Form 1040A (2016)
Page 2
Tax, credits,
and
payments
22 Enter the amount from line 21 (adjusted gross income). 22
23 a
Check
if:
{
You were born before January 2, 1952,
Blind
Spouse was born before January 2, 1952,
Blind
}
Total boxes
checked
▶
23a
b If you are married filing separately and your spouse itemizes
deductions, check here
▶
23b
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,
$6,300
Married filing
jointly or
Qualifying
widow(er),
$12,600
Head of
household,
$9,300
24 Enter your standard deduction. 24
25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25
26 Exemptions. Multiply $4,050 by the number on line 6d. 26
27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
This is your taxable income.
▶
27
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. 30
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. 36
37
Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-.
37
38
Health care: individual responsibility (see instructions).
Full-year coverage
38
39 Add line 37 and line 38. This is your total tax. 39
40
Federal income tax withheld from Forms W-2 and 1099.
40
41 2016 estimated tax payments and amount applied
from 2015 return. 41
If you have
a qualifying
child, attach
Schedule
EIC.
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.
▶
46
Refund
Direct
deposit?
See
instructions
and fill in
48b, 48c,
and 48d or
Form 8888.
47 If line 46 is more than line 39, subtract line 39 from line 46.
This is the amount you overpaid.
47
48a
Amount of line 47 you want refunded to you. If Form 8888 is attached, check here
▶
48a
▶
b
Routing
number
▶
c Type:
Checking Savings
▶
d
Account
number
49 Amount of line 47 you want applied to your
2017 estimated tax. 49
Amount
you owe
50 Amount you owe. Subtract line 46 from line 39. For details on how to pay,
see instructions.
▶
50
51 Estimated tax penalty (see instructions). 51
Third party
designee
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete the following. 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 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. 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.
Form 1040A (2016)
