2017 Form 1040A NOR FOUND ENC SIWP F1040a

User Manual: NOR FOUND ENC-SIWP

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Form

1040A

Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return (99)

2017

IRS Use Only—Do not write or staple in this space.

Your first name and initial

Last name

OMB No. 1545-0074
Your social security number

If a joint return, spouse’s first name and initial

Last name

Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions.

Apt. no.

▲

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Foreign country name

Filing
status
Check only
one box.

Exemptions

Foreign province/state/county

1
2
3
6a
b
c

If more than six
dependents, see
instructions.

Make sure the SSN(s) above
and on line 6c are correct.

Presidential Election Campaign
Foreign postal code

Check here if you, or your spouse if
filing jointly, want $3 to go to this fund.
Checking a box below will not change your
tax or refund.
You
Spouse

Single
4
Head of household (with qualifying person). (See instructions.)
Married filing jointly (even if only one had income)
If the qualifying person is a child but not your dependent,
Married filing separately. Enter spouse’s SSN above and
enter this child’s name here. ▶
▶
full name here.
5
Qualifying widow(er) (see instructions)
Boxes
Yourself. If someone can claim you as a dependent, do not check
checked on
box 6a.
6a and 6b
No. of children
Spouse
on 6c who:
(4) ✓ if child under
Dependents:
• lived with
(3) Dependent’s

}

(1) First name

Last name

(2) Dependent’s social
security number

relationship to you

age 17 qualifying for
child tax credit (see
instructions)

you

• did not live
with you due to
divorce or
separation (see
instructions)
Dependents
on 6c not
entered above
Add numbers
on lines
above ▶

d Total number of exemptions claimed.

Income
Attach
Form(s) W-2
here. Also
attach
Form(s)
1099-R if
tax was
withheld.
If you did not
get a W-2, see
instructions.

Adjusted
gross
income

7

Wages, salaries, tips, etc. Attach Form(s) W-2.

7

8a
b
9a
b
10
11a

Taxable interest. Attach Schedule B if required.
Tax-exempt interest. Do not include on line 8a. 8b
Ordinary dividends. Attach Schedule B if required.
Qualified dividends (see instructions).
9b
Capital gain distributions (see instructions).
IRA
11b Taxable amount
distributions.
11a
(see instructions).
12a Pensions and
12b Taxable amount
annuities.
12a
(see instructions).

8a
9a
10
11b
12b

13 Unemployment compensation and Alaska Permanent Fund dividends.
14a Social security
14b Taxable amount
benefits.
14a
(see instructions).

14b

15

Add lines 7 through 14b (far right column). This is your total income.

15

16
17
18

Educator expenses (see instructions).
IRA deduction (see instructions).
Student loan interest deduction (see instructions).

19
20

Tuition and fees. Attach Form 8917.
19
Add lines 16 through 19. These are your total adjustments.

21

Subtract line 20 from line 15. This is your adjusted gross income.

13

▶

16
17
18

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

20
▶

21

Cat. No. 11327A

Form 1040A (2017)

Page 2

Form 1040A (2017)

Tax, credits, 22 Enter the amount from line 21 (adjusted gross income).
You were born before January 2, 1953,
Blind Total boxes
23a Check
and
Spouse
was
born
before
January
2,
1953,
Blind checked ▶ 23a
if:
payments

{

Standard
Deduction
for—
• People who
check any
box on line
23a or 23b or
who can be
claimed as a
dependent,
see
instructions.
• All others:
Single or
Married filing
separately,
$6,350
Married filing
jointly or
Qualifying
widow(er),
$12,700
Head of
household,
$9,350

If you have
a qualifying
child, attach
Schedule
EIC.

Refund
Direct
deposit?
See
instructions
and fill in
48b, 48c,
and 48d or
Form 8888.

Amount
you owe

Paid
preparer
use only

Do you want to allow another person to discuss this return with the IRS (see instructions)?
Designee’s
name

▲

Joint return?
See instructions.
Keep a copy
for your records.

}

b If you are married filing separately and your spouse itemizes
▶ 23b
deductions, check here
24 Enter your standard deduction.
25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-.
26 Exemptions. Multiply $4,050 by the number on line 6d.
27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
▶
This is your taxable income.
28 Tax, including any alternative minimum tax (see instructions). 28
29 Excess advance premium tax credit repayment. Attach
Form 8962.
29
30 Add lines 28 and 29.
31 Credit for child and dependent care expenses. Attach
Form 2441.
31
32 Credit for the elderly or the disabled. Attach
Schedule R.
32
33 Education credits from Form 8863, line 19.
33
34 Retirement savings contributions credit. Attach Form 8880. 34
35 Child tax credit. Attach Schedule 8812, if required.
35
36 Add lines 31 through 35. These are your total credits.
37 Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-.
38 Health care: individual responsibility (see instructions). Full-year coverage
39 Add line 37 and line 38. This is your total tax.
40 Federal income tax withheld from Forms W-2 and 1099. 40
41 2017 estimated tax payments and amount applied
from 2016 return.
41
42a Earned income credit (EIC).
42a
b Nontaxable combat pay election. 42b
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.
47 If line 46 is more than line 39, subtract line 39 from line 46.
This is the amount you overpaid.
48a Amount of line 47 you want refunded to you. If Form 8888 is attached, check here ▶
Routing
▶ c Type:
Checking
Savings
▶ b
number
Account
▶ d
number
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,
▶
see instructions.
51 Estimated tax penalty (see instructions).
51

Third party
designee
Sign
here

22

Phone
no.

▶

24
25
26
27

30

36
37
38
39

46
47
48a

50

Yes. Complete the following.

No

Personal identification
▶
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
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.
Your signature
Date
Your occupation
Daytime phone number
Spouse’s signature. If a joint return, both must sign.
Print/Type preparer’s name

Date

Preparer’s signature

Spouse’s occupation
Date

If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)
Check ▶
if PTIN
self-employed

Firm’s name

Firm’s EIN ▶

▶

Firm’s address

▶

Go to www.irs.gov/Form1040A for instructions and the latest information.

Phone no.
Form 1040A (2017)



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Title                           : 2017 Form 1040A
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Subject                         : U.S. Individual Income Tax Return

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