Form
1040
Department of the Treasury—Internal Revenue Service
(99)
IRS Use Only—Do not write or staple in this space.
U.S. Individual Income Tax Return
20
10
Name,
Address,
and SSN
See separate
instructions.
P
R
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For the year Jan. 1–Dec. 31, 2010, or other tax year beginning
, 2010, ending
, 20
OMB No. 1545-0074
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
Home address (number and street). If you have a P.O. box, see instructions.
Apt. no.
â–²
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, see instructions.
Checking a box below will not
change your tax or refund.
Presidential
Election Campaign
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Check here if you, or your spouse if filing jointly, want $3 to go to this fund .
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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.
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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.
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5
Qualifying widow(er) with dependent child
Exemptions
If more than four
dependents, see
instructions and
check here
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6a
Yourself.
If someone can claim you as a dependent,
do not
check box 6a .
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b
Spouse
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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 under age 17
qualifying for child tax credit
(see page 15)
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 .
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Add numbers on
lines above
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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 page 20.
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.
7
Wages, salaries, tips, etc. Attach Form(s) W-2
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7
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
9 a
Ordinary dividends. Attach Schedule B if required .
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9a
b
Qualified dividends .
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9b
10
Taxable refunds, credits, or offsets of state and local income taxes .
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11
Alimony received .
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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
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14
Other gains or (losses). Attach Form 4797 .
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14
15 a
IRA distributions .
15a
b
Taxable amount
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15b
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
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18
Farm income or (loss). Attach Schedule F .
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19
Unemployment compensation .
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20 a
Social security benefits
20a
b
Taxable amount
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20b
21
Other income. List type and amount
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22
Combine the amounts in the far right column for lines 7 through 21. This is your
total income
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22
Adjusted
Gross
Income
23
Educator expenses
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24
Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
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25
Health savings account deduction. Attach Form 8889 .
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26
Moving expenses. Attach Form 3903 .
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27
One-half of self-employment tax. Attach Schedule SE .
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28
Self-employed SEP, SIMPLE, and qualified plans
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29
Self-employed health insurance deduction
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30
Penalty on early withdrawal of savings .
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31 a
Alimony paid
b
Recipient’s SSN
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31a
32
IRA deduction .
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33
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
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36
Add lines 23 through 31a and 32 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
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 11320B
Form
1040
(2010)
Form 1040 (2010)
Page
2
Tax and
Credits
38
Amount from line 37 (adjusted gross income)
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38
39a
Check
if:
{
You
were born before January 2, 1946,
Blind.
Spouse
was born before January 2, 1946,
Blind.
}
Total boxes
checked
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39a
b
If your spouse itemizes on a separate return or you were a dual-status alien, check here
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39b
40
Itemized deductions
(from Schedule A)
or
your
standard deduction
(see instructions) .
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40
41
Subtract line 40 from line 38
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42
Exemptions.
Multiply $3,650 by the number on line 6d .
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42
43
Taxable income.
Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- .
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44
Tax
(see instructions). Check if any tax is from:
a
Form(s) 8814
b
Form 4972 .
44
45
Alternative minimum tax
(see instructions). Attach Form 6251 .
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45
46
Add lines 44 and 45 .
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46
47
Foreign tax credit. Attach Form 1116 if required .
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47
48
Credit for child and dependent care expenses. Attach Form 2441
48
49
Education credits from Form 8863, line 23 .
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50
Retirement savings contributions credit. Attach Form 8880
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51
Child tax credit (see instructions) .
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51
52
Residential energy credits. Attach Form 5695
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53
Other credits from Form:
a
3800
b
8801
c
53
54
Add lines 47 through 53. These are your
total credits
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54
55
Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-
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55
Other
Taxes
56
Self-employment tax. Attach Schedule SE .
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57
Unreported social security and Medicare tax from Form:
a
4137
b
8919 .
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58
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required
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59
a
Form(s) W-2, box 9
b
Schedule H
c
Form 5405, line 16
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60
Add lines 55 through 59. This is your
total tax
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60
Payments
61
Federal income tax withheld from Forms W-2 and 1099
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62
2010 estimated tax payments and amount applied from 2009 return
62
63
Making work pay credit. Attach Schedule M .
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63
If you have a
qualifying
child, attach
Schedule EIC.
64a
Earned income credit (EIC)
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64a
b
Nontaxable combat pay election
64b
65
Additional child tax credit. Attach Form 8812 .
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66
American opportunity credit from Form 8863, line 14 .
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First-time homebuyer credit from Form 5405, line 10 .
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68
Amount paid with request for extension to file
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69
Excess social security and tier 1 RRTA tax withheld
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70
Credit for federal tax on fuels. Attach Form 4136 .
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70
71
Credits from Form:
a
2439
b
8839
c
8801
d
8885
71
72
Add lines 61, 62, 63, 64a, and 65 through 71. These are your
total payments
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72
73
If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you
overpaid
73
Refund
74a
Amount of line 73 you want
refunded to you.
If Form 8888 is attached, check here .
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74a
Direct deposit?
See
instructions.
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b
Routing number
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c
Type:
Checking
Savings
d
Account number
75
Amount of line 73 you want
applied to your 2011 estimated tax
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75
Amount
You Owe
76
Amount you owe.
Subtract line 72 from line 60. For details on how to pay, see instructions
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76
77
Estimated tax penalty (see instructions) .
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77
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes.
Complete below.
No
Designee’s
name
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Phone
no.
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Personal identification
number (PIN)
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Sign
Here
Joint return?
See page 12.
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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature
Date
Your occupation
Daytime phone number
Spouse’s signature. If a joint return,
both
must sign.
â–²
Date
Spouse’s occupation
Paid
Preparer
Use Only
Print/Type preparer’s name
Preparer’s signature
Date
Check if
self-employed
PTIN
Firm’s name
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Firm's EIN
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Firm’s address
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Phone no.
Form
1040
(2010)