Form 1040
Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return
2012 For the year Jan. 1–Dec. 31, 2012, or other tax year beginning, 2012, ending ,20 See separate instructions.

[When to Use this Form!]

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
▲ Make sure the SSN(s) above and on line 6c are correct.

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Foreign country name Foreign province/state/county Foreign postal code

Presidential Election Campaign
Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund.

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. ▶

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. ▶

5 Qualifying widow(er) with dependent child

Exemptions

6a Yourself. If someone can claim you as a dependent, do not check box 6a
b Spouse
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 instructions) If more than four dependents, see instructions and check here ▶

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. Add numbers on lines above.

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. Enclose, but do not attach, any payment. Also, please use Form 1040-V.

7 Wages, salaries, tips, etc. Attach Form(s) W-2

8a Taxable interest. Attach Schedule B if required
b Tax-exempt interest. Do not include on line 8a

9 a Ordinary dividends. Attach Schedule B if required
b Qualified dividends

10 Taxable refunds, credits, or offsets of state and local income taxes

11 Alimony received

12 Business income or (loss). Attach Schedule C or C-EZ

13 Capital gain or (loss). Attach Schedule D if required. If not required, check here

14 Other gains or (losses). Attach Form 4797

15 a IRA distributions
b Taxable amount

16 a Pensions and annuities
b Taxable amount

17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

18 Farm income or (loss). Attach Schedule F

19 Unemployment compensation

20 a Social security benefits
b Taxable amount

21 Other income. List type and amount

22 Combine the amounts in the far right column for lines 7 through 21. This is your total income

Adjusted Gross 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

26 Moving expenses. Attach Form 3903

27 Deductible part of self-employment tax. Attach Schedule SE

28 Self-employed SEP, SIMPLE, and qualified plans

29 Self-employed health insurance deduction

30 Penalty on early withdrawal of savings

31a Alimony paid
b Recipient’s SSN

32 IRA deduction

33 Student loan interest deduction

34 Tuition and fees. Attach Form 8917

35 Domestic production activities deduction. Attach Form 8903

36 Add lines 23 through 35

37 Subtract line 36 from line 22. This is your adjusted gross income

Tax and Credits

38 Amount from line 37 (adjusted gross income)

39a Check if:
You were born before January 2, 1948
Blind.
Spouse was born before January 2, 1948
Blind.
Total boxes checked
b If your spouse itemizes on a separate return or you were a dual-status alien, check here

40 Itemized deductions (from Schedule A) or your standard deduction (see left margin)
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, $5,950
Married filing jointly or Qualifying widow(er), $11,900
Head of household, $8,700

41 Subtract line 40 from line 38

42 Exemptions. Multiply $3,800 by the number on line 6d

43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-

44 Tax (see instructions). Check if any from:
a Form(s) 8814
b Form 4972
c 962 election

45 Alternative minimum tax (see instructions). Attach Form 6251

46 Add lines 44 and 45

47 Foreign tax credit. Attach Form 1116 if required

48 Credit for child and dependent care expenses. Attach Form 2441

49 Education credits from Form 8863, line 19

50 Retirement savings contributions credit. Attach Form 8880

51 Child tax credit. Attach Schedule 8812, if required

52 Residential energy credits. Attach Form 5695

53 Other credits from Form:
a 3800
b 8801
c 53

54 Add lines 47 through 53. These are your total credits

55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-

Other Taxes

56 Self-employment tax. Attach Schedule SE

57 Unreported social security and Medicare tax from Form:
a 4137
b 8919

58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required

59a Household employment taxes from Schedule H
b First-time homebuyer credit repayment. Attach Form 5405 if required

60 Other taxes. Enter code(s) from instructions

61 Add lines 55 through 60. This is your total tax

Payments
62 Federal income tax withheld from Forms W-2 and 1099

63 2012 estimated tax payments and amount applied from 2011 return

64a Earned income credit (EIC)
If you have a qualifying child, attach Schedule EIC.
b Nontaxable combat pay election

65 Additional child tax credit. Attach Schedule 8812

66 American opportunity credit from Form 8863, line 8

67 Reserved

68 Amount paid with request for extension to file

69 Excess social security and tier 1 RRTA tax withheld

70 Credit for federal tax on fuels. Attach Form 4136

71 Credits from Form:
a 2439
b Reserved
c 8801
d 8885

72 Add lines 62, 63, 64a, and 65 through 71. These are your total payments

Refund
Direct deposit? See instructions.

73 If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid

74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here
b Routing number
c Type: Checking Savings
d Account number

75 Amount of line 73 you want applied to your 2013 estimated tax

Amount You Owe

76 Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions

77 Estimated tax penalty (see instructions)

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
Phone no.
Personal identification number (PIN)

Sign Here
Joint return? See instructions.

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.

Date Spouse’s occupation

If the IRS sent you an Identity Protection PIN, enter it here (see inst.)

Paid Preparer Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if self-employed
PTIN
Firm’s name
Firm’s address
Firm's EIN
Phone no.