00000000: 00 06 20 20 20 20 20 20 20 20 20 20 20 20 20 20 |.. |
00000010: 20 20 0D 0A 20 20 20 20 74 61 78 20 63 6F 6D 70 | .. tax comp|
00000020: 75 74 61 74 69 6F 6E 0D 0A 33 31 20 20 61 44 4A |utation..31 aDJ|
00000030: 55 53 54 45 44 20 47 52 4F 53 53 20 49 4E 43 4F |USTED GROSS INCO|
00000040: 4D 45 0D 0A 33 32 41 20 77 45 52 45 20 59 4F 55 |ME..32A wERE YOU|
00000050: 20 4F 56 45 52 20 36 35 3F 0D 0A 20 20 20 20 77 | OVER 65?.. w|
00000060: 45 52 45 20 59 4F 55 20 42 4C 49 4E 44 3F 0D 0A |ERE YOU BLIND?..|
00000070: 20 20 20 20 77 41 53 20 59 4F 55 52 20 53 50 4F | wAS YOUR SPO|
00000080: 55 53 45 20 4F 56 45 52 20 36 35 3F 0D 0A 20 20 |USE OVER 65?.. |
00000090: 20 20 77 41 53 20 59 4F 55 52 20 53 50 4F 55 53 | wAS YOUR SPOUS|
000000A0: 45 20 42 4C 49 4E 44 3F 0D 0A 20 20 20 20 6E 55 |E BLIND?.. nU|
000000B0: 4D 42 45 52 20 4F 46 20 42 4F 58 45 53 20 43 48 |MBER OF BOXES CH|
000000C0: 45 43 4B 45 44 0D 0A 20 20 42 20 63 41 4E 20 59 |ECKED.. B cAN Y|
000000D0: 4F 55 20 42 45 20 43 4C 41 49 4D 45 44 20 41 53 |OU BE CLAIMED AS|
000000E0: 20 41 0D 0A 20 20 20 20 44 45 50 45 4E 44 45 4E | A.. DEPENDEN|
000000F0: 54 20 4F 4E 20 41 4E 4F 54 48 45 52 0D 0A 20 20 |T ON ANOTHER.. |
00000100: 20 20 50 45 52 53 4F 4E 27 53 20 52 45 54 55 52 | PERSON'S RETUR|
00000110: 4E 3F 20 28 79 65 73 2F 6E 6F 29 0D 0A 20 20 43 |N? (yes/no).. C|
00000120: 20 61 52 45 20 59 4F 55 20 4D 41 52 52 49 45 44 | aRE YOU MARRIED|
00000130: 20 57 49 54 48 20 41 20 0D 0A 20 20 20 20 53 50 | WITH A .. SP|
00000140: 4F 55 53 45 20 57 48 4F 20 49 54 45 4D 49 5A 45 |OUSE WHO ITEMIZE|
00000150: 53 20 26 0D 0A 20 20 20 20 46 49 4C 45 53 20 53 |S &.. FILES S|
00000160: 45 50 41 52 41 54 45 4C 59 3F 20 28 79 65 73 2F |EPARATELY? (yes/|
00000170: 6E 6F 29 0D 0A 33 33 41 20 69 54 45 4D 49 5A 45 |no)..33A iTEMIZE|
00000180: 20 44 45 44 55 43 54 49 4F 4E 53 20 28 66 35 29 | DEDUCTIONS (f5)|
00000190: 0D 0A 20 20 42 20 73 54 41 4E 44 41 52 44 20 44 |.. B sTANDARD D|
000001A0: 45 44 55 43 54 49 4F 4E 0D 0A 33 34 20 20 6E 45 |EDUCTION..34 nE|
000001B0: 54 20 49 4E 43 2E 20 41 46 54 45 52 20 44 45 44 |T INC. AFTER DED|
000001C0: 55 43 54 49 4F 4E 53 0D 0A 33 35 20 20 23 20 6F |UCTIONS..35 # o|
000001D0: 66 20 65 58 45 4D 50 54 49 4F 4E 53 20 78 20 24 |f eXEMPTIONS x $|
000001E0: 31 39 30 30 0D 0A 33 36 20 20 74 41 58 41 42 4C |1900..36 tAXABL|
000001F0: 45 20 49 4E 43 4F 4D 45 0D 0A 20 20 20 20 77 45 |E INCOME.. wE|
00000200: 52 45 20 59 4F 55 20 55 4E 44 45 52 20 41 47 45 |RE YOU UNDER AGE|
00000210: 20 31 34 20 57 49 54 48 20 0D 0A 20 20 20 20 4D | 14 WITH .. M|
00000220: 4F 52 45 20 54 48 41 4E 20 24 31 30 30 30 20 4F |ORE THAN $1000 O|
00000230: 46 20 49 4E 56 45 53 54 2D 0D 0A 20 20 20 20 4D |F INVEST-.. M|
00000240: 45 4E 54 20 49 4E 43 4F 4D 45 3F 20 28 79 65 73 |ENT INCOME? (yes|
00000250: 2F 6E 6F 29 0D 0A 33 37 20 20 74 41 58 20 46 52 |/no)..37 tAX FR|
00000260: 4F 4D 20 74 41 58 20 54 41 42 4C 45 20 6F 72 20 |OM tAX TABLE or |
00000270: 73 63 68 0D 0A 20 20 20 20 73 43 48 45 44 55 4C |sch.. sCHEDUL|
00000280: 45 53 20 64 0D 0A 20 20 20 20 66 4F 52 4D 20 38 |ES d.. fORM 8|
00000290: 36 31 35 20 28 66 35 29 0D 0A 20 20 20 20 74 41 |615 (f5).. tA|
000002A0: 58 0D 0A 33 38 20 20 61 44 44 49 54 49 4F 4E 41 |X..38 aDDITIONA|
000002B0: 4C 20 54 41 58 45 53 0D 0A 20 20 20 20 66 4F 52 |L TAXES.. fOR|
000002C0: 4D 20 34 39 37 30 0D 0A 20 20 20 20 66 4F 52 4D |M 4970.. fORM|
000002D0: 20 34 39 37 32 0D 0A 20 20 20 20 74 4F 54 41 4C | 4972.. tOTAL|
000002E0: 20 41 44 44 49 54 49 4F 4E 41 4C 20 54 41 58 45 | ADDITIONAL TAXE|
000002F0: 53 0D 0A 33 39 20 20 74 4F 54 41 4C 0D 0A 0D 0A |S..39 tOTAL....|
00000300: 20 20 20 20 63 72 65 64 69 74 73 0D 0A 34 30 20 | credits..40 |
00000310: 20 63 48 49 4C 44 20 26 20 44 45 50 2E 20 43 41 | cHILD & DEP. CA|
00000320: 52 45 20 28 66 35 29 0D 0A 34 31 20 20 63 52 45 |RE (f5)..41 cRE|
00000330: 44 49 54 20 46 4F 52 20 45 4C 44 45 52 4C 59 20 |DIT FOR ELDERLY |
00000340: 28 66 35 29 0D 0A 34 32 20 20 74 4F 54 41 4C 0D |(f5)..42 tOTAL.|
00000350: 0A 34 33 20 20 6C 49 4E 45 20 34 32 20 46 52 4F |.43 lINE 42 FRO|
00000360: 4D 20 33 39 0D 0A 34 34 20 20 66 4F 52 45 49 47 |M 39..44 fOREIG|
00000370: 4E 20 54 41 58 20 43 52 45 44 49 54 0D 0A 20 20 |N TAX CREDIT.. |
00000380: 20 20 67 45 4E 45 52 41 4C 20 42 55 53 2E 20 43 | gENERAL BUS. C|
00000390: 52 45 44 49 54 0D 0A 20 20 20 20 66 4F 52 4D 20 |REDIT.. fORM |
000003A0: 33 38 30 30 0D 0A 20 20 20 20 66 4F 52 4D 20 33 |3800.. fORM 3|
000003B0: 34 36 38 0D 0A 20 20 20 20 66 4F 52 4D 20 35 38 |468.. fORM 58|
000003C0: 38 34 0D 0A 20 20 20 20 66 4F 52 4D 20 36 34 37 |84.. fORM 647|
000003D0: 38 0D 0A 20 20 20 20 66 4F 52 4D 20 36 37 36 35 |8.. fORM 6765|
000003E0: 0D 0A 20 20 20 20 66 4F 52 4D 20 38 35 38 36 0D |.. fORM 8586.|
000003F0: 0A 34 35 20 20 74 4F 54 41 4C 20 47 45 4E 2E 20 |.45 tOTAL GEN. |
00000400: 42 55 53 2E 20 43 52 45 44 49 54 0D 0A 34 36 20 |BUS. CREDIT..46 |
00000410: 20 74 4F 54 41 4C 0D 0A 34 37 20 20 6C 49 4E 45 | tOTAL..47 lINE|
00000420: 20 34 36 20 46 52 4F 4D 20 34 33 0D 0A 0D 0A 20 | 46 FROM 43.... |
00000430: 20 20 20 6F 74 68 65 72 20 74 61 78 65 73 0D 0A | other taxes..|
00000440: 34 38 20 20 73 45 4C 46 2D 45 4D 50 20 54 41 58 |48 sELF-EMP TAX|
00000450: 20 28 66 35 29 0D 0A 34 39 20 20 61 4C 54 45 52 | (f5)..49 aLTER|
00000460: 4E 41 54 49 56 45 20 4D 49 4E 49 4D 55 4D 20 54 |NATIVE MINIMUM T|
00000470: 41 58 20 20 20 20 20 0D 0A 35 30 20 20 74 41 58 |AX ..50 tAX|
00000480: 2D 2D 52 45 43 41 50 54 55 52 45 20 49 4E 56 20 |--RECAPTURE INV |
00000490: 43 52 45 44 49 54 0D 0A 35 31 20 20 73 4F 43 20 |CREDIT..51 sOC |
000004A0: 53 45 43 20 54 41 58 20 4F 4E 20 55 4E 52 45 50 |SEC TAX ON UNREP|
000004B0: 2E 20 54 49 50 53 0D 0A 35 32 20 20 74 41 58 20 |. TIPS..52 tAX |
000004C0: 4F 4E 20 52 45 54 49 52 45 4D 45 4E 54 20 50 4C |ON RETIREMENT PL|
000004D0: 41 4E 53 0D 0A 35 33 20 20 74 4F 54 41 4C 20 54 |ANS..53 tOTAL T|
000004E0: 41 58 0D 0A 20 20 20 20 20 20 20 20 20 20 20 20 |AX.. |
000004F0: 20 20 20 20 20 0D 0A 20 20 20 20 70 61 79 6D 65 | .. payme|
00000500: 6E 74 73 0D 0A 35 34 20 20 66 45 44 45 52 41 4C |nts..54 fEDERAL|
00000510: 20 49 4E 43 2E 20 54 41 58 20 57 49 54 48 48 45 | INC. TAX WITHHE|
00000520: 4C 44 0D 0A 35 35 20 20 38 37 20 45 53 54 49 4D |LD..55 87 ESTIM|
00000530: 41 54 45 44 20 54 41 58 20 50 41 59 4D 45 4E 54 |ATED TAX PAYMENT|
00000540: 53 0D 0A 35 36 20 20 65 41 52 4E 45 44 20 49 4E |S..56 eARNED IN|
00000550: 43 4F 4D 45 20 43 52 45 44 49 54 0D 0A 35 37 20 |COME CREDIT..57 |
00000560: 20 61 4D 4F 55 4E 54 20 50 41 49 44 20 57 49 54 | aMOUNT PAID WIT|
00000570: 48 20 66 4F 52 4D 20 34 38 36 38 0D 0A 35 38 20 |H fORM 4868..58 |
00000580: 20 65 58 43 45 53 53 20 53 4F 43 20 53 45 43 20 | eXCESS SOC SEC |
00000590: 26 20 72 72 74 61 20 54 41 58 0D 0A 35 39 20 20 |& rrta TAX..59 |
000005A0: 63 52 45 44 49 54 20 46 4F 52 20 46 45 44 20 54 |cREDIT FOR FED T|
000005B0: 41 58 20 4F 4E 20 46 55 45 4C 53 0D 0A 36 30 20 |AX ON FUELS..60 |
000005C0: 20 72 45 47 55 4C 41 54 45 44 20 49 4E 56 2E 20 | rEGULATED INV. |
000005D0: 43 4F 2E 20 43 52 45 44 49 54 0D 0A 36 31 20 20 |CO. CREDIT..61 |
000005E0: 74 4F 54 41 4C 20 50 41 59 4D 45 4E 54 53 0D 0A |tOTAL PAYMENTS..|
000005F0: 20 20 20 20 20 20 20 20 20 20 20 20 20 0D 0A 20 | .. |
00000600: 20 20 20 72 65 66 75 6E 64 20 6F 72 20 61 6D 6F | refund or amo|
00000610: 75 6E 74 20 6F 77 65 64 0D 0A 36 32 20 20 61 4D |unt owed..62 aM|
00000620: 4F 55 4E 54 20 6F 76 65 72 70 61 69 64 0D 0A 36 |OUNT overpaid..6|
00000630: 33 20 20 61 4D 4F 55 4E 54 20 54 4F 20 42 45 20 |3 aMOUNT TO BE |
00000640: 72 65 66 75 6E 64 65 64 0D 0A 36 34 20 20 61 50 |refunded..64 aP|
00000650: 50 4C 59 20 41 4D 54 20 54 4F 20 38 38 20 45 53 |PLY AMT TO 88 ES|
00000660: 54 20 54 41 58 0D 0A 20 20 20 20 20 20 20 20 20 |T TAX.. |
00000670: 20 20 20 20 20 20 20 20 20 20 20 0D 0A 36 35 20 | ..65 |
00000680: 20 70 45 4E 41 4C 54 59 20 61 4D 4F 55 4E 54 0D | pENALTY aMOUNT.|
00000690: 0A 20 20 20 20 61 4D 4F 55 4E 54 20 79 4F 55 20 |. aMOUNT yOU |
000006A0: 6F 77 65 0D 0A 20 20 20 20 20 20 20 20 20 20 20 |owe.. |
000006B0: 20 20 20 20 20 20 0D 0A 20 20 20 20 79 4F 55 52 | .. yOUR|
000006C0: 20 4F 43 43 55 50 41 54 49 4F 4E 0D 0A 20 20 20 | OCCUPATION.. |
000006D0: 20 73 50 4F 55 53 45 27 53 20 4F 43 43 55 50 41 | sPOUSE'S OCCUPA|
000006E0: 54 49 4F 4E 0D 0A 1A |TION... |
.. .. TAX COMPUTATION.
.31 ADJUSTED GROSS INCOME..32A WERE YOU
OVER 65?.. WERE YOU BLIND?.. WAS
YOUR SPOUSE OVER 65?.. WAS YOUR SPOUS
E BLIND?.. NUMBER OF BOXES CHECKED..
B CAN YOU BE CLAIMED AS A.. DEPENDEN
T ON ANOTHER.. PERSON'S RETURN? (YES/
NO).. C ARE YOU MARRIED WITH A .. SP
OUSE WHO ITEMIZES &.. FILES SEPARATEL
Y? (YES/NO)..33A ITEMIZE DEDUCTIONS (F5)
.. B STANDARD DEDUCTION..34 NET INC. A
FTER DEDUCTIONS..35 # OF EXEMPTIONS X $
1900..36 TAXABLE INCOME.. WERE YOU U
NDER AGE 14 WITH .. MORE THAN $1000 O
F INVEST-.. MENT INCOME? (YES/NO)..37
TAX FROM TAX TABLE OR SCH.. SCHEDUL
ES D.. FORM 8615 (F5).. TAX..38 A
DDITIONAL TAXES.. FORM 4970.. FORM
4972.. TOTAL ADDITIONAL TAXES..39 T
OTAL.... CREDITS..40 CHILD & DEP. CA
RE (F5)..41 CREDIT FOR ELDERLY (F5)..42
TOTAL..43 LINE 42 FROM 39..44 FOREIG
N TAX CREDIT.. GENERAL BUS. CREDIT..
FORM 3800.. FORM 3468.. FORM 58
84.. FORM 6478.. FORM 6765.. FO
RM 8586..45 TOTAL GEN. BUS. CREDIT..46
TOTAL..47 LINE 46 FROM 43.... OTHER
TAXES..48 SELF-EMP TAX (F5)..49 ALTER
NATIVE MINIMUM TAX ..50 TAX--RECAPT
URE INV CREDIT..51 SOC SEC TAX ON UNREP
. TIPS..52 TAX ON RETIREMENT PLANS..53
TOTAL TAX.. .. PAYME
NTS..54 FEDERAL INC. TAX WITHHELD..55
87 ESTIMATED TAX PAYMENTS..56 EARNED IN
COME CREDIT..57 AMOUNT PAID WITH FORM 4
868..58 EXCESS SOC SEC & RRTA TAX..59
CREDIT FOR FED TAX ON FUELS..60 REGULAT
ED INV. CO. CREDIT..61 TOTAL PAYMENTS..
.. REFUND OR AMOUNT OWED
..62 AMOUNT OVERPAID..63 AMOUNT TO BE
REFUNDED..64 APPLY AMT TO 88 EST TAX..
..65 PENALTY AMOUNT.
. AMOUNT YOU OWE.. ..
YOUR OCCUPATION.. SPOUSE'S OCCUPA
TION...
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