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1040 Form 2012

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1040 Form 2012
1040 Form 2012
Form
1040
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 instructions.
Apt. no.
City, town or post office, state, and ZIP code. If you have a foreign address, 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 Educator expenses . . . . . . . . . . 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 Tuition and fees. Attach Form 8917 . . . . . . . 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 separate instructions.
Cat. No. 11320B
Form 1040 (2012)
1040 Form 2012
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