Title: US Federal 1040 Tax Form - 2003 - EXAMPLE Status Married/joint {1=Single, 2=Married/joint, 3=Head house, 4=Married/sep.} Dependents 2 {Number of Dependents, self=1, spouse, etc.} {Income} L7 20267.70 {Wages} 28188.53 {Spouse's} ; L8a {Interest 1099-INT} 37.71 {Bank Savings} 12.65 {Credit Union} 16.85 {Savings Bank} ; L9 {Dividends 1099-DIV} 70.90 {USX Dividends} 44.36 {Fidelity Mutual Funds} 64.13 { Growth Fund} 31.54 { 500 Index} 28.66 { Mid-Cap Fund} 74.52 {Company Stock Div} 81.90 { IBM ISP } ; L10 625.83 ; { Taxable refunds. (pg 23, 1099-G, etc.) } L11 ; { Alimony received. } L12 ; { Business income/loss. (Sched C) } L13 {Capital Gains, 1099-B. Each: buyamnt date sellamnt date } -3658.22 12-15-99 { 100 Shares XOM } 4209.95 1-25-02 -4949.98 3-26-02 { 500 Shares NAB } 6009.01 12-27-02 ; L14 ; { Other gains or losses. (form 4794) } L15 ; { Taxable IRA distributions (pg 25) } L16 ; { Taxable Pensions/annuities (pg 25) } L17 ; { Rent realestate/royalties/partnerships/S corp. Sched E } L18 ; { Farm income/loss. (Sched F) } L19 ; { Unemployment compensation } L20 ; { Taxable Social security benefits } L21 ; { Other income. (pg 27) } {Adjusted Gross Income} L23 ; { Educator expenses (page 29) } L24 ; { IRA deduction (page 29) } L25 ; { Student loan interest deduction (page 31) } L26 ; { Tuition and fees deduction (page 32) } L27 ; { Moving expenses. Attach Form 3903 } L28 ; { One-half of self-employment tax. Attach Schedule SE} L29 ; { Self-employed health insurance deduction (page 33)} L30 ; { Self-employed SEP, SIMPLE, and qualified plans } L31 ; { Penalty on early withdrawal of savings } L32 ; { Alimony paid } {Tax and Credits} {Itemized deductions from Schedule A} A1 0 ; { Unreimbursed medical expenses. } A5 { State and local income taxes. } 1771.05 {Prop-tax} 39.88 { Sate-UI (Unemployment Insurance) } 1479.21 { State-tax withheld/owed } 1928.35 { Spouse's local tax (paid) } ; A6 0 ; { Real estate taxes.} A7 0 ; { Personal property taxes.} A8 0 ; { Other taxes.} A10 0 ; { Home mortgage interest and points} A11 0 ; { Home mortgage interest not reported to you on Form 1098.} A12 0 ; { Points not reported to you on Form 1098.} A13 0 ; { Investment interest. Attach Form 4952} A15 124.0 ; { Charity contributions.} A16 0 ; { Contributions other than cash or check.} A17 0 ; { Carryover from prior year} A19 0 ; { Casualty or theft loss(es).} A20 0 ; { Unreimbursed employee expenses} A21 0 ; { Tax preparation fees} A22 0 ; { Other expenses} A27 0 ; { Other deductions, listed on Sched-A page A-6.} L44 ; { Foriegn tax credit, form 1116 } L45 ; { Child/dependent care expense credits. Form 2441. } L46 ; { Credit for elderly/disabled. Schedule R. } L47 ; { Education credits. Form 8863 } L48 ; { Retirement savings contributions credit. Form 8880. } L49 ; { Child tax credit (see page 40). } L50 ; { Adoption credit. Form 8839. } L51 ; { Credits from forms 8396 8859. } L52 ; { Other credits. Forms 3800, 8801, ect. } {Other Taxes} L55 ; { Self-employment tax. Sched SE } L56 ; { Social Sec/Medicare tax on tips. Form 4137 } L57 ; { Tax on tax-favored accounts. Form 5329 } L58 ; { Advance earned income credit payments from W-2 } L59 ; { Household employment taxes. Sched H } {Payments} L61 1565.50 {Federal income tax witheld, from W-2 } 3188.09 { Spouse's} ; L62 ; { '03 estimated payments + amnt applied from '02 } L63 ; { Earned income credit (EIC) } L64 ; { Excess soc. sec. + tier1 RRTA tax withheld, pg 56} L65 ; { Additional child tax credit. Attach Form 8812 } L66 ; { Amnt paid in filing extension req. (page 56) } L67 ; { Other payments forms 2439, 4136, 8885.}