Form 1040 Department of the Treasury—Internal Revenue Service OMB No. 1545-0074 (99) IRS Use Only—Do not write or staple in this space. U.S. Individual Income Tax Return 20 13 For the year Jan. 1–Dec. 31, 2013, or other tax year beginning , 2013, 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.
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