Form 1040 U.S. Individual Income Tax Return 2012

Summary: This is an example of Form 1040 (2012) completed as pertains to the example in the text. The completed line items are:

- Your first name and initial field contains Glenn M.
- Last name field contains Johnson
- Your social security number field contains 765-00-4321
- Home address (number and street). If you have a P.O. box, see instructions field contains 5603 East Main Street
- City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). field contains Anytown, Virginia 20000
UnderPresidential Election Campaign:
- Check here if you, or your spouse if filing jointly, want $3 to go to this fund? Checking a box below will not change your tax or refund. You--Yes checkbox checked
UnderFiling Status:
- 1. Single checkbox checked
UnderExemptions:
- 6a. Yourself. If someone can claim you as a dependent, do not check box 6a checkbox checked
- Boxes checked on 6a and 6b field contains 1
- 6d. Total number of exemptions claimed field contains 1
UnderIncome:
- 7. Wages, salaries, tips, etc. Attach Form(s) W-2 field contains 1,225
- 8a. Taxable interest. Attach Schedule B if required field contains 425
- 12. Business income or (loss). Attach Schedule C or C-EZ field contains negative 5,000
- 13. Capital gain or (loss). Attach Schedule D if required. If not required, check here field contains 1,000 Footnote: Net capital gain ($2,000 gain less $1,000 loss)
- 22. Combine the amounts in the far right column for lines 7 through 21. This is your total income field contains negative 2,350
UnderAdjusted Gross Income:
- 37. Subtract line 36 from line 22. This is your adjusted gross income field contains negative 2,350

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