Form 1040 U.S. Individual Income Tax Return 2011, Page 2.

• Page 1:
• Under Income:
• • 7. Wages, salaries, tips, etc. Attach Form(s) W-2 field contains 28,450
  • 8a. Taxable interest. Attach Schedule B if required field contains 395
  • 9a. Ordinary dividends. Attach Schedule B if required field contains 120
  • 22. Add the amounts in the far right column for lines 7 through 21. This is your total income field contains 28,965
• Under Adjusted Gross Income:
• • 26. Moving expenses. Attach Form 3903 field contains 8,300
  • 36. Add lines 23 through 31a and 32 through 35 field contains 8,300
  • 37. Subtract line 36 from line 22. This is your adjusted gross income field contains 20,665
• Page 2:
• Under Tax and Credits:
• • 38. Amount from line 37 (adjusted gross income) field contains 20,665
  • 39b. If your spouse itemizes deductions on a separate return or you were a dual-status alien, see page 34 and check here field contains box with check mark
  • 40a. Itemized deductions (from Schedule A) or your standard deduction (see left margin) field contains 922
  • 41. Subtract line 40 from line 38 field contains 19,743
  • 42. If line 38 is $125,100 or less, multiply $3,650 by the total number of exemptions claimed on line 6d. field contains 3,650
  • 43. Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter 0 field contains 16,093
  • 44. Tax (see page 36). Check if any tax is from a (checkbox) Form(s) 8814 b (checkbox) Form 4972 field contains 1,994
  • 46. Add lines 44 and 45 field contains 1,994
  • 55. Subtract line 54 from line 46. If line 54 is more than line 46, enter 0 field contains 1,994
• Under Other Taxes:
• • 60. Add lines 55 through 59. This is your total tax. Total from 1040NR $36 field contains 2,030
• Under Payments:
• • 61. Federal income tax withheld from Forms W-2 and 1099 (Line 61 includes $36 from Form 1040NR.) field contains 2,690
  • 71. Add lines 61,62,63, 64a, and 65 through 70. These are your total payments field contains 2,690
• Under Refund:
• • 72. If line 71 is more than line 60, subtract line 60 from line 71. This is the amount you overpaid field contains 660
  • 73a. Amount of line 72 you want refunded to you field contains 660
• Under Sign Here:
• • Your signature field contains Sam R. Brown
  • Date field contains 3-16-2010
  • Your occupation field contains R&D Specialist

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