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Form
1040
Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return
2009
(99)
IRS Use Only—Do not write or staple in this space.
Label
(See
instructions
on page 14.)
Use the IRS
label.
Otherwise,
please print
or type.
For the year Jan. 1–Dec. 31, 2009, or other tax year beginning , 2009, ending
, 20
OMB No. 1545-0074
Your first name and initial
Last name
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 page 14.
Apt. no.
¶
You must enter
your SSN(s) above.
¶
City, town or post office, state, and ZIP code. If you have a foreign address, see page 14.
Checking a box below will not
change your tax or refund.
Presidential
Election Campaign
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Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 14)
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You Spouse
Filing Status
Check only one
box.
1
Single
2
Married filing jointly (even if only one had income)
3
Married filing separately. Enter spouse’s SSN above
and full name here.
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4
Head of household (with qualifying person). (See page 15.) If the
qualifying person is a child but not your dependent, enter this
child’s name here.
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5
Qualifying widow(er) with dependent child (see page 16)
Exemptions
If more than four
dependents, see
page 17 and
check here
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6a Yourself. If someone can claim you as a dependent, do not check box 6a . . . . .
b
Spouse . . . . . . . . . . . . . . . . . . . . . . . .
%
Boxes checked
on 6a and 6b
c
Dependents:
(1) First name Last name
(2) Dependent’s
social security number
(3) Dependent’s
relationship to you
(4) ✓ if qualifying
child for child tax
credit (see page 17)
No. of children
on 6c who:
● lived with you
● did not live with
you due to divorce
or separation
(see page 18)
Dependents on 6c
not entered above
d
Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Add numbers on
lines above
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Income
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a W-2,
see page 22.
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.
7
Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . .
7
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
9 a
Ordinary dividends. Attach Schedule B if required . . . . . . . . . . .
9a
b
Qualified dividends (see page 22) . . . . . . .
9b
10
Taxable refunds, credits, or offsets of state and local income taxes (see page 23) . .
10
11
Alimony received . . . . . . . . . . . . . . . . . . . . .
11
12
Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . .
12
13
Capital gain or (loss). Attach Schedule D if required. If not required, check here
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13
14
Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . .
14
15 a
IRA distributions .
15a b
Taxable amount (see page 24)
15b
16 a
Pensions and annuities
16a b
Taxable amount (see page 25)
16b
17
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
17
18
Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . .
18
19
Unemployment compensation in excess of $2,400 per recipient (see page 27) . . .
19
20 a
Social security benefits
20a b
Taxable amount (see page 27)
20b
21
Other income. List type and amount (see page 29)
21
22
Add the amounts in the far right column for lines 7 through 21. This is your total income
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22
Adjusted
Gross
Income
23
Educator expenses (see page 29) . . . . . . .
23
24
Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
24
25
Health savings account deduction. Attach Form 8889 .
25
26
Moving expenses. Attach Form 3903 . . . . . .
26
27
One-half of self-employment tax. Attach Schedule SE .
27
28
Self-employed SEP, SIMPLE, and qualified plans . .
28
29
Self-employed health insurance deduction (see page 30)
29
30
Penalty on early withdrawal of savings . . . . . .
30
31 a
Alimony paid
b Recipient’s SSN
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31a
32
IRA deduction (see page 31) . . . . . . . .
32
33
Student loan interest deduction (see page 34) . . .
33
34
Tuition and fees deduction. Attach Form 8917 . . .
34
35
Domestic production activities deduction. Attach Form 8903
35
36
Add lines 23 through 31a and 32 through 35 . . . . . . . . . . . . .
36
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . .
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37
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 97.
Cat. No. 11320B
Form 1040 (2009)
