EFTA01222537.pdf

1040 U.S. Individual Income Tax Return Department of the Treasury—Internal Rriseue Servne OMB No. 1545-0074 IRS Use Only—Do not mite ce staple in the space. For the year Jan. I-Dec.31.2017. or other tax year beginning 2017. ending .20 See separate instructions. Vow first name and initial Last rare Your social security number If a mint return. spouse first name and initial Last name Spouse's social security number Home address (number and street). 1( you have a P.O. box. see instructions. Apt. no. A Make size the SSN(s) above a and on line 6c are correct. City, town or post office. slate. and ZIP code. If you have a foreign address. also complete spaces below (see instructions). Presidential Election Campaign check here if you. or your spouse 4 ding per. yaw $3 to go to ens lund Checkkg Foreign country name Foreign province/state/county Foreign postal code a habelowall net dame yam tax or refund. O You O SPciese Filing Status 1 O Single 4 O Head of househdd (wall qualifying person). (See instructions.) 2 O Married filing jointly (even if only one had income) If the quabfying person is a child but not your dependent. enter this Check only one 3 rl Married filing separately. Enter spouse's SSN above clam's name here. PO box. and full name here. li. 5 O Qualifying widow(er) (see instructions) Ba O Yourself. If someone can claim you as a dependent do not check box 6a Boxes checked Exemptions on 6a and 6b b O Spouse No. of children c Dependents: (2) Dependent's (3) Dependents (4) ./ if child under age 17 on 6c who: somal security reinter relationship to ycu qualnying for ctdd lax mein • lived with you (1) First name last (see instructions) • did not live with you due to divorce O Of separation If more than four (see Instructions) dependents. see O Dependents on 6c instructions and O not entered above O check here lil• O d Total number of exemptions claimed 7 Wages, salaries, tips. etc. Attach Form(s) W-2 7 Add numbers on lines above IP El Income 8a Taxable interest. Attach Schedule B if required 8a b Tax-exempt interest. Do not include on line 8a . . 18b Attach Form(s) 9a Ordinary dividends. Attach Schedule B if required 9a W-2 here. Also attach Forms b Qualified dividends I ob I W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes 10 1099-R if tax 11 Alimony received 11 was withheld. 12 Business income or Doss). Attach Schedule C or C•EZ 12 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ► O 13 If you did not 14 Other gains or (losses). Attach Form 4797 14 get a W-2. see instructions. 15a IRA distributions . 15a l I b Taxable amount . . 15b 16a Pensions and annuities lea b Taxable amount . . 18b 17 Rental real estate. royalties, partnerships. S corporations, trusts. etc. Attach Schedule E 17 18 Fann income or (loss). Attach Schedule F 18 19 Unemployment compensation 19 20a Social security benefits 120a I I b Taxable amount . . 20b 21 Other income. List type and amount 21 22 Combine the amounts in the far right column for laws 7 through 21. This Is your total ktcome ► 22 23 Educator expenses 23 Adjusted 24 Certain business expenses of reservists. performing artists, and Gross feebasis government officials. Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889 25 26 Moving expenses. Attach Form 3903 26 27 Deductible part of self-employment tax. Attach Schedule SE 27 28 Self-employed SEP, SIMPLE, and qualified plans 28 29 Self-employed health insurance deduction . 29 30 Penalty on early withdrawal of savings 30 31a Alimony paid b Recipient's SSN ► 31a 32 IRA deduction 32 33 Student loan interest deduction 33 34 Tuition and fees. Attach Form 8917 34 35 Domestic production actwities deduction. Attach Form 8903 35 36 Add lines 23 through 35 36 37 Subtract line 36 from line 22. This is your adjusted gross Income ► 37 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate Instructions. Form 1040 (2017) EFTA01222537 Form 1040 (2017) Page 2 38 Amount from line 37 (adjusted gross Income) 38 39a Check { O You were born before January 2. 1953, O Blind. } Total boxes Tax and if: O Spouse was born before January 2, 1953. O Blind. checked IIP, 39a Credits b If your spouse itemizes on a separate return or you were a dual-status alien, check here lo 39bD Standard 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . 40 Deduction for— 41 Subtract line 40 from line 38 41 • People who 42 Exemptions. If line 38 is 5156.900 or less. multply$4.050 by the number on line 6d. Monroe. see instructions 42 check any box on line 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . 43 39a or 39b or 44 Tax (see instructions). Check if any from: a ❑ Form(s) 8814 b El Form 4972 e ❑ 44 who can be claimed as a 45 Alternative minimum tax (see instructions). Attach Form 6251 45 dependent. See 46 Excess advance premium tax credit repayment. Attach Form 8962 48 instructions. 47 Add lines 44. 45. and 46 le• 47 • All others: 48 Foreign tax credit. Attach Fowl 1116 if required . . . . 48 Single or Married filing 49 Credit for child and dependent care expenses. Attach Form 2441 49 separatety. 56.350 50 Education credits from Form 8863. line 19 50 Married filing 51 Retirement savings contributions credit. Attach Form 8880 51 jointly or Qualifying 52 Child tax credit. Attach Schedule 8812, if required. . . 52 widow(er). 53 Residential energy credits. Attach Form 5695 . . . . 53 $12.700 Head of 54 Other credits from Form: a ❑ 3800 b O 8801 e O 54 household. 55 Add lines 48 through 54. These are your total credits 55 59.350 58 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- lo se 57 Self-employment tax. Attach Schedule SE 67 Other 58 Unreported social security and Medicare tax from Form: a ❑ 4137 b O 8919 68 59 Additional tax on IRAs, other qualified retirement plans. etc. Attach Form 5329 it required 59 Taxes 60a Household employment taxes from Schedule H 60a b First-time homebuyer credit repayment. Attach Form 5405 if required 60b 61 Health care: individual responsibility (see instructions) Full-year coverage O 81 82 Taxes from: a O RCM 8959 b ❑ Rag 8960 c O Instructions; enter code(s) 82 83 Add lines 56 through 62. This is your total tax ► 83 Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . 64 ,L6j. 2017 estimated tax payments and amount applied from 2016 return 65 If you have a 66a Earned Income credit (EIC) qualifying child, attach b Nontaxable combat pay election 188b Schedule EIC. 67 Additional child tax credit. Attach Schedule 8812 68 American opportunity credit from Form 8863, line 8 68 69 Net premium tax credit. Attach Form 8962 89 70 Amount paid with request for extension to file 70 71 Excess social security and tier 1 RRTA tax withheld 71 72 Credit for federal tax on fuels. Attach Fowl 4136 72 73 Credts from Feint a 02439 b Rimed c O 8885 dID 73 74 Add lines 64. 65. 66a, and 67 through 73. These are your total payments O. 74 Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75 76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . IP O 78a Direct deposit? Il. D Routing number lli.c Type: Checking O Savings See Is. d Account number I 1 1 O 1 1 1 1 instructions. 77 Amount of line 75 you want applied to your 2018 estimated tax BPI 77 I Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions lo 78 You Owe 79 Estimated tax penalty (see instructions) 79 I Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? O Yes Complete below. ❑ No Designee Designee's Phone Personal iden ideation name ► no. ► number (PIN) . I Urslei ornate of palmy. I &Ogre that I have exainked the return end ftCOMpanying schedules and statements. and ID IS best of My knowledge and tenet they are bit. MYNA. and Sign accurately let al arnasill and SOurCee a Wane I received dating Melee year. DeCkfranOn Of prepare, lother than taMayed is bated on al infOMM5Crl et wroth paperer hat any knowledge. Here Vow signature Date Vow occupation Daytime phone number Jont return? See insuecoons. Keep a copy for Spouse's signature. If a joint return. both must sign Date Spouse's occupation If the IRS sera you an Identity Protection your records. PIN. enter it j here (see inst)i Pnnt/Type preparer's name Preparer's signature Date PTIN Paid Check O if self-employed Preparer Firm's name ► Firm's 9N ► Use Only Firm's address ► Phone no. Go to itninviragov/Fom7/040 for instructions and the latest information. Form 1040 poln EFTA01222538