Da form 5841 sep 2009 fillable

Social Security Numbers

Complete the following tax return's 1040 and Schedule A.
Following is a list of information for Peter and Amy Jones for the current tax year. Peter and Amy are married and have three children, Aubrynne, Bryson and Caden. They live at 1846 Joplin Way, Lakeville, MN 55022. Peter is a lawyer and Amy works part-time at a genetics research lab. The Jones' Social Security Numbers and ages are as follows:
Name S.S. Number Age
Peter 215-60-1989 ,32
Amy 301-60-2828 ,28
Aubrynne 713-84-5555 ,5
Bryson 714-87-2222 ,3
Caden 714-89-1684 ,1
Peter's Salary: $70,000
Amy's Salary: $32,000
Items they want you to consider for their itemized deduction:
Eyeglasses and eye exam for Aubrynne $600
Orthodontic work for Bryson to correct congenital defect 2,500
Medical insurance premiums 1,800
Withholding for state income taxes 7,200
Withholding for federal income taxes 16,000
State income taxes paid with last year's return 500
Property taxes on home 1,100
Property taxes on automobile 300
Interest on home 9,700
Interest on credit cards 200

SCHEDULE A (Form 1040)

Department of the Treasury Internal Revenue Service (99)

Itemized Deductions ▶ Information about Schedule A and its separate instructions is at www.irs.gov/form1040.

▶ Attach to Form 1040.

OMB No. 1545-0074

2012 Attachment Sequence No. 07

Name(s) shown on Form 1040 Your social security number

Medical and Dental Expenses

Caution. Do not include expenses reimbursed or paid by others. 1 Medical and dental expenses (see instructions) . . . . . 1 2 Enter amount from Form 1040, line 38 2 3 Multiply line 2 by 7.5% (.075) . . . . . . . . . . . 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . 4

Taxes You Paid

5 State and local (check only one box): a Income taxes, or b General sales taxes } . . . . . . . . . . . 5

6 Real estate taxes (see instructions) . . . . . . . . . 6 7 Personal property taxes . . . . . . . . . . . . . 7 8 Other taxes. List type and amount ▶

8 9 Add lines 5 through 8 . . . . . . . . . . . . . . . . . . . . . . 9

Interest You Paid

Note. Your mortgage interest deduction may be limited (see instructions).

10 Home mortgage interest and points reported to you on Form 1098 10 11

Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions and show that person’s name, identifying no., and address ▶

11 12

Points not reported to you on Form 1098. See instructions for special rules . . . . . . . . . . . . . . . . . 12

13 Mortgage insurance premiums (see instructions) . . . . . 13 14 Investment interest. Attach Form 4952 if required. (See instructions.) 14 15 Add lines 10 through 14 . . . . . . . . . . . . . . . . . . . . . 15

Gifts to Charity If you made a gift and got a benefit for it, see instructions.

16

Gifts by cash or check. If you made any gift of $250 or more, see instructions . . . . . . . . . . . . . . . . 16

17

Other than by cash or check. If any gift of $250 or more, see instructions. You must attach Form 8283 if over $500 . . . 17

18 Carryover from prior year . . . . . . . . . . . . 18 19 Add lines 16 through 18 . . . . . . . . . . . . . . . . . . . . . 19

Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) . . . . . . . . 20 Job Expenses and Certain Miscellaneous Deductions

21

Unreimbursed employee expenses—job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. (See instructions.) ▶ 21

22 Tax preparation fees . . . . . . . . . . . . . 22 23

Other expenses—investment, safe deposit box, etc. List type and amount ▶

23 24 Add lines 21 through 23 . . . . . . . . . . . . 24 25 Enter amount from Form 1040, line 38 25 26 Multiply line 25 by 2% (.02) . . . . . . . . . . . 26 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- . . . . . . 27

Other Miscellaneous Deductions

28 Other—from list in instructions. List type and amount ▶

28 Total Itemized Deductions

29

Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, line 40 . . . . . . . . . . . . . . . . . . . . . 29

30

If you elect to itemize deductions even though they are less than your standard deduction, check here . . . . . . . . . . . . . . . . . . . ▶

For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 17145C Schedule A (Form 1040) 2012

Version A, Cycle 3

IINTERNAL USE ONLY

DRAFT AS OF

January 4, 2013

2012 Form 1040 (Schedule A)

SE:W:CAR:MP

Itemized Deductions

SCHEDULE A (Form 1040)

Department of the Treasury Internal Revenue Service (99)

Itemized Deductions

▶ Information about Schedule A and its separate instructions is at www.irs.gov/form1040.

Attach to Form 1040. See Instructions for Schedule A (Form 1040).

▶ Attach to Form 1040.

Attach to Form 1040. See Instructions for Schedule A (Form 1040).

OMB No. 1545-0074

2012

2012. Catalog Number 17145C.

Attachment

Sequence No. 07

Attachment Sequence number 07. For Paperwork Reduction Act Notice, see Form 1040 instructions.

Medical and Dental Expenses

Caution. Do not include expenses reimbursed or paid by others.

1

Medical and dental expenses (see instructions)

1

2

Enter amount from Form 1040, line 38

2

3

Multiply line 2 by 7.5% (.075)

3

4

Subtract line 3 from line 1. If line 3 is more than line 1, enter -0-

4

Taxes YouPaid

5

State and local (check only one box):

a

b

}

5

6

Real estate taxes (see instructions)

6

7

Personal property taxes

7

8

8

9

Add lines 5 through 8

9

InterestYou Paid

Note.Your mortgage interest deduction may be limited (see instructions).

10

Home mortgage interest and points reported to you on Form 1098

10

11

Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions and show that person’s name, identifying no., and address ▶

Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see page A-7 and show that person’s name, identifying no., and address.

11

12

Points not reported to you on Form 1098. See instructions for special rules

12

13

Mortgage insurance premiums (see instructions)

13

14

Investment interest. Attach Form 4952 if required. (See instructions.)

14

15

Add lines 10 through 14

15

Gifts toCharity

If you made agift and got abenefit for it,see instructions.

16

Gifts by cash or check. If you made any gift of $250 or more, see instructions

16

17

Other than by cash or check. If any gift of $250 or more, see instructions. You must attach Form 8283 if over $500

17

18

Carryover from prior year

18

19

Add lines 16 through 18

19

Casualty and Theft Losses

20

Casualty or theft loss(es). Attach Form 4684. (See instructions.)

20

Job Expensesand Certain Miscellaneous Deductions

21

Unreimbursed employee expenses—job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. (See instructions.) ▶

Unreimbursed employee expenses—job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. (See page A-10.)

21

22

Tax preparation fees

22

23

Other expenses—investment, safe deposit box, etc. List type and amount ▶

Other expenses—investment, safe deposit box, etc. List type and amount.

23

24

Add lines 21 through 23

24

25

Enter amount from Form 1040, line 38

25

26

Multiply line 25 by 2% (.02)

26

27

Subtract line 26 from line 24. If line 26 is more than line 24, enter -0-

27

Other Miscellaneous Deductions

28

28

Total Itemized Deductions

29

Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, line 40

29

30

If you elect to itemize deductions even though they are less than your standard deduction, check here ▶

If you elect to itemize deductions even though they are less than your standard deduction, check here.

For Paperwork Reduction Act Notice, see Form 1040 instructions.

Cat. No. 17145C

Schedule A (Form 1040) 2012

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