Publication 517 - Social Security And Other Information For Members Of The Clergy And Religious Workers - 2011 Page 16

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2
Form 1040 (2011)
Page
35,282
38
Amount from line 37 (adjusted gross income)
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38
Tax and
}
{
39a
You were born before January 2, 1947,
Blind.
Check
Total boxes
Credits
if:
Spouse was born before January 2, 1947,
Blind.
checked
39a
If your spouse itemizes on a separate return or you were a dual-status alien, check here
b
39b
Standard
Deduction
12,781
40
Itemized deductions (from Schedule A) or your standard deduction (see left margin)
40
.
.
for—
22,501
41
Subtract line 40 from line 38
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41
• People who
check any
11,100
42
Exemptions. Multiply $3,700 by the number on line 6d .
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42
box on line
39a or 39b or
11,401
43
Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- .
.
43
who can be
1,143
claimed as a
44
Tax (see instructions). Check if any from: a
Form(s) 8814 b
Form 4972 c
962 election
44
dependent,
45
Alternative minimum tax (see instructions). Attach Form 6251 .
45
.
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.
see
instructions.
1,143
46
Add lines 44 and 45 .
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46
• All others:
47
Foreign tax credit. Attach Form 1116 if required .
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47
Single or
48
48
Married ling
Credit for child and dependent care expenses. Attach Form 2441
separately,
49
Education credits from Form 8863, line 23
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49
$5,800
50
Retirement savings contributions credit. Attach Form 8880
50
Married ling
jointly or
1,000
51
Child tax credit (see instructions) .
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51
Qualifying
widow(er),
52
Residential energy credits. Attach Form 5695
.
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.
52
$11,600
53
Other credits from Form: a
3800 b
8801
c
53
Head of
household,
1,000
54
Add lines 47 through 53. These are your total credits .
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54
$8,500
143
55
Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-
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55
5,373
56
56
Other
Self-employment tax. Attach Schedule SE
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57
Unreported social security and Medicare tax from Form:
a
4137
b
8919
.
.
57
Taxes
58
58
Additional tax on IRAs, other quali ed retirement plans, etc. Attach Form 5329 if required
.
.
59a
Household employment taxes from Schedule H
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59a
b
59b
First-time homebuyer credit repayment. Attach Form 5405 if required .
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60
60
Other taxes. Enter code(s) from instructions
5,516
61
Add lines 55 through 60. This is your total tax
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61
Payments
62
Federal income tax withheld from Forms W-2 and 1099
.
.
62
272
63
63
7,000
2011 estimated tax payments and amount applied from 2010 return
If you have a
64a
Earned income credit (EIC)
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.
64a
qualifying
b
Nontaxable combat pay election
64b
child, attach
Schedule EIC.
65
Additional child tax credit. Attach Form 8812
.
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.
65
66
American opportunity credit from Form 8863, line 14
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.
66
67
67
First-time homebuyer credit from Form 5405, line 10 .
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68
Amount paid with request for extension to le
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68
69
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.
69
Excess social security and tier 1 RRTA tax withheld
70
70
Credit for federal tax on fuels. Attach Form 4136
.
.
.
.
71
Credits from Form: a
2439 b
8839 c
8801 d
8885
71
7,272
72
Add lines 62, 63, 64a, and 65 through 71. These are your total payments .
.
.
.
.
72
Refund
1,756
73
If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid
73
74a
Amount of line 73 you want refunded to you. If Form 8888 is attached, check here
.
74a
b
c Type:
Routing number
Checking
Savings
Direct deposit?
See
d
Account number
instructions.
1,756
75
75
Amount of line 73 you want applied to your 2012 estimated tax
Amount
76
Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions
76
You Owe
77
Estimated tax penalty (see instructions)
.
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.
77
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete below.
No
Third Party
Designee
Designee’s
Phone
Personal identi cation
name
no.
number (PIN)
Sign
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
Here
they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature
Date
Your occupation
Daytime phone number
Joint return? See
John E. White
3/1/2012
Minister
instructions.
Keep a copy for
Spouse’s signature. If a joint return, both must sign.
Date
Spouse’s occupation
If the IRS sent you an Identity Protection
your records.
PIN, enter it
Susan R. White
3/1/2012
Homemaker
here (see inst.)
Print/Type preparer’s name
PTIN
Preparer’s signature
Date
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
Firm’s address
Phone no.
1040
Form
(2011)
Publication 517 (2011)
Page 16

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