43 44 American opportunity credit from Form 8863, line 8. 44 45 Net premium tax credit. Attach Form 8962. 45 46 Add lines 40, 41, 42a, 43, 44, and 45. These are your total payments. ► 46 47 If line 46 is more than line 39, subtract line 39 from line 46. Refund This is the amount you overpaid. 47 Direct 48a Amount of line 47 you want refunded to you. If Form 8888 is attached, check here ► 0 48a deposit? See op. b Routing ► c Type: 0 Checking 0 Savings instructions number and fill In 48b, 48c, op. d Account and 48d or number Form 8888. 49 Amount of line 47 you want applied to your 2018 estimated tax. 49 Amount 50 Amount you owe. Subtract line 46 from line 39. For details on how to pay, you owe see instructions. ► 50 51 Estimated tax penalty (see instructions). 51 Third party Do you want to allow another person to discuss this return with the IRS (see Instructions)? El Yes. Complete the following. 0 No designee Designee's Phone Personal identification name P. no. IP. number (PIN) ► Under penalties of perjury. I declare that I have exarnmed this return and accompanyng schedules and statements. and to the best of my knowledge Sign and be they are true. correct. and accurately list all amounts and sources of income I received during the tax year. Declaration of prepare' (other than the taxpayer) is based on all information of which the preparer has any knowledge. here Your signature Date Your occupation Daytime phone number Joint return? See instructions. Keep a copy Spouse's signature. If a pint return. both must sign. Date Spouse's occupation tithe IRS sent you en Identity Protection PIN. enter it for your records. here(see inst.) Print/Type preparer's name Preparer s signature Date Check If PTIN Paid self-employed preparer Firm's name le Arm's EIN ► use only Firm's address e Phone no. Go to wwwits.govIForm1040A for instructions and the latest information. Form 1040A (2017) EFTA01222547