Form 1040 (2011) Page 2

• Under Tax and Credits:
• • 38. Amount from line 37 (adjusted gross income) field contains 35,282
  • 40. Itemized deductions (from Schedule A) or your standard deduction (see page 35) field contains 12,781
  • 41. Subtract line 40 from line 38 field contains 22,501
  • 42. Exemptions. Multiply $3,700 by the number on line 6d. field contains 11,100
  • 43. Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- field contains 11,401
  • 44. Tax (see page 37). field contains 1,143
  • 46. Add lines 44 and 45 field contains 1,143
  • 51. Child tax credit (see page 42). field contains 1,000
  • 54. Add lines 47 through 53. These are your total credits field contains 1,000
  • 55. Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- field contains 143
• Under Other Taxes:
• • 56. Self-employment tax. Attach Schedule SE field contains 5,373
  • 61. Add lines 55 through 60. This is your total tax field contains 5,516
• Under Payments:
• • 62. Federal income tax withheld from Forms W-2 and 1099 field contains 272
  • 63. 2011 estimated tax payments and amount applied from 2010 return field contains 7,000
  • 72. Add lines 62, 63, 64a, and 65 through 71. These are your total payments field contains 7,272
• Under Refund:
• • 73. If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid field contains 1,756
  • 75. Amount of line 73 you want applied to your 2012 estimated tax field contains 1,756
• Under Third Party Designee:
• Do you want to allow another person to discuss this return with the IRS? No checkbox is checked.
• Under Sign Here:
• • Your signature field contains John E. White
  • Date field contains 3/1/2012
  • Your occupation field contains Minister
  • Spouse's signature. If a joint return, both must sign. field contains Susan R. White
  • Date field contains 3/1/2012
  • Spouse's occupation field contains Homemaker

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