tax return

F o

rm 1040 Department of the Treasury—Internal Revenue Service (99)U.S. Individual Income Tax Return 2016 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space. For the year Jan. 1–Dec. 31, 2016, or other tax year beginning , 2016, ending , 20 See separate instructions. Your first name and initial Last name Your social security number

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

▲ Make sure the SSN(s) above and on line 6c are correct.

Home address (number and street). If you have a P.O. box, see instructions. Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Foreign country name Foreign province/state/county Foreign postal code

Presidential 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 Spouse

Filing Status

Check only one box.

1 Single

2 Married filing jointly (even if only one had income)

3 Married filing separately. Enter spouse’s SSN above and full name here. ▶

4 Head of household (with qualifying person). (See instructions.) If the qualifying person is a child but not your dependent, enter this

child’s name here. ▶

5 Qualifying widow(er) with dependent child

Exemptions 6a Yourself. If someone can claim you as a dependent, do not check box 6a . . . . . b Spouse . . . . . . . . . . . . . . . . . . . . . . . .

} c Dependents:

(1) First name Last name

(2) Dependent’s social security number

(3) Dependent’s relationship to you

(4) ✓ if child under age 17 qualifying for child tax credit

(see instructions)

If more than four dependents, see instructions and check here ▶

d Total number of exemptions claimed . . . . . . . . . . . . . . . . .

Boxes checked on 6a and 6b No. of children on 6c who: • lived with you • did not live with you due to divorce or separation (see instructions)

Dependents on 6c not entered above

Add numbers on lines above ▶

Income

Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld.

If you did not get a W-2, see instructions.

7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7

8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a

b Tax-exempt interest. Do not include on line 8a . . . 8b

9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a

b Qualified dividends . . . . . . . . . . . 9b

10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10

11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11

12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12

13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ▶ 13

14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14

15 a IRA distributions . 15a b Taxable amount . . . 15b

16 a Pensions and annuities 16a b Taxable amount . . . 16b

17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17

18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18

19 Unemployment compensation . . . . . . . . . . . . . . . . . 19

20 a Social security benefits 20a b Taxable amount . . . 20b

21 Other income. List type and amount 21 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income ▶ 22

Adjusted Gross Income

23 Educator expenses . . . . . . . . . . . 23

24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ 24

25 Health savings account deduction. Attach Form 8889 . 25

26 Moving expenses. Attach Form 3903 . . . . . . 26

27 Deductible part of self-employment tax. Attach Schedule SE . 27

28 Self-employed SEP, SIMPLE, and qualified plans . . 28

29 Self-employed health insurance deduction . . . . 29

30 Penalty on early withdrawal of savings . . . . . . 30

31 a Alimony paid b Recipient’s SSN ▶ 31a

32 IRA deduction . . . . . . . . . . . . . 32

33 Student loan interest deduction . . . . . . . . 33

34 Tuition and fees. Attach Form 8917 . . . . . . . 34

35 Domestic production activities deduction. Attach Form 8903 35

36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . ▶ 37

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2016)

Form 1040 (2016) Page 2

Tax and Credits

38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38

39a Check if:

{ You were born before January 2, 1952, Blind. Spouse was born before January 2, 1952, Blind.

} Total boxes checked ▶ 39a

b If your spouse itemizes on a separate return or you were a dual-status alien, check here ▶ 39b Standard Deduction for— • People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions. • All others: Single or Married filing separately, $6,300 Married filing jointly or Qualifying widow(er), $12,600 Head of household, $9,300

40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . 40

41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41

42 Exemptions. If line 38 is $155,650 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions 42

43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43

44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44

45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45

46 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . 46

47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . ▶ 47

48 Foreign tax credit. Attach Form 1116 if required . . . . 48

49 Credit for child and dependent care expenses. Attach Form 2441 49

50 Education credits from Form 8863, line 19 . . . . . 50

51 Retirement savings contributions credit. Attach Form 8880 51

52 Child tax credit. Attach Schedule 8812, if required . . . 52

53 Residential energy credits. Attach Form 5695 . . . . 53

54 Other credits from Form: a 3800 b 8801 c 54

55 Add lines 48 through 54. These are your total credits . . . . . . . . . . . . 55

56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . ▶ 56

Other Taxes

57 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 57

58 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 58

59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 59

60 a Household employment taxes from Schedule H . . . . . . . . . . . . . . 60a

b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . 60b

61 Health care: individual responsibility (see instructions) Full-year coverage . . . . . 61

62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62

63 Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . ▶ 63

Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . 64 65 2016 estimated tax payments and amount applied from 2015 return 65

If you have a qualifying child, attach Schedule EIC.

66a Earned income credit (EIC) . . . . . . . . . . 66a

b Nontaxable combat pay election 66b

67 Additional child tax credit. Attach Schedule 8812 . . . . . 67

68 American opportunity credit from Form 8863, line 8 . . . 68

69 Net premium tax credit. Attach Form 8962 . . . . . . 69

70 Amount paid with request for extension to file . . . . . 70

71 Excess social security and tier 1 RRTA tax withheld . . . . 71 72 Credit for federal tax on fuels. Attach Form 4136 . . . . 72

73 Credits from Form: a 2439 b Reserved c 8885 d 73

74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . ▶ 74

Refund

Direct deposit? See instructions.

75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75

76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . ▶ 76a ▶

▶

b Routing number ▶ c Type: Checking Savings

d Account number

77 Amount of line 75 you want applied to your 2017 estimated tax ▶ 77 Amount You Owe

78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions ▶ 78 79 Estimated tax penalty (see instructions) . . . . . . . 79

Third Party Designee

Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No Designee’s name ▶

Phone no. ▶

Personal identification number (PIN) ▶

Sign Here Joint return? See instructions. Keep a copy for your records.

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature Date Your occupation Daytime phone number

Spouse’s signature. If a joint return, both must sign. Date

▲

Spouse’s occupation If the IRS sent you an Identity Protection PIN, enter it here (see inst.)

Paid Preparer Use Only

Print/Type preparer’s name Preparer’s signature Date Check if self-employed

PTIN

Firm’s name ▶

Firm’s address ▶

Firm’s EIN ▶

Phone no.

www.irs.gov/form1040 Form 1040 (2016)

Version A, Cycle 3

Internal Use Only

DRAFT AS OF

September 13, 2016

Version A, Cycle 3

Internal Use Only

DRAFT AS OF

September 13, 2016

2016 Form 1040

SE:W:CAR:MP

U.S. Individual Income Tax Return

Form

1040 

Department of the Treasury—Internal Revenue Service 

(99)

U.S. Individual Income Tax Return

2016

2016. Catalog Number 11320B.

OMB No. 1545-0074

O M B Number 1545-0074. For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

IRS Use Only—Do not write or staple in this space.

See separate instructions.

▲

Make sure the SSN(s) above and on line 6c are correct.

Presidential 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.

Filing Status

Check only one box. 

1

Single

2

Married filing jointly (even if only one had income)

3

Married filing separately. Enter spouse’s SSN above and full name here. ▶

4

Head of household (with qualifying person). (See instructions.) If the qualifying person is a child but not your dependent, enter this child’s name here.  ▶

5

Qualifying widow(er) with dependent child

Exemptions

6

a

Yourself. If someone can claim you as a dependent, do not check box 6a          

b

Spouse           

}

c

Dependents: 

(1)  First name                         Last name 

(2) Dependent’s

social security number 

(3) Dependent’s  relationship to  you 

(4)  ✓ if child under age 17 qualifying for child tax credit 

(see instructions) 

(4) Check if child under age 17 qualifying for child tax credit (see instructions).

If more than four  dependents, see  instructions and check here  ▶

d

Total number of exemptions claimed          

Boxes checked on 6a and 6b

No. of children  on 6c who:

• lived with you 

• did not live with  you due to divorce  or separation 

(see instructions)

Dependents on 6c not entered above

Add numbers on  lines above  ▶

Income

Attach Form(s)  W-2 here. Also  attach Forms  W-2G and 

1099-R if tax  was withheld. 

If you did not 

get a W-2, 

see instructions. 

7

Wages, salaries, tips, etc. Attach Form(s) W-2          

7

8

a

Taxable interest. Attach Schedule B if required          

8a

b

Tax-exempt interest. Do not include on line 8a          

8b

9

a

Ordinary dividends. Attach Schedule B if required          

9a

b

Qualified dividends          

9b

10

Taxable refunds, credits, or offsets of state and local income taxes          

10

11

Alimony received          

11

12

Business income or (loss). Attach Schedule C or C-EZ          

12

13

Capital gain or (loss). Attach Schedule D if required. If not required, check here  ▶

13

14

Other gains or (losses). Attach Form 4797          

14

15

a

IRA distributions          

15a

b  Taxable amount          

15b

16

a

Pensions and annuities 

16a

b  Taxable amount          

16b

17

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 

17

18

Farm income or (loss). Attach Schedule F          

18

19

Unemployment compensation         

19

20

a

Social security benefits 

20a

b  Taxable amount          

20b

21

Other income. List type and amount

21

22

Combine the amounts in the far right column for lines 7 through 21. This is your total income  ▶

22

Adjusted Gross Income

23

Educator expenses         

23

24

Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ

24

25

Health savings account deduction. Attach Form 8889          

25

26

Moving expenses. Attach Form 3903          

26

27

Deductible part of self-employment tax. Attach Schedule SE          

27

28

Self-employed SEP, SIMPLE, and qualified plans          

28

29

Self-employed health insurance deduction          

29

30

Penalty on early withdrawal of savings          

30

31

a

Alimony paid 

b  Recipient’s SSN  ▶

31a

32

IRA deduction          

32

33

Student loan interest deduction          

33

34

Tuition and fees. Attach Form 8917         

34

35

Domestic production activities deduction. Attach Form 8903 

35

36

Add lines 23 through 35          

36

37

Subtract line 36 from line 22. This is your adjusted gross income             ▶

37

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 11320B

Form  1040  (2016) 

Form 1040 (2016)

Page 2 

Tax and  Credits 

38

Amount from line 37 (adjusted gross income)          

38

39

a

Check  if: 

{

}

Total boxes  checked  ▶

39a

b

If your spouse itemizes on a separate return or you were a dual-status alien,  check here ▶

Standard  Deduction  for—

• People who  check any  box on line  39a or 39b or who can be claimed as a  dependent,  see instructions.

• All others:

Single or  Married filing  separately,  $6,300

Married filing  jointly or  Qualifying  widow(er),  $12,600 

Head of  household,  $9,300 

40

Itemized deductions (from Schedule A) or your standard deduction (see left margin)          

40

41

Subtract line 40 from line 38          

41

42

Exemptions. If line 38 is $155,650 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions

42

43

Taxable income.  Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-          

43

44

Tax  (see instructions). Check if any from: 

a

b

c

44

45

Alternative minimum tax  (see instructions). Attach Form 6251          

45

46

Excess advance premium tax credit repayment. Attach Form 8962          

46

47

Add lines 44, 45, and 46           ▶

47

48

Foreign tax credit. Attach Form 1116 if required          

48

49

Credit for child and dependent care expenses. Attach Form 2441

49

50

Education credits from Form 8863, line 19          

50

51

Retirement savings contributions credit. Attach Form 8880

51

52

Child tax credit. Attach Schedule 8812, if required         

52

53

Residential energy credits. Attach Form 5695         

53

54

Other credits from Form: 

a

b

c

54

55

Add lines 48 through 54. These are your total credits          

55

56

Subtract line 55 from line 47. If line 55 is more than line 47, enter -0-           ▶

56

Other Taxes

57

Self-employment tax. Attach Schedule SE          

57

58

Unreported social security and Medicare tax from Form:

a

b

58

59

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required          

59

60

a

Household employment taxes from Schedule H          

60a

b

First-time homebuyer credit repayment. Attach Form 5405 if required          

60b

61

Health care: individual responsibility (see instructions)

         

61

62

Taxes from:

a

b

c

enter code(s)

62

63

Add lines 56 through 62. This is your total tax             ▶

63

Payments

64

Federal income tax withheld from Forms W-2 and 1099          

64

65

2016 estimated tax payments and amount applied from 2015 return

65

If you have a qualifying child, attach Schedule EIC.

66

a

Earned income credit (EIC)          

66a

b

Nontaxable combat pay election 

66b

67

Additional child tax credit. Attach Schedule 8812            .

67

68

American opportunity credit from Form 8863, line 8          

68

69

Net premium tax credit. Attach Form 8962         

69

70

Amount paid with request for extension to file         

70

71

Excess social security and tier 1 RRTA tax withheld          

71

72

Credit for federal tax on fuels. Attach Form 4136          

72

73

Credits from Form:

a

b

c

d

73

74

Add lines 64, 65, 66a, and 67 through 73. These are your total payments             ▶

74

Refund

Direct deposit? See instructions.

75

If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 

75

76

a

Amount of line 75 you want refunded to you. If Form 8888 is attached, check here           ▶

76a

▶

▶

b

Routing number

▶ c Type: 

d

Account number

77

Amount of line 75 you want applied to your 2017 estimated tax ▶

77

Amount You Owe

78

Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions    ▶

78

79

Estimated tax penalty (see instructions)          

79

Third Party Designee

Do you want to allow another person to discuss this return with the IRS (see instructions)?

Designee’sname  ▶

Phoneno.  ▶

Personal identificationnumber (PIN)              ▶

Sign Here

Joint return? See instructions. Keep a copy for your records.

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature

Date

Spouse’s signature. If a joint return, both must sign. 

Date

▲

If the IRS sent you an Identity Protection PIN, enter it 

here (see inst.)

Paid Preparer Use Only

Preparer’s signature

Date

Check         if 

self-employed

www.irs.gov/form1040

Form 1040 (2016)