2017. Tax return for individuals 1 July 2016 to 30 June

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Tax return for individuals 20171 July 2016 to 30 June 2017
Your tax file number (TFN) See the Privacy note in the Taxpayer’s
declaration on page 10 of this return.
Yes NoAre you an Australian resident?
Your postal addressPrint the address where you want your mail sent.
Suburb/town/locality
Country if not Australia
State/territory Postcode
No Yes
Has this address changed since
completing your last tax return?
Is your home address different from
your postal address?
Suburb/town/locality
Country if not Australia
State/territory Postcode
No Yes Print your home address below.Read on.
Use Individual tax return instructions 2017 to fill in this tax return.
n Print clearly using a black pen only.
n Use BLOCK LETTERS and print one character in each box.
S M I T H S T
n Print X in all appropriate boxes.
n Do not use correction fluid or tape.
n Complete your details carefully to avoid delays
in processing your tax return.
Individual information
Your name(Print your full name)
Surname or family name
First given name Other given names
Title: Mr Mrs Miss Ms Other
No Yes See Completing individual information on your
tax return on page 8 of the instructions.
Has any part of your name changed
since completing your last tax return? Read on.
NAT 2541-06.2017
Your mobile phone number Your daytime phone number
(if different from your mobile phone number)
Your email address
Your contact details may be used by the ATO:
n to advise you of tax return lodgment options
n to correspond with you with regards to your taxation and superannuation affairs
n to issue notices to you, or
n to conduct research and marketing.
Your contact details
25410617
1 8 9 4 2 6 7 6 5
X
X
R O B E R T O
4 5
A L I B A B A H E I G H T S
V I C T O R I A 5 4 6 9 8 6 4
r o b e r t o @ g m a i l. c o m

Sensitive (when completed)Page 2 TAX RETURN FOR INDIVIDUALS 2017
Income
1 Salary or wages Your main salary and
wage occupation
Payer’s Australian business number Tax withheld – do not show cents Income – do not show cents
.00,C.00,$ $
.00,D.00,$ $
.00,E.00,$ $
.00,F.00,$ $
.00,G.00,$ $
.00,K.00,2 Allowances, earnings, tips, director’s fees etc$ $
3 Employer lump sum payments .00,R.00,
.00,H.00,
Amount A in lump sum payments box
5% of amount B in lump sum payments b
TYPE
$
$
$
$
.00,A.00,
5 Australian Government allowances and
payments like Newstart, Youth Allowance
and Austudy payment
$ $
.00,B.00,
6 Australian Government pensions and allowances
You must complete item T1 in Tax offsets. $ $
.00,J
.00,
7 Australian annuities and superannuation
income streams $
$Taxed element
.00,N $Untaxed element
.00,Y $Taxed element
.00,Z $Untaxed element
Taxable component
Lump sum in arrears – taxable component
.00,I
4 Employment termination payments (ETP)
.00,$ $
Taxable component CODEDay Month Year
Payer’s
ABN
Date of
payment
Electronic funds transfer (EFT)
We need your financial institution details to pay any refund owing to you, even if you have provided them to us befor
Write the BSB number, account number and account name below.
BSB number (must be six digits) Account number
Account name (for example, JQ Citizen. Do not show the account type, such as cheque, savings, mortgage offset)
Your date of birth Day Month Year
If you were under 18 years old on 30 June 2017
you must complete item A1 on page 7.
Provide your date of birth to avoid delays
the processing of your tax return.
Will you need to lodge an Australian
tax return in the future? Yes No FINAL TAX RETURNDon’t know
TYPE
TYPE
TYPE
TYPE
TYPE
B A N K M A N A G E R
1 2 3 4 5 6 7 8 9 0 0 1 7 2 5 0 8 0 0 0 0
1 2 0 0

Sensitive (when completed) Page 3TAX RETURN FOR INDIVIDUALS 2017
I If you completed theTax return for individuals (supplementary
section) 2017,write here the amount from TOTAL SUPPLEMENT INCOME
OR LOSS on page 15.
.00,
LOSS
,$
.00,
LOSS
$ ,
TOTAL INCOME
OR LOSS Add up the income amounts and deduct any loss amount in the$ boxes
on pages 2 and 3.
Your tax file number (TFN)
Attach here all documents that the instructions tell you to attach.
Do not send in your tax return until you have attached all requested attachments.
Income –continued
Income – do not show cents
11 Dividends
$ ,V .
Unfranked amount
Tax file number amounts
withheld from dividends
Franked amount
Franking credit
If you are a foreign-resident make sure you have printed
your country of residence on page 1.
$ .00,S ,
$ .00,T ,
$ .00,U ,
12 Employee share schemes
Discount from taxed upfront
schemes – eligible for reduction
$ .00,D ,
Discount from taxed upfront schemes
– not eligible for reduction$ .00,E ,
Discount from deferral schemes$ .00,F ,
Discount on ESS Interests acquired
pre 1 July 2009 and ‘cessation time’
occurred during financial year
.00,G $ ,
Total assessable discount amount$ .00,B ,
Foreign source discounts $ .00,A ,
TFN amounts withheld from discountsC $ , .,
.00$ ,TOTAL TAX WITHHELD Add up the$ boxes. ,
.00,O.00,9 Attributed personal services income $ $
8 Australian superannuation lump sum payments .00,$
$
TYPE
Payer’s
ABN .00,P $Untaxed element
Day Month Year
Date of
payment .00,QTaxed elementTaxable component
Do not include
total income here
Tax withheld – do not show cents Income – do not show cents
$ ,M .Tax file number amounts
withheld from gross interest
10 Gross interest
Gross interestIf you are a foreign-resident make sure you have printed
your country of residence on page 1.
$ .00,L ,
25410717
1 7 2 5 0
1 2 2 5
7 0 0
2 8 0 0
1 8 0 0
8 7 7 2 5

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Deductions
D1 Work-related car expenses .00$ ,A TYPE
CLAIM
D2 Work-related travel expenses .00$ ,B
D3 Work-related uniform, occupation specific
or protective clothing, laundry and dry
cleaning expenses
.00$ ,C TYPE
CLAIM
D4 Work-related self-education expenses .00$ ,D TYPE
CLAIM
D5 Other work-related expenses .00$ ,E
D6 Low value pool deduction .00$ ,K
D7 Interest deductions .00$ ,I
D8 Dividend deductions .00$ ,H
D9 Gifts or donations .00$ ,J
D10 Cost of managing tax affairs .00$ ,M
TOTAL DEDUCTIONS Add amounts at itemsD1 to D .00,$ ,
SUBTOTAL TOTAL INCOME OR LOSS less TOTAL DEDUCTIONS .00$ ,
LOSS
,
You must read
the deductions
section in the
instructions if you
are claiming
deductions for
expenses that relate
to your work as an
employee at items
D1–D6.
Losses
L1 Tax losses of earlier income years
.00$ ,F
.00$ ,Z
Primary production losses
claimed this income year
Non-primary production losses
claimed this income year
.00$ ,Q
.00$ ,R
Primary production losses carried
forward from earlier income years
Non-primary production losses carried
forward from earlier income years
If you were not required to complete L1,
TAXABLE INCOME write the amount from SUBTOTAL above here.
OR LOSS If you completed L1, add up the amounts you wrote at F and Z and take the total
the amount you wrote at SUBTOTAL. Write the answer at $ TAXABLE INCOME O
.00$ ,
LOSS
,
Make sure that you complete item M2 on page 6.
D If you completed theTax return for individuals (supplementary section)
2017, write here the amount from TOTAL SUPPLEMENT DEDUCTIONS on page 15.
.00,$ ,
1 2 0
2 2 7 9
1 6 0
2 0 0
2 7 5 9
8 4 9 6 6

Sensitive (when completed) Page 5TAX RETURN FOR INDIVIDUALS 2017
Your tax file number (TFN)
Tax offsets
T1 Seniors and pensioners (includes self-funded retirees) N CODE
TAX OFFSET
If you had a spouse during 2016 –17 you must also
complete Spouse details – married or de facto
on pages 8–9.
The ATO will work out this tax offset
amount. Print your code letter in the
TAX OFFSET CODE box. Y CODE
VETERAN
T2 Australian superannuation income stream .00$ ,S
Add up all the tax offset amounts at items T2 andT . .00$ ,UTOTAL TAX OFFSETS
T If you completed theTax return for individuals (supplementary section)
2017,write here the amount from TOTAL SUPPLEMENT TAX OFFSETS on page 16.
.00,$
25410817
2 0 2 0 0
2 0 2 0 0
X

Sensitive (when completed)Page 6 TAX RETURN FOR INDIVIDUALS 2017
Medicare levy related items
M1 Medicare levy reduction or exemption
If you have completed item M1 and had a spouse during 2016 –17 you must also
complete Spouse details – married or de facto on pages 8–9.
YNumber of dependent children and students
CLAIM
TYPE
VFull 2.0% levy exemption – number of days
WHalf 2.0% levy exemption – number of days
Reduction based on family income
Exemption categories
NOTE
Only certain taxpayers are entitled to a Medicare
levy reduction or exemption. Read M1 Medicare
levy reduction or exemption in the instructions
to work out if you are eligible to claim.
M2 Medicare levy surcharge (MLS)
If you do not complete this item you may be charged the full Medicare levy surcharge.
To help you determine if you have to pay the surcharge read M2 Medicare levy surcharge in the instructions.
For the whole period 1 July 2016 to 30 June 2017 were you and all of your dependants (including your spouse) –
had any – covered by private patient hospital cover?
A
Number of days you do not
have to pay the surcharge
THIS ITEM IS COMPULSORY FOR ALL TAXPAYERS.
Yes You must complete Private health insurance policy
details on the next page. You have now finished this item.No Read on.E
For the whole of 2016 –17 were you:
n a single person – without a dependent child or children – and your income for surcharge purposes
(including your total reportable fringe benefits amounts) was $90,000 or less or
n a member of a family – which may consist of you and your spouse (married or de facto) with or without
a dependent child or children; or a sole parent with a dependent child or children – and the combined
income for surcharge purposes (including the total reportable fringe benefits amounts) of you and your
spouse (if you had one) was $180,000 or less (plus $1,500 for each dependent child after the first)?
No Yes You do not have to pay the surcharge
You must write 365 at A.
You may have to pay the surcharge. Read M2 Medicare
levy surcharge in the instructions.
You must write the following at A:
n 0 when you have to pay the surcharge for the whole period
1 July 2016 to 30 June 2017
n 365 when you do not have to pay the surcharge for the
whole period 1 July 2016 to 30 June 2017
n the number of days you do not have to pay the surcharge
for part of the period 1 July 2016 to 30 June 2017.
If you had a spouse during 2016 –17 complete Spouse details – married or de facto on pages 8–9.
If you were covered by private patient hospital cover at any time during 2016 –17 you must complete Private he
insurance policy details on the next page. Read the Private health insurance policy details section in the instruc
3 6 5 X
X
X
3 6 5

Sensitive (when completed) Page 7TAX RETURN FOR INDIVIDUALS 2017
Adjustments
A1 Under 18
.00,
TYPE
$
If you were under 18 years old on 30 June 2017 you must complete
this item or you may be taxed at a higher rate. Read A1 Under 18
in the instructions for more information.
J
A2 Part-year tax-free threshold NDay Month Year
Date
Months eligible for threshold
Read A3 Government super contributions in the instructions before completing this item.
A3 Government super contributions
$F .00,Income from investment, partnership and other sources
$G .00,Other income from employment and business
Other deductions from business income
,
,
$H .00,,
CODE
LOSS
Private health insurance policy details
You must read Private health insurance policy details in the instructions before completing this item.
Fill all the labels below unless directed in the instructions.
Health
insurer IDB Membership
number C
.00$ ,J
Your premiums eligible for
Australian Government rebate .00$ ,K
Your Australian Government
rebate received
Benefit code L Tax claim code. Read the instructions.
CODE
Health
insurer IDB Membership
number C
.00$ ,J
Your premiums eligible for
Australian Government rebate .00$ ,K
Your Australian Government
rebate received
Benefit code L Tax claim code. Read the instructions.
CODE
Health
insurer IDB Membership
number C
.00$ ,J
Your premiums eligible for
Australian Government rebate .00$ ,K
Your Australian Government
rebate received
Benefit code L Tax claim code. Read the instructions.
CODE
Health
insurer IDB Membership
number C
.00$ ,J
Your premiums eligible for
Australian Government rebate .00$ ,K
Your Australian Government
rebate received
Benefit code L Tax claim code. Read the instructions.
CODE
A4 Working holiday maker net income $D .00,,
1 2 3 4 5 6 7 8 9
6 0 0 0
1 2 3 4 5 6 7 8 9
6 0 0 0

Sensitive (when completed)Page 8 TAX RETURN FOR INDIVIDUALS 2017
IT1 Total reportable fringe benefits amounts
Income tests
You must complete this section. If you had a spouse during 2016 –17 you must also complete
Spouse details – married or de facto on pages8–9.
You must complete this section. If you had a spouse during 2016 –17 you must also complete
Spouse details – married or de facto on pages8–9.
.00$ ,NEmployers exempt from FBT under section 57A of the FBTAA 1986
.00$ ,WEmployers not exempt from FBT under section 57A of the FBTAA 1986
If the amount is zero write 0.
IT2 Reportable employer superannuation contributions .00$ ,T
IT3 Tax-free government pensions .00$ ,U
IT4 Target foreign income .00$ ,V
IT7 Child support you paid .00$ ,Z
IT5 Net financial investment loss .00$ ,X
IT6 Net rental property loss .00$ ,Y
IT8 Number of dependent children D
Spouse details – married or de facto
If you had a spouse during 2016 –17 you must complete Spouse details – married or de facto.
We need the information included in this section to assess your tax accurately.
If you did not have a spouse, go to page 10.
Your spouse’s name
If you had more than one spouse during 2016 –17 print the name of your spouse on 30 June 2017 or your last spouse
Surname or family name
First given name Other given names
Your spouse’s date of birth
Day Month Year
K
Your spouse’s gender Male Female Indeterminate
Period you had a spouse – married or de facto
L Yes No
Did you have a spouse for the full year
– 1 July 2016 to 30 June 2017?
Yes NoDid your spouse die during the year?
If you did not have a spouse for the
full year, write the dates you had a spouse
between 1 July 2016 and 30 June 2017.
Day Month Year
M
From
Day Month Year
N
To
8 0 0 0

Sensitive (when completed) Page 9TAX RETURN FOR INDIVIDUALS 2017
Family Assistance consent– Complete this section only if you consent to use part or all of your 2017
tax refund to repay your spouse’s Family Assistance debt.
Complete the details below only if:
n you were the spouse of a family tax benefit (FTB) claimant, or the spouse of a child care benefit claimant on 30 Ju
n your spouse has given you authority to quote their customer reference number (CRN) on your tax return – if your
not know their CRN, they can contact the Department of Human Services and
n your spouse has a Family Assistance debt or expects to have a Family Assistance debt for 2017 and
n you expect to receive a refund for 2017 and
n you consent to use part or all of your refund to repay your spouse’s Family Assistance debt.
ZNo Yes
You do not need to complete
this section. Go to page 10. Your spouse’s CRN
Do you consent to use
part or all of your 2017
tax refund to repay your
spouse’s Family
Assistance debt?
I consent to the ATO using part or all of my 2017 tax refund to repay any Family Assistance debt of my spouse,
whose details I have provided above. I have obtained my spouse’s permission to quote their CRN.
Your signature for Department of Human Services consent purposes only
Day Month Year
Date
Spouse details – married or de facto –continued
The information on this page relates to your spouse’s income.
You must complete all labels.
Your spouse’s 2016 –17 taxable income .00,,$O
Your spouse’s share of trust income on which the trustee is assessed under
section 98, and which has not been included in your spouse’s taxable income .00,$T
Distributions to your spouse on which family trust distribution tax has been paid and which
your spouse would have had to show as assessable income if the tax had not been paid .00,$U
Your spouse’s total reportable fringe benefits amounts
Employers not exempt from FBT under section 57A of the FBTAA 1986 .00,$S
Employers exempt from FBT under section 57A of the FBTAA 1986 .00,$R
Amount of Australian Government pensions and allowances (see Q6 Australian
Government pensions and allowances in the instructions) that your spouse
received in 2016 –17 (exclude exempt pension income)
.00,$P
Amount of exempt pension income (see Spouse details – married or de facto
in the instructions) that your spouse received in 2016 –17. Do not include any
amount paid under the Military Rehabilitation and Compensation Act 2004
.00,$Q
Amount of your spouse’s reportable superannuation contributions
(which is the total of reportable employer superannuation
contributions and deductible personal superannuation contributions)
.00,$A
Other specified exempt payments (see Spouse details – married or
de facto in the instructions) that your spouse received .00,$B
Your spouse’s target foreign income .00,$C
Your spouse’s total net investment loss (total of net financial
investment loss and net rental property loss) .00,$D
Child support your spouse paid .00,$E
Your spouse’s taxed element of a superannuation lump sum for which the
tax rate is zero (see M2 Medicare levy surcharge in the instructions) .00,$F
If the amount is zero write 0.

Sensitive (when completed)Page 10 TAX RETURN FOR INDIVIDUALS 2017
Taxpayer’s declarationAll taxpayers must sign and date the declaration below.
Read and answer the questions below before you sign the Taxpayer’s declaration.
1 Are you required to complete any of the items on the Tax return for individuals (supplementary section)
To find out, read Will you need Individual tax return instructions supplement 2017? in the instructions.
No YesRead on. Attach pages 13–16 to this page and read on.
No YesRead on. Attach the information to page 3 of your tax return and read on.
2 Have the instructions asked you to attach further information relating to specific questions?
Make sure you have also attached all other documents that the instructions tell you to.
Privacy
The ATO is authorised by the Taxation Administration Act 1953 to request your tax file number (TFN). We will use
TFN to identify you in our records. It is not an offence not to provide your TFN. However if you do not provide you
your assessment may be delayed.
Taxation law authorises the ATO to collect information and to disclose it to other government agencies. For inform
about your privacy go to ato.gov.au/privacy
I declare that:
n all the information I have given on this tax return, including any attachments, is true and correct
n I have shown all my income – including net capital gains – for tax purposes for 2016 –17
n I have completed and attached the supplementary section, schedules and other attachments – as appropriate –
the instructions told me to provide
n I have completed item M2 – Medicare levy surcharge
n I have the necessary receipts and/or other records – or expect to obtain the necessary written evidence within
reasonable time of lodging this tax return – to support my claims for deductions and tax offsets.
IMPORTANT
The tax law imposes heavy penalties for giving false or misleading information.
The ATO will issue your assessment based on your tax return. However, the ATO has some time to review your ta
issue an amended assessment if a review shows inaccuracies that change the assessment. The standard review
years, but for some taxpayers it is four years. For more information go to ato.gov.au/notices
FOR YOUR TAX RETURN TO BE VALID YOU MUST SIGN BELOW.
Day Month Year
Date
WHERE TO SEND YOUR TAX RETURN
Send your completed tax return to:
Australian Taxation Office
GPO Box 9845
IN YOUR CAPITAL CITY
Do not replace the words IN YOUR CAPITAL CITY with the name of your capital city and its postcode.
For more information, read the Important information section in the instructions.
If you are completing the supplementary section (pages 13–16) of your tax return, attach it here.
1 8 1 0 2 0 1 9

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