Form 1040 (2017) - U.S. Individual Income Tax Return

Form 1040 (2017) is used by U.S. taxpayers to file their annual income tax returns. This form is for the tax year Jan. 1–Dec. 31, 2017, or other tax year beginning. Taxpayers need to fill out their personal information, exemptions, filing status, income, tax and credits, other taxes, payments, and refund/amount owed. Check out the instructions before filling the form.

Form
1040Department of the Treasury—Internal Revenue Service (99)
U.S. Individual Income Tax Return2017 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2017, or other tax year beginning , 2017, 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) (see instructions)
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.
If you did not
get a W-2,
see instructions.
7 Wages, salaries, tips, etc. Attach Form(s) W-2. . . . . . . . . . . . 7
8a Taxable interest. Attach Schedule B if required. . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a. . . 8b
9 a Ordinary dividends. Attach Schedule B if required. . . . . . . . . . . 9a
b Qualified dividends . . . . . . . . . . . 9b
10 Taxable refunds, credits, or offsets of state and local income taxes. . . . . . 10
11 Alimony received. . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ. . . . . . . . . . 12
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here▶ 13
14 Other gains or (losses). Attach Form 4797 .. . . . . . . . . . . . . 14
15 a IRA distributions . 15a b Taxable amount . . . 15b
16 a Pensions and annuities 16a b Taxable amount . . . 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E17
18 Farm income or (loss). Attach Schedule F .. . . . . . . . . . . . . 18
19 Unemployment compensation. . . . . . . . . . . . . . . . . 19
20 a Social security benefits 20a b Taxable amount . . . 20b
21 Other income. List type and amount 21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income▶ 22
Adjusted
Gross
Income
23 Educator expenses . . . . . . . . . . . 23
24 Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ24
25 Health savings account deduction. Attach Form 8889. 25
26 Moving expenses. Attach Form 3903. . . . . . 26
27 Deductible part of self-employment tax. Attach Schedule SE. 27
28 Self-employed SEP, SIMPLE, and qualified plans. . 28
29 Self-employed health insurance deduction. . . . 29
30 Penalty on early withdrawal of savings .. . . . . 30
31 a Alimony paid b Recipient’s SSN▶ 31a
32 IRA deduction . . . . . . . . . . . . . 32
33 Student loan interest deduction .. . . . . . . 33
34 Tuition and fees. Attach Form 8917. . . . . . 34
35 Domestic production activities deduction. Attach Form 890335
36 Add lines 23 through 35. . . . . . . . . . . . . . . . . . . 36
37 Subtract line 36 from line 22. This is your adjusted gross income. . . . . ▶ 37
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.Cat. No. 11320B Form 1040(2017)
Bob S. Jones 5 1 2 6 0 4 4 4 4
Becky K. Jones 1 0 3 6 0 6 6 6 6
334 S. Harrison Street,
Omaha, NE 68146
✔
✔
✔
Derek Jones 7 1 4 8 4 2 2 2 2 Son ✔
David Jones 7 1 4 8 5 1 1 1 1 Son ✔
Diana Jones 7 1 4 8 6 3 3 3 3 Daughter ✔
2
3
5
230000
1200
900
3400
✔ 3450
12500
247150
0
247150

Form 1040 (2017) Page 2
Tax and
Credits
38 Amount from line 37 (adjusted gross income). . . . . . . . . . . . . . 38
39a Check
if: { You were born before January 2, 1953, Blind.
Spouse was born before January 2, 1953, Blind.
}Total boxes
checked▶ 39a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here▶ 39b
Standard
Deduction
for—
• People who
check any
box on line
39a or 39b or
who can be
claimed as a
dependent,
see
instructions.
• All others:
Single or
Married filing
separately,
$6,350
Married filing
jointly or
Qualifying
widow(er),
$12,700
Head of
household,
$9,350
40 Itemized deductions (from Schedule A) or your standard deduction (see left margin). . 40
41 Subtract line 40 from line 38. . . . . . . . . . . . . . . . . . . 41
42 Exemptions.If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions42
43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-. . 43
44 Tax (see instructions). Check if any from:a Form(s) 8814 b Form 4972 c 44
45 Alternative minimum tax (see instructions). Attach Form 6251. . . . . . . . . 45
46 Excess advance premium tax credit repayment. Attach Form 8962. . . . . . . . 46
47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . ▶ 47
48 Foreign tax credit. Attach Form 1116 if required .. . . 48
49 Credit for child and dependent care expenses. Attach Form 244149
50 Education credits from Form 8863, line 19. . . . . 50
51 Retirement savings contributions credit. Attach Form 888051
52 Child tax credit. Attach Schedule 8812, if required. . . 52
53 Residential energy credits. Attach Form 5695. . . . 53
54 Other credits from Form:a 3800 b 8801 c 54
55 Add lines 48 through 54. These are your total credits. . . . . . . . . . . . 55
56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0-. . . . . . ▶ 56
Other
Taxes
57 Self-employment tax. Attach Schedule SE. . . . . . . . . . . . . . . 57
58 Unreported social security and Medicare tax from Form:a 4137 b 8919 . . 58
59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required. . 59
60 a Household employment taxes from Schedule H. . . . . . . . . . . . . . 60a
b First-time homebuyer credit repayment. Attach Form 5405 if required. . . . . . . . 60b
61 Health care: individual responsibility (see instructions)Full-year coverage . . . . . 61
62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62
63 Add lines 56 through 62. This is your total tax. . . . . . . . . . . . . ▶ 63
Payments 64 Federal income tax withheld from Forms W-2 and 1099. . 64
65 2017 estimated tax payments and amount applied from 2016 return65
If you have a
qualifying
child, attach
Schedule EIC.
66a Earned income credit (EIC). . . . . . . . . . 66a
b Nontaxable combat pay election 66b
67 Additional child tax credit. Attach Schedule 8812. . . . . 67
68 American opportunity credit from Form 8863, line 8. . . 68
69 Net premium tax credit. Attach Form 8962 .. . . . . 69
70 Amount paid with request for extension to file. . . . . 70
71 Excess social security and tier 1 RRTA tax withheld. . . . 71
72 Credit for federal tax on fuels. Attach Form 4136. . . . 72
73 Credits from Form:a 2439 b Reserved c 8885 d 73
74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments. . . . . ▶ 74
Refund
Direct deposit?
See
instructions.
75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid75
76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here. ▶ 76a
▶
▶
b Routing number ▶ c Type: Checking Savings
d Account number
77 Amount of line 75 you want applied to your 2018 estimated tax▶ 77
Amount
You Owe
78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions▶ 78
79 Estimated tax penalty (see instructions). . . . . . . 79
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS (see instructions)?Yes. Complete below. No
Designee’s
name ▶
Phone
no. ▶
Personal identification
number (PIN) ▶
Sign
Here
Joint return? See
instructions.
Keep a copy for
your records.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, a
accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any know
Your signature Date Your occupation Daytime phone number
Spouse’s signature. If a joint return, both must sign.Date
▲ Spouse’s occupation If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date Check if
self-employed
PTIN
Firm’s name ▶
Firm’s address▶
Firm’s EIN ▶
Phone no.
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040(2017)
247150
40407
206743
20250
186493
38661
38661
38661
38661
35500
35500
3161
P11223355
UNO LLP
1040 South 102nd Street, Omaha, NE 68166
14-7598461