Form 1041 U.S. Income Tax Return for Estates and Trusts 2012

• A. Type of entity: (see instructions)--Decedent's estate checkbox checked
• B. Number of Schedules K-1 attached (see instructions) field contains 1
• Name of estate or trust (if a grantor type trust, see page 14 of the instructions) field contains Estate of John R. Smith
• Name and title of fiduciary field contains Charles R. Smith, Executor
• Number, street, and room or suite number (if a P.O. box, see page 15 of the instructions) field contains 6406 Mayflower Street
• City or town, state, and ZIP code field contains Juneville, Maine 00000
• C. Employer identification number field contains 10-0123456
• D. Date entity created field contains 4-9-09
• F. Check applicable boxes: Initial return checkbox checked
• UnderIncome
  • 1. Interest income field contains 2,250
  • 2a Total ordinary dividends field contains 750
  • 2b. Qualified dividends allocable to: (1) Beneficiaries field contains 121 (2) Estate or trust field contains 629
  • 4. Capital gain or (loss). Attach Schedule D (Form 1041) field contains 200
  • 8. Other income. List type and amount line contains IRD Salary and Vacation Pay and field contain 12,000
  • 9. Total income. Combine lines 1, 2a, and 3 through 8 field contains 15,200
• Under Deductions
  • 11. Taxes field contains 2,250
  • 14. Attorney, accountant, and return preparer fees field contains 325
  • 16. Total. Add line 10 through 15b field contains 2,575
  • 17. Adjusted total income or (loss). Subtract line 16 from line 9. field contains 12,625
  • 18. Income distribution deduction (from Schedule B, line 15). Attach Schedules K-1 (Form 1041) field contains 2,000
  • 20. Exemption field contains 600
  • 21. Add lines 18 through 20 field contains 2,600
• Under Under Tax and Payments
  • 22. Taxable income. Subtract line 21 from line 17. If a loss, see page 23 of the instructions field contains 10,025
  • 23. Total tax (from Schedule G, line 7) field contains 2,384
  • 27. Tax due. If line 25 is smaller than the total of lines 23 and 26, enter amount owed field contains 2,384
• UnderSign Here
  • Signature of fiduciary or officer representing fiduciary field contains Charles R. Smith
  • Date field contains 3-24-10

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