Prentice Hall 2013 Income Tax

Form

1040

Department of the Treasury - Internal Revenue Service

(99)

U.S. Individual Income Tax Return
Last name

2011

OMB No. 1545-0074 IRS Use Only - Do not write or staple in this space.
, 20

For the year Jan. 1-Dec. 31, 2011, or other tax year beginning

, 2011, ending

Your first name and initial

Your social security number

Heather
If a joint return, spouse's first name and initial

Laubert
Last name

584-11-3456
Spouse's social security number

Nikolay 123 main st

Laubert
Apt. no.

564-11-3457
Make sure the SSN(s) above and on line 6c are correct. 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.

Home address (number and street). If you have a P.O. box, see instructions.

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Chicago, IL 60123
Foreign country name Foreign province/county Foreign postal code

You

Spouse

Filing Status
Check only one box.

1 2 3 6a b c

Single

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.

X X X

Married filing jointly (even if only one had income) Married filing separately. Enter spouse's SSN above and full name here. 5

Qualifying widow(er) with dependent child

Exemptions

Yourself. If someone can claim you as a dependent, do not check box 6a . . . . . . . . Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Dependent's social security number (3) Dependent's relationship to you

}

Dependents:
Last name

If more than four dependents, see instructions and check here

(1) First name

(4) X if child under age 17 qualifying for child tax credit (see instr.)

Boxes checked on 6a and 6b No. of