Form 1040 U.S. Individual Tax Return

Form

1040

Name,
Address,
and SSN
See separate
instructions.

P
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Presidential
Election Campaign

Filing Status
Check only one
box.

Exemptions

2010

Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2010, or other tax year beginning
Last name
Your first name and initial

(99)

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

, 2010, 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 instructions.

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

Check here if you, or your spouse if filing jointly, want $3 to go to this fund

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4

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

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3

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

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(1) First name

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(2) Dependent’s
social security number

Last name

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You

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child’s name here. ▶

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Qualifying widow(er) with dependent child

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(4) ✓ if child under age 17
qualifying for child tax credit
(see page 15)

(3) Dependent’s
relationship to you

Dependents on 6c
not entered above

d

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 20.
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 instructions)

If more than four
dependents, see
instructions and
check here ▶

Income

Spouse

Head of household (with qualifying person). (See instructions.) If

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

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the 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
c

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Make sure the SSN(s) above
and on line 6c are correct.

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8b
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8a

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9a

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Qualified dividends . . . . . . . . . . .
9b
Taxable refunds, credits, or offsets of state and local income taxes
Alimony received . . . . . . . . . . . . . . .

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14

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 . . . . . . . . . . . . .

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13
14

15a
16a
17

IRA distributions .
15a
b Taxable amount
. . .
Pensions and annuities 16a
b Taxable amount
. . .
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

15b
16b
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19
20a

Farm income or (loss). Attach Schedule F .
Unemployment compensation . . . .
Social security benefits 20a

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20b

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22

Other income. List type and amount
Combine the amounts in the far right column for lines 7 through 21. This is your total income

23

Educator expenses

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

25

Health savings account deduction. Attach Form 8889

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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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31a

Self-employed health insurance deduction
Penalty on early withdrawal of savings . .

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34

Alimony paid b Recipient’s SSN ▶
IRA deduction . . . . . . .
Student loan interest deduction . .
Tuition and fees. Attach Form 8917 .

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31a

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37

Domestic production activities deduction. Attach Form 8903
35
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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8a
b
9a
b

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 .
Ordinary dividends. Attach Schedule B if required

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b Taxable amount

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Add numbers on
lines above ▶

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21
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For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

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37

Cat. No. 11320B

Form

1040

(2010)

Page 2

Form 1040 (2010)

Tax and
Credits

38

Amount from line 37 (adjusted gross income)

39a

Check
if:

b

Other
Taxes

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

Sign
Here

Paid
Preparer
Use Only

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You were born before January 2, 1946,
Spouse was born before January 2, 1946,

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Blind.
Blind.

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38

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Total boxes
checked ▶ 39a

If your spouse itemizes on a separate return or you were a dual-status alien, check here ▶
Subtract line 40 from line 38

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43

Exemptions. Multiply $3,650 by the number on line 6d . . . . . . . . . . .
Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- .

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45
46

Tax (see instructions). Check if any tax is from: a
Form(s) 8814
Alternative minimum tax (see instructions). Attach Form 6251 . .
Add lines 44 and 45 . . . . . . . . . . . . . . .

47
48

Foreign tax credit. Attach Form 1116 if required .

Credit for child and dependent care expenses. Attach Form 2441

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48

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50
51

Education credits from Form 8863, line 23 . . . . .
Retirement savings contributions credit. Attach Form 8880
Child tax credit (see instructions) . . . . . . . .

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50
51

52
53
54
55

Residential energy credits. Attach Form 5695 . . . .
52
3800 b
8801 c
Other credits from Form: a
53
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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57

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

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54

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8919

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59
60

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

a
Form(s) W-2, box 9
b
Schedule H
Add lines 55 through 59. This is your total tax .

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63

Federal income tax withheld from Forms W-2 and 1099 . .
2010 estimated tax payments and amount applied from 2009 return
Making work pay credit. Attach Schedule M . . . . . . .

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62

64a
b

Earned income credit (EIC) . . . .
Nontaxable combat pay election
64b
Additional child tax credit. Attach Form 8812

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c
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Form 5405, line 16
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64a

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American opportunity credit from Form 8863, line 14 .
First-time homebuyer credit from Form 5405, line 10 .
Amount paid with request for extension to file . . .

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60

67
68

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69
Credit for federal tax on fuels. Attach Form 4136 . . . .
70
Credits from Form: a
2439 b
8839 c
8801 d
8885 71
Add lines 61, 62, 63, 64a, and 65 through 71. These are your total payments .
Excess social security and tier 1 RRTA tax withheld

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73

If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid

74a
b
d

Amount of line 73 you want refunded to you. If Form 8888 is attached, check here . ▶
▶ c Type:
Routing number
Checking
Savings
Account number
Amount of line 73 you want applied to your 2011 estimated tax ▶ 75
Amount you owe. Subtract line 72 from line 60. For details on how to pay, see instructions ▶

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63

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Form 4972 .
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a
4137

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41
42

b
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77
77
Estimated tax penalty (see instructions) . . . . . . .
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Designee’s
name ▶

Phone
no. ▶

72
73
74a

76

▶

Yes. Complete below.

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

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Joint return?
See page 12.
Keep a copy
for your
records.

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Third Party
Designee

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39b
Itemized deductions (from Schedule A) or your standard deduction (see instructions) . .

Direct deposit?
See
▶
instructions.

Amount
You Owe

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40

67
68
69
70
71
72

Refund

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

Print/Type preparer’s name

Firm’s name

▶

Firm’s address ▶

Date

Your occupation

Date

Spouse’s occupation

Preparer’s signature

Date

Daytime phone number

Check
if
self-employed

PTIN

Firm's EIN ▶
Phone no.
Form 1040 (2010)