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Text File  |  1990-01-23  |  14KB  |  188 lines
  1. 186
  2.  000,00,001, ,00,0, , , ,C, 
  3.  000,00,002, ,00,0, , , ,C, 
  4.  000,00,003, ,00,0, , , ,C,              *NOT SUITABLE FOR FILING - FOR INFORMATION USE ONLY!
  5.  000,00,004, ,00,0, , , ,C,   Form 1040       U.S. Individual Income Tax Return 1989     OMB # 1545-0074
  6.  000,00,005, ,00,0, , , ,C,   __________________________________________________________________________
  7.  000,00,006, ,00,0, , , ,C,        Year Jan-Dec 31, 1989 or from_________ 1989-__________19___
  8.  000,00,007, ,00,0, , , ,C,   Use |                                                    |Your SSN
  9.  000,10,008,S,23,0,E, , , ,    L  |                                                    |               
  10.  001,35,008,S,20,0,E, , , , 
  11.  002,62,008,S,14,0,E, , , , 
  12.  000,00,009, ,00,0, , , ,C,    a  |                                                    |Spouse's SSN
  13.  003,10,010,S,23,0,E, , , ,    b  |                                                    |               
  14.  004,35,010,S,20,0,E, , , , 
  15.  005,62,010,S,14,0,E, , , , 
  16.  006,10,011,S,40,0,E, , , ,    e  |                                                    
  17.  007,51,011,S,09,0,E, , , , 
  18.  008,10,012,S,40,0,E, , , ,    l  |                                          
  19.  000,51,013,B,01,0,E, , , ,   Presidential  Do you want $1 to go to fund?   |[ ]|Yes |[ ]|No
  20.  001,60,013,B,01,0,E, , , , 
  21.  002,51,014,B,01,0,E, , , ,   Campaign >    If joint return, does spouse?   |[ ]|Yes |[ ]|No
  22.  003,60,014,B,01,0,E, , , , 
  23.  004,18,015,B,01,0,E, , , ,              1 |[ ]| Single
  24.  005,18,016,B,01,0,E, , , ,   Filing     2 |[ ]| Married filing joint return
  25.  006,18,017,B,01,0,E, , , ,   Status     3 |[ ]| Married filing sep. Spouse full name>                  
  26.  009,60,017,S,17,0,E, , , , 
  27.  007,18,018,B,01,0,E, , , ,              4 |[ ]| Head of household If qual. person is your child & not
  28.  010,41,019,S,36,0,E, , , ,                |   | a dep. enter name>                                     
  29.  008,18,020,B,01,0,E, , , ,   ___________5 |[ ]| Widow(er) with dep child.  (19   ) < Year spouse died.
  30.  011,52,020,S,03,0,E, , , , 
  31.  009,18,021,B,01,0,E, , , ,             6a |[ ]| Yourself
  32.  000,74,022,V,03,0,E, , , ,   Exemptions         Number of boxes checked on 6a & 6b..................   
  33.  010,18,023,B,01,0,E, , , ,              b |[ ]| Spouse
  34.  000,00,024, ,00,0, , , ,C,              c Dependents:                                |# mnths|
  35.  000,00,025, ,00,0, , , ,C,                   Name          |<2?| SSN if >2 |Relation |in home|lived w/
  36.  012,11,026,S,22,0,E, , , ,                                 |[ ]|           |         |        you>     
  37.  011,35,026,B,01,0,E, , , , 
  38.  013,38,026,S,11,0,E, , , , 
  39.  014,50,026,S,09,0,E, , , , 
  40.  015,60,026,S,04,0,E, , , , 
  41.  001,74,026,V,03,0,E, , , , 
  42.  016,11,027,S,22,0,E, , , ,                                 |[ ]|           |         |       didn't due
  43.  012,35,027,B,01,0,E, , , , 
  44.  017,38,027,S,11,0,E, , , , 
  45.  018,50,027,S,09,0,E, , , , 
  46.  019,60,027,S,04,0,E, , , , 
  47.  020,11,028,S,22,0,E, , , ,                                 |[ ]|           |         |       to div.   
  48.  013,35,028,B,01,0,E, , , , 
  49.  021,38,028,S,11,0,E, , , , 
  50.  022,50,028,S,09,0,E, , , , 
  51.  023,60,028,S,04,0,E, , , , 
  52.  002,74,028,V,03,0,E, , , , 
  53.  024,11,029,S,22,0,E, , , ,                                 |[ ]|           |         |    
  54.  014,35,029,B,01,0,E, , , , 
  55.  025,38,029,S,11,0,E, , , , 
  56.  026,50,029,S,09,0,E, , , , 
  57.  027,60,029,S,04,0,E, , , , 
  58.  028,11,030,S,22,0,E, , , ,                                 |[ ]|           |         |       Other     
  59.  015,35,030,B,01,0,E, , , , 
  60.  029,38,030,S,11,0,E, , , , 
  61.  030,50,030,S,09,0,E, , , , 
  62.  031,60,030,S,04,0,E, , , , 
  63.  003,74,030,V,03,0,E, , , , 
  64.  032,11,031,S,22,0,E, , , ,                                 |[ ]|           |         |    
  65.  016,35,031,B,01,0,E, , , , 
  66.  033,38,031,S,11,0,E, , , , 
  67.  034,50,031,S,09,0,E, , , , 
  68.  035,60,031,S,04,0,E, , , , 
  69.  017,63,032,B,01,0,E, , , ,              d Ck if you claim child but didn't live with.  >[ ]
  70.  004,74,033,V,03,0,E, , , ,   ___________e Total number of exemptions claims.......................     
  71.  000,00,034, ,00,0, , , ,C,              7 Wages, tips, etc......._______________________  |
  72.  005,65,035,V,12,2,E, , , ,                ______________________________________________ 7|            
  73.  006,65,036,V,12,2,E, , , ,             8a Taxable interest income ......................8a|            
  74.  007,49,037,V,13,2,E, , , ,              b Tax-exempt interest income....8b|               |
  75.  008,65,038,V,12,2,E, , , ,   Income     9 Dividend income............................... 9|            
  76.  009,65,039,V,12,2,E, , , ,             10 Taxable refunds of state and local inc. taxes 10|            
  77.  010,65,040,V,12,2,E, , , ,             11 Alimony received..............................11|            
  78.  011,65,041,V,12,2,E, , , ,             12 Business income or (loss).....................12|            
  79.  012,65,042,V,12,2,E, , , ,             13 Capital gain or (loss)........................13|            
  80.  013,65,043,V,12,2,E, , , ,             14 Capital gain distrib. not reported on line 13.14|            
  81.  014,65,044,V,12,2,E, , , ,             15 Other gains or (losses)................._____.15|            
  82.  015,33,045,V,12,2,E, , , ,            16a IRA contrib. 16a|            16b Taxable amt.16b|            
  83.  016,65,045,V,12,2,E, , , , 
  84.  017,33,046,V,12,2,E, , , ,            17a Pens & annu. 17a|            17b Taxable amt.17b|            
  85.  018,65,046,V,12,2,E, , , , 
  86.  019,65,047,V,12,2,E, , , ,             18 Rents, royalties, partnerships, estates, etc..18|            
  87.  020,65,048,V,12,2,E, , , ,             19 Farm income or (loss).........................19|            
  88.  021,65,049,V,12,2,E, , , ,             20 Unemployment compensation (insurance).________20|            
  89.  022,33,050,V,12,2,E, , , ,            21a SS benefits. 21a|            21b Taxable amt.21b|            
  90.  023,65,050,V,12,2,E, , , , 
  91.  036,24,051,S,38,0,E, , , ,             22 Other:                                          |
  92.  024,65,052,V,12,2,E, , , ,                ______________________________________________22|            
  93.  025,65,053,V,12,2,E, , , ,   __________23 Add right column of lines 7-22. Total income.>23|            
  94.  026,49,054,V,13,2,E, , , ,             24 Your IRA deduction............24|               |
  95.  027,49,055,V,13,2,E, , , ,             25 Spouse's IRA deduction........25|               |
  96.  028,49,056,V,13,2,E, , , ,   Adjustmts 26 Self empl. health ins. ded....26|               |
  97.  029,49,057,V,13,2,E, , , ,   to Income 27 Keogh retirement & SEP ded....27|               |
  98.  030,49,058,V,13,2,E, , , ,             28 Penalty on early withdrawal...28|               |
  99.  037,28,059,S,18,0,E, , , ,             29 Alimony pd.                     |               |
  100.  038,28,060,S,16,0,E, , , ,                to:     SSN                   29|               |
  101.  031,49,060,V,13,2,E, , , , 
  102.  000,00,061, ,00,0, , , ,C,                ______________________________________________  |
  103.  032,65,062,V,12,2,E, , , ,             30 Add lines 24 - 29. Total adjust.__________...>30|            
  104.  033,65,063,V,12,2,E, , , ,   __________31 Subtract line 30 from 23. Adj. Gross Inc.....>31|            
  105.  000,00,064, ,00,0, ,F, ,C,       For Paperwork Reduction Act Notice, see Separate Instructions. 
  106.  000,00,065, ,00,0, , , ,C, 
  107.  000,00,066, ,00,0, , , ,C, 
  108.  000,00,067, ,00,0, , , ,C,   _____________________________________________________________________Pg. 2
  109.  033,65,068,V,12,2,E, , , ,   Form    32 Amount from line 31 (adjusted gross income).....32|            
  110.  018,20,069,B,01,0,E, , , ,   1040   33a YOU  [ ]>65 Blind[ ]   [ ]SPOUSE >65 [ ]Blind     |
  111.  019,32,069,B,01,0,E, , , , 
  112.  020,38,069,B,01,0,E, , , , 
  113.  021,52,069,B,01,0,E, , , , 
  114.  034,58,070,V,04,2,E, , , ,   (1989)     Enter no. of checked boxes >.............33a      |
  115.  022,59,071,B,01,0,E, , , ,            b Someone else claims you as a dependent...33b[ ]   |
  116.  023,59,072,B,01,0,E, , , ,            c Married, filing sep. & spouse itemizes.. 33c[ ]   |
  117.  000,00,073, ,00,0, , , ,C,           34 Largest of *Your standard deduction, or           |
  118.  035,65,074,V,12,2,E, , , ,   Tax                   *Your itemized deductions............34|            
  119.  024,50,075,B,01,0,E, , , ,   Compu-     If itemizing, attach Sch A & check>[ ]            |
  120.  036,65,076,V,12,2,E, , , ,   tation  35 Subtract line 34 from 32 and enter result here..35|            
  121.  037,65,077,V,12,2,E, , , ,           36 Multiply $2,000 by # of exemptions on line 6e...36|            
  122.  038,65,078,V,12,2,E, , , ,           37 Taxable income, subtract line 36 from 35........37|            
  123.  025,60,079,B,01,0,E, , , ,              Check if you're under 14 and have more than  [ ]  |
  124.  000,00,080, ,00,0, , , ,C,              $1,000 of investment income.                      |
  125.  026,28,081,B,01,0,E, , , ,           38 Tax from:    [ ]Table[ ]Rate Sch.  [ ]Form 8615   |
  126.  027,36,081,B,01,0,E, , , , 
  127.  028,50,081,B,01,0,E, , , , 
  128.  039,42,082,V,11,2,E, , , ,              Enter amount from 8814......                    38|            
  129.  040,65,082,V,12,2,E, , , , 
  130.  029,38,083,B,01,0,E, , , ,           39 Additional taxes from: [ ]4970   [ ]4972........39|            
  131.  030,48,083,B,01,0,E, , , , 
  132.  041,65,083,V,12,2,E, , , , 
  133.  042,65,084,V,12,2,E, , , ,   _______ 40 Add lines 38 and 39 and enter here..............40|            
  134.  043,49,085,V,13,2,E, , , ,           41 Cr for child/dep. care expense..41|               |
  135.  044,49,086,V,13,2,E, , , ,   Credits 42 Cr for the elderly or disabled..42|               |
  136.  045,49,087,V,13,2,E, , , ,           43 Foreign tax credit..............43|               |
  137.  031,33,088,B,01,0,E, , , ,           44 Bus Cr from:  3800[ ]or[ ]      44|               |
  138.  032,38,088,B,01,0,E, , , , 
  139.  039,41,088,S,05,0,E, , , , 
  140.  046,49,088,V,13,2,E, , , , 
  141.  047,49,089,V,13,2,E, , , ,           45 Credit for prior year min. tax..45|               |
  142.  048,65,090,V,12,2,E, , , ,           46 Add lines 41 through 45. Enter total........... 46|            
  143.  049,65,091,V,12,2,E, , , ,   _______ 47 Subract line 46 from 40. If less than 0 enter 0.47|            
  144.  050,65,092,V,12,2,E, , , ,           48 Self-employment tax.............................48|            
  145.  051,65,093,V,12,2,E, , , ,           49 Alternative minumum tax.........................49|            
  146.  033,38,094,B,01,0,E, , , ,   Other   50 Recapture taxes. From: [ ] 4255    [ ] 8611     50|            
  147.  034,50,094,B,01,0,E, , , , 
  148.  052,65,094,V,12,2,E, , , , 
  149.  053,65,095,V,12,2,E, , , ,   Taxes   51 SS tax on tip income not reported to employer...51|            
  150.  054,65,096,V,12,2,E, , , ,           52 Tax on an IRA or a qualified retirement plan....52|            
  151.  000,00,097, ,00,0, , , ,C,              ________________________________________________  |
  152.  000,00,098, ,00,0, , , ,C,              ________________________________________________  |
  153.  055,65,099,V,12,2,E, , , ,   _______ 53 Add lines 47 through 52.  Enter the total.......53|            
  154.  056,65,100,V,12,2,E, , , ,   Medicare54 Supplemental Medicare premium...................54|            
  155.  057,65,101,V,12,2,E, , , ,   _______ 55 Add lines 53 & 54. Total tax and Medicare.......55|            
  156.  035,44,102,B,01,0,E, , , ,           56 Tax withheld. Ck if from 1099[ ]56|               |
  157.  058,49,102,V,13,2,E, , , , 
  158.  059,49,103,V,13,2,E, , , ,           57 1989 est tax pymts & 1988 amt...57|               |
  159.  060,49,104,V,13,2,E, , , ,           58 Earned income credit ...........58|               |
  160.  061,49,105,V,13,2,E, , , ,   Pymts.  59 Amount paid with Form 4868......59|               |
  161.  062,49,106,V,13,2,E, , , ,           60 Excess SS tax & RRTA withheld...60|               |
  162.  063,49,107,V,13,2,E, , , ,           61 Credit for Fed tax on fuels.....61|               |
  163.  064,49,108,V,13,2,E, , , ,           62 Regulated invest. co. credit....62|               |
  164.  000,00,109, ,00,0, , , ,C,              ________________________________________________  |
  165.  065,65,110,V,12,2,E, , , ,   _______ 63 Add lines 56 through 62.  Your total payments...63|            
  166.  066,65,111,V,12,2,E, , , ,           64 If line 63 is > than 55, enter amount OVERPAID..64|            
  167.  067,65,112,V,12,2,E, , , ,   Refund  65 Amount of line 64 to be REFUNDED TO YOU.........65|            
  168.  068,48,113,V,14,2,E, , , ,   or Amt  66 Amt to apply to 1990 est tax...66|                |
  169.  000,00,114, ,00,0, , , ,C,   You     67 If line 55 is > than 63, enter the amt you OWE.   |
  170.  069,65,115,V,12,2,E, , , ,   Owe        Attach check or money order for full amount.....67|            
  171.  070,49,116,V,13,2,E, , , ,   _______ 68 Underpayment of est tax penalty.68|             
  172.  000,00,117, ,00,0, , , ,C,           Under penalties of perjury, I declare that to the best of my
  173.  000,00,118, ,00,0, , , ,C,   Sign    knowledge and belief, this return is true, correct and complete.
  174.  000,00,119, ,00,0, , , ,C,   Here    Your signature                 |Date     |Your occupation:
  175.  040,43,120,S,08,0,E, , , ,          >_______________________________|        |                       
  176.  041,53,120,S,22,0,E, , , , 
  177.  000,00,121, ,00,0, , , ,C,           Spouse's signature             |Date    |Spouse's occupation:
  178.  040,43,122,S,08,0,E, , , ,   _______>_______________________________|        |                       
  179.  042,53,122,S,22,0,E, , , , 
  180.  000,00,123, ,00,0, , , ,C,   Paid    Preparer's signature           |Date    |Self-      |Prep's SSN
  181.  040,43,124,S,08,0,E, , , ,   Prep.  >_______________________________|        |empl...>[ ]|             
  182.  036,61,124,B,01,0,E, , , , 
  183.  043,64,124,S,13,0,E, , , , 
  184.  044,22,125,S,34,0,E, , , ,         Firm name(or                                   |EI#                 
  185.  045,61,125,S,16,0,E, , , , 
  186.  046,22,126,S,34,0,E, , , ,         your's if  >                                   |--------------------
  187.  047,62,127,S,10,0,E, , , ,   _______ self-empl.)  ________________________________|ZIP:           
  188.