question 2part A
Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return (99)
IRS Use Only—Do not write or staple in this space.
Your first name and initial
OMB No. 1545-0074
Your social security number
4 6 7 7 4 4 4 5 1
If a joint return, spouse’s first name and initial
Spouse’s social security number
4 6 6 4 7 3 3 1 1
Home address (number and street). If you have a P.O. box, see instructions.
143 Snapdragon Drive
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
If more than six
Make sure the SSN(s) above
and on line 6c are correct.
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
Reno, NV 82102
Foreign country name
Head of household (with qualifying person). (See instructions.)
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.
Qualifying widow(er) with dependent child (see instructions)
Yourself. If someone can claim you as a dependent, do not check
6a and 6b
No. of children
on 6c who:
(4) ✓ if child under
• lived with
(1) First name
(2) Dependent’s social
relationship to you
age 17 qualifying for
child tax credit (see
• did not live
with you due to
on 6c not
d Total number of exemptions claimed.
1099-R if tax
If you did not
get a W-2, see
Wages, salaries, tips, etc. Attach Form(s) W-2.
Taxable interest. Attach Schedule B if required.
Tax-exempt interest. Do not include on line 8a. 8b
Ordinary dividends. Attach Schedule B if required.
Qualified dividends (see instructions).
Capital gain distributions (see instructions).
11b Taxable amount
12a Pensions and
12b Taxable amount
Add lines 7 through 14b (far right column). This is your total income.
Educator expenses (see instructions).
IRA deduction (see instructions).
Student loan interest deduction (see instructions).
Tuition and fees. Attach Form 8917.
Add lines 16 through 19. These are your total adjustments.
Subtract line 20 from line 15. This is your adjusted gross income.
13 Unemployment compensation and Alaska Permanent Fund dividends.
14a Social security
14b Taxable amount