Form 1040a - U.s. Individual Income Tax Return - 2012 Page 2
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22
Form 1040A (2012)
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, 1948,
Blind
and
if:
Spouse was born before January 2, 1948,
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 $3,800 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
Credit for child and dependent care expenses. Attach
• All others:
Form 2441.
29
Single or
30
Credit for the elderly or the disabled. Attach
Married filing
separately,
Schedule R.
30
$5,950
31
Education credits from Form 8863, line 19.
31
Married filing
jointly or
32
Retirement savings contributions credit. Attach
Qualifying
widow(er),
Form 8880.
32
$11,900
33
Child tax credit. Attach Schedule 8812, if required.
33
Head of
household,
34
Add lines 29 through 33. These are your total credits.
34
$8,700
35
Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. This is
your total tax.
35
36
Federal income tax withheld from Forms W-2 and
1099.
36
37
2012 estimated tax payments and amount applied
If you have
from 2011 return.
37
a qualifying
child, attach
38a Earned income credit (EIC).
38a
Schedule
b Nontaxable combat pay
EIC.
election.
38b
39
Additional child tax credit. Attach Schedule 8812.
39
40
American opportunity credit from Form 8863, line 8.
40
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
This is the amount you overpaid.
42
43a Amount of line 42 you want refunded to you. If Form 8888 is attached, check here
43a
▶
Direct
deposit?
b Routing
c Type:
Checking
Savings
See
▶
▶
number
instructions
and fill in
d Account
43b, 43c,
▶
number
and 43d or
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 to pay,
Amount
see instructions.
45
▶
you owe
46
Estimated tax penalty (see instructions).
46
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.
Date
Spouse’s occupation
If the IRS sent you an Identity Protection
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
Form
(2012)
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