Form 8815 Exclusion of Interest From Series E.E. and I. U.S. Savings Bonds Issued After 1989

• Name(s) shown on returnfield contains Mark & Joan Washington
• Your social security numberfield contains 000-00-4567
• 1a. Name of person (you, your spouse, or your dependent) who was enrolled at or attended an eligible educational institutionfield contains Anna Washington
• 1b. Name and address of eligible educational institutionfield contains
• • Jamestown University
  • Normal, Virginia 20100
• 2. Enter the total qualified higher education expenses you paid in 2012 for the person(s) listed in column (a) of line 1. See the instructions to find out which expenses qualifyfield contains 7,650
• 3. Enter the total of any nontaxable educational benefits (such as nontaxable scholarship or fellowship grants) received for 2012 for the person(s) listed in column (a) of line 1 (see instructions)field contains 0
• 4. Subtract line 3 from line 2. If zero or less, stop. You cannot take the exclusionfield contains 7,650
• 5. Enter the total proceeds (principal and interest) from all series EE and I U.S. savings bonds issued after 1989 that you cashed during 2012field contains 9,000
• 6. Enter the interest included on line 5 (see instructions)field contains 3,000
• 7. If line 4 is equal to or more than line 5, enter 1.000. If line 4 is less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to at least three places)field contains .850
• 8. Multiply line 6 by line 7field contains 2,550
• 9. Enter your modified adjusted gross income (see instructions) Note: If line 9 is $87,850 or more and if you are single or head of household, or if line 9 is $139,250 or more and if you are filing jointly or qualifying widow (er) with dependent child, stop. You cannot take the exclusion.field contains 118,900
• 10. Enter: $72,850 if single or head of household; $109,250 if married filing jointly or qualifying widow(er)field contains 109,250
• 11. Subtract line 10 from line 9. If zero or less, skip line 12, enter 0 on line 13, and go to line 14field contains 9,650
• 12. Divide line 11 by: $15,000 if single or head of household; $30,000 if married filing jointly or qualifying widow(er) with dependent child. Enter the result as a decimal (rounded to at least three places)field contains 0.3217
• 13. Multiply line 8 by line 12field contains 820.33
• 14. Excludable savings bond interest. Subtract line 13 from line 8. Enter the result here and on Schedule B (Form 1040A or Form 1040), line 3field contains 1,729.67

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