Form
1040A
Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return (99)
2014
IRS Use Only—Do not write or staple in this space.
Your first name and initial
Last name
OMB No. 1545-0074
Your social security number
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
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
Filing
status
Check only
one box.
Exemptions
▲
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
refund.
You
Spouse
Foreign province/state/county
1
2
3
4
Single
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.
5
Qualifying widow(er) with dependent child (see instructions)
Boxes
6a
Yourself. If someone can claim you as a dependent, do not check
checked on
box 6a.
6a and 6b
No. of children
b
Spouse
on 6c who:
(4) ✓ if child under
c Dependents:
• lived with
(3) Dependent’s
}
If more than six
dependents, see
instructions.
(1) First name
Last name
(2) Dependent’s social
security number
relationship to you
age 17 qualifying for
child tax credit (see
instructions)
you
• did not live
with you due to
divorce or
separation (see
instructions)
Dependents
on 6c not
entered above
Add numbers
on lines
above ▶
d Total number of exemptions claimed.
Income
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