Form 1040 U.S. Individual Income Tax Return 2009

Summary: This is an example of a Form 1040 (2009) with items included as described in the text. Additionally, these line items are completed:

DECEASED and John R. Smith--April 9, 2009 are written across the top of the form.

Label
Your first name and initial field contains John R.
Last name field contains Smith
Your social security number field contains 234-00-7890
If a joint return, spouse's first name and initial field contains Mary L.
Last name field contains Smith
Spouse's social security number field contains 567-00-0123
Home address (number and street). If you have a P.O. box, see page 14. field contains 6406 Mayflower Street
City, town or post office, state, and ZIP code. If you have a foreign address, see page 14. field contains Juneville, Maine 00000

Exemptions
6a. Yourself. If your parent (or someone else) can claim you as a dependent, do not check box 6a checkbox checked
6b. Spouse checkbox checked
Boxes checked on 6a and 6b field contains 2
d. Total number of exemptions claimed. Add numbers on lines above field contains 2

Income
7. Wages, salaries, tips, etc. Attach Form(s) W-2 field contains 11,000
8a. Taxable interest. Attach Schedule B if required field contains 3,140
17. Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E field contains 8,183
- 22. Add the amounts in the far right column for lines 7 through 21. This is your total income. field contains 22,323
- Adjusted Gross Income
- 37. Subtract line 36 from line 22. This is your adjusted gross income field contains 22,323

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