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

7. Wages, salaries, tips, etc. Attach Form(s) W2
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8a. Taxable interest. Attach Schedule B if required
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9a. Ordinary dividends. Attach Schedule B if required
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22. Add the amounts in the far right column for lines 7 through 21. This is your total
income
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Adjusted Gross Income
: 

26. Moving expenses. Attach Form 3903
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36. Add lines 23 through 31a and 32 through 35
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37. Subtract line 36 from line 22. This is your adjusted gross
income
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Tax and Credits
: 

38. Amount from line 37 (adjusted gross income)
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39b. If your spouse itemizes deductions on a separate return or you were a dualstatus alien, see page 34 and check
here
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40a. Itemized deductions (from Schedule A) or your standard deduction (see left
margin)
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41. Subtract line 40 from line 38
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42. If line 38 is $125,100 or less, multiply $3,650 by the total number of exemptions claimed on line
6d.
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43. Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter
0
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44. Tax (see page 36). Check if any tax is from a (checkbox) Form(s) 8814 b (checkbox) Form
4972
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46. Add lines 44 and 45
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55. Subtract line 54 from line 46. If line 54 is more than line 46, enter
0
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Other Taxes
: 

60. Add lines 55 through 59. This is your total tax. Total from 1040NR
$36
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Payments
: 

61. Federal income tax withheld from Forms W2 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
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Refund
: 

72. If line 71 is more than line 60, subtract line 60 from line 71. This is the amount you
overpaid
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73a. Amount of line 72 you want refunded to you
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Sign Here
: 

Your signature
field contains Sam R. Brown 
Date
field contains 3162010 
Your occupation
field contains R&D Specialist
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