Form 1116 Foreign Tax Credit 2012

Summary: This is an example of Form 1116 (2012) with items included as described in the text. Additionally, these line items are completed:

Name field contains Betsy Wilson
Identifying number as shown on page 1 of your tax return field contains 111-00-1111
Use a separate Form 1116 for each category of income listed below. See Categories of Income in the instructions. Check only one box on each Form 1116. field contains check in box a, Passive category income
f. Resident of (name of country) field contains United States
UnderTaxable Income or Loss From Sources Outside the United States)
1a. Gross income from sources within country shown above field contains 620
UnderDeductions and losses (Caution: See the instructions):
3a. Certain itemized deductions or standard deduction (see instructions) field contains 5,950
3b. Other deductions field contains 0
3c. Add lines 3a and 3b field contains 5,950
3d. Gross foreign source income (see instructions) field contains 620
3e. Gross income from all sources (see instructions) field contains 620
3f. Divide line 3d by line 3e (see instructions) field contains .0136
3g. Multiply line 3c by line 3f field contains 81
6. Add lines 2, 3g, 4a, 4b, and 5 field contains 81
7 Subtract line 6 from line 1a. field contains 539
UnderPart II: Foreign Taxes Paid or Accrued:
- Country A: Credit is claimed for taxes (you must check one): (h) Paid checkbox checked
- (j) Date paid or accrued field contains 1099 taxes
- (o) Taxes withheld at source on: Dividends field contains 93
- (s) Total foreign taxes paid or accrued (add columns (o) through (r)) field contains 93
- 8. Add lines A through C, column (s). Enter the total here and on line 9, page 2 field contains 93

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