Form 1040 - U.s. Individual Income Tax Return - 2009 Page 2
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31040
2009
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.
Label
For the year Jan. 1–Dec. 31, 2009, or other tax year beginning
, 2009, ending
, 20
OMB No. 1545-0074
Last name
Your first name and initial
Your social security number
L
A
(See
B
instructions
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
E
on page 14.)
L
Use the IRS
label.
Home address (number and street). If you have a P.O. box, see page 14.
Apt. no.
H
You must enter
E
Otherwise,
your SSN(s) above.
R
please print
City, town or post office, state, and ZIP code. If you have a foreign address, see page 14.
E
Checking a box below will not
or type.
change your tax or refund.
Presidential
You
Spouse
Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 14)
Election Campaign
1
4
Single
Head of household (with qualifying person). (See page 15.) If the
Filing Status
2
Married filing jointly (even if only one had income)
qualifying person is a child but not your dependent, enter this
Check only one
child’s name here.
3
Married filing separately. Enter spouse’s SSN above
box.
and full name here.
5
Qualifying widow(er) with dependent child (see page 16)
Boxes checked
6a
Yourself. If someone can claim you as a dependent, do not check box 6a .
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Exemptions
on 6a and 6b
b
Spouse
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No. of children
Dependents:
on 6c who:
c
(4)
if qualifying
(2) Dependent’s
(3) Dependent’s
● lived with you
child for child tax
social security number
relationship to you
(1) First name
Last name
credit (see page 17)
● did not live with
you due to divorce
or separation
If more than four
(see page 18)
dependents, see
Dependents on 6c
not entered above
page 17 and
check here
Add numbers on
d
Total number of exemptions claimed
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lines above
7
7
Wages, salaries, tips, etc. Attach Form(s) W-2
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Income
8a
Taxable interest. Attach Schedule B if required .
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8a
b
Tax-exempt interest. Do not include on line 8a .
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8b
Attach Form(s)
9 a
9a
Ordinary dividends. Attach Schedule B if required
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W-2 here. Also
b
Qualified dividends (see page 22)
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9b
attach Forms
W-2G and
10
Taxable refunds, credits, or offsets of state and local income taxes (see page 23) .
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10
1099-R if tax
11
11
Alimony received .
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was withheld.
12
12
Business income or (loss). Attach Schedule C or C-EZ .
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13
Capital gain or (loss). Attach Schedule D if required. If not required, check here
13
If you did not
14
Other gains or (losses). Attach Form 4797 .
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14
get a W-2,
15 a
15a
b Taxable amount (see page 24)
15b
IRA distributions .
see page 22.
16 a
Pensions and annuities
16a
b Taxable amount (see page 25)
16b
17
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
17
Enclose, but do
18
18
Farm income or (loss). Attach Schedule F .
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not attach, any
19
Unemployment compensation in excess of $2,400 per recipient (see page 27) .
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19
payment. Also,
20 a
Social security benefits
20a
b Taxable amount (see page 27)
20b
please use
Form 1040-V.
21
21
Other income. List type and amount (see page 29)
22
Add the amounts in the far right column for lines 7 through 21. This is your total income
22
23
Educator expenses (see page 29) .
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23
Adjusted
24
Certain business expenses of reservists, performing artists, and
Gross
24
fee-basis government officials. Attach Form 2106 or 2106-EZ
Income
25
Health savings account deduction. Attach Form 8889
.
25
26
Moving expenses. Attach Form 3903 .
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26
27
27
One-half of self-employment tax. Attach Schedule SE .
28
Self-employed SEP, SIMPLE, and qualified plans
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28
29
Self-employed health insurance deduction (see page 30)
29
30
30
Penalty on early withdrawal of savings .
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31 a
b Recipient’s SSN
31a
Alimony paid
32
IRA deduction (see page 31)
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32
33
33
Student loan interest deduction (see page 34)
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34
34
Tuition and fees deduction. Attach Form 8917
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35
Domestic production activities deduction. Attach Form 8903
35
36
Add lines 23 through 31a and 32 through 35 .
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36
37
Subtract line 36 from line 22. This is your adjusted gross income
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37
1040
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 97.
Form
(2009)
Cat. No. 11320B
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