Department of the Treasury—Internal Revenue Service
Income Tax Return for Single and
Form
2011
1040EZ
Joint Filers With No Dependents
(99)
OMB No. 1545-0074
Your first name and initial
Last name
Your social security number
Spouse’s social security number
If a joint return, spouse’s first name and initial
Last name
Home address (number and street). If you have a P.O. box, see instructions.
Apt. no.
Make sure the SSN(s)
▲
above 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 Campaign
Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign country name
Foreign province/county
Foreign postal code
a box below will not change your tax or
refund.
You
Spouse
1
Wages, salaries, and tips. This should be shown in box 1 of your Form(s) W-2.
Income
Attach your Form(s) W-2.
1
Attach
Form(s) W-2
2
2
Taxable interest. If the total is over $1,500, you cannot use Form 1040EZ.
here.
Enclose, but do
3
3
Unemployment compensation and Alaska Permanent Fund dividends (see instructions).
not attach, any
payment.
4
Add lines 1, 2, and 3. This is your adjusted gross income.
4
5
If someone can claim you (or your spouse if a joint return) as a dependent, check
the applicable box(es) below and enter the amount from the worksheet on back.
You
Spouse
If no one can claim you (or your spouse if a joint return), enter $9,500 if single;
$19,000 if married filing jointly. See back for explanation.
5
6
Subtract line 5 from line 4. If line 5 is larger than line 4, enter -0-.
This is your taxable income.
6
▶
7
Federal income tax withheld from Form(s) W-2 and 1099.
7
Payments,
8a
Earned income credit (EIC) (see instructions).
8a
Credits,
b Nontaxable combat pay election.
8b
and Tax
9
9
Add lines 7 and 8a. These are your total payments and credits.
▶
10
Tax. Use the amount on line 6 above to find your tax in the tax table in the
instructions. Then, enter the tax from the table on this line.
10
11a
If line 9 is larger than line 10, subtract line 10 from line 9. This is your refund.
Refund
If Form 8888 is attached, check here
11a
▶
Have it directly
deposited! See
b Routing number
c Type:
▶
Checking
Savings
instructions and
▶
fill in 11b, 11c,
and 11d or
d Account number
▶
Form 8888.
12
Amount
If line 10 is larger than line 9, subtract line 9 from line 10. This is
You Owe
the amount you owe. For details on how to pay, see instructions.
12
▶
Yes. Complete below.
No
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Third Party
Designee
Designee’s
Phone
Personal identification
name
no.
number (PIN)
▶
▶
▶
Sign
Under penalties of perjury, I declare that I have examined this return and, to the best of my knowledge and belief, it is true, correct, and
accurately lists all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based
Here
on all information of which the preparer has any knowledge.
Daytime phone number
Your signature
Date
Your occupation
Joint return? See
instructions.
Spouse’s occupation
Spouse’s signature. If a joint return, both must sign.
Date
If the IRS sent you an Identity Protection
Keep a copy for
PIN, enter it
your records.
here (see inst.)
Print/Type preparer’s name
Preparer’s signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
▶
▶
Firm’s address
Phone no.
▶
1040EZ
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
Cat. No. 11329W
Form
(2011)