8903 Domestic Production Activities Deduction

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
If you have any comments on this draft form, you can
submit them to us on our web site. Include the word
DRAFT in your response. You may make comments
anonymously, or you may include your name and
e-mail address or phone number. We will be unable
to respond to all comments due to the high volume
we receive. However, we will carefully consider
each suggestion. So that we can properly consider
your comments, please send them to us within 30
days from the date the draft was posted.

1
TLS, have you
transmitted all R
text files for this
cycle update?

Date

Form

5074

I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 706, PAGE 1 OF 2
MARGINS; TOP 13mm (1/2"), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (8-1/2") x 279mm (11")
PERFORATE: None
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Name(s) shown on Form 1040

Revised proofs
requested

17
18
19
20
21
22
23
24
25
26
27
28
29

30
31
32
33
34

2006

f
o
s
a
6
t
0
f
0
a
2
r
/
D /14
7
0
©

Attach to Form 1040.

60

Your social security number

Income From Guam or the CNMI Reported on Form 1040

CNMI

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Adjusted Gross Income From Guam or the CNMI Reported on Form 1040

Archer MSA deduction
Certain business expenses of reservists, performing artists, and
fee-basis government officials
Health savings account deduction
Moving expenses
One-half of self-employment tax
Self-employed SEP, SIMPLE, and qualified plans
Self-employed health insurance deduction
Penalty on early withdrawal of savings
IRA deduction
Student loan interest deduction
Jury duty pay you gave to your employer
Add lines 17 through 27
©
Adjusted gross income. Subtract line 28 from line 16

Part III

OMB No. 1545-0074

Attachment
Sequence No.

Wages, salaries, tips, etc.
Taxable interest
Ordinary dividends
Taxable refunds, credits, or offsets of local Guam or CNMI income taxes
Alimony received
Business income or (loss)
Capital gain or (loss)
Other gains or (losses)
IRA distributions (taxable amount)
Pensions and annuities (taxable amount)
Rental real estate, royalties, partnerships, S corporations, trusts, etc.
Farm income or (loss)
Unemployment compensation
Social security benefits (taxable amount)
Other income. List type and amount ©
©
Total income. Add lines 1 through 15

Part II

Signature

O.K. to print

Guam

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Date

Allocation of Individual Income Tax to Guam or the
Commonwealth of the Northern Mariana Islands (CNMI)

Department of the Treasury
Internal Revenue Service

Part I

Action

17
18
19
20
21
22
23
24
25
26
27
28
29

Payments of Income Tax to Guam or the CNMI

Payments on estimated tax return filed with Guam or the CNMI
Income tax withheld from your wages while employed by the U.S.
Government as a civilian in Guam or the CNMI
Income tax withheld from your wages while employed as a member of
the U.S. Armed Forces in Guam or the CNMI
Income tax withheld from your wages earned in Guam or the CNMI other
than amounts on lines 30 through 32
©
Total payments. Add lines 30 through 33

For Paperwork Reduction Act Notice, see back of form.

30
31
32
33
34

Cat. No. 42243X

Form

5074

(2006)