Form 1040 U.S. Individual Income Tax Return 2011

Summary: This is an example of Form 1040 (2011) with items included as described in the text. Additionally, these line items are completed:

UnderLabel:
- Your first name and initial field contains John E.
- Last name field contains White
- Your social security number field contains 011-00-2222
- If a joint return, spouse's first name and initial field contains Susan R.
- Last name field contains White
- Spouse's social security number field contains 011-00-1111
- Home address (number and street). If you have a P.O. box, see page 12. field contains 1040 Main Street
- City, town or post office, state, and ZIP code. If you have a foreign address, see page 12. field contains Hometown, Texas 77099
- Presidential Election Campaign: Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 12)
- - You: Yes box checked
  - Spouse: Yes box checked
UnderFiling Status:
- 2. Married filing jointly (even if only one had income) box checked
UnderExemptions:
- 6a. Yourself. If someone can claim you as a dependent, do not check box 6a) box checked
- 6b. Spouse box checked
- 6c. Dependents:
- - (1) First name Last name field contains Jennifer White
  - (2) Dependent's social security number field contains 111-00-1113
  - (3) Dependent's relationship to you field contains daughter
  - (4) Check if qualifying child for child tax credit (see page 15) box checked
- Number of boxes checked on 6a and 6b field contains 2
- Number of children on 6c who lived with you field contains 1
- 6d. Total number of exemptions claimed field contains 3
UnderIncome:
- 7. Wages, salaries, tips, etc. Attach Form(s) W-2: Taxpayer entered Excess Allowance $240 on the dotted line and field contains 34,640
- 12. Business income or (loss). Attach Schedule C or C-EZ field contains 3,732
- 22. Add the amounts in the far right column for lines 7 through 21. This is your total income field contains 38,372
UnderAdjusted Gross Income:
- 27. One-half of self-employment tax. Attach Schedule SE field contains 3,090
- 36. Add lines 23 through 31a and 32 through 35 field contains 3,090
- 37. Subtract line 36 from line 22. This is your adjusted gross income field contains 35,282

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