Kent_Pham_1040part 1.png - E 1 040 RevenueSe-rvice E U S Individual Income Tax Return Forthe year Jan.1~Dec.31 2016 or othertax year beginning Your rst

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Unformatted text preview: E 1 040 DeparhnentoitheTreasury—lntemal RevenueSe-rvice E U. S. Individual Income Tax Return Forthe year Jan.1~Dec.31, 2016, or othertax year beginning Your first name and initial 560+ If a io‘lnt return, spouse’s first name and initial 2(1) 1 6 0MB No.1545-QDT4 iRSUseOnly—Do not writeorstaple initiis space. ,2015. ending , 20 See separate instructions. Last name Your social security number rP Ho m M53 (035‘: 5"! 53> S Home address (number and street). If you have a PD. box, see instructions. A Make sure the 3531(5) above i L001 .’ “CA“ 6 _ 66-5? andonlineecalecorrect. PresidentiaiEloctionCampaigI-t City, town oI post office, state, and ZiP code. If you have a foreign address, aisc complete spaces below (see instructions). Checkhereiiyou, aryumspouse illifing Lona fie-mo "A. O: 2.02:1:- oI want to toihisfunti. Chadd Foreign country name FOTEIQT‘ pfOVinBE’SthEJCOUHtY Foreign 1305131 code 2;?wa nogtuchangaWW9iax 9' “9 D You I: Spouse Filing Status 1 '3 '“Q‘3 4 D Head Of-household (with qualifying person) (See instructions.) If. 2 :1 Married filing jointly (even if only one had income) the qualifying person is a Child but not your dependent, enter this Check only one 3 :1 Married filing separately. Enter spouse’s SSN above Child‘s name hat—‘- > bDX. and full name here. D 5 El Qualifying widow(er) w'rliI dependent child Exemptions 6a Q’fourseif. if someone can claim you as a dependent, do not check box Ea . . . . . Eggsazléegged j; " D 3”“ ' ' ' ' ‘ ' ' ‘ ' ii, Actuaries tight?” (1) a; refipendems- Lastname “Egg"mfiw ’fimgfyz“ “‘“a'i‘iéiiiiéiiiiii‘is‘f'm Igmffifiih M . you due to divorce or separation If more than four (see insimclious) __ dependents, see Dependents on E: instructions and "0t entered aha“? CheCk here ’ a Add numbers on E d Total number of exemptions claimed . . . . . . . . . . lines above P income 7 ”Wages, salades, tips, etc. Attach Form(s) w-2 . . . . . . . -_ ,_. 8a Taxable interest. Attach Schsduie B if required . . . . . . . . . . . . mm— b Tax-exempt interest. Do not include on line 8a . . . 8b - ‘ a -‘ E- aflg‘mmg 9a Ordinary dividends. Attach Schedule B if required . . . . . . . attach Forms b Qualified dividends . . . . . . an .H- W-ZG and 10 Taxable refunds, credits, or offsets of state and locai Income taxes 1999"? “tax 11 Alimony received . . . . . . . . . . . . -= was Mhdd' 12 Business' Income or (loss). Attach Schedule C or C~EZ . . _ 13 Capital gain or (loss). Attach Schedule D if required. If not required check here i ij “E If flou‘fiinm 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . -_ gzeastructions. 153 IRA distributions l 153 i l ‘ b Taxable amount -_ 16a Pensions and annuities — b Taxable amount . -_ 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E -— 18 Farm income or (toss). Attach Schedule F . . . m— 19 Unemployment compensation . . . . . . . . . . . . . . -— aoa Social security benefits I sea I b Taxable amount @3— 21 Other income. list type and amount M_ _____________ ‘ M..- _ ______ m— 2 Combine the amounts in the far right column for lines 7 wouéhiii'fhi‘s is your iii-til swag?“ a ' —-— _ 23 Educator expenses . . . . . . . . . . . E— AdluSted 24 Certain business expenses of reservists, performing artists, and a Grass fee—basis government officials Attach Form 2106 or 21 Ofi-E Income 25 Health savings account deduction. Attach Form 8889 E- 26 Moving expenses. Attach Form 3903 . . . . m— 27 Deductible part at self-employment tax. Attach Schedule SE. a— 28 Self—employed SEP, StMPLE, and quaiified plans a- 29 Self—employed health insurance deduction -— 30 Penalty on early withdrawat of savings . m- 313 Alimony paid b Recipient’s SSN > m— 32 lFlAdeduction. . . . . . . E 33 Student loan interest deduction . E 34 Tuition and fees. Attach Form 8917. . .m 35 Domestic production activities deduction. Attach Form 8903 E—- 36 Add lines 23 through 35 . 37 Subtract line 36 from line 22. This' Is your adjusted gross income >- For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see capers-townie. Cat. No. 113203 Form 1040 (2015) ...
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  • Spring '16
  • Revenue, Taxation in the United States, Attach Form, attach schedule

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