| | Source of Income | (a) Taxable | (b) Tax-free | (c) Total |
| 1 | W-2 salary as a minister (from box 1 of Form W-2) | 1 | | | | |
| 2 | Gross income from weddings, baptisms, writing, lecturing, etc. (from line 1 of Schedule C or C-EZ) | 2 | | | | |
| Note. Complete either lines 3a–3e or lines 4a–4i. | | | | |
| • If your church provides you with a parsonage, complete lines 3a–3e. | | | | |
• If, instead of providing a parsonage, your church provides you with a rental or parsonage allowance, complete lines 4a–4i. | | | | |
3a | FRV* of parsonage provided by church | 3a | | | | |
b | Utility allowance, if any | 3b | | | | |
c | Actual expenses for utilities | 3c | | | | |
| d | Enter the smaller of line 3b or 3c | 3d | | | | |
e | Excess utility allowance (subtract line 3d from line 3b) | 3e | | | | |
4a | Parsonage or rental allowance | 4a | | | | |
| b | Utility allowance, if separate | 4b | | | | |
| c | Total allowance (add lines 4a and 4b) | 4c | | | | |
d | Actual expenses for parsonage | 4d | | | | |
| e | Actual expenses for utilities | 4e | | | | |
| f | Total actual expenses for parsonage and utilities (add lines 4d and 4e) | 4f | | | | |
| g | FRV* of home, plus the cost of utilities | 4g | | | | |
h | Enter the smaller of line 4c, 4f, or 4g | 4h | | | | |
i | Excess allowance (Subtract line 4h from line 4c) | 4i | | | | |
5 | Ministerial income (for columns (a), (b), and (c), add lines 1 through 4i) | 5 | | | | |
6 | Percentage of tax-free income: Total tax-free income $ Total income $ | = | %** |