Publication 536 - Net Operating Losses (Nols) For Individuals, Estates, And Trusts - 2011 Page 4
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191040
1040
2011
2011
Department of the Treasury—Internal Revenue Service
Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return
U.S. Individual Income Tax Return
OMB No. 1545-0074
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
IRS Use Only—Do not write or staple in this space.
See separate instructions.
See separate instructions.
For the year Jan. 1–Dec. 31, 2011, or other tax year beginning
For the year Jan. 1–Dec. 31, 2011, or other tax year beginning
, 2011, ending
, 2011, ending
, 20
, 20
Your rst name and initial
Your rst name and initial
Last name
Last name
Your social security number
Your social security number
765
00 4321
Glenn M.
Johnson
If a joint return, spouse’s rst name and initial
If a joint return, spouse’s rst name and initial
Last name
Last name
Spouse’s social security number
Spouse’s social security number
Apt. no.
Apt. no.
Home address (number and street). If you have a P.O. box, see instructions.
Home address (number and street). If you have a P.O. box, see instructions.
Make sure the SSN(s) above
Make sure the SSN(s) above
5603 E. Main Street
and on line 6c are correct.
and on line 6c are correct.
City, town or post of ce, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
City, town or post of ce, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Presidential Election Campaign
Presidential Election Campaign
Anytown, VA 20000
Check here if you, or your spouse if ling
Check here if you, or your spouse if ling
jointly, want $3 to go to this fund. Checking
jointly, want $3 to go to this fund. Checking
Foreign country name
Foreign country name
Foreign province/county
Foreign province/county
Foreign postal code
Foreign postal code
a box below will not change your tax or
a box below will not change your tax or
refund.
refund.
You
You
Spouse
Spouse
1
1
4
4
Single
Single
Head of household (with qualifying person). (See instructions.) If
Head of household (with qualifying person). (See instructions.) If
Filing Status
Filing Status
2
2
Married ling jointly (even if only one had income)
Married ling jointly (even if only one had income)
the qualifying person is a child but not your dependent, enter this
the qualifying person is a child but not your dependent, enter this
Check only one
Check only one
child’s name here.
child’s name here.
3
3
Married ling separately. Enter spouse’s SSN above
Married ling separately. Enter spouse’s SSN above
box.
box.
and full name here.
and full name here.
5
5
Qualifying widow(er) with dependent child
Qualifying widow(er) with dependent child
}
}
Boxes checked
Boxes checked
6a
6a
Yourself. If someone can claim you as a dependent, do not check box 6a .
Yourself. If someone can claim you as a dependent, do not check box 6a .
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Exemptions
Exemptions
1
on 6a and 6b
on 6a and 6b
b
b
Spouse
Spouse
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No. of children
No. of children
(4)
(4)
if child under age 17
if child under age 17
on 6c who:
on 6c who:
c
c
Dependents:
Dependents:
(2) Dependent’s
(2) Dependent’s
(3) Dependent’s
(3) Dependent’s
qualifying for child tax credit
qualifying for child tax credit
• lived with you
• lived with you
social security number
social security number
relationship to you
relationship to you
(1) First name
(1) First name
Last name
Last name
(see instructions)
(see instructions)
• did not live with
• did not live with
you due to divorce
you due to divorce
or separation
or separation
If more than four
If more than four
(see instructions)
(see instructions)
dependents, see
dependents, see
Dependents on 6c
Dependents on 6c
instructions and
instructions and
not entered above
not entered above
check here
check here
Add numbers on
Add numbers on
1
d
d
Total number of exemptions claimed
Total number of exemptions claimed
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lines above
lines above
1,225
7
7
7
7
Wages, salaries, tips, etc. Attach Form(s) W-2
Wages, salaries, tips, etc. Attach Form(s) W-2
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Income
Income
8a
8a
Taxable interest. Attach Schedule B if required .
Taxable interest. Attach Schedule B if required .
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8a
8a
425
b
b
Tax-exempt interest. Do not include on line 8a .
Tax-exempt interest. Do not include on line 8a .
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8b
8b
Attach Form(s)
Attach Form(s)
9 a
9 a
Ordinary dividends. Attach Schedule B if required
Ordinary dividends. Attach Schedule B if required
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9a
9a
W-2 here. Also
W-2 here. Also
b
b
9b
9b
Quali ed dividends
Quali ed dividends
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attach Forms
attach Forms
W-2G and
W-2G and
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10
Taxable refunds, credits, or offsets of state and local income taxes
Taxable refunds, credits, or offsets of state and local income taxes
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10
10
1099-R if tax
1099-R if tax
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11
Alimony received .
Alimony received .
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11
was withheld.
was withheld.
(5,000)
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12
Business income or (loss). Attach Schedule C or C-EZ .
Business income or (loss). Attach Schedule C or C-EZ .
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12
*
1,000
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13
Capital gain or (loss). Attach Schedule D if required. If not required, check here
Capital gain or (loss). Attach Schedule D if required. If not required, check here
If you did not
If you did not
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14
Other gains or (losses). Attach Form 4797 .
Other gains or (losses). Attach Form 4797 .
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get a W-2,
get a W-2,
15 a
15 a
IRA distributions
IRA distributions
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15a
15a
b Taxable amount
b Taxable amount
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15b
15b
see instructions.
see instructions.
16 a
16 a
Pensions and annuities
Pensions and annuities
16a
16a
b Taxable amount
b Taxable amount
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16b
16b
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Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
Enclose, but do
Enclose, but do
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Farm income or (loss). Attach Schedule F .
Farm income or (loss). Attach Schedule F .
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not attach, any
not attach, any
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Unemployment compensation .
Unemployment compensation .
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payment. Also,
payment. Also,
20 a
20 a
Social security bene ts
Social security bene ts
20a
20a
b Taxable amount
b Taxable amount
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20b
20b
please use
please use
Form 1040-V.
Form 1040-V.
21
21
Other income. List type and amount
Other income. List type and amount
21
21
(2,350)
22
22
Combine the amounts in the far right column for lines 7 through 21. This is your total income
Combine the amounts in the far right column for lines 7 through 21. This is your total income
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23
23
Educator expenses
Educator expenses
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23
23
Adjusted
Adjusted
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24
Certain business expenses of reservists, performing artists, and
Certain business expenses of reservists, performing artists, and
Gross
Gross
fee-basis government of cials. Attach Form 2106 or 2106-EZ
fee-basis government of cials. Attach Form 2106 or 2106-EZ
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24
Income
Income
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25
25
25
Health savings account deduction. Attach Form 8889
Health savings account deduction. Attach Form 8889
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26
Moving expenses. Attach Form 3903 .
Moving expenses. Attach Form 3903 .
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26
27
27
Deductible part of self-employment tax. Attach Schedule SE .
Deductible part of self-employment tax. Attach Schedule SE .
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27
28
28
Self-employed SEP, SIMPLE, and quali ed plans
Self-employed SEP, SIMPLE, and quali ed plans
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28
28
29
29
29
29
Self-employed health insurance deduction
Self-employed health insurance deduction
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30
Penalty on early withdrawal of savings .
Penalty on early withdrawal of savings .
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31 a
31 a
Alimony paid
Alimony paid
b Recipient’s SSN
b Recipient’s SSN
31a
31a
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32
IRA deduction .
IRA deduction .
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Student loan interest deduction .
Student loan interest deduction .
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Tuition and fees. Attach Form 8917 .
Tuition and fees. Attach Form 8917 .
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35
Domestic production activities deduction. Attach Form 8903
Domestic production activities deduction. Attach Form 8903
35
35
36
36
Add lines 23 through 35 .
Add lines 23 through 35 .
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36
36
(2,350)
37
37
Subtract line 36 from line 22. This is your adjusted gross income
Subtract line 36 from line 22. This is your adjusted gross income
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37
1040
1040
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Form
Form
(2011)
(2011)
Cat. No. 11320B
Cat. No. 11320B
* Net capital gain ($2,000 less $1,000 loss)
Publication 536 (2011)
Page 4
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