Form 1040 (2012) Page 2

Summary: This is an example of Form 1040 (2009), page 2. The line items are completed as follows.

Tax and Credits
38. Amount from line 37 (adjusted gross income) field contains 22,323
40a. Itemized deductions (from Schedule A) or your standard deduction (see left margin) field contains 11,708
41. Subtract line 40 from line 38 field contains 10,615
42. Exemptions. If line 38 is $125,100 or less and you did not provide housing to a Midwestern displaced individual, multiply $3,650 by the number on line 6d. Otherwise, see page 37 field contains 7,300
43. Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- field contains 3,315
44. Tax (see page 37). Check if any tax is from:a checkbox Form(s) 8814b checkbox Form 4972 field contains 333
46. Add lines 44 and 45 field contains 333
55. Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- field contains 333

Payments
61. Federal income tax withheld from Forms W-2 and 1099 field contains 845
63. Making work pay and government retiree credits. Attach Schedule M field contains 682
71. Add lines 61, 62, 63, 64a, and 65 through 70. These are your total payments field contains 1,527

Refund
72. If line 71 is more than line 60, subtract line 60 from line 71. This is the amount you overpaid field contains 1,194
73a. Amount of line 72 you want refunded to you. If Form 8888 is attached, check here field contains 1,194

Sign Here
Your signature field contains Charles R. Smith, Executor
Date field contains 3-25-10
Spouse's signature. If a joint return, both must sign. field contains Mary L. Smith
Date field contains 3-25-10

Tax and Credits