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Unformatted text preview: Department of the Treasury - Internal Revenue Service (99) 1040 Form IRS Use Only - Do not write or staple in this space. U.S. Individual Income Tax Return For the year Jan. 1-Dec. 31, 2009, or other tax year beginning , 2009, ending , OMB No. 1545-0074 Label Your first name and initial Last name Your social security number L A B E L H E R E (See instructions on page 14.) If a joint return, spouse's first name and initial Last name Spouse's social security number Use the IRS label. Home address (number and street). If you have a P.O. box, see page 14. Apt. no. You must enter your SSN(s) above. Otherwise, please print or type. City, town or post office, state, and ZIP code. If you have a foreign address, see page 14. Checking a box below will not change your tax or refund. Presidential Election Campaign You Spouse Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 14) 1 Single 4 5 Head of household (with qualifying person). (See page 15.) If the qualifying person is a child but not your dependent, enter this child's name here. Qualifying widow(er) with dependent child (see page 16) Filing Status 2 Married filing jointly (even if only one had income) 3 Married filing separately. Enter spouse's SSN above and full name here. Check only one box. Boxes checked on 6a and 6b a 6 Yourself. If someone can claim you as a dependent, do not check box 6a Exemptions No. of children on 6c who: Spouse b (4) if qualifying c Dependents: (3) Dependent's lived with you (2) Dependent's child for child tax relationship to did not live with social security number credit (see page 17) Last name you (1) First name you due to divorce or separation (see page 18) If more than four dependents, see page 17 and check here Dependents on 6c not entered above Add numbers on lines above d Total number of exemptions claimed 7 7 Wages, salaries, tips, etc. Attach Form(s) W-2 Income 8 a Taxable interest. Attach Schedule B if required 8 a b Tax-exempt interest. Do not include on line 8a 8 b Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld. 9a a 9 Ordinary dividends. Attach Schedule B if required b Qualified dividends (see page 22) 9b 10 10 Taxable refunds, credits, or offsets of state and local income taxes (see page 23) 11 11 Alimony received...
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- Winter '10