Form 1040 2017 (99) Department of the Treasury—Internal Revenue Service U.S. Individual Income Tax Return OMB No. 1545-0074 , 2017, ending IRS Use Only—Do not write or staple in this space. See separate instructions. For the year Jan. 1–Dec. 31, 2017, or other tax year beginning Your first name and initial Last name , 20 Your social security number If a joint return, spouse’s first name and initial Last name Spouse’s social security number Apt. no. Home address (number and street). If you have a P.O. box, see instructions. 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). Foreign country name Filing Status Check only one box. Exemptions Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking Foreign postal code a box below will not change your tax or refund. You Spouse Foreign province/state/county 1 2 3 ✔ 4 Single Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, enter this child’s name here. Married filing separately. Enter spouse’s SSN above and full name here. 6a b c ✔ 5 Qualifying widow(er) (see instructions) Yourself. If someone can claim you as a dependent, do not check box 6a . ✔ Spouse . Dependents: (1) First name Head of household (with qualifying person). (See instructions.) . . . . . . . . . . . (2) Dependent’s social security number Last name . . . . . . . . . . . . . . . . } (4) if child under age 17 qualifying for child tax credit (see instructions) (3) Dependent’s relationship to you • did not live with you due to divorce or separation (see instructions) ✔ If more than four dependents, see instructions and check here ✔ Dependents on 6c not entered above d 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 instructions. Adjusted Gross Income Boxes checked on 6a and 6b No. of children on 6c who: • lived with you Total number of exemptions claimed . . . . . . . . . . . . . . . . . . . . . . . 7 . 8b . . . . . . . . . 8a . . . . . . . 9a 10 11 Qualified dividends . . . . . . . . . . . 9b Taxable refunds, credits, or offsets of state and local income taxes Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 12 13 14 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . Capital gain or (loss). Attach Schedule D if required. If not required, check here Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . 12 13 14 15a 16a 17 IRA distributions . 15a b Taxable amount . . . Pensions and annuities 16a b Taxable amount . . . Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 15b 16b 17 18 19 20a Farm income or (loss). Attach Schedule F . Unemployment compensation . . . . Social security benefits 20a 18 19 20b 21 22 Other income. List type and amount Combine the amounts in the far right column for lines 7 through 21. This is your total income 23 Educator expenses 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ 25 Health savings account deduction. Attach Form 8889 . 24 25 26 27 28 Moving expenses. Attach Form 3903 . . . . . . Deductible part of self-employment tax. Attach Schedule SE . Self-employed SEP, SIMPLE, and qualified plans . . 26 27 28 29 30 31a Self-employed health insurance deduction Penalty on early withdrawal of savings . . . . . . . . . . 32 33 34 Alimony paid b Recipient’s SSN IRA deduction . . . . . . . Student loan interest deduction . . Tuition and fees. Attach Form 8917 29 30 31a . . . . . . . . . . . . 32 33 34 35 36 37 Domestic production activities deduction. Attach Form 8903 35 Add lines 23 through 35 . . . . . . . . . . . . . Subtract line 36 from line 22. This is your adjusted gross income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . 8a b 9a Taxable interest. Attach Schedule B if required . Tax-exempt interest. Do not include on line 8a . Ordinary dividends. Attach Schedule B if required . . . . . . . b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Taxable amount . . . . . . . . . . . Add numbers on lines above 21 22 23 . . For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. . . . . . . . . . 36 37 Cat. No. 11320B Form 1040 (2017) Page 2 Form 1040 (2017) 38 Amount from line 37 (adjusted gross income) Tax and Credits 39a Check if: If your spouse itemizes on a separate return or you were a dual-status alien, check here 39b Standard Deduction for— • People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions. • All others: Single or Married filing separately, $6,350 Married filing jointly or Qualifying widow(er), $12,700 Head of household, $9,350 40 41 Itemized deductions (from Schedule A) or your standard deduction (see left margin) Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 42 43 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . Form 4972 c Tax (see instructions). Check if any from: a Form(s) 8814 b . . Other Taxes 58 59 60a Unreported social security and Medicare tax from Form: a b 61 First-time homebuyer credit repayment. Attach Form 5405 if required 62 63 Form 8960 c Taxes from: a Form 8959 b Add lines 56 through 62. This is your total tax . . Payments If you have a qualifying child, attach Schedule EIC. b 44 45 46 47 48 49 50 51 52 53 54 55 56 57 64 65 66a b 67 68 69 70 71 72 73 74 Refund Direct deposit? See instructions. Amount You Owe Third Party Designee Sign Here Joint return? See instructions. Keep a copy for your records. Paid Preparer Use Only 75 76a { . . . . . You were born before January 2, 1953, Spouse was born before January 2, 1953, . . Blind. Blind. Alternative minimum tax (see instructions). Attach Form 6251 . Excess advance premium tax credit repayment. Attach Form 8962 . } . . . . . . . . . . . . . . . . . . 48 . . . . . . 52 Residential energy credits. Attach Form 5695 . . . . 53 3800 b 8801 c Other credits from Form: a 54 Add lines 48 through 54. These are your total credits . . . . . Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . . . . . . . Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . . . . . . . . . Instructions; enter code(s) . . . . . . . . . . 64 Federal income tax withheld from Forms W-2 and 1099 . . 2017 estimated tax payments and amount applied from 2016 return 65 Earned income credit (EIC) . . . . . . . . . . 66a . . . . . . . b 4137 . . . . . . . . . . . . . 67 American opportunity credit from Form 8863, line 8 . Net premium tax credit. Attach Form 8962 . . . . Amount paid with request for extension to file . . . . . . . . . 68 69 70 . 71 72 Credits from Form: a 2439 b Reserved c 8885 d 73 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . Excess social security and tier 1 RRTA tax withheld Credit for federal tax on fuels. Attach Form 4136 . . Full-year coverage Health care: individual responsibility (see instructions) Nontaxable combat pay election 66b Additional child tax credit. Attach Schedule 8812 . . . . 8919 Household employment taxes from Schedule H . . . . . . . . . 40 41 42 43 44 45 46 47 49 50 51 Credit for child and dependent care expenses. Attach Form 2441 Education credits from Form 8863, line 19 . . . . . Retirement savings contributions credit. Attach Form 8880 Child tax credit. Attach Schedule 8812, if required . . . . 38 Total boxes checked 39a . . Add lines 44, 45, and 46 . . . . . . . Foreign tax credit. Attach Form 1116 if required . . 55 56 57 58 59 60a 60b 61 62 . 63 . 74 . . . . . If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75 Amount of line 75 you want refunded to you. If Form 8888 is attached, check here 76a . b d Routing number c Type: ✔ Checking Savings Account number 77 Amount of line 75 you want applied to your 2018 estimated tax 77 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions 78 79 Estimated tax penalty (see instructions) . . . . . . . 79 Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. ✔ No Personal identification number (PIN) Phone no. Designee’s name 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 accurately list all amounts and sources of income I received during the tax year. 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. Date Spouse’s occupation If the IRS sent you an Identity Protection PIN, enter it here (see inst.) PTIN Check if self-employed Print/Type preparer’s name Preparer’s signature Date Firm’s name Firm’s EIN Firm’s address Phone no. Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2017)
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