Schedule A 8609 Annual Statement

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FORM 8815, PAGE 1 of 2
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Form

8815

Department of the Treasury
Internal Revenue Service (99)

Name(s) shown on return

1

Action

Date

Signature

O.K. to print
Revised proofs
requested

Exclusion of Interest From Series EE and I
U.S. Savings Bonds Issued After 1989

OMB No. 1545-0074

2006

f
o
s
a
6
t
0
f
0
a
2
r
/
D /09
6
0

(For Filers With Qualified Higher Education Expenses)
©

Attach to Form 1040 or Form 1040A.

(a)
Name of person (you, your spouse, or your dependent) who
was enrolled at or attended an eligible educational institution

Attachment
Sequence No. 57
Your social security number

(b)
Name and address of eligible educational institution

If you need more space, attach a statement.
2
3
4
5
6
7
8
9

10
11
12

13
14

Enter the total qualified higher education expenses you paid in 2006 for the person(s) listed in
column (a) of line 1. See the instructions to find out which expenses qualify
Enter the total of any nontaxable educational benefits (such as nontaxable scholarship or
fellowship grants) received for 2006 for the person(s) listed in column (a) of line 1 (see instructions)
Subtract line 3 from line 2. If zero or less, stop. You cannot take the exclusion
Enter the total proceeds (principal and interest) from all series EE and I U.S. savings bonds
issued after 1989 that you cashed during 2006
Enter the interest included on line 5 (see instructions)
If line 4 is equal to or more than line 5, enter “1.000.” If line 4 is less than line 5, divide line 4
by line 5. Enter the result as a decimal (rounded to at least three places)
Multiply line 6 by line 7
Enter your modified adjusted gross income (see instructions)
Note: If line 9 is $78,100 or more if single or head of household, or
$124,700 or more if married filing jointly or qualifying widow(er), stop.
You cannot take the exclusion.

3
4
5
6
7
8

3

.

12

3

.

9

Enter: $63,100 if single or head of household; $94,700 if married filing
10
jointly or qualifying widow(er)
Subtract line 10 from line 9. If zero or less, skip line 12, enter -0- on
11
line 13, and go to line 14
Divide line 11 by: $15,000 if single or head of household; $30,000 if married filing jointly or
qualifying widow(er). Enter the result as a decimal (rounded to at least three places)
Multiply line 8 by line 12
Excludable savings bond interest. Subtract line 13 from line 8. Enter the result here and on
©
Schedule B (Form 1040), line 3, or Schedule 1 (Form 1040A), line 3, whichever applies

For Paperwork Reduction Act Notice, see back of form.

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Cat. No. 10822S

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Form

8815

(2006)