Fillable Printable 2004 Form 1040
Fillable Printable 2004 Form 1040
2004 Form 1040
4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
TLS, have you
transmitted all R
text files for this
cycle update?
Date
Action
Revised proofs
requested
Date Signature
O.K. to print
INSTRUCTIONS TO PRINTERS
FORM 1040, PAGE 1 of 2
MARGINS: TOP 13 mm (
1
⁄2”), CENTER SIDES. PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 203 mm (8”) 279 mm (11”)
PERFORATE: (NONE)
Department of the Treasury—Internal Revenue Service
1040
U.S. Individual Income Tax Return
OMB No. 1545-0074
For the year Jan. 1–Dec. 31, 2004, or other tax year beginning , 2004, ending , 20
Last nameYour first name and initial Your social security number
(See
instructions
on page 16.)
L
A
B
E
L
H
E
R
E
Last name Spouse’s social security numberIf a joint return, spouse’s first name and initial
Use the IRS
label.
Otherwise,
please print
or type.
Home address (number and street). If you have a P.O. box, see page 16. Apt. no.
City, town or post office, state, and ZIP code. If you have a foreign address, see page 16.
Presidential
Election Campaign
1 Single
Filing Status
Married filing jointly (even if only one had income)2
Check only
one box.
3
Qualifying widow(er) with dependent child (see page 17)
6a Yourself. If someone can claim you as a dependent, do not check box 6a
Exemptions
Spouseb
(4) if qualifying
child for child tax
credit (see page 18)
Dependents:c
(2) Dependent’s
social security number
(3) Dependent’s
relationship to
you
(1) First name Last name
If more than four
dependents, see
page 18.
d Total number of exemptions claimed
7
Wages, salaries, tips, etc. Attach Form(s) W-27
8a
8a Taxable interest. Attach Schedule B if required
Income
8b
b Tax-exempt interest. Do not include on line 8a
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
9a
9a Ordinary dividends. Attach Schedule B if required
10
10 Taxable refunds, credits, or offsets of state and local income taxes (see page 20)
11
11 Alimony received
12
12 Business income or (loss). Attach Schedule C or C-EZ
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.
13
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here
䊳
14
14 Other gains or (losses). Attach Form 4797
15a 15b
IRA distributions b
Taxable amount (see page 22)
15a
16b16a
Pensions and annuities b
Taxable amount (see page 22)
16a
17
17
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
18
18 Farm income or (loss). Attach Schedule F
19
19 Unemployment compensation
20b20a
b
Taxable amount (see page 24)
20a
Social security benefits
21
21
22 Add the amounts in the far right column for lines 7 through 21. This is your total income
䊳
22
25
IRA deduction (see page 26)
23
27
26
One-half of self-employment tax. Attach Schedule SE
29
Self-employed health insurance deduction (see page 30)
27
30
29
Self-employed SEP, SIMPLE, and qualified plans
31
30
Penalty on early withdrawal of savings
32
31
Alimony paid b Recipient’s SSN
䊳
35
Add lines 23 through 34a
32
Subtract line 35 from line 22. This is your adjusted gross income
䊳
33
Adjusted
Gross
Income
36
If you did not
get a W-2,
see page 19.
Form
Married filing separately. Enter spouse’s SSN above
and full name here.
䊳
Cat. No. 11320B
䊳
Label
Form 1040 (2004)
IRS Use Only—Do not write or staple in this space.
Head of household (with qualifying person). (See page 17.) If
the qualifying person is a child but not your dependent, enter
this child’s name here.
䊳
Other income. List type and amount (see page 24)
Moving expenses. Attach Form 3903
25
26
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 75.
Boxes checked
on 6a and 6b
No. of children
on 6c who:
Dependents on 6c
not entered above
Add numbers on
lines above
䊳
● lived with you
● did not live with
you due to divorce
or separation
(see page 18)
34a
34a
Student loan interest deduction (see page 28)
33
35
䊱䊱
Separation 1 of 2: Black
Important!
NoYes
Note. Checking “Yes” will not change your tax or reduce your refund.
Do you, or your spouse if filing a joint return, want $3 to go to this fund?
䊳
You must enter
your SSN(s) above.
YesNo
SpouseYou
(See page 16.)
(99)
Tuition and fees deduction (see page 29)
36
4
5
23
Educator expenses (see page 26)
9b
b Qualified dividends (see page 20)
20
04
24
Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
24
28
Health savings account deduction. Attach Form 8889
28
Version K
Married filing
jointly or
Qualifying
widow(er),
$9,700
Head of
household,
$7,150
4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Itemized deductions (from Schedule A) or your standard deduction (see left margin)
Add lines 63, 64, 65a, and 66 through 69. These are your total payments
䊳
INSTRUCTIONS TO PRINTERS
FORM 1040, PAGE 2 of 2
MARGINS: TOP 13 mm (
1
⁄2”), CENTER SIDES. PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 203 mm (8”) 279 mm (11”)
PERFORATE: (NONE)
Page 2
Form 1040 (2004)
Amount from line 36 (adjusted gross income)37
37
Check
if:
38a
Tax and
Credits
38a
Single or
Married filing
separately,
$4,850
If your spouse itemizes on a separate return or you were a dual-status alien, see page 31 and check here
䊳
b
38b
39
39
40
Subtract line 39 from line 3740
41
If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on
line 6d. If line 37 is over $107,025, see the worksheet on page 33
41
42
Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0-42
43
43
48
52
Education credits. Attach Form 8863
47
Other credits. Check applicable box(es):
46
55
56
Add lines 46 through 54. These are your total credits
Subtract line 55 from line 45. If line 55 is more than line 45, enter -0-
䊳
55
Self-employment tax. Attach Schedule SE
56
Other
Taxes
57
71
Social security and Medicare tax on tip income not reported to employer. Attach Form 4137
59
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required
58
60
Add lines 56 through 61. This is your total tax
䊳
61
61
Federal income tax withheld from Forms W-2 and 109963
63
64
2004 estimated tax payments and amount applied from 2003 return
64
Payments
65a
68
Amount paid with request for extension to file (see page 54)
67
66
Excess social security and tier 1 RRTA tax withheld (see page 54)
68
70
Other payments from:
69
72a
72a
73 73
If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid
74
74
Amount of line 71 you want refunded to you
䊳
Refund
75
Amount of line 71 you want applied to your 2005 estimated tax
䊳
Estimated tax penalty (see page 55)
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, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
75
You were born before January 2, 1940, Blind.
Spouse was born before January 2, 1940,
Blind.
a Form 3800
b
Form 8801
c Specify
a
Form 2439
b
Form 4136
59
Household employment taxes. Attach Schedule H
60
69
Amount
You Owe
Sign
Here
DateYour signature
Keep a copy
for your
records.
DateSpouse’s signature. If a joint return, both must sign.
Preparer’s SSN or PTINDate
Preparer’s
signature
Check if
self-employed
Paid
Preparer’s
Use Only
Firm’s name (or
yours if self-employed),
address, and ZIP code
EIN
Phone no.
䊳
䊳
䊳
Your occupation
Tax (see page 33). Check if any tax is from:
Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55
䊳
b
Direct deposit?
See page 54
and fill in 72b,
72c, and 72d.
Routing number
Account number
c
Checking Savings
a Form(s) 8814 Form 4972
b
d
䊳
䊳
70
53
Retirement savings contributions credit. Attach Form 8880
57
58
Advance earned income credit payments from Form(s) W-2
71
䊳
Child tax credit (see page 37)
Credits from:
51
Additional child tax credit. Attach Form 8812
66
67
Standard
Deduction
for—
Joint return?
See page 17.
Daytime phone number
()
Separation 1 of 2: Black
Earned income credit (EIC)
Credit for the elderly or the disabled. Attach Schedule R
44
45
Alternative minimum tax (see page 35). Attach Form 6251
Add lines 43 and 44
䊳
Credit for child and dependent care expenses. Attach Form 2441
49
If you have a
qualifying
child, attach
Schedule EIC.
44
45
65a
Spouse’s occupation
()
Form
1040 (2004)
● People who
checked any
box on line
38a or 38b or
who can be
claimed as a
dependent,
see page 31.
● All others:
Designee’s
name
䊳
Do you want to allow another person to discuss this return with the IRS (see page 56)?
Third Party
Designee
Phone
no.
䊳 ()
Yes. Complete the following. No
Personal identification
number (PIN)
䊳
54
Foreign tax credit. Attach Form 1116 if required
54
a Form 8396
b
Form 8859
50
Adoption credit. Attach Form 8839
62
62
Type:
c
Form 8885
Total boxes
checked
䊳
Version K
50
48
52
47
46
53
51
49
65b
Nontaxable combat pay election
䊳
b
