SCHEDULE A (Form 1040) Schedule A--Itemized Deductions 2012

Summary: This is an example of Schedule A—Itemized Deductions (Form 1040) 2009. The line items are completed as follows.

Name(s) shown on Form 1040 field contains John R. (Deceased) & Mary L. Smith
Your social security number field contains 234-00-7890

Medical and Dental Expenses
1. Medical and dental expenses (see page A-1) field contains 6,061
2. Enter amount from Form 1040, line 38 field contains 22,323
3. Multiply line 2 by 7.5% (.075) field contains 1,674
4. Subtract line 3 from line 1. If line 3 is more than line 1, enter 0 field contains 4,387

Taxes You Paid
5. State and local (check only one box): a. checkbox Income taxes, or b. checkbox General sales taxes checkbox Income taxes is checked and field contains 891
6. Real estate taxes (see page A-5) field contains 2,600
9. Add lines 5 through 8 field contains 3,491

Gifts to Charity
16. Gifts by cash or check. If you made any gift of $250 or more, see page A-8 field contains 3,830
19. Add lines 16 through 18 field contains 3,830

Total Itemized Deductions
29. Is Form 1040, line 38, over $166,800 (over $83,400 if married filing separately)? checkbox No. checkbox checked and field contains 11,708