This document is an IRS Form 1040A for an individual income tax return. It includes information such as the filer's name, address, social security number, filing status, exemptions, income sources, adjustments, tax, credits and payments. The summary is:
1. John and Jane Doe filed a married filing jointly Form 1040A for tax year 2014 reporting $10,779 in total income and $3,975 in adjusted gross income.
2. They claimed one dependent, Elizabeth M Law, and received a standard deduction of $9,100, resulting in $3,305 in taxable income.
3. After credits and withholdings, the Does owed $670 in taxes
Homework_changChang - Form 1040 - Calendar 2014.pdfFo.docxadampcarr67227
Homework_chang/Chang - Form 1040 - Calendar 2014.pdf
F
o
rm 1040 Department of the Treasury—Internal Revenue Service (99)U.S. Individual Income Tax Return 2014 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2014, or other tax year beginning , 2014, ending , 20 See separate instructions.
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. You Spouse
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 . . . . . . . . . . . . . . . . . . . . . . . .
}
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 ▶
d Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Boxes checked
on 6a and 6b
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
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.
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
b Qualified dividends . . . . . . . . . . . 9b
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12
.
Form 1040 Department of the Treasury—Internal Revenue Servic.docxhanneloremccaffery
Fo
rm 1040 Department of the Treasury—Internal Revenue Service (99)U.S. Individual Income Tax Return 2015 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2015, or other tax year beginning , 2015, ending , 20 See separate instructions.
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. You Spouse
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 . . . . . . . . . . . . . . . . . . . . . . . . }
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
d Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Boxes checked
on 6a and 6b
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
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.
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
b Qualified dividends . . . . . . . . . . . 9b
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12
13 Capital gain or (loss). Attach Schedule D if required. If not ...
Form 1040 Department of the Treasury—Internal Revenue Se.docxhanneloremccaffery
F
o
rm 1040 Department of the Treasury—Internal Revenue Service (99)U.S. Individual Income Tax Return 2015 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2015, or other tax year beginning , 2015, ending , 20 See separate instructions.
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. You Spouse
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 . . . . . . . . . . . . . . . . . . . . . . . .
}
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 ▶
d Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Boxes checked
on 6a and 6b
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
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.
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
b Qualified dividends . . . . . . . . . . . 9b
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12
13 Capital gain or (loss). Attach Schedule D if require ...
Homework_changChang - Form 1040 - Calendar 2014.pdfFo.docxadampcarr67227
Homework_chang/Chang - Form 1040 - Calendar 2014.pdf
F
o
rm 1040 Department of the Treasury—Internal Revenue Service (99)U.S. Individual Income Tax Return 2014 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2014, or other tax year beginning , 2014, ending , 20 See separate instructions.
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. You Spouse
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 . . . . . . . . . . . . . . . . . . . . . . . .
}
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 ▶
d Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Boxes checked
on 6a and 6b
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
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.
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
b Qualified dividends . . . . . . . . . . . 9b
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12
.
Form 1040 Department of the Treasury—Internal Revenue Servic.docxhanneloremccaffery
Fo
rm 1040 Department of the Treasury—Internal Revenue Service (99)U.S. Individual Income Tax Return 2015 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2015, or other tax year beginning , 2015, ending , 20 See separate instructions.
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. You Spouse
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 . . . . . . . . . . . . . . . . . . . . . . . . }
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
d Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Boxes checked
on 6a and 6b
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
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.
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
b Qualified dividends . . . . . . . . . . . 9b
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12
13 Capital gain or (loss). Attach Schedule D if required. If not ...
Form 1040 Department of the Treasury—Internal Revenue Se.docxhanneloremccaffery
F
o
rm 1040 Department of the Treasury—Internal Revenue Service (99)U.S. Individual Income Tax Return 2015 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2015, or other tax year beginning , 2015, ending , 20 See separate instructions.
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. You Spouse
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 . . . . . . . . . . . . . . . . . . . . . . . .
}
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 ▶
d Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Boxes checked
on 6a and 6b
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
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.
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
b Qualified dividends . . . . . . . . . . . 9b
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12
13 Capital gain or (loss). Attach Schedule D if require ...
Form 1040 2020U.S. Individual Income Tax Return DepartmeShainaBoling829
F
o
rm 1040 2020U.S. Individual Income Tax Return Department of the Treasury—Internal Revenue Service (99) OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
Filing Status
Check only
one box.
Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying
person is a child but not your dependent a
Your first name and middle initial Last name Your social security number
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions. Apt. no.
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
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.
You Spouse
At any time during 2020, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency? Yes No
Standard
Deduction
Someone can claim: You as a dependent Your spouse as a dependent
Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness You: Were born before January 2, 1956 Are blind Spouse: Was born before January 2, 1956 Is blind
Dependents (see instructions):
If more
than four
dependents,
see instructions
and check
here a
(2) Social security
number
(3) Relationship
to you
(4) � if qualifies for (see instructions):
(1) First name Last name Child tax credit Credit for other dependents
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . 1
Attach
Sch. B if
required.
2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . a 7
8 Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . 8
9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . a 9
10 Adjustments to income:
a From Schedule 1, line 22 . . . . . . . . . . . . . . 10a
b Charitable contributions if you take the standard deduction. See instructions 10b
c Add lines 10a and 10b. These are your total adjustments to income . . . . . . . . a 10c
11 Subtract line 10c from line 9. This is your adjusted gross income . . . . . . . . . a 11
12 Standard deduction or itemized dedu ...
Form 1040 Department of the Treasury—Internal Revenue Servic.docxbudbarber38650
Fo
rm 1040 Department of the Treasury—Internal Revenue Service OMB No. 1545-0074(99) IRS Use Only—Do not write or staple in this space. 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.
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. You Spouse
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 . . . . . . . . . . . . . . . . . . . . . . . . }
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 ▶
d Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Boxes checked
on 6a and 6b
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
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 . . . . . . . . . . . . 7
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
b Qualified dividends . . . . . . . . . . . 9b
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ ..
Form 1040Form 1040 Department of the Treasury Internal Revenue Ser.docxhanneloremccaffery
Form 1040Form 1040 Department of the Treasury Internal Revenue Service2013U.S. Individual Tax FormOMB No.1545-0074IRS Use Only--Do not write or staple in this spaceFor the year Jan.1--Dec. 31,2013, or any other tax year beginning,2013,,20See Separate InstructionsYour first name and initialLast nameSocial Security NumberIf a joint return, spouses first name and initialLast nameSpouse Social Security NumberHome address( number and street). If you have a P.O. Box, see instructionsMake Sure that 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).Presidential Election CampaignCheck here if you, or your spouse if filing jointly,Foreign country nameForeign province/state/countryForeign postal codechecking this box below will not change your taxrefund.youspouseFiling Status1. Single4.Head of Household (with qualifying person.) (See instructions.) IfCheck only one box2.. married filing jointlythe qualifying person is a child but not your dependent, enter this3. Married filing separately. Enter spouse's SSN abovechild's name hereand full name here.5. Qualifying Window(er) with dependent childExemptions6a Yourself. If someone can claim you as a dependent, do not check box 6a]Boxes checkedb spouse]on 6a and 6bIf more than fourc. Dependentsdependents, see(1) First nameLast name(2) dependents(3) dependents (4) check if child under age 17No. of childreninstructions and social security numberrelationship to youqualifying for tax credit seeon 6c who:check hereinstructions.lived with youdid not live with youdue to divorce orseparation(see instructions)Dependents on6c not entered aboved. Total number of Exemptions ClaimedAdd numbers on lines aboveIncome7Wages, salaries, tips, etc. Attach Forms (W-2)78aTaxable interest. Attach Schedule B if required8aAttach Form(s)bTax-exempt interest. Do not include on line 8a8bW-2 here. Also9aOrdinary dividends. Attach Schedule B if required9aattach Forms(s) bQualified dividends9bW-2 and 1099-R10Taxable refunds, credits, or offsets state or local income taxes10if tax was withheld.11Alimony received1112Business income or (loss). Attach Schedule C or C-EZ12If you did not 13Capital gain or (loss). Attach Schedule D if required. If not required, check here13get a W-2,14other gains or (losses). Attach Form 479714see instructions15aIRA distributions15ab Taxable amount15b16aPensions and annuities16ab Taxable amount16b17Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E1718Farm income or (loss). Attach Schedule F1819Unemployment compensation1920aSocial security benefits20ab Taxable amount20b21other income. List type and amount2122combine the amounts in the far right column for lines 7 through 21. This is your total incomeThis is your total income.22Adjusted 23Educator expenses23Gross24Certain business expenses of reservists, performing artists, and fee-basis government. Atta ...
1. Form
1040A 2014U.S. Individual Income Tax Return
Department of the Treasury—Internal Revenue Service
IRS Use Only—Do not write or staple in this space.(99)
OMB No. 1545-0074Your 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. You Spouse
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 (see instructions)
Exemptions
If more than six
dependents, see
instructions.
6a Yourself. If someone can claim you as a dependent, do not check
box 6a.
b Spouse
}
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)
d Total number of exemptions claimed.
Boxes
checked on
6a and 6b
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
Add numbers
on lines
above
Income
Attach
Form(s) W-2
here. Also
attach
Form(s)
1099-R if tax
was
withheld.
If you did not
get a W-2, see
instructions.
7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7
8a Taxable interest. Attach Schedule B if required. 8a
b Tax-exempt interest. Do not include on line 8a. 8b
Ordinary dividends. Attach Schedule B if required. 9a
b Qualified dividends (see instructions). 9b
10 Capital gain distributions (see instructions). 10
11a IRA
distributions. 11a
11b Taxable amount
(see instructions). 11b
12a Pensions and
annuities. 12a
12b Taxable amount
(see instructions). 12b
13 Unemployment compensation and Alaska Permanent Fund dividends. 13
14a Social security
benefits. 14a
14b Taxable amount
(see instructions). 14b
15 Add lines 7 through 14b (far right column). This is your total income. 15
Adjusted
gross
income
16 Educator expenses (see instructions). 16
17 IRA deduction (see instructions). 17
18 Student loan interest deduction (see instructions). 18
19 Tuition and fees. Attach Form 8917. 19
20 Add lines 16 through 19. These are your total adjustments. 20
21 Subtract line 20 from line 15. This is your adjusted gross income. 21
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040A (2014)
1
2
Law
256 W Franklin St 2
1
10,779.
10,779.
6,779.
4,000.
4,000.
Kendra E Kineg 198-76-4256 Daughter
Elizabeth M 205 48 9337
Womelsdorf PA 19567
BAA REV 01/20/15 Intuit.cg.cfp.sp
2. Form 1040A (2014) Page 2
Tax, credits,
and
payments
22 Enter the amount from line 21 (adjusted gross income). 22
23a Check
if: { You were born before January 2, 1950, Blind
Spouse was born before January 2, 1950, Blind }Total boxes
checked 23a
b If you are married filing separately and your spouse itemizes
deductions, check here 23bStandard
Deduction
for—
• People who
check any
box on line
23a or 23b or
who can be
claimed as a
dependent,
see
instructions.
• All others:
Single or
Married filing
separately,
$6,200
Married filing
jointly or
Qualifying
widow(er),
$12,400
Head of
household,
$9,100
24 Enter your standard deduction. 24
25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25
26 Exemptions. Multiply $3,950 by the number on line 6d. 26
27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
This is your taxable income. 27
28 Tax, including any alternative minimum tax (see instructions). 28
29 Excess advance premium tax credit repayment. Attach
Form 8962. 29
30 Add lines 28 and 29. 30
31 Credit for child and dependent care expenses. Attach
Form 2441. 31
32 Credit for the elderly or the disabled. Attach
Schedule R. 32
33 Education credits from Form 8863, line 19. 33
34 Retirement savings contributions credit. Attach Form 8880. 34
35 Child tax credit. Attach Schedule 8812, if required. 35
36 Add lines 31 through 35. These are your total credits. 36
37 Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-. 37
38 Health care: individual responsibility (see instructions). Full-year coverage 38
39 Add line 37 and line 38. This is your total tax. 39
40 Federal income tax withheld from Forms W-2 and 1099. 40
41 2014 estimated tax payments and amount applied
from 2013 return. 41
If you have
a qualifying
child, attach
Schedule
EIC.
42a Earned income credit (EIC). 42a
b Nontaxable combat pay election. 42b
43 Additional child tax credit. Attach Schedule 8812. 43
44 American opportunity credit from Form 8863, line 8. 44
45 Net premium tax credit. Attach Form 8962. 45
46 Add lines 40, 41, 42a, 43, 44, and 45. These are your total payments. 46
Refund
Direct
deposit?
See
instructions
and fill in
48b, 48c,
and 48d or
Form 8888.
47 If line 46 is more than line 39, subtract line 39 from line 46.
This is the amount you overpaid. 47
48a Amount of line 47 you want refunded to you. If Form 8888 is attached, check here 48a
b Routing
number
c Type: Checking Savings
d Account
number
49 Amount of line 47 you want applied to your
2015 estimated tax. 49
Amount
you owe
50 Amount you owe. Subtract line 46 from line 39. For details on how to pay,
see instructions. 50
51 Estimated tax penalty (see instructions). 51
Third party
designee
Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. 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 accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other
than the taxpayer) is based on all information of which the 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.
Form 1040A (2014)
Self-Prepared
0.
0.
0.
0.
0.
0.
9 8 6 0 3 2 0 9 5 2
9,100.
7,900.
customer service (510)589-4255
6,779.
670.
3,975.
3,975.
3,975.
3,305.
0 3 1 3 0 2 9 5 5
REV 01/20/15 Intuit.cg.cfp.sp
3. SCHEDULE EIC
(Form 1040A or 1040)
Department of the Treasury
Internal Revenue Service (99)
Earned Income Credit
Qualifying Child Information
Complete and attach to Form 1040A or 1040 only if you have a qualifying child.
1040A
. . . . . . . . . .
1040
EIC
OMB No. 1545-0074
2014
Attachment
Sequence No. 43
Information about Schedule EIC (Form 1040A or 1040) and its instructions is at www.irs.gov/scheduleeic.
Name(s) shown on return Your social security number
Before you begin:
• See the instructions for Form 1040A, lines 42a and 42b, or Form 1040, lines 66a and 66b, to make
sure that (a) you can take the EIC, and (b) you have a qualifying child.
• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card.
Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child’s
social security card is not correct, call the Social Security Administration at 1-800-772-1213.
!CAUTION
• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.
• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.
Qualifying Child Information Child 1 Child 2 Child 3
1 Child’s name
If you have more than three qualifying
children, you have to list only three to get
the maximum credit.
First name Last name First name Last name First name Last name
2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040A, lines 42a
and 42b, or Form 1040, lines 66a and 66b,
unless the child was born and died in
2014. If your child was born and died in
2014 and did not have an SSN, enter
“Died” on this line and attach a copy of
the child’s birth certificate, death
certificate, or hospital medical records.
3 Child’s year of birth
Year
If born after 1995 and the child is
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b;
go to line 5.
Year
If born after 1995 and the child is
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b;
go to line 5.
Year
If born after 1995 and the child is
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b;
go to line 5.
4 aWas the child under age 24 at the end of
2014, a student, and younger than you (or
your spouse, if filing jointly)?
Yes.
Go to
line 5.
No.
Go to line 4b.
Yes.
Go to
line 5.
No.
Go to line 4b.
Yes.
Go to
line 5.
No.
Go to line 4b.
bWas the child permanently and totally
disabled during any part of 2014?
Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
5 Child’s relationship to you
(for example, son, daughter, grandchild,
niece, nephew, foster child, etc.)
6 Number of months child lived
with you in the United States
during 2014
• If the child lived with you for more than
half of 2014 but less than 7 months,
enter “7.”
• If the child was born or died in 2014 and
your home was the child’s home for more
than half the time he or she was alive
during 2014, enter “12.”
months
Do not enter more than 12
months.
months
Do not enter more than 12
months.
months
Do not enter more than 12
months.
For Paperwork Reduction Act Notice, see your tax
return instructions.
Schedule EIC (Form 1040A or 1040) 2014
Elizabeth M Law 205-48-9337
Kendra E Kineg
198-76-4256
1 9 9 6
Daughter
12
BAA REV 12/12/14 Intuit.cg.cfp.sp
4. Form 8917
Department of the Treasury
Internal Revenue Service
Tuition and Fees Deduction
Attach to Form 1040 or Form 1040A.
Information about Form 8917 and its instructions is at www.irs.gov/form8917.
OMB No. 1545-0074
2014Attachment
Sequence No. 60
Name(s) shown on return Your social security number
!CAUTION
You cannot take both an education credit from Form 8863 and the tuition and fees deduction from this form for the
same student for the same tax year.
Before you begin: To see if you qualify for this deduction, see Who Can Take the Deduction in the instructions below.
If you file Form 1040, figure any write-in adjustments to be entered on the dotted line next to Form
1040, line 36. See the 2014 Form 1040 instructions for line 36.
1 (a) Student’s name (as shown on page 1 of your tax return)
First name Last name
(b) Student’s social security
number (as shown on page
1 of your tax return)
(c) Adjusted qualified
expenses (see
instructions)
2 Add the amounts on line 1, column (c), and enter the total . . . . . . . . . . . . . 2
3 Enter the amount from Form 1040, line 22, or Form 1040A, line 15 3
4 Enter the total from either:
• Form 1040, lines 23 through 33, plus any write-in adjustments
entered on the dotted line next to Form 1040, line 36, or
• Form 1040A, lines 16 through 18. . . . . . . . . . . 4
5 Subtract line 4 from line 3.* If the result is more than $80,000 ($160,000 if married filing jointly),
stop; you cannot take the deduction for tuition and fees . . . . . . . . . . . . . 5
*If you are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from Puerto Rico,
see Effect of the Amount of Your Income on the Amount of Your Deduction in Pub. 970, chapter
6, to figure the amount to enter on line 5.
6 Tuition and fees deduction. Is the amount on line 5 more than $65,000 ($130,000 if married
filing jointly)?
Yes. Enter the smaller of line 2, or $2,000.
No. Enter the smaller of line 2, or $4,000.
Also enter this amount on Form 1040, line 34, or Form 1040A, line 19.
} . . . . . . . . . . . . . . 6
For Paperwork Reduction Act Notice, see your tax return instructions. Form 8917 (2014)
10,779.
Elizabeth M Law 205-48-9337
10,779.
4,000.
4,427.
Elizabeth M Law 205-48-9337 4,427.
BAA REV 01/22/15 Intuit.cg.cfp.sp
5. PA-40 - 2014
Pennsylvania Income Tax Return
ENTER ONE LETTER OR NUMBER IN EACH BOX (06-14)
Extension.
1a Gross Compensation. Do not include exempt income, such as combat zone pay and
qualifying retirement benefits. See the instructions.
1b Unreimbursed Employee Business Expenses.
1c Net Compensation. Subtract Line 1b from Line 1a.
2 Interest Income. Complete PA Schedule A if required.
3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required.
4 Net Income or Loss from the Operation of a Business, Profession or Farm.
5 Net Gain or Loss from the Sale, Exchange or Disposition of Property.
6 Net Income or Loss from Rents, Royalties, Patents or Copyrights.
7 Estate or Trust Income. Complete and submit PA Schedule J.
8 Gambling and Lottery Winnings. Complete and submit PA Schedule T.
9 Total PA Taxable Income. Add only the positive income amounts from Lines 1c,
2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6.
10 Other Deductions. Enter the appropriate code for the type of deduction.
See the instructions for additional information.
11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9.
Amended Return.
Farmers.
Taxpayer Date of Death
Deceased
Spouse Date of Death
School District Name ________________________
1a
1b
1c
2
3
4
5
6
7
8
9
10
11
Single, Married/Filing Jointly,
Married/Filing Separately, Final Return
Occupation
Occupation
Residency Status.
PA Resident/Nonresident/Part-Year Resident
from to
Page 1 of 2
EC FCOFFICIAL USE ONLY
0N
0
0
0
0
N
N
N
10779
0
10779
10779
10779
205489337
LAW
ELIZABETH M
APT 2
256 W FRANKLIN ST
WOMELSDORF PA 19567
CUSTOMER S
N N
R
S
N
510-589-4255 06110
1400115224
CONRAD WEISER
0
0
0
1555 REV 12/19/14 INTUIT.CG.CFP.SP
1400115224
6. Tax Forgiveness Credit. Submit PA Schedule SP.
19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased
19b Dependents, Part B, Line 2, PA Schedule SP
20 Total Eligibility Income from Part C, Line 11, PA Schedule SP.
21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP.
22 Resident Credit. Submit your PA Schedule(s) G-L and/or RK-1.
23 Total Other Credits. Submit your PA Schedule OC.
24 TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22 and 23.
25 USE TAX. Due on internet, mail order or out-of-state purchases. See instructions.
26 TAX DUE. If the total of Line 12 and Line 25 is more than line 24, enter the difference here.
27 Penalties and Interest. See the instructions. Enter Code:
If including form REV-1630/REV-1630A, mark the box.
28 TOTAL PAYMENT DUE. See the instructions.
29 OVERPAYMENT. If Line 24 is more than the total of Line 12, Line 25 and Line 27, enter
the difference here.
The total of Lines 30 through 36 must equal Line 29.
30 Refund – Amount of Line 29 you want as a check mailed to you. REFUND
31 Credit – Amount of Line 29 you want as a credit to your 2015 estimated account.
32 Refund donation line. Enter the organization code and donation amount. See instructions.
33 Refund donation line. Enter the organization code and donation amount. See instructions.
34 Refund donation line. Enter the organization code and donation amount. See instructions.
35 Refund donation line. Enter the organization code and donation amount. See instructions.
36 Refund donation line. Enter the organization code and donation amount. See instructions.
Your Signature Spouse’s Signature, if filing jointly
Preparer’s Name and Telephone Number Date
PA-40 - 2014
Page 2 of 2
SocialSecurity Number
Name(s)
13
14
15
16
17
18
19a
19b
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307).
13 Total PA Tax Withheld. See the instructions.
14 Credit from your 2013 PA Income Tax return.
15 2014 Estimated Installment Payments. REV-459B included.
16 2014 Extension Payment.
17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only)
18 Total Estimated Payments and Credits. Add Lines 14, 15, 16 and 17.
12
E-File Opt Out
Firm FEIN
Preparer’s PTIN
Signature(s). Under penalties of perjury, I (we) declare that I (we) have examined this return, including all
accompanying schedules and statements, and to the best of my (our) belief, they are true, correct, and complete.
N
SELF-PREPARED
N
N
0
01
01
ELIZABETH M LAW205489337
0
331
0
0
0
662
331
10779
331
331
331
0
1555 REV 12/19/14 INTUIT.CG.CFP.SP
1400215230
0
0
0
0
0
0
1400215230 1400215230
7. OFFICIAL USE ONLY
PA SCHEDULE W-2S
Wage Statement Summary
2014PA-40 Schedule W-2S
(07-14)(I)
Use this schedule to list and calculate your total PA-taxable compensation and PA tax withheld from all sources.
Part A Instructions: List each federal Form W-2 for you and your spouse, if married, received from your employer(s). In the first column enter T for the taxpayer’s Social
Security Number that appears first on the PA tax return and enter S for the second or spouse SSN. From the Forms W-2, enter each employer’s federal identification num-
ber. Enter the amounts from the Forms W-2 in each column. IMPORTANT: You do not have to submit a copy of your Form W-2 if you earned all your income in
Pennsylvania and your employer reported your PA wages correctly and withheld the correct amount of PA income tax. You must submit a copy of your Form W-2 in cer-
tain circumstances. See the PA Schedule W-2S instructions for a list of when a copy of a W-2 is required.
Part B Instructions: List each source of income received during the taxable year on a form or statement other than a federal Form W-2. Enter each payer’s name. List
the payment type that most closely describes the source of your non-employee compensation. Enter the amount of other compensation that you earned. If the form or
statement does not have separately stated amounts, enter the amount shown in both federal and PA columns.
IMPORTANT: You must submit a copy of each form and statement that you list in Part B, whether or not the payer withheld any PA income tax and regardless of
whether or not the income was taxable in PA. CAUTION: The federal and Pennsylvania (state) wages may be different in Part A and Part B.
If you need more space, you may photocopy this schedule or make your own schedules in this format.
Part A - Federal Forms W-2 SEE THE INSTRUCTIONS FOR WHEN TO SUBMIT FORM(S) W-2
T/S Employer’s identification number from Box b
Federal wages Medicare wages PA compensation PA income tax
from Box 1 from Box 5 from Box 16 withheld from Box 17
Total Part A- Add the Pennsylvania columns
Part B - Miscellaneous and Non-employee Compensation from federal Forms 1099-R, 1099-MISC and other statements
YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART
A. B. C. D. E. F. G. H.
T/S Type Payer name 1099R code Total federal amount Adjusted plan basis PA compensation PA tax withheld
Total Part B - Add the Pennsylvania columns
TOTAL - Add the totals from Parts A and B
Enter the TOTALS on your PA tax return on: Line 1a Line 13
Payment type: A. Executor fee B. Jury duty pay C. Director’s fee D. Expert witness fee
E. Honorarium F. Covenant not to compete G. Damages or settlement for lost wages, other than personal injury
H. Other nonemployee compensation. Describe:
I. Distribution from employer sponsored retirement, pension or qualified deferred compensation plan
J. Distribution from IRA (Traditional or Roth) K. Distribution from Life Insurance, Annuity or Endowment Contracts
L. Distribution from Charitable Gift Annuities
Name shown first on the PA-40 (if filing jointly) Social Security Number (shown first)
Summary of PA-Taxable Employee, Non-employee and Miscellaneous Compensation
10,779 331
10,779 331
ELIZABETH M LAW 205-48-9337
T 22-3606734 9,251 9,251 9,251 284
T 45-2403263 1,231 1,231 1,231 38
T 20-0360283 297 297 297 9
1401910029
1555
1401910029 REV 09/16/14 INTUIT.CG.CFP.SP
1401910029
8. PA SCHEDULE SP
Special Tax Forgiveness
PA-40 Schedule SP (07-14)(I) 2014 OFFICIAL USE ONLY
1. Unmarried - use Column A to calculate your Eligibility Income. Fill in the Unmarried oval on Line 19a of your PA-40. Fill in the oval that describes your situation:
a. Single. Unmarried/divorced on Dec. 31, 2014
b. Single and claimed as a dependent on another person’s PA Schedule SP. Enter the other person’s:
2. Separated – use Column A to calculate your Eligibility Income.
Fill in this oval only if (a) you are separated pursuant to a written agreement or (b) you were married, but separated and lived apart for the last six
months of the year. Fill in the Unmarried oval on Line 19a of your PA-40.
3. Married - Fill in the Married oval on Line 19a of your PA-40. Enter your spouse’s name and SSN above. Fill in the oval that describes your situation:
a. Married and claiming Tax Forgiveness together with my spouse. Use Column A to calculate Eligibility Income.
b. Married and filing separate PA tax returns. Certification. Fill in this oval certifying that you and your spouse are submitting the same
information on each PA Schedule SP. Use Columns B and C to calculate your Eligibility Income.
c. Married with a spouse who is a dependent on another person’s PA Schedule SP or federal income tax return. Use Columns B and C to calculate
Eligibility Income. Enter the other person’s:
d. Separated and lived apart from my spouse but for less than the last six months of the year. Use Columns B and C to calculate Eligibility Income.
Enter your spouse’s name and SSN above.
4. Deceased - use Column A to calculate your Eligibility Income.
Fill in the Deceased oval on Line 19a of the PA-40. You must annualize the decedent’s income (see the instructions) and briefly describe your method:
1. Dependent’s Name Age
2.
Relationship Social Security No.
2. Number of dependent children.
Enter on Line 19b of your PA-40. . . . . . . .
Part C. Eligibility Income.
Married taxpayers filing jointly use Column A and Eligibility Income Married taxpayers filing separately, and taxpayers separated but not for the last
Table 2. Single filers, qualifying separated filers, and if filing for six months of the year use Columns B and C, and Eligibility Income Table 2.
a decedent use Column A and Eligibility Income Table 1.
Column A The Eligibility Income Tables are on page 36 of the PA-40 booklet.
Married Filing Separately
Unmarried or Married Column B Column C
Filing Jointly Taxpayer Spouse
1. PA taxable income from Line 9 of your PA-40 1.
2. Nontaxable interest, dividends and gains and/or annualized income 2.
3. Alimony 3.
4. Insurance proceeds and inheritances 4.
5. Gifts, awards and prizes 5.
6. Nonresident income – part-year residents and nonresidents 6.
7. Nontaxable military income – Do not include combat pay 7.
8. Gain excluded from the sale of a residence 8.
9. Nontaxable educational assistance 9.
10. Cash received for personal purposes from outside your home 10.
11. ÁTotal Eligibility Income for Column A
Total Eligibility Income for Columns B and C – add Lines 1 through 10 for each spouse and enter the total Ë 11.
Part D. Calculating your Tax Forgiveness Credit
12. PA Tax Liability from your PA-40, Line 12 (if amended return, see instructions) 12.
13. Less Resident Credit from your PA-40, Line 22 13.
14. Net PA Tax Liability. Subtract Line 13 from Line 12 14.
15. Percentage of Tax Forgiveness entered as a decimal from the Eligibility Income Table 15.
using your dependents from Part B and your Total Eligibility Income from Line 11
16. Tax Forgiveness Credit. Multiply Line 14 by the decimal on Line 15. 16.
Enter on your PA-40, Line 21.
Part A. Filing Status for Tax Forgiveness.
Part B. Dependent Children. Provide all the information for each dependent child. If more than four dependent children, submit additional sheets in this format.
IMPORTANT: Only claim the child or children that you
claimed as your dependent(s) on your 2014 Federal
Income Tax return.
Name of taxpayer claiming Tax Forgiveness (if filing a PA-40 jointly, enter the name shown first) Social Security Number (shown first)
Spouse’s Name (even if filing separately) Spouse’s Social Security Number
Eligibility Questions
1. Are you a dependent on another taxpayer’s (parent, guardian, step-parent, etc.) federal tax return? Yes No
2. If you answered “Yes” above, does the taxpayer on whose return you are a dependent qualify for tax forgiveness? Yes No
IMPORTANT: If you answered “No” to Question 1, please proceed with completing Schedule SP. If you answered “Yes to Question 1, you must also have answered
“Yes” to Question 2 to be eligible for tax forgiveness and complete Line 1b. or Line 3c. from Part A below.
SSN: Name:
SSN: Name:
ELIZABETH M LAW 205-48-9337
X
1
10,779
10,779
331
0
331
1.00
331
0
0
0
0
0
0
0
0
0
KENDRA E KINEG 18DAUGHTER 198-76-4256
1401110026
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0
0
0
0
1555
REV 09/03/14 INTUIT.CG.CFP.SP