Form
1040-SR
Department of the Treasury—Internal Revenue Service
U.S. Tax Return for Seniors
2019
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
(99)
Filing
Status
Check only one
box.
Single Married filing jointly
Married filing separately (MFS)
Head of household (HOH)
Qualifying widow(er) (QW)
If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child’s
name if the qualifying person is a child but not your dependent.
▶
Your first name and middle initial Last name
Your social security number
If joint return, spouse’s first name and middle 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 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
Standard
Deduction
Someone can claim: You as a dependent
Your spouse as a dependent
Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness
You: Were born before January 2, 1955 Are blind
Spouse:
Was born before January 2, 1955 Is blind
If more than four dependents,
see inst. and ✓ here
▶
Dependents (see instructions):
(2) Social security number (3) Relationship to you (4) ✓ if qualifies for
(see inst.)
:
(1) First name Last name
Child tax credit
Credit for other dependents
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . 1
Attach
Schedule B
if required.
2a Tax-exempt interest . .
2a b Taxable interest . . . 2b
3a Qualified dividends . . . 3a b Ordinary dividends . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . 4b
c Pensions and annuities . 4c d Taxable amount . . . 4d
5a
Social security benefits
. . 5a b Taxable amount . . . 5b
6
Capital gain or (loss). Attach Schedule D if required. If not required, check here
.
▶
6
7 a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . 7a
b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . .
▶
7b
8 a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . 8a
b Subtract line 8a from line 7b. This is your adjusted gross income . . . .
▶
8b
Standard
Deduction
See Standard
Deduction Chart
below.
9
Standard deduction or itemized deductions (from Schedule A)
9
10
Qualified business income deduction. Attach Form 8995 or Form 8995-A
10
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . 11a
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . 11b
Standard
Deduction
Chart*
Add the number of boxes checked in the “Age/Blindness” section of Standard Deduction . . .
▶
Single
Married
filing jointly
or
Qualifying
widow(er)
IF your filing
status is. . .
AND the number of
boxes checked is. . .
THEN your standard
deduction is. . .
1 13,850
2 15,500
1 25,700
2 27,000
3 28,300
4 29,600
Head of
household
Married filing
separately
IF your filing
status is. . .
AND the number of
boxes checked is. . .
THEN your standard
deduction is. . .
1 20,000
2 21,650
1 13,500
2 14,800
3 16,100
4 17,400
*Don’t use this chart if someone can claim you (or your spouse if filing jointly) as a dependent, your
spouse itemizes on a separate return, or you were a dual-status alien. Instead, see instructions.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 71930F
Form 1040-SR (2019)