Form 1040a - U.s. Individual Income Tax Return - 2016 Page 2
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22
Form 1040A (2017)
Page
22
Enter the amount from line 21 (adjusted gross income).
22
Tax, credits,
{
}
Total boxes
23 a Check
You were born before January 2, 1953,
Blind
and
if:
Spouse was born before January 2, 1953,
Blind
checked
23a
▶
payments
b If you are married filing separately and your spouse itemizes
deductions, check here
23b
Standard
▶
Deduction
24
Enter your standard deduction.
24
for—
25
Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-.
25
• People who
check any
26
Exemptions. Multiply $4,050 by the number on line 6d.
26
box on line
23a or 23b or
27
Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
who can be
This is your taxable income.
27
claimed as a
▶
dependent,
28
Tax, including any alternative minimum tax (see instructions). 28
see
instructions.
29
Excess advance premium tax credit repayment. Attach
• All others:
Form 8962.
29
Single or
30
Add lines 28 and 29.
30
Married filing
separately,
31
Credit for child and dependent care expenses. Attach
$6,350
Form 2441.
31
Married filing
jointly or
32
Credit for the elderly or the disabled. Attach
Qualifying
widow(er),
Schedule R.
32
$12,700
33
Education credits from Form 8863, line 19.
33
Head of
household,
34
Retirement savings contributions credit. Attach Form 8880. 34
$9,350
35
Child tax credit. Attach Schedule 8812, if required.
35
36
Add lines 31 through 35. These are your total credits.
36
37
Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-.
37
Health care: individual responsibility (see instructions). Full-year coverage
38
38
39
Add line 37 and line 38. This is your total tax.
39
40
Federal income tax withheld from Forms W-2 and 1099. 40
41
2017 estimated tax payments and amount applied
If you have
from 2016 return.
41
a qualifying
child, attach
42a Earned income credit (EIC).
42a
Schedule
b Nontaxable combat pay election. 42b
EIC.
43
Additional child tax credit. Attach Schedule 8812.
43
44
American opportunity credit from Form 8863, line 8.
44
45
Net premium tax credit. Attach Form 8962.
45
46
Add lines 40, 41, 42a, 43, 44, and 45. These are your total payments.
46
▶
47
If line 46 is more than line 39, subtract line 39 from line 46.
Refund
This is the amount you overpaid.
47
48a Amount of line 47 you want refunded to you. If Form 8888 is attached, check here
48a
▶
Direct
deposit?
b Routing
c Type:
Checking
Savings
See
▶
▶
number
instructions
and fill in
d Account
48b, 48c,
▶
number
and 48d or
Form 8888.
49
Amount of line 47 you want applied to your
2018 estimated tax.
49
50
Amount you owe. Subtract line 46 from line 39. For details on how to pay,
Amount
see instructions.
50
▶
you owe
51
Estimated tax penalty (see instructions).
51
Third party
Yes. Complete the following.
No
Do you want to allow another person to discuss this return with the IRS (see instructions)?
designee
Designee’s
Phone
Personal identification
name
no.
number (PIN)
▶
▶
▶
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign
and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other
than the taxpayer) is based on all information of which the preparer has any knowledge.
here
Your occupation
Daytime phone number
Your signature
Date
Joint return?
See instructions.
Spouse’s signature. If a joint return, both must sign.
Spouse’s occupation
If the IRS sent you an Identity Protection
Date
Keep a copy
PIN, enter it
for your records.
here (see inst.)
Paid
Print/Type preparer’s name
Preparer’s signature
Date
PTIN
Check
if
▶
self-employed
preparer
Firm’s name
Firm’s EIN
▶
▶
use only
Firm’s address
Phone no.
▶
1040A
Go to for instructions and the latest information.
Form
(2017)
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