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Your name:
Your SSN or ITIN:
Whole
only
dollars
Taxable
Income and
Credits
9 Total wages (federal Form W-2, box 16). See instructions. . . . . . . . . . . . . . . . . .
9
,
.
00
10 Total interest income (Form 1099-INT, box 1). See instructions. . . . . . . . . . . . . .
10
,
00
.
11 Total dividend income (Form 1099-DIV, box 1a). See instructions. . . . . . . . . . . .
11
,
00
.
12 Total pension income
. See instructions. Taxable amount. . . . . . . . .
12
,
.
00
13 Total capital gains distributions from mutual funds (Form 1099-DIV, box 2a).
Enclose, but do
See instructions.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
,
00
.
not staple, any
payment.
14 Unemployment compensation . . . . . . . . . . . 14
,
00
.
15
15
,
U.S. social security or railroad retirement benefits..
00
.
16 Add line 9, line 10, line 11, line 12, and line 13. Do not include
line 14 and line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
,
00
.
17 Using the 2EZ Table for your filing status, enter the tax for the amount on line 16.
Caution: If you checked the box on line 6, STOP. See instructions for
completing the Dependent Tax Worksheet.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
,
00
.
18 Senior exemption: See instructions. If you are 65 or older and entered 1 in the
box on line 7, enter $108. If you entered 2 in the box on line 7, enter $216 . . . . . 18
00
.
19 Nonrefundable renter’s credit. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . .
19
.
00
20 Credits. Add line 18 and line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
00
.
21 Tax. Subtract line 20 from line 17. If zero or less, enter -0- . . . . . . . . . . . . . . . . .
21
,
.
00
Overpaid
22 Total tax withheld (federal Form W-2, box 17
Tax/
or Form 1099-R, box 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
,
00
.
Tax Due
.
23 Overpaid tax. If line 22 is more than line 21, subtract line 21 from line 22. . . . . .
23
,
00
.
24 Tax due. If line 22 is less than line 21, subtract line 22 from line 21.
See instructions.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
,
00
.
This space reserved for 2D barcode
Side 2
Form 540 2EZ
2014
C1
3112143