DS9 Document EFTA01222537

1 040 Department of the Treasury—Internal Rriseue Servne U.S. Individual Income Tax Return OMB No. 1545-0074 IRS Use Only—Do not mite ce staple in the space. For the year Jan. I-Dec.31.2017. or other tax year beginning 2017. ending .20 Vow first name and initial Last rare If a mint return. spouse first name and initial Last name See separate instructions. Your social security number Spouse's social security number Home address (number and street). 1( you have a P.O. box. see instructions. Apt. no. A Make size the SSN(s) above a and on line 6c are correct. City, town or post office. slate. and ZIP code. If you have a foreign address. also complete spaces below (see instructions). Foreign country name Foreign province/state/county Presidential Election Campaign check here if you. or your spouse 4 ding per. yaw $3 to go to ens lund Checkkg Foreign postal code a habelowall net dame yam tax or refund. O You O SPciese Filing Status Check only one box. 1 O Single 2 O Married filing jointly (even if only one had income) 3 rl Married filing separately. Enter spouse's SSN above and full name here. li. Ba O Yourself. If someone can claim you as a dependent do not check box 6a 4 O Head of househdd (wall qualifying person). (See instructions.) If the quabfying person is a child but not your dependent. enter this clam's name here. PO 5 O Qualifying widow(er) (see instructions) Exemptions If more than four dependents. see instructions and check here lil• O b O Spouse c Dependents: (1) First name last (2) Dependent's somal security reinter (3) Dependents relationship to ycu (4) ./ if child under age 17 qualnying for ctdd lax mein (see instructions) O O O O Boxes checked on 6a and 6b No. of children on 6c who: • lived with you • did not live with you due to divorce Of separation (see Instructions) Dependents on 6c not entered above Add numbers on d Total number of exemptions claimed lines above IP El 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. 7 Wages, salaries, tips. etc. Attach Form(s) W-2 8a Taxable interest. Attach Schedule B if required 18b b Tax-exempt interest. Do not include on line 8a . . 9a Ordinary dividends. Attach Schedule B if required b Qualified dividends I ob I 10 Taxable refunds, credits, or offsets of state and local income taxes 11 Alimony received 12 Business income or Doss). Attach Schedule C or C•EZ 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ► O 14 Other gains or (losses). Attach Form 4797 15a IRA distributions . 15a l I b Taxable amount . . 16a Pensions and annuities lea b Taxable amount . . 17 Rental real estate. royalties, partnerships. S corporations, trusts. etc. Attach Schedule E 18 Fann income or (loss). Attach Schedule F 19 Unemployment compensation 20a Social security benefits 120a I I b Taxable amount . . 21 Other income. List type and amount 22 Combine the amounts in the far right column for laws 7 through 21. This Is your total ktcome ► 23 Educator expenses 23 24 Certain business expenses of reservists. performing artists, and feebasis government officials. Attach Form 2106 or 2106-EZ 25 Health savings account deduction. Attach Form 8889 26 Moving expenses. Attach Form 3903 27 Deductible part of self-employment tax. Attach Schedule SE 28 Self-employed SEP, SIMPLE, and qualified plans 29 Self-employed health insurance deduction . 30 Penalty on early withdrawal of savings 31a Alimony paid b Recipient's SSN ► 32 IRA deduction 33 Student loan interest deduction 34 Tuition and fees. Attach Form 8917 35 Domestic production actwities deduction. Attach Form 8903 36 Add lines 23 through 35 Adjusted Gross Income 24 25 26 27 28 29 30 31a 32 33 34 35 7 8a 9a 10 11 12 13 14 15b 18b 17 18 19 20b 21 22 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. Form 1040 (2017) EFTA01222537 Form 1040 (2017) Page 2 Tax and Credits 38 Amount from line 37 (adjusted gross Income) { O Blind. } Total boxes 39a Check O You were born before January 2. 1953, if: O Spouse was born before January 2, 1953. O Blind. checked IIP, 39a b If your spouse itemizes on a separate return or you were a dual-status alien, check here lo 39bD 38 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 separatety. 56.350 Married filing jointly or Qualifying widow(er). $12.700 Head of household. 59.350 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . 41 Subtract line 40 from line 38 42 Exemptions. If line 38 is 5156.900 or less. multply$4.050 by the number on line 6d. Monroe. see instructions 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . 44 Tax (see instructions). Check if any from: a K Form(s) 8814 b El Form 4972 e K 45 Alternative minimum tax (see instructions). Attach Form 6251 46 Excess advance premium tax credit repayment. Attach Form 8962 47 Add lines 44. 45. and 46 le• 47 48 Foreign tax credit. Attach Fowl 1116 if required . . . . 48 49 Credit for child and dependent care expenses. Attach Form 2441 50 Education credits from Form 8863. line 19 51 Retirement savings contributions credit. Attach Form 8880 52 Child tax credit. Attach Schedule 8812, if required. . . 53 Residential energy credits. Attach Form 5695 . . . . 54 Other credits from Form: a K 3800 b O 8801 e O 54 55 Add lines 48 through 54. These are your total credits 40 41 42 43 44 45 48 49 50 51 52 53 55 58 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- lo se 57 Self-employment tax. Attach Schedule SE 58 Unreported social security and Medicare tax from Form: a K 4137 b O 8919 59 Additional tax on IRAs, other qualified retirement plans. etc. Attach Form 5329 it required 60a Household employment taxes from Schedule H b First-time homebuyer credit repayment. Attach Form 5405 if required 61 Health care: individual responsibility (see instructions) Full-year coverage O 82 Taxes from: a O RCM 8959 b K Rag 8960 c O Instructions; enter code(s) 83 Add lines 56 through 62. This is your total tax ► Other Taxes Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . ,L6j. 2017 estimated tax payments and amount applied from 2016 return If you have a 66a Earned Income credit (EIC) qualifying child, attach b Nontaxable combat pay election 188b Schedule EIC. 67 Additional child tax credit. Attach Schedule 8812 68 American opportunity credit from Form 8863, line 8 69 Net premium tax credit. Attach Form 8962 70 Amount paid with request for extension to file 71 Excess social security and tier 1 RRTA tax withheld 72 Credit for federal tax on fuels. Attach Fowl 4136 73 Credts from Feint a 02439 b Rimed c O 8885 dID 64 65 68 89 70 71 72 73 67 68 59 60a 60b 81 82 83 74 Add lines 64. 65. 66a, and 67 through 73. These are your total payments O. 74 Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . IP O Direct deposit? Il. D Routing number lli.c Type: O Checking O Savings See Is. d Account number I 1 1 1 1 1 1 instructions. 77 Amount of line 75 you want applied to your 2018 estimated tax BPI 77 I Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions lo You Owe 79 Estimated tax penalty (see instructions) Third Party Designee Sign Here Jont return? See insuecoons. Keep a copy for your records. 79 I 75 78a 78 Do you want to allow another person to discuss this return with the IRS (see instructions)? O Yes Complete below. K No Designee's Phone Personal iden ideation name ► no. ► number (PIN) . I Urslei ornate of palmy. I &Ogre that I have exainked the return end ft COMpanying schedules and statements. and ID IS best of My knowledge and tenet they are bit. MYNA. and accurately let al arnasill and SOurCee a Wane I received dating Melee year. DeCkfranOn Of prepare, lother than taMayed is bated on al infOMM5Crl et wroth paperer hat any knowledge. Vow signature Date Vow occupation Daytime phone number Spouse's signature. If a joint return. both must sign Date Spouse's occupation If the IRS sera you an Identity Protection PIN. enter it j here (see inst)i Check O if self-employed Paid Preparer Use Only Pnnt/Type preparer's name Preparer's signature Date PTIN Firm's name ► Firm's 9N ► Firm's address ► Phone no. Go to itninviragov/Fom7/040 for instructions and the latest information. Form 1040 poln EFTA01222538