Form 1npr Draft - Nonresident & Part-Year Resident Wisconsin Income Tax - 2012 Page 10
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18Form 1040A (2012)
SINGLE PARENT
600-00-1002
Page 2
20,000.
20,000
Tax, credits,
22
Enter the amount from line 21 (adjusted gross income).
22
and
23a
Check
You were born before January 2, 1948,
Blind
Total boxes
payments
if:
Spouse was born before January 2, 1948,
Blind
checked
23a
Standard
b
If you are married filing separately and your spouse itemizes
Deduction
deductions, check here
23b
for -
8,700.
8,700
24
Enter your standard deduction.
24
People who
11,300.
11,300
check any
25
Subtract line 24 from line 22. If line 24 is more than line 22, enter - 0- .
25
box on line
7,600
7,600.
26
Exemptions. Multiply $3,800 by the number on line 6d.
26
23a or 23b
or who can
27
Subtract line 26 from line 25. If line 26 is more than line 25, enter - 0- .
be claimed as
3,700
3,700.
This is your taxable income.
27
a dependent,
373
373.
see instr.
28
Tax, including any alternative minimum tax
28
(see inst ruct ions).
373.
373
All others:
29
Credit for child and dependent care expenses. Attach Form 2441.
29
Single or
30
Credit for the elderly or the disabled. Attach
M arried f iling
Schedule R.
30
separat ely,
$5,950
31
Education credits from Form 8863, line 19.
31
M arried f iling
32
Retirement savings contributions credit. Attach Form 8880.
32
joint ly or
Qualif ying
33
Child tax credit.
Attach Sch 8812 if required.
33
w id ow (er),
373
$11,900
373.
34
Add lines 29 through 33. These are your total credits.
34
H ead of
35
Subtract line 34 from line 28. If line 34 is more than line 28, enter - 0- . This is
h ouseh old ,
$8,700
0
0.
your total tax.
35
3,600.
3,600
36
Federal income tax withheld from Forms W- 2 and 1099.
36
37
2012 estimated tax payments and amount
applied from 2011 return.
If you have
37
a qualifying
2,700
2,700.
38a
Earned income credit (EIC).
38a
child, attach
b Nontaxable combat pay election.
38b
Schedule EIC.
1,000
1,000.
39
Additional child tax credit. Attach Schedule 8812.
39
40
American opportunity credit from Form 8863, line 8.
40
7,300
7,300.
41
Add lines 36, 37, 38a, 39, and 40. These are your total payments.
41
42
If line 41 is more than line 35, subtract line 35 from line 41.
Refund
7,300
7,300.
This is the amount you overpaid.
42
7,300.
7,300
43a
Amount of line 42 you want refunded to you. If Form 8888 is attached, check here
43a
Direct
deposit?
b
Routing
See instructions
number
c
Type:
Checking
Savings
and fill in
43b, 43c,
d
Account
and 43d or
number
Form 8888.
44
Amount of line 42 you want applied to your
2013 estimated tax.
44
45
Amount you owe. Subtract line 41 from line 35. For details on how
Amount
to pay, see instructions.
45
you owe
Estimated tax penalty
46
46
(see inst ruct ions).
✔
X
Do you want to allow another person to discuss this return with the IRS
Yes.
Complete the following.
No
(see inst ruct ions)?
Third party
Designee's name
Phone no.
Personal ID number
designee
(PIN)
Und er penalt ies of perjury, I d eclare t h at I h ave examined t h is ret urn and accompanying sch ed ules and st at ement s, and t o t h e b est of my
Sign
know led ge and b elief , t h ey are t rue, correct , and accurat ely list all amount s and sources of income I received d uring t h e t ax year. D eclarat ion
of preparer (ot h er t h an t h e t axpayer) is b ased on all inf ormat ion of w h ich t h e preparer h as any know led ge.
here
Your signature
Date
Your occupation
Daytime phone number
Joint return?
clerk
123-45-6789
See inst ruct ions.
For Info Only-Do not file
CLERK
Keep a copy
If t h e IRS sent y ou an ID Prot ect ion
Spouse's signature. If a joint return, both must sign. Date
Spouse's occupation
PIN, ent er it h ere (see inst .)
for your
For Info Only-Do not file
records.
Print/type preparer's name
Preparer's signature
Date
PTIN
Check
if
Paid
P13333333
09/17/2012
Michele Taxpro
self- employed
MICHELE TAXPRO
09/17/2012
P13333333
preparer
44-0607856
H AND R BLOCK
44-0607856
H & R Block
Firm's name
Firm's EIN
use only
Dublin, OH 43017
DUBLIN, OH 43017
(614) 659-1158
614
659-1158
Firm's address
Phone no.
Form 1040A (2012)
1040A (2012)
FD1040A- 2 (DRAFT FORM)
Form Sof t w are Copyrigh t 1996 - 2013 H RB Tax Group, Inc. 1.18- 15.2
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