Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return (99)
IRS Use Only—Do not write or staple in this space.
Your first name and initial
OMB No. 1545-0074
Your social security number
If a joint return, spouse’s first name and initial
Spouse’s social security number
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).
Foreign country name
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
Foreign postal code a box below will not change your tax or
Head of household (with qualifying person). (See instructions.)
Married filing jointly (even if only one had income)
If the qualifying person is a child but not your dependent,
enter this child’s name here. ▶
Married filing separately. Enter spouse’s SSN above and
full name here.
Qualifying widow(er) with dependent child (see instructions)
Yourself. If someone can claim you as a dependent, do not check
6a and 6b
No. of children
on 6c who:
(4) ✓ if child under
• lived with
If more than six
(1) First name
(2) Dependent’s social
relationship to you
age 17 qualifying for
child tax credit (see
• did not live
with you due to
on 6c not
d Total number of exemptions claimed.