Schedule M (Form 1040a Or 1040) - Making Work Pay And Government Retiree Credits - 2009 Page 2

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SCHEDULE M
OMB No. 1545-0074
Making Work Pay and Government
(Form 1040A or 1040)
2009
Retiree Credits
Attachment
Department of the Treasury
Attach to Form 1040A, 1040, or 1040NR.
See separate instructions.
166
(99)
Sequence No.
Internal Revenue Service
Name(s) shown on return
Your social security number
1a
Important: See the instructions if you can be claimed as someone else’s dependent, you have a net loss
from a business, your wages include pay for work performed while an inmate in a penal institution, or you
are filing Form 1040NR, 2555, or 2555-EZ. Residents of Puerto Rico or American Samoa, see Pub. 570.
Do you (and your spouse if filing jointly) have 2009 wages of more than $6,451 ($12,903 if
married filing jointly)?
Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly) on line 4 and go to line 5.
1a
No. Enter your earned income (see instructions)
b
Nontaxable combat pay included on
1b
line 1a (see instructions)
2
2
Multiply line 1a by 6.2% (.062)
3
3
Enter $400 ($800 if married filing jointly)
4
4
Enter the smaller of line 2 or line 3 (unless you checked “Yes” on line 1a)
5
5
Enter the amount from Form 1040, line 38*, or Form 1040A, line 22
6
6
Enter $75,000 ($150,000 if married filing jointly)
7
Is the amount on line 5 more than the amount on line 6?
No. Skip line 8. Enter the amount from line 4 on line 9 below.
7
Yes. Subtract line 6 from line 5
8
8
Multiply line 7 by 2% (.02)
9
9
Subtract line 8 from line 4. If zero or less, enter -0-
10
Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2009? You
may have received this payment if you received social security benefits, supplemental security
income, railroad retirement benefits, or veterans disability compensation or pension benefits (see
instructions).
No. Enter -0- on line 10 and go to line 11.
10
Yes. Enter the total of the payments received by you (and your spouse, if filing
jointly). Do not enter more than $250 ($500 if married filing jointly)
11
Did you (or your spouse, if filing jointly) receive a pension or annuity in 2009 for services performed
as an employee of the U.S. Government or any U.S. state or local government from work not
covered by social security? Do not include any pension or annuity reported on Form W-2.
No. Enter -0- on line 11 and go to line 12.
Yes.
If you checked “No” on line 10, enter $250 ($500 if married filing jointly
and the answer on line 11 is “Yes” for both spouses)
11
If you checked “Yes” on line 10, enter -0- (exception: enter $250 if filing
jointly and the spouse who received the pension or annuity did not receive
an economic recovery payment described on line 10)
12
12
Add lines 10 and 11
13
13
Subtract line 12 from line 9. If zero or less, enter -0-
14
Making work pay and government retiree credits. Add lines 11 and 13. Enter the result here
14
and on Form 1040, line 63; Form 1040A, line 40; or Form 1040NR, line 60
*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions.
For Paperwork Reduction Act Notice, see Form 1040A, 1040, or
Schedule M (Form 1040A or 1040) 2009
Cat. No. 52903Q
1040NR instructions.

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