1040A
Internal Revenue Service
Form 1040A
U.S. Individual Income Tax Return 2012
Department of the Treasury—Internal Revenue Service

[When to Use this Form!]

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 (see instructions)
Exemptions

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

b Spouse

Boxes checked on 6a and 6b

c Dependents:
(1) First name Last name
(2) Dependent’s social security number
(3) Dependent’s relationship to you
(4) ✓if child underage 17 qualifying for child tax credit (see instructions)
If more than six dependents, see instructions.
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

d Total number of exemptions claimed. Add numbers on lines above.

Income
Attach Form(s) W-2 here. Also attach Form(s) 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.

8a Taxable interest. Attach Schedule B if required.
b Tax-exempt interest. Do not include on line 8a.

9a Ordinary dividends. Attach Schedule B if required.
b Qualified dividends (see instructions).

10 Capital gain distributions (see instructions).

11a IRA distributions.
11b Taxable amount (see instructions).

12a Pensions and annuities.
12b Taxable amount (see instructions).

13 Unemployment compensation and Alaska Permanent Fund dividends.

14 a Social security benefits.
b Taxable amount (see instructions).

15 Add lines 7 through 14b (far right column). This is your total income.

Adjusted gross income
16 Educator expenses (see instructions).

17 IRA deduction (see instructions).

18 Student loan interest deduction (see instructions).

19 Tuition and fees. Attach Form 8917.

20 Add lines 16 through 19. These are your total adjustments.

21 Subtract line 20 from line 15. This is your adjusted gross income.

Tax, credits, and payments

22 Enter the amount from line 21 (adjusted gross income).

23a Check if:
You were born before January 2, 1948
Blind
Spouse was born before January 2, 1948
Blind
Total boxes checked ▶
b If you are married filing separately and your spouse itemizes Standard deductions, check here

24 Enter your standard deduction. 24
Deduction for—
• People who check any box on line 23a or 23b 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

25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-.

26 Exemptions. Multiply $3,800 by the number on line 6d.

27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is your taxable income.

28 Tax, including any alternative minimum tax (see instructions).

29 Credit for child and dependent care expenses. Attach Form 2441.

30 Credit for the elderly or the disabled. Attach Schedule R.

31 Education credits from Form 8863, line 19.

32 Retirement savings contributions credit. Attach Form 8880.

33 Child tax credit. Attach Schedule 8812, if required.

34 Add lines 29 through 33. These are your total credits.

35 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. This is your total tax.

36 Federal income tax withheld from Forms W-2 and 1099.

37 2012 estimated tax payments and amount applied from 2011 return.

38a Earned income credit (EIC).
If you have a qualifying child, attach Schedule EIC.
b Nontaxable combat pay election.

39 Additional child tax credit. Attach Schedule 8812.

40 American opportunity credit from Form 8863, line 8.

41 Add lines 36, 37, 38a, 39, and 40. These are your total payments.

Refund

Direct deposit? See instructions and fill in 43b, 43c, and 43d or Form 8888.

42 If line 41 is more than line 35, subtract line 35 from line 41. This is the amount you overpaid.

43a Amount of line 42 you want refunded to you. If Form 8888 is attached, check here
b Routing number
c Type: Checking
Savings
d Account number

44 Amount of line 42 you want applied to your 2013 estimated tax.

Amount you owe

45 Amount you owe. Subtract line 41 from line 35. For details on how to pay, see instructions.

46 Estimated tax penalty (see instructions).

Third party designee

Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete the following. No

Designee’s name
Phone no.
Personal identification number (PIN)
Sign here

Joint return? See instructions.

Keep a copy for your records.

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 accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.

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.
Write the lyrics for a misc song made in 2013, titled "1040A", by artist "Internal Revenue Service".