Form 1040 U.S. Individual Income Tax Return

Summary: This is an example of Form 1040 (2016) with items included as described in the text. Additionally, these line items are completed:

Under“Label”:
Your first name and initial” field contains John E.
Last name” field contains White
Your social security number” field contains 011-00-2222
If a joint return, spouse's first name and initial” field contains Susan R.
Last name” field contains White
Spouse's social security number” field contains 011-00-1111
Home address (number and street). If you have a P.O. box, see page 12.” field contains 1040 Main Street
City, town or post office, state, and ZIP code. If you have a foreign address, see page 12.” field contains Hometown, Texas 77099
Presidential Election Campaign: Check here if you, or your spouse if filing jointly, want $3 to go to this fund
You: Yes” box checked
Spouse: Yes” box checked
Under“Filing Status”:
2. Married filing jointly (even if only one had income)” box checked
Under“Exemptions”:
6a. Yourself. If someone can claim you as a dependent, do not check box 6a)” box checked
6b. Spouse” box checked
6c. Dependents:
(1) First name Last name” field contains Jennifer White
(2) Dependent's social security number” field contains 111-00-1113
(3) Dependent's relationship to you” field contains daughter
(4) Check if child under age 17 qualifying for child tax credit (see instructions)” box checked
Boxes checked on 6a and 6b” field contains 2
Number of children on 6c who lived with you” field contains 1
6d. Total number of exemptions claimed” field contains 3
Under“Income”:
7. Wages, salaries, tips, etc. Attach Form(s) W-2: ” “Taxpayer entered Excess Allowance $240 on the dotted line” and field contains 34,640
12. Business income or (loss). Attach Schedule C or C-EZ” field contains 3,729
22. Combine the amounts in the far right column for lines 7 through 21. This is your total income” field contains 38,369
Under“Adjusted Gross Income”:
27. Deductible part of self-employment tax. Attach Schedule SE” field contains 3,089
36. Add lines 23 through 35” field contains 3,089
37. Subtract line 36 from line 22. This is your adjusted gross income” field contains 35,280