Form 8815 Exclusion of Interest From Series E.E. and I. U.S. Savings Bonds Issued After 1989 2011

Summary: This is an example of Form 8815 (2011) as pertains to the description in the text. The line items completed are:

Name(s) shown on return field contains Mark & Joan Washington
Your social security number field contains 000-00-4567
1a. Name of person (you, your spouse, or your dependent) who was enrolled at or attended an eligible educational institution field contains Anna Washington
1b. Name and address of eligible educational institution field contains
- Jamestown University
- Normal, Virginia 20100
2. Enter the total qualified higher education expenses you paid in 2011 for the person(s) listed in column (a) of line 1. See the instructions to find out which expenses qualify field contains 7,650
3. Enter the total of any nontaxable educational benefits (such as nontaxable scholarship or fellowship grants) received for 2011 for the person(s) listed in column (a) of line 1 (see instructions) field contains 0
4. Subtract line 3 from line 2. If zero or less, stop. You cannot take the exclusion field contains 7,650
5. Enter the total proceeds (principal and interest) from all series EE and I U.S. savings bonds issued after 1989 that you cashed during 2011 field contains 9,000
6. Enter the interest included on line 5 (see instructions) field contains 3,000
7. If line 4 is equal to or more than line 5, enter 1.000. If line 4 is less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to at least three places) field contains .850
8. Multiply line 6 by line 7 field contains 2,550
9. Enter your modified adjusted gross income (see instructions) Note: If line 9 is $86,100 or more and if you are single or head of household, or if line 9 is $136,650 or more and if you are filing jointly or qualifying widow (er) with dependent child, stop. You cannot take the exclusion. field contains 118,900
10. Enter: $71,100 if single or head of household; $106,650 if married filing jointly or qualifying widow(er) field contains 106,650
11. Subtract line 10 from line 9. If zero or less, skip line 12, enter 0 on line 13, and go to line 14 field contains 12,250
12. Divide line 11 by: $15,000 if single or head of household; $30,000 if married filing jointly or qualifying widow(er) with dependent child. Enter the result as a decimal (rounded to at least three places) field contains .408
13. Multiply line 8 by line 12 field contains 1,040
14. Excludable savings bond interest. Subtract line 13 from line 8. Enter the result here and on Schedule B (Form 1040A or Form 1040), line 3 field contains 1,510

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