Form 1040 - U.s. Individual Income Tax Return - 2012
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1
21040
2012
(99)
Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
See separate instructions.
For the year Jan. 1–Dec. 31, 2012, or other tax year beginning
, 2012, ending
, 20
Your social security number
Your first name and initial
Last name
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions.
Apt. no.
Make sure the SSN(s) above
▲
and on line 6c are correct.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Presidential Election Campaign
Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign country name
Foreign province/state/county
Foreign postal code
a box below will not change your tax or
refund.
You
Spouse
1
Single
4
Head of household (with qualifying person). (See instructions.) If
Filing Status
2
Married filing jointly (even if only one had income)
the qualifying person is a child but not your dependent, enter this
Check only one
child’s name here.
3
Married filing separately. Enter spouse’s SSN above
▶
box.
and full name here.
5
Qualifying widow(er) with dependent child
▶
}
Boxes checked
6a
Yourself. If someone can claim you as a dependent, do not check box 6a .
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Exemptions
on 6a and 6b
b
Spouse
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No. of children
(4) ✓ if child under age 17
on 6c who:
Dependents:
c
(2) Dependent’s
(3) Dependent’s
• lived with you
qualifying for child tax credit
social security number
relationship to you
(1) First name
Last name
(see instructions)
• did not live with
you due to divorce
or separation
If more than four
(see instructions)
dependents, see
Dependents on 6c
instructions and
not entered above
check here
▶
Add numbers on
d
Total number of exemptions claimed
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lines above
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7
Wages, salaries, tips, etc. Attach Form(s) W-2
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7
Income
8a
Taxable interest. Attach Schedule B if required .
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8a
b
Tax-exempt interest. Do not include on line 8a .
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8b
Attach Form(s)
9 a
Ordinary dividends. Attach Schedule B if required
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9a
W-2 here. Also
b
Qualified dividends
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9b
attach Forms
W-2G and
10
Taxable refunds, credits, or offsets of state and local income taxes
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10
1099-R if tax
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Alimony received .
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was withheld.
12
Business income or (loss). Attach Schedule C or C-EZ .
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13
Capital gain or (loss). Attach Schedule D if required. If not required, check here
13
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If you did not
14
Other gains or (losses). Attach Form 4797 .
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14
get a W-2,
15 a
IRA distributions .
15a
b Taxable amount
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15b
see instructions.
16 a
Pensions and annuities
16a
b Taxable amount
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16b
17
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
17
Enclose, but do
18
Farm income or (loss). Attach Schedule F .
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not attach, any
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Unemployment compensation .
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19
payment. Also,
20 a
Social security benefits
20a
b Taxable amount
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20b
please use
Form 1040-V.
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
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23
Educator expenses
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23
Adjusted
24
Certain business expenses of reservists, performing artists, and
Gross
fee-basis government officials. Attach Form 2106 or 2106-EZ
24
Income
25
Health savings account deduction. Attach Form 8889
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26
Moving expenses. Attach Form 3903 .
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Deductible part of self-employment tax. Attach Schedule SE .
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28
Self-employed SEP, SIMPLE, and qualified plans
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Self-employed health insurance deduction
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Penalty on early withdrawal of savings .
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31 a
Alimony paid
b Recipient’s SSN
31a
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32
IRA deduction .
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32
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Student loan interest deduction .
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34
Tuition and fees. Attach Form 8917 .
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35
Domestic production activities deduction. Attach Form 8903
35
36
Add lines 23 through 35 .
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36
37
Subtract line 36 from line 22. This is your adjusted gross income
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37
▶
1040
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Form
(2012)
Cat. No. 11320B
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