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1040

Department of the Treasury—Internal Revenue Service

2005

U.S. Individual Income Tax Return

(99)

IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2005, or other tax year beginning

, 2005, ending

, 20

OMB No. 1545-0074

Label

Your first name and initial

Last name

Your social security number

Glenn M.

Johnson

765

4321

(See

instructions

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

Last name

Spouse’s social security number

on page 16.)

Use the IRS

label.

Home address (number and street). If you have a P.O. box, see page 16.

Apt. no.

You must enter

Otherwise,

5603 E. Main Street

your SSN(s) above.

please print

or type.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 16.

Checking a box below will not

Anytown, VA 20000

change your tax or refund.

Presidential

Election Campaign

Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 16)

You

Spouse

Single

Head of household (with qualifying person). (See page 17.) If

Filing Status

the qualifying person is a child but not your dependent, enter

Married filing jointly (even if only one had income)

this child’s name here.

Check only

Married filing separately. Enter spouse’s SSN above

one box.

Qualifying widow(er) with dependent child (see page 17)

and full name here.

Boxes checked

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

on 6a and 6b

Exemptions

Spouse

No. of children

on 6c who:

(3) Dependent’s

(4)

if qualifying

Dependents:

(2) Dependent’s

● lived with you

relationship to

child for child tax

social security number

(1) First name

Last name

● did not live with

you

credit (see page 19)

you due to divorce

or separation

If more than four

(see page 20)

dependents, see

Dependents on 6c

page 19.

not entered above

Add numbers on

d Total number of exemptions claimed

lines above

1,225

Wages, salaries, tips, etc. Attach Form(s) W-2

Income

425

8a Taxable interest. Attach Schedule B if required

b Tax-exempt interest. Do not include on line 8a

Attach Form(s)

W-2 here. Also

9a Ordinary dividends. Attach Schedule B if required

attach Forms

b Qualified dividends (see page 23)

W-2G and

Taxable refunds, credits, or offsets of state and local income taxes (see page 23)

1099-R if tax

was withheld.

Alimony received

(5,000)

Business income or (loss). Attach Schedule C or C-EZ

1,000

Capital gain or (loss). Attach Schedule D if required. If not required, check here

If you did not

Other gains or (losses). Attach Form 4797

get a W-2,

15a

15b

15a

IRA distributions

b Taxable amount (see page 25)

see page 22.

16a

16b

16a

Pensions and annuities

b Taxable amount (see page 25)

Enclose, but do

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

not attach, any

Farm income or (loss). Attach Schedule F

payment. Also,

Unemployment compensation

please use

20a

20b

Form 1040-V.

20a Social security benefits

b Taxable amount (see page 27)

Other income. List type and amount (see page 29)

Add the amounts in the far right column for lines 7 through 21. This is your total income

(2,350)

Educator expenses (see page 29)

Adjusted

Certain business expenses of reservists, performing artists, and

Gross

fee-basis government officials. Attach Form 2106 or 2106-EZ

Income

Health savings account deduction. Attach Form 8889

Moving expenses. Attach Form 3903

One-half of self-employment tax. Attach Schedule SE

Self-employed SEP, SIMPLE, and qualified plans

Self-employed health insurance deduction (see page 30)

Penalty on early withdrawal of savings

31a

Alimony paid

b Recipient’s SSN

IRA deduction (see page 31)

Student loan interest deduction (see page 33)

Tuition and fees deduction (see page 34)

Domestic production activities deduction. Attach Form 8903

Add lines 23 through 31a and 32 through 35

(2,350)

Subtract line 36 from line 22. This is your adjusted gross income

1040

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 78.

Cat. No. 11320B

Form

(2005)

* Net capital gain ($2,000 gain less $1,000 loss)

Page 4

Publication 536 - Net Operating Losses (Nols) For Individuals, Estates, And Trusts - 2005 Page 4

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