DO NOT FILE
July 24, 2014
DRAFT AS OF
Form
1040EZ
Department of the Treasury—Internal Revenue Service
Income Tax Return for Single and
Joint Filers With No Dependents
(99)
2014
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
▲
Make sure the SSN(s)
above are correct.
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
Foreign province/state/county
Foreign postal code
Presidential Election Campaign
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
Income
Attach
Form(s) W-2
here.
Enclose, but do
not attach, any
payment.
1 Wages, salaries, and tips. This should be shown in box 1 of your Form(s) W-2.
Attach your Form(s) W-2.
1
2 Taxable interest. If the total is over $1,500, you cannot use Form 1040EZ. 2
3
Unemployment compensation and Alaska Permanent Fund dividends (see instructions).
3
4 Add lines 1, 2, and 3. This is your adjusted gross income. 4
5
If someone can claim you (or your spouse if a joint return) as a dependent, check
the applicable box(es) below and enter the amount from the worksheet on back.
You Spouse
If no one can claim you (or your spouse if a joint return), enter $10,150 if single;
$20,300 if married filing jointly. See back for explanation.
5
6 Subtract line 5 from line 4. If line 5 is larger than line 4, enter -0-.
This is your taxable income.
▶
6
Payments,
Credits,
and Tax
7 Federal income tax withheld from Form(s) W-2 and 1099. 7
8a Earned income credit (EIC) (see instructions) 8a
b Nontaxable combat pay election.
8b
9
Add lines 7 and 8a. These are your total payments and credits.
▶
9
10
Tax. Use the amount on line 6 above to find your tax in the tax table in the
instructions. Then, enter the tax from the table on this line.
10
11 Health care: individual responsibility (see instructions) Full-year coverage 11
12
Add lines 10 and 11. This is your total tax.
12
13a If line 9 is larger than line 12, subtract line 12 from line 9. This is your refund.
If Form 8888 is attached, check here
▶
13a
Refund
Have it directly
deposited! See
instructions and
fill in 13b, 13c,
and 13d, or
Form 8888.
▶
b
Routing number
▶
c Type:
Checking Savings
▶
d
Account number
Amount
You Owe
14
If line 12 is larger than line 9, subtract line 9 from line 12. This is
the amount you owe. For details on how to pay, see instructions.
▶
14
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete below. No
Designee’s
name
▶
Phone
no.
▶
Personal identification
number (PIN)
▶
Sign
Here
Joint return? See
instructions.
Keep a copy for
your records.
Under penalties of perjury, I declare that I have examined this return and, to the best of my knowledge and belief, it is true, correct, and
accurately lists 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. Date
Spouse’s occupation
If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)
Paid
Preparer
Use Only
Print/Type preparer’s name
Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
▶
Firm’s address
▶
Firm’s EIN
▶
Phone no.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Cat. No. 11329W
Form 1040EZ (2014)
