Form 1040-SS (2011 U.S. Self Employment Tax Return (Including the Additiona

Version A, Cycle 1

Form

1040-SS

U.S. Self-Employment Tax Return (Including the Additional Child Tax
Credit for Bona Fide Residents of Puerto Rico)

Please type or print

U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern
Mariana Islands (CNMI), or Puerto Rico. For the year Jan. 1–Dec. 31, 2011,
Department of the Treasury
or other tax year beginning
, 2011, and ending
, 20
Internal Revenue Service
Your first name and initial
Last name

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

OMB No. 1545-0090

2011

.

Your social security number

Last name

Spouse’s social security number

Present home address (number, street, and apt. no., or rural route)

City, town or post office, commonwealth or territory, and ZIP code

Part I

Total Tax and Credits

1 Filing status. Check the box for your filing status (see instructions).
Single
Married filing jointly
Married filing separately. Enter spouse's social security no. above and full name here. a
2 Qualifying children. Complete only if you are a bona fide resident of Puerto Rico and you are claiming the additional child
tax credit (see instructions).
(a) First name

3
4
5
6
7
8
9
10
11
12a

(b) Child’s
social security number

Last name

(c) Child’s
relationship to you

DRAFT AS OF
April 27, 2011

Self-employment tax from Part V, line 12. . . . . . . . . . . . . . . . . .
Household employment taxes (see instructions). Attach Schedule H (Form 1040) . . . .
Total tax. Add lines 3 and 4 (see instructions) . . . . . . . . . . . . . . . .
2011 estimated tax payments (see instructions) . . . . . . .
6
Excess social security tax withheld (see instructions). . . . . .
7
Additional child tax credit from Part II, line 3 . . . . . . . .
8
Health coverage tax credit. Attach Form 8885 . . . . . . . .
9
Total payments and credits (see instructions) . . . . . . . . . . . . . . .
If line 10 is more than line 5, subtract line 5 from line 10. This is the amount you overpaid .
a
Amount of line 11 you want refunded to you. If Form 8888 is attached, check here .

b Routing Number

ac

Type:

Checking

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3
4
5

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10
11
12a

Savings

d Account Number
13
14

13
Amount of line 11 you want applied to 2012 estimated tax . . a
Amount you owe. If line 5 is more than line 10, subtract line 10 from line 5. For details on how
to pay, see instructions . . . . . . . . . . . . . . . . . . . . . . . a
Do you want to allow another person to discuss this return with the IRS (see instructions)?

Third Party
Designee

Designee's

Phone

a

a

name

Sign
Here
Joint Return?
See instructions
Keep a copy
for your
records.

F

Comp:
insert a
period.

Paid
Preparer
Use Only

no.

14

Yes. Complete the following.

No

Personal Identification
a

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 the taxpayer) is based on all information of which the preparer has
any knowledge.
Daytime phone number
Your signature
Date

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

Print/Type preparer’s name

Preparer's signature

Date

Date

PTIN
Check
if
self-employed

Firm’s name

a

Firm's EIN

Firm's address

a

Phone no.

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

Cat. No. 17184B

a

Form 1040-SS (2011)

Version A, Cycle 1

Form 1040-SS (2011)

Page

2

Part II Bona Fide Residents of Puerto Rico Claiming Additional Child Tax Credit—See instructions.
Caution. You must have three or more qualifying children to claim the additional child tax credit.
1

Income derived from sources within Puerto Rico .

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2
3

Withheld social security and Medicare taxes from Forms 499R-2/W-2PR (attach copy of form(s)) . .
Additional child tax credit. Use the worksheet in the instructions to figure the amount to enter
here and in Part I, line 8 . . . . . . . . . . . . . . . . . . . . . . . . .

2
3

Part III Profit or Loss From Farming—See the instructions for Schedule F (Form 1040).
Name of proprietor

Social security number

Note. If you are filing a joint return and both you and your spouse had a profit or loss from a farming business, see Joint returns and
Husband-Wife Business in the instructions for more information.

1
2
3
4
5a
6
7
8
9
10
11

Section A—Farm Income—Cash Method
Complete Sections A and B. (Accrual method taxpayers, complete Sections B and C, and Section A, line 11.)
Do not include sales of livestock held for draft, breeding, sport, or dairy purposes (see instructions).
Sales of livestock and other items you bought for resale . . . . .
1
Cost or other basis of livestock and other items reported on line 1 . .
2
Subtract line 2 from line 1. . . . . . . . . . . . . . . . . . . . . . . . .
3
Sales of livestock, produce, grains, and other products you raised . . . . . . . . . . .
4
Total cooperative distributions (Form(s)
1099-PATR) . . . . . . . . . . .
5a
5b Taxable amount
5b
Agricultural program payments received . . . . . . . . . . . . . . . . . . . .
6
Commodity Credit Corporation (CCC) loans reported under election (or forfeited) . . . . . .
7
Crop insurance proceeds . . . . . . . . . . . . . . . . . . . . . . . . .
8
Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . .
9
Other income. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
Gross farm income. Add amounts in the right column for lines 3 through 10. If accrual method
11
taxpayer, enter the amount from Section C, line 50 . . . . . . . . . . . . . . . a

DRAFT AS OF
April 27, 2011

Section B—Farm Expenses—Cash and Accrual Method
Do not include personal or living expenses (such as taxes, insurance, or repairs on your home) that did not produce farm income.
Reduce the amount of your farm expenses by any reimbursements before entering the expenses below.
12
Car and truck expenses
25
Pension and profit-sharing
(see instructions) . . . .
plans . . . . . . . .
12
25
13
Chemicals . . . . . . .
13
26
Rent or lease:
a Vehicles, machinery, and
14
Conservation expenses . .
14
equipment . . . . . . . 26a
15
Custom hire (machine work)
15
b
Other (land, animals, etc.) . . 26b
16
Depreciation and section 179
27
Repairs and maintenance . .
27
expense deduction not
28
Seeds and plants purchased
28
claimed elsewhere (attach
Form 4562 if required). . .
16
29
Storage and warehousing
.
29
30
Supplies purchased . . . .
30
17
Employee benefit programs
other than on line 25 . . .
31
Taxes . . . . . . . .
31
17
18
Feed purchased . . . . .
18
32
Utilities . . . . . . . .
32
19
Fertilizers and lime . . . .
19
33
Veterinary, breeding, and
medicine . . . . . . .
20
Freight and trucking . . .
20
33
21
Gasoline, fuel, and oil . . .
21
34
Other expenses (specify):
a
22
Insurance (other than health)
22
34a
23
Interest:
b
34b
c
34c
a Mortgage (paid to banks, etc.) 23a
b Other . . . . . . . .
23b
d
34d
24
Labor hired . . . . . .
24
e
34e
35
Total expenses. Add lines 12 through 34e . . . . . . . . . . . . . . . . . . a
35
36
Net farm profit or (loss). Subtract line 35 from line 11. Enter the result here and in Part V, line 1a
36
Form 1040-SS (2011)

Version A, Cycle 1

Form 1040-SS (2011)

Page

3

Section C—Farm Income—Accrual Method
Do not include sales of livestock held for draft, breeding, sport, or dairy purposes on any of the lines below (see page instruction).
37
38a
39
40
41
42
43
44
45
46
47
48
49
50

Sales of livestock, produce, grains, and other products during the year. . . . . . . . . .
Total cooperative distributions (Form(s) 1099-PATR) 38a
38b Taxable amount
Agricultural program payments received . . . . . . . . . . . . . . . . . . . .
Commodity Credit Corporation (CCC) loans reported under election (or forfeited) . . . . . .
Crop insurance proceeds . . . . . . . . . . . . . . . . . . . . . . . . .
Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . .
Other farm income (specify)
Add the amounts in the right column for lines 37 through 43 . . . . . . . . . . . . .
Inventory of livestock, produce, grains, and other products at the
beginning of the year . . . . . . . . . . . . . . . . .
45
Cost of livestock, produce, grains, and other products purchased during the year
46
Add lines 45 and 46 . . . . . . . . . . . . . . . . .
47
Inventory of livestock, produce, grains, and other products at the end of the year 48
Cost of livestock, produce, grains, and other products sold. Subtract line 48 from line 47* . . .
Gross farm income. Subtract line 49 from line 44. Enter the result here and in Part III, line 11 a

s

37
38b
39
40
41
42
43
44

49
50

*If you use the unit-livestock-price method or the farm-price method of valuing inventory and the amount on line 48 is larger than the amount on
line 47, subtract line 47 from line 48. Enter the result on line 49. Add lines 44 and 49. Enter the total on line 50 and in Part III, line 11.

Part IV Profit or Loss From Business (Sole Proprietorship)—See the instructions for Schedule C (Form 1040).
Name of proprietor

Social security number

Note. If you are filing a joint return and both you and your spouse had a profit or loss from a business, see Joint returns and
Husband-Wife Business in the instructions for more information.
Section A—Income
1
Gross receipts $
Less returns and allowances $
Balance a
1
2a Inventory at beginning of year . . . . . . . . . . . . . .
2a
b Purchases less cost of items withdrawn for personal use . . . . .
2b
c Cost of labor. Do not include any amounts paid to yourself. . . . .
2c
d Materials and supplies. . . . . . . . . . . . . . . . .
2d
e Other costs (attach statement) . . . . . . . . . . . . . .
2e
f Add lines 2a through 2e . . . . . . . . . . . . . . . .
2f
g Inventory at end of year . . . . . . . . . . . . . . . .
2g
h Cost of goods sold. Subtract line 2g from line 2f . . . . . . . . . . . . . . . . .
2h
3
Gross profit. Subtract line 2h from line 1 . . . . . . . . . . . . . . . . . . .
3
4
Other income. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5
Gross income. Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . a
5
Section B—Expenses
6
Advertising . . . . . .
6
18
Rent or lease:
a Vehicles, machinery, and
7
Car and truck expenses
equipment . . . . . . . 18a
7
(see instructions) . . . .
8
Commissions and fees . .
8
b Other business property . . 18b
Repairs and maintenance . .
9
Contract labor . . . . .
9
19
19
10
Depletion . . . . . . .
10
Supplies (not included in Section A) 20
20
Taxes and licenses . . . .
21
21
Depreciation and section 179
11
expense deduction (not
22
Travel, meals, and entertainment:
included in Section A). (Attach
a Travel . . . . . . . . 22a
Form 4562 if required.) . .
11
b Deductible meals and entertainment 22b
23
Utilities . . . . . . . .
23
12
Employee benefit programs
(other than on line 17) . . .
24
Wages not included on line 2c
24
12
13
Insurance (other than health)
13
25a Other expenses (list type and amount):
14
Interest on business
indebtedness. . . . . .
14
15
Legal and professional services 15
16
Office expense . . . . .
16
17
Pension and profit-sharing plans 17
25b Total other expenses . . . 25b
26
Total expenses. Add lines 6 through 25b . . . . . . . . . . . . . . . . . . a
26
27
Net profit or (loss). Subtract line 26 from line 5. Enter the result here and in Part V, line 2 . . .
27

DRAFT AS OF
April 27, 2011

Form 1040-SS (2011)

Version A, Cycle 1

Form 1040-SS (2011)

Part V

Page

4

Self-Employment Tax—If you had church employee income, see instructions before you begin.

Name of person with self-employment income

Social security number of person
with self-employment income a

Note. If you are filing a joint return and both you and your spouse had self-employment income, you must each complete a
separate Part V.
If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had
A
a
$400 or more of other net earnings from self-employment, check here and continue with Part V . . . . . . .
1a Net farm profit or (loss) from Part III, line 36, and your distributive share from farm partnerships.
Note. Skip lines 1a and 1b if you use the farm optional method (see instructions) . . . . . .
1a
b If you received social security retirement or disability benefits, enter the amount of Conservation
Reserve Program payments included in Part III, line 6, plus your distributive share of these
payments from farm partnerships . . . . . . . . . . . . . . . . . . . . . .

1b (

)

2

Net nonfarm profit or (loss) from Part IV, line 27, and your distributive share from nonfarm
partnerships. Ministers and members of religious orders, see instructions for amounts to report on
this line. See instructions for other income to report. Note. Skip this line if you use the nonfarm
optional method (see instructions) . . . . . . . . . . . . . . . . . . . . . .
3
Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . .
4a If line 3 is more than zero, multiply line 3 by 92.35% (.9235). Otherwise, enter the amount from
line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Note. If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see
instructions.
b If you elect one or both of the optional methods, enter the total of lines 2 and 4 of Part VI here . .
c Combine lines 4a and 4b. If less than $400, stop; you do not owe self-employment tax.
Exception. If less than $400 and you had church employee income, enter -0- and continue . a
5a

Enter your church employee income from Form(s) W-2, W-2AS,
W-2CM, W-2GU, W-2VI, or 499R-2/W-2PR. See instructions for
definition of church employee income. . . . . . . . . . . .
b Multiply line 5a by 92.35% (.9235). If less than $100, enter -0- . . .
6
Add lines 4c and 5b . . . . . . . . . . . . . . . . .
7
Maximum amount of combined wages and self-employment earnings
tax for 2011 . . . . . . . . . . . . . . . . . . . .
8a

DRAFT AS OF
April 27, 2011
5a
. . . . . . . . .
. . . . . . . . a
subject to social security
. . . . . . . . .

Total social security wages and tips from Form(s) W-2, W-2AS,
W-2CM, W-2GU, W-2VI, or 499R-2/W-2PR. If $106,800 or more, skip
lines 8b through 10, and go to line 11 . . . . . . . . . . . .
8a
b Unreported tips subject to social security tax from Form 4137, line 10
(see instructions) . . . . . . . . . . . . . . . . . .
8b
c Wages subject to social security tax from Form 8919, line 10 (see
instructions) . . . . . . . . . . . . . . . . . . . .
8c
d Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . .
9
Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11
10
Multiply the smaller of line 6 or line 9 by 10.4% (.104) . . . . . . . . . . . .
11
Multiply line 6 by 2.9% (.029) . . . . . . . . . . . . . . . . . . . .
12
Self-employment tax. Add lines 10 and 11. Enter here and in Part I, line 3 . . . . .

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3
4a

4b
4c

5b
6
7

106,800

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8d
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10
11
12

Part VI Optional Methods To Figure Net Earnings—See instructions for limitations.
Note. If you are filing a joint return and both you and your spouse choose to use an optional method to figure net earnings, you
must each complete and attach a separate Part VI.
Farm Optional Method
1
Maximum income for optional methods . . . . . . . . . . . . . . . . . . . .
1
4,480 00
2

3
4

Enter the smaller of: two-thirds (2/3) of gross farm income (Part III, line 11, plus your distributive
share from farm partnerships), but not less than zero; or $4,480. Also include this amount in Part
V, line 4b, above. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nonfarm Optional Method
Subtract line 2 from line 1. . . . . . . . . . . . . . . . . . . . . . . . .
Enter the smaller of: two-thirds (2/3) of gross nonfarm income (Part IV, line 5, plus your distributive
share from nonfarm partnerships), but not less than zero; or the amount in Part VI, line 3, above.
Also include this amount in Part V, line 4b, above . . . . . . . . . . . . . . . . .

2
3

4
Form 1040-SS (2011)