Form 1040 U.S. Individual Tax Return

Form

1040

Label
(See
instructions
on page 14.)

Use the IRS
label.
Otherwise,
please print
or type.

L
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Presidential
Election Campaign

Filing Status
Check only one
box.

Exemptions

2009

Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2009, or other tax year beginning
Last name
Your first name and initial

(99)

IRS Use Only—Do not write or staple in this space.

, 2009, ending

, 20

OMB No. 1545-0074
Your social security number

Last name

If a joint return, spouse’s first name and initial

Spouse’s social security number
Apt. no.

Home address (number and street). If you have a P.O. box, see page 14.

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City, town or post office, state, and ZIP code. If you have a foreign address, see page 14.

4

Single
Married filing jointly (even if only one had income)

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(1) First name

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child’s name here. ©

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Qualifying widow(er) with dependent child (see page 16)

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(3) Dependent’s (4) ✓ if qualifying
relationship to you child for child tax
credit (see page 17)

(2) Dependent’s
social security number

Last name

%

If more than four
dependents, see
page 17 and
check here ©

Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.

If you did not
get a W-2,
see page 22.
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.

Adjusted
Gross
Income

Boxes checked
on 6a and 6b
No. of children
on 6c who:
● lived with you
● did not live with
you due to divorce
or separation
(see page 18)
Dependents on 6c
not entered above

d

Income

Spouse

Head of household (with qualifying person). (See page 15.) If the

Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse
.
Dependents:

You

©

qualifying person is a child but not your dependent, enter this

Married filing separately. Enter spouse’s SSN above
and full name here. ©

6a
b

¶

Checking a box below will not
change your tax or refund.

© Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 14)

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2
3

You must enter
your SSN(s) above.

7
8a
b
9a
b
10
11
12
13
14
15a
16a
17

Total number of exemptions claimed

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Wages, salaries, tips, etc. Attach Form(s) W-2
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Taxable interest. Attach Schedule B if required .
Tax-exempt interest. Do not include on line 8a .

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8b

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8a

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9b
Qualified dividends (see page 22) . . . . . . .
Taxable refunds, credits, or offsets of state and local income taxes (see page 23) .
Alimony received . . . . . . . . . . . . . . . . . . . .

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9a

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10
11

Ordinary dividends. Attach Schedule B if required

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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 Form 4797 . . . . . . . . . . . . . .
15a
b Taxable amount (see page 24)
IRA distributions .
b Taxable amount (see page 25)
Pensions and annuities 16a

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14

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 in excess of $2,400 per recipient (see page 27) . . .
b Taxable amount (see page 27)
Social security benefits 20a

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20b

21
22

Other income. List type and amount (see page 29)
Add the amounts in the far right column for lines 7 through 21. This is your total income

23

Educator expenses (see page 29)

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25

Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
Health savings account deduction. Attach Form 8889 .

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25

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27
28

Moving expenses. Attach Form 3903 . . . . .
One-half of self-employment tax. Attach Schedule SE
Self-employed SEP, SIMPLE, and qualified plans
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27
28

29
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31a

Self-employed health insurance deduction (see page 30)
Penalty on early withdrawal of savings . . . . . .
Alimony paid b Recipient’s SSN ©

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30
31a

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33
34

IRA deduction (see page 31)
. . . . .
Student loan interest deduction (see page 34)
Tuition and fees deduction. Attach Form 8917

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34

35
36
37

35
Domestic production activities deduction. Attach Form 8903
Add lines 23 through 31a and 32 through 35 . . . . . . .
Subtract line 36 from line 22. This is your adjusted gross income

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For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 97.

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Add numbers on
lines above ©

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Cat. No. 11320B

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36
37
Form

1040

(2009)

Page 2

Form 1040 (2009)

38

Tax and
Credits

39a
b

Standard
Deduction
for—
● People who
check any
box on line
39a, 39b, or
40b or who
can be
claimed as a
dependent,
see page 35.
● All others:
Single or
Married filing
separately,
$5,700
Married filing
jointly or
Qualifying
widow(er),
$11,400
Head of
household,
$8,350

40a
b
41
42

Other
Taxes

Payments
If you have a
qualifying
child, attach
Schedule EIC.

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If you are increasing your standard deduction by certain real estate taxes, new motor
vehicle taxes, or a net disaster loss, attach Schedule L and check here (see page 35) . © 40b
Subtract line 40a from line 38 . . . . . . . . . . . . . . . . . . .
Exemptions. If line 38 is $125,100 or less and you did not provide housing to a Midwestern
displaced individual, multiply $3,650 by the number on line 6d. Otherwise, see page 37 . .
Tax (see page 37). Check if any tax is from:
a
Form(s) 8814
Alternative minimum tax (see page 40). Attach Form 6251 . . .

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Add lines 44 and 45 .

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47
48

Foreign tax credit. Attach Form 1116 if required .

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49
50
51
52
53
54
55

49
Education credits from Form 8863, line 29 . . . . .
50
Retirement savings contributions credit. Attach Form 8880
51
Child tax credit (see page 42) . . . . . . . . .
52
Credits from Form: a
8396 b
8839 c
5695
3800 b
8801 c
53
Other credits from Form: a
Add lines 47 through 53. These are your total credits . . . . .
Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-

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56
57

Self-employment tax. Attach Schedule SE . . . .
Unreported social security and Medicare tax from Form:

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8919

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58
59
60

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required

61
62
63

Federal income tax withheld from Forms W-2 and 1099 . .
2009 estimated tax payments and amount applied from 2008 return
Making work pay and government retiree credits. Attach Schedule M
Earned income credit (EIC) . . . . . . . . . .
64b
Nontaxable combat pay election

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Credit for child and dependent care expenses. Attach Form 2441

Additional taxes: a
AEIC payments b
Add lines 55 through 59. This is your total tax

Additional child tax credit. Attach Form 8812

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47
48

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Form 4972 .
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42
43
44
45
46

54
55
56
57

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Household employment taxes. Attach Schedule H
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58
59
60

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a
4137

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Refundable education credit from Form 8863, line 16 . .
First-time homebuyer credit. Attach Form 5405 . . .
Amount paid with request for extension to file (see page 72)

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Excess social security and tier 1 RRTA tax withheld (see page 72)

61
62
63
64a
65
66
67
68
69

Credits from Form: a
2439 b
4136 c
8801 d
8885 70
Add lines 61, 62, 63, 64a, and 65 through 70. These are your total payments .

72

If line 71 is more than line 60, subtract line 60 from line 71. This is the amount you overpaid

75

41

©

70
71
Direct deposit? 73a
See page 73
© b
and fill in 73b,
73c, and 73d, © d
or Form 8888.
74

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Amount of line 72 you want refunded to you. If Form 8888 is attached, check here
© c Type:
Routing number
Checking

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71
72
73a

©

Savings

Account number
Amount of line 72 you want applied to your 2010 estimated tax © 74
Amount you owe. Subtract line 71 from line 60. For details on how to pay, see page 74 .

76
Estimated tax penalty (see page 74) . . . . . . . .
Do you want to allow another person to discuss this return with the IRS (see page 75)?

©

75

76

Third Party
Designee

Sign
Here

Paid
Preparer’s
Use Only

40a

.

44
45
46

67
68
69

Joint return?
See page 15.
Keep a copy
for your
records.

Blind. Total boxes
Blind. checked © 39a
If your spouse itemizes on a separate return or you were a dual-status alien, see page 35 and check here © 39b
Itemized deductions (from Schedule A) or your standard deduction (see left margin) . .

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Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- .

65
66

Amount
You Owe

38

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43

64a
b

Refund

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Amount from line 37 (adjusted gross income)
. . . .
You were born before January 2, 1945,
Check
Spouse was born before January 2, 1945,
if:

Designee’s
name ©

Phone
no. ©

Yes. Complete the following.

No

Personal identification
©
number (PIN)

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

©

Your signature

Date

Your occupation

Spouse’s signature. If a joint return, both must sign.

Date

Spouse’s occupation

Preparer’s
signature

Date

©

Firm’s name (or
yours if self-employed),
address, and ZIP code

©

Daytime phone number

Check if
self-employed

Preparer’s SSN or PTIN

EIN
Phone no.
Form 1040 (2009)