00000000: 00 06 20 20 20 20 20 20 20 20 20 20 20 20 20 20 |.. |
00000010: 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 | |
00000020: 20 0D 0A 73 54 45 50 20 34 20 20 69 6E 63 6F 6D | ..sTEP 4 incom|
00000030: 65 0D 0A 0D 0A 20 36 2E 20 20 77 41 47 45 53 20 |e.... 6. wAGES |
00000040: 53 41 4C 41 52 49 45 53 20 54 49 50 53 20 45 54 |SALARIES TIPS ET|
00000050: 43 2E 20 0D 0A 20 37 41 2E 20 74 41 58 41 42 4C |C. .. 7A. tAXABL|
00000060: 45 20 49 4E 54 45 52 45 53 54 20 49 4E 43 20 28 |E INTEREST INC (|
00000070: 66 35 29 0D 0A 20 20 42 2E 20 74 41 58 2D 45 58 |f5).. B. tAX-EX|
00000080: 45 4D 50 54 20 49 4E 54 45 52 45 53 54 0D 0A 20 |EMPT INTEREST.. |
00000090: 38 2E 20 20 64 49 56 49 44 45 4E 44 53 20 28 66 |8. dIVIDENDS (f|
000000A0: 35 29 0D 0A 20 39 2E 20 20 75 4E 45 4D 50 4C 4F |5).. 9. uNEMPLO|
000000B0: 59 4D 45 4E 54 20 43 4F 4D 50 45 4E 53 41 54 49 |YMENT COMPENSATI|
000000C0: 4F 4E 0D 0A 20 20 20 20 20 46 52 4F 4D 20 66 4F |ON.. FROM fO|
000000D0: 52 4D 20 31 30 39 39 2D 67 0D 0A 31 30 2E 20 20 |RM 1099-g..10. |
000000E0: 74 4F 54 41 4C 20 49 4E 43 4F 4D 45 0D 0A 0D 0A |tOTAL INCOME....|
000000F0: 73 54 45 50 20 35 20 20 61 64 6A 75 73 74 65 64 |sTEP 5 adjusted|
00000100: 20 67 72 6F 73 73 20 69 6E 63 6F 6D 65 0D 0A 0D | gross income...|
00000110: 0A 31 31 41 2E 20 79 4F 55 52 20 69 72 61 20 44 |.11A. yOUR ira D|
00000120: 45 44 55 43 54 49 4F 4E 0D 0A 20 20 20 20 20 73 |EDUCTION.. s|
00000130: 45 45 20 50 41 47 45 20 31 38 0D 0A 20 20 42 2E |EE PAGE 18.. B.|
00000140: 20 73 50 4F 55 53 45 27 53 20 69 72 61 20 44 45 | sPOUSE'S ira DE|
00000150: 44 55 43 54 49 4F 4E 0D 0A 20 20 20 20 20 73 45 |DUCTION.. sE|
00000160: 45 20 50 41 47 45 20 31 38 0D 0A 20 20 43 2E 20 |E PAGE 18.. C. |
00000170: 74 4F 54 41 4C 20 41 44 4A 55 53 54 4D 45 4E 54 |tOTAL ADJUSTMENT|
00000180: 53 0D 0A 31 32 2E 20 20 61 44 4A 55 53 54 45 44 |S..12. aDJUSTED|
00000190: 20 47 52 4F 53 53 20 49 4E 43 4F 4D 45 0D 0A 0D | GROSS INCOME...|
000001A0: 0A 73 54 45 50 20 36 20 20 74 61 78 61 62 6C 65 |.sTEP 6 taxable|
000001B0: 20 69 6E 63 6F 6D 65 0D 0A 0D 0A 31 33 2E 20 20 | income....13. |
000001C0: 61 44 4A 55 53 54 45 44 20 47 52 4F 53 53 20 49 |aDJUSTED GROSS I|
000001D0: 4E 43 4F 4D 45 0D 0A 31 34 41 2E 20 77 45 52 45 |NCOME..14A. wERE|
000001E0: 20 59 4F 55 20 4F 56 45 52 20 36 35 3F 0D 0A 20 | YOU OVER 65?.. |
000001F0: 20 20 20 20 77 45 52 45 20 59 4F 55 20 42 4C 49 | wERE YOU BLI|
00000200: 4E 44 3F 0D 0A 20 20 20 20 20 77 41 53 20 59 4F |ND?.. wAS YO|
00000210: 55 52 20 53 50 4F 55 53 45 20 4F 56 45 52 20 36 |UR SPOUSE OVER 6|
00000220: 35 3F 0D 0A 20 20 20 20 20 77 41 53 20 59 4F 55 |5?.. wAS YOU|
00000230: 52 20 53 50 4F 55 53 45 20 42 4C 49 4E 44 3F 0D |R SPOUSE BLIND?.|
00000240: 0A 20 20 20 20 20 6E 4F 2E 20 4F 46 20 42 4F 58 |. nO. OF BOX|
00000250: 45 53 20 43 48 45 43 4B 45 44 0D 0A 20 20 42 2E |ES CHECKED.. B.|
00000260: 20 63 41 4E 20 59 4F 55 20 42 45 20 43 4C 41 49 | cAN YOU BE CLAI|
00000270: 4D 45 44 20 41 53 20 41 20 0D 0A 20 20 20 20 20 |MED AS A .. |
00000280: 44 45 50 45 4E 44 45 4E 54 20 4F 4E 20 41 4E 4F |DEPENDENT ON ANO|
00000290: 54 48 45 52 0D 0A 20 20 20 20 20 50 45 52 53 4F |THER.. PERSO|
000002A0: 4E 27 53 20 52 45 54 55 52 4E 3F 20 28 79 65 73 |N'S RETURN? (yes|
000002B0: 2F 6E 6F 29 20 20 0D 0A 20 20 43 2E 20 61 52 45 |/no) .. C. aRE|
000002C0: 20 59 4F 55 20 4D 41 52 52 49 45 44 20 46 49 4C | YOU MARRIED FIL|
000002D0: 49 4E 47 20 0D 0A 20 20 20 20 20 53 45 50 41 52 |ING .. SEPAR|
000002E0: 41 54 45 4C 59 20 57 49 54 48 20 41 20 53 50 4F |ATELY WITH A SPO|
000002F0: 55 53 45 0D 0A 20 20 20 20 20 46 49 4C 49 4E 47 |USE.. FILING|
00000300: 20 31 30 34 30 20 41 4E 44 20 49 54 45 4D 49 5A | 1040 AND ITEMIZ|
00000310: 49 4E 47 20 0D 0A 20 20 20 20 20 44 45 44 55 43 |ING .. DEDUC|
00000320: 54 49 4F 4E 53 3F 20 28 79 65 73 2F 6E 6F 29 20 |TIONS? (yes/no) |
00000330: 0D 0A 20 20 44 2E 20 73 54 41 4E 44 41 52 44 20 |.. D. sTANDARD |
00000340: 44 45 44 55 43 54 49 4F 4E 0D 0A 31 35 2E 20 20 |DEDUCTION..15. |
00000350: 6C 49 4E 45 20 31 34 44 20 46 52 4F 4D 20 31 33 |lINE 14D FROM 13|
00000360: 0D 0A 31 36 2E 20 20 23 20 4F 46 20 45 58 45 4D |..16. # OF EXEM|
00000370: 50 54 49 4F 4E 53 20 58 20 24 31 39 30 30 0D 0A |PTIONS X $1900..|
00000380: 31 37 2E 20 20 74 41 58 41 42 4C 45 20 49 4E 43 |17. tAXABLE INC|
00000390: 4F 4D 45 0D 0A 0D 0A 73 54 45 50 20 37 20 20 74 |OME....sTEP 7 t|
000003A0: 61 78 20 63 72 65 64 69 74 73 20 41 4E 44 20 70 |ax credits AND p|
000003B0: 61 79 6D 65 6E 74 73 0D 0A 0D 0A 20 20 20 20 20 |ayments.... |
000003C0: 61 52 45 20 59 4F 55 20 55 4E 44 45 52 20 31 34 |aRE YOU UNDER 14|
000003D0: 20 41 4E 44 20 48 41 56 45 20 0D 0A 20 20 20 20 | AND HAVE .. |
000003E0: 20 4D 4F 52 45 20 54 48 41 4E 20 24 31 30 30 30 | MORE THAN $1000|
000003F0: 20 4F 46 20 49 4E 56 45 53 54 2D 0D 0A 20 20 20 | OF INVEST-.. |
00000400: 20 20 4D 45 4E 54 20 49 4E 43 4F 4D 45 20 28 79 | MENT INCOME (y|
00000410: 65 73 2F 6E 6F 29 0D 0A 20 20 20 20 20 74 41 58 |es/no).. tAX|
00000420: 20 54 41 42 4C 45 0D 0A 20 20 20 20 20 66 4F 52 | TABLE.. fOR|
00000430: 4D 20 38 36 31 35 20 28 66 35 29 0D 0A 31 38 2E |M 8615 (f5)..18.|
00000440: 20 20 74 41 58 0D 0A 31 39 2E 20 20 63 48 49 4C | tAX..19. cHIL|
00000450: 44 20 26 20 44 45 50 20 43 41 52 45 20 28 66 35 |D & DEP CARE (f5|
00000460: 29 0D 0A 32 30 2E 20 20 74 4F 54 41 4C 20 54 41 |)..20. tOTAL TA|
00000470: 58 0D 0A 32 31 41 2E 20 66 45 44 45 52 41 4C 20 |X..21A. fEDERAL |
00000480: 49 4E 43 20 54 41 58 20 57 49 54 48 48 45 4C 44 |INC TAX WITHHELD|
00000490: 0D 0A 20 20 42 2E 20 65 41 52 4E 45 44 20 49 4E |.. B. eARNED IN|
000004A0: 43 4F 4D 45 20 43 52 45 44 49 54 0D 0A 32 32 2E |COME CREDIT..22.|
000004B0: 20 20 74 4F 54 41 4C 20 50 41 59 4D 45 4E 54 53 | tOTAL PAYMENTS|
000004C0: 0D 0A 0D 0A 73 54 45 50 20 38 20 72 65 66 75 6E |....sTEP 8 refun|
000004D0: 64 20 4F 52 20 61 6D 6F 75 6E 74 20 79 6F 75 20 |d OR amount you |
000004E0: 6F 77 65 0D 0A 0D 0A 32 33 2E 20 72 45 46 55 4E |owe....23. rEFUN|
000004F0: 44 20 41 4D 4F 55 4E 54 0D 0A 32 34 2E 20 61 4D |D AMOUNT..24. aM|
00000500: 4F 55 4E 54 20 79 4F 55 20 6F 77 65 0D 0A 0D 0A |OUNT yOU owe....|
00000510: 79 4F 55 52 20 4F 43 43 55 50 41 54 49 4F 4E 0D |yOUR OCCUPATION.|
00000520: 0A 73 50 4F 55 53 45 27 53 20 4F 43 43 55 50 41 |.sPOUSE'S OCCUPA|
00000530: 54 49 4F 4E 0D 0A 1A |TION... |
.. ..STEP
4 INCOME.... 6. WAGES SALARIES TIPS ET
C. .. 7A. TAXABLE INTEREST INC (F5).. B
. TAX-EXEMPT INTEREST.. 8. DIVIDENDS (F
5).. 9. UNEMPLOYMENT COMPENSATION..
FROM FORM 1099-G..10. TOTAL INCOME....
STEP 5 ADJUSTED GROSS INCOME....11A. YO
UR IRA DEDUCTION.. SEE PAGE 18.. B.
SPOUSE'S IRA DEDUCTION.. SEE PAGE 1
8.. C. TOTAL ADJUSTMENTS..12. ADJUSTED
GROSS INCOME....STEP 6 TAXABLE INCOME.
...13. ADJUSTED GROSS INCOME..14A. WERE
YOU OVER 65?.. WERE YOU BLIND?..
WAS YOUR SPOUSE OVER 65?.. WAS YOU
R SPOUSE BLIND?.. NO. OF BOXES CHECK
ED.. B. CAN YOU BE CLAIMED AS A ..
DEPENDENT ON ANOTHER.. PERSON'S RETU
RN? (YES/NO) .. C. ARE YOU MARRIED FIL
ING .. SEPARATELY WITH A SPOUSE..
FILING 1040 AND ITEMIZING .. DEDUC
TIONS? (YES/NO) .. D. STANDARD DEDUCTIO
N..15. LINE 14D FROM 13..16. # OF EXEM
PTIONS X $1900..17. TAXABLE INCOME....S
TEP 7 TAX CREDITS AND PAYMENTS....
ARE YOU UNDER 14 AND HAVE .. MORE TH
AN $1000 OF INVEST-.. MENT INCOME (Y
ES/NO).. TAX TABLE.. FORM 8615 (
F5)..18. TAX..19. CHILD & DEP CARE (F5
)..20. TOTAL TAX..21A. FEDERAL INC TAX
WITHHELD.. B. EARNED INCOME CREDIT..22.
TOTAL PAYMENTS....STEP 8 REFUND OR AMO
UNT YOU OWE....23. REFUND AMOUNT..24. AM
OUNT YOU OWE....YOUR OCCUPATION..SPOUSE'
S OCCUPATION...
×
C64 Image
> CLICK IMAGE PREVIEW FOR FULL MODAL