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IRS 1040 Tax Form

In order to state the personal annual income for the IRS, the following form has to be completed and submitted.

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Form1040 	Department of the Treasury—Internal Revenue Service 	
OMB No. 1545-0074
(99)	IRS Use Only—Do not write or staple in this space. 	U.S. Individual Income Tax Return 	2012	
For the year Jan. 1–Dec. 31, 2012, or other tax year beginning 	, 2012, ending 	, 20 	See separate instructions.	
Your first name and initial 	Last name 	Your social security number 	
If a joint return, spouse’s first name and initial 	Last name 	Spouse’s social security number 
▲	Make sure the SSN(s) above 
and on line 6c are correct.	Home address (number and street). If you have a P.O. box, see instruct\
ions. 	Apt. no. 	
City, town or post office, state, and ZIP code. If you have a foreign ad\
dress, also complete spaces below (see instructions). 
Foreign country name                                        	Foreign province/state/county                        	Foreign postal code   	
Presidential Election Campaign
Check here if you, or your spouse if filing 
jointly, want $3 to go to this fund. Checking 
a box below will not change your tax or 
refund. 	
You 	Spouse	
Filing Status 
Check only one 
box.  1 	
Single 
2 
Married filing jointly (even if only one had income) 
3 
Married filing separately. Enter spouse’s SSN above 
and full name here. 	▶	
4 	Head of household (with qualifying person). (See instructions.) If 
the qualifying person is a child but not your dependent, enter this 
child’s name here.  	
▶	
5 	Qualifying widow(er) with dependent child 	
Exemptions 	6a	Yourself. If someone can claim you as a dependent, do not check box 6a  .....
b 
Spouse   ........................	}	
c	Dependents:  	
(1)  First name                         Last name 	
(2) Dependent’s 
social security number 	(3) Dependent’s  
relationship to  you 	(4)  ✓ if child under age 17 
qualifying for child tax credit   (see instructions) 	
If more than four  
dependents, see  
instructions and 
check here  	
▶	
d Total number of exemptions claimed  .................	
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)
Dependents on 6c 
not entered above 
Add numbers on  
lines above  	▶	
Income 
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 instructions. 
Enclose, but do  
not attach, any  
payment. Also,  
please use   
Form 1040-V.  7 
Wages, salaries, tips, etc. Attach Form(s) W-2  ............	
7 	
8a Taxable interest. Attach Schedule B if required  ............	8a 	
b  Tax-exempt interest. Do not include on line 8a  ...	8b 	
9 a Ordinary dividends. Attach Schedule B if required  ...........	9a 	
b  Qualified dividends  ...........	9b 	
10  Taxable refunds, credits, or offsets of state and local income taxes  ......	10 	
11  Alimony received  .....................	11 	
12  Business income or (loss). Attach Schedule C or C-EZ  ..........	12 	
13  Capital gain or (loss). Attach Schedule D if required. If not required\
, check here  	▶	13 	
14 Other gains or (losses). Attach Form 4797  ..............	14 	
15 a IRA distributions  .	15a 	b  Taxable amount  ...	15b 	
16 a	Pensions and annuities 	16a 	b  Taxable amount  ...	16b 	
17  Rental real estate, royalties, partnerships, S corporations, trusts, etc\
. Attach Schedule E 	17 	
18 Farm income or (loss). Attach Schedule F  ..............	18 	
19  Unemployment compensation .................	19 	
20 a	Social security benefits 	20a 	b  Taxable amount  ...	20b 	
21  Other income. List type and amount 	21 	
22 	Combine the amounts in the far right column for lines 7 through 21. This\
 is your  total income  	▶	22 	
Adjusted  
Gross  
Income 	23 Reserved .............	23 	
24 	Certain  business  expenses  of reservists,  performing  artists, and 
fee-basis government officials. Attach Form 2106 or 2106-EZ 	
24 	
25  Health savings account deduction. Attach Form 8889  .	25 	
26 Moving expenses. Attach Form 3903  ......	26 	
27 	Deductible part of self-employment tax. Attach Schedule SE  .	27 	
28 Self-employed SEP, SIMPLE, and qualified plans  ..	28 	
29  Self-employed health insurance deduction  ....	29 	
30  Penalty on early withdrawal of savings  ......	30 	
31 a	Alimony paid 	b  Recipient’s SSN 	 ▶	31a 	
32  IRA deduction  .............	32 	
33  Student loan interest deduction  ........	33 	
34  Reserved ..............	34 	
35 	Domestic production activities deduction. Attach Form 8903 	35 	
36  Add lines 23 through 35  ...................	36 	
37  Subtract line 36 from line 22. This is your adjusted gross income   .....  	▶	37 	
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see sep\
arate instructions.	Cat. No. 11320B 	Form  	1040 	 (2012)

Form 1040 (2012) 	Page 	2 
Tax and  
Credits	
 	
38  Amount from line 37 (adjusted gross income)  ..............	38 	
39a 
Check 
if: 	{	You were born before January 2, 1948, 	Blind.	
Spouse was born before January 2, 1948, 	Blind.	}Total boxes  
checked	
  ▶	39a 	
b 	If your spouse itemizes on a separate return or you were a dual-status a\
lien,  check here	 ▶	39b 	Standard  
Deduction  
for— 
• People who  
check any  
box on line  
39a or 39b or 
who  can be 
claimed as a  
dependent,  
see 
instructions. 
• All others: 
Single or  
Married filing  
separately,  
$5,950 
Married filing  
jointly or  
Qualifying  
widow(er),  
$11,900  
Head of  
household,  
$8,700 	
40 Itemized deductions (from Schedule A) or your standard deduction (see left margin)  ..	40	
41  Subtract line 40 from line 38  ...................	41 	
42  Exemptions. Multiply $3,800 by the number on line 6d ............	42 	
43  Taxable income.  Subtract line 42 from line 41. If line 42 is more than line 41, enter -0\
-  ..	43 	
44 	Tax  (see instructions). Check if any from: 	a 	Form(s) 8814  b 	Form 4972c	962 election	44 	
45 Alternative minimum tax  (see instructions). Attach Form 6251  .........	45 	
46  Add lines 44 and 45  .....................  	▶	46 	
47  Foreign tax credit. Attach Form 1116 if required  ....	47 	
48 	Credit for child and dependent care expenses. Attach Form 2441 	48 	
49  Education credits from Form 8863, line 19  .....	49 	
50 	Retirement savings contributions credit. Attach Form 8880	50 	
51 	Child tax credit. Attach Schedule 8812, if required	...	51 	
52  Residential energy credit. Attach Form 5695 .....	52 	
53 	Other credits from Form: 	a 	3800 
b 	8801  c 	53	
54 Add lines 47 through 53. These are your total credits  ............	54	
55  Subtract line 54 from line 46. If line 54 is more than line 46, enter -0\
-  ......  	▶	55	
Other  
Taxes 	56  Self-employment tax. Attach Schedule SE  ...............	56 	
57  Unreported social security and Medicare tax from Form:  a 	4137 b 	8919 ..	57 	
58 	Additional tax on IRAs, other qualified retirement plans, etc. Attach Fo\
rm 5329 if required  ..	58	
59a 	59a	
b 	59b	
Household employment taxes from Schedule H  ..............
First-time homebuyer credit repayment. Attach Form 5405 if required ........	
60 	Other taxes. Enter code(s) from instructions 	60	
61 Add lines 55 through 60. This is your total tax  .............   	▶	61	
Payments 	62 Federal income tax withheld from Forms W-2 and 1099  ..	62	
63	2012 estimated tax payments and amount applied from 2011 return 	63	If you have a  
qualifying  
child, attach  
Schedule EIC. 	64a Earned income credit (EIC)  ..........	64a 	
b 	Nontaxable combat pay election 	64b 	
65	Additional child tax credit. Attach Schedule 8812  ....  .	65	
66 American opportunity credit from Form 8863, line 8  ....	66	
67	Reserved  ................	67	
68 Amount paid with request for extension to file
.....	68	
69	Excess social security and tier 1 RRTA tax withheld	 . ...	69	
70	Credit for federal tax on fuels. Attach Form 4136 ....	70	
71	Credits from Form: 	a 	2439  b 	Reserved	c 	8801 d 	8885	71	
72 Add lines 62, 63, 64a,  and 65 through 71. These are your total payments  .....   	▶	72	
Refund 
Direct deposit?  
See 
instructions. 	
73	If line 72 is more than line 61, subtract line 61 from line 72. This is \
the amount you  overpaid 	73	
74aAmount of line 73 you want refunded to you. If Form 8888 is attached, check here  . 	▶	74a 	▶ 
▶	b  Routing number 	▶
 c Type: 	Checking	 	Savings	
d  Account number
75	Amount of line 73 you want applied to your 2013 estimated tax	 ▶	75	
Amount  
You Owe 	76 Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructi\
ons     	▶	76	
77Estimated tax penalty (see instructions)  .......	77	
Third Party  
Designee 	Do you want to allow another person to discuss this return with the IRS \
(see instructions)?	Yes. Complete below. 	No	
Designee’s  
name  	▶	Phone  
no.  	▶	Personal identification 
number (PIN)               	▶	
Sign  
Here 
Joint r eturn?  See 
instructions.  
Keep a copy  for 
your  r ecords. 	
Under penalties of perjury, I declare that I have examined this return a\
nd accompanying schedules and statements, and to the best of my knowledg\
e and belief, 
they are true, correct, and complete. Declaration of preparer (other th\
an taxpayer) is based on all information of which preparer has any know\
ledge.
Your signature 	Date 	Your occupation 	Daytime phone number	
Spouse’s signature. If a joint return, both must sign. 
▲	
Date 	Spouse’s occupation	If the IRS sent you an Identity Protection 
PIN, enter it  
here (see inst.)	
Paid  
Preparer  
Use Only 	Print/Type preparer’s name 	Preparer’s signature 	Date 	Check         if  
self-employed	 PTIN	
Firm’s name     	▶	
Firm’s address 	▶	
Firm's EIN  	▶	
Phone no. 	
Form 	1040 	(2012)
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