1 040

Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return

00 1

(99)

IRS Use Only—Do not write or staple in this space.

ARLEBEHLE

For the year Jan. 1–Dec. 31, 2001, or other tax year beginning

, 2001, ending

, 20

OMB No. 1545-0074

Label

		

(See

instructions

on page 19.)

Use the IRS

label.

Home address (number and street). If you have a P.O. box, see page 19.

Apt. no.

A Important! A

Otherwise,

please print

City, town or post office, state, and ZIP code. If you have a foreign address, see page 19.

You must enter

or type.

your SSN(s) above.

Presidential

Election Campaign

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?

You

Spouse

(See page 19.)

Yes

No

Yes

No

Check only

Filing Status

2341

Single

Married filing joint return (even if only one had income)

Married filing separate return. Enter spouse’s social security no. above and full name here.

enter this child’s name here.

Head of household (with qualifying person). (See page 19.) If the qualifying person is a child but not your dependent,

one box.

5

Qualifying widow(er) with dependent child (year spouse died

). (See page 19.)

6a

Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax

No. of boxes

Exemptions

return, do not check box 6a

	

checked on

6a and 6b

b

Spouse

	

No. of your

c Dependents:

children on 6c

who:

• lived with you

If more than six

• did not live with

you due to divorce

dependents

or separation

see page 20.

(see page 20)

Dependents on 6c

not entered above

Add numbers

entered on

d Total number of exemptions claimed

lines above

Income

7	Wages, salaries, tips, etc. Attach Form(s) W-2
8a	Taxable interest. Attach Schedule B if required

	

Attach

b Tax-exempt interest. Do not include on line 8a

8b

Forms W-2 and

9

Ordinary dividends. Attach Schedule B if required

W-2G here.

10

Taxable refunds, credits, or offsets of state and local income taxes (see page 22) Alimony received

Also attach

Form(s) 1099-R

11

	

if tax was

12

Business income or (loss). Attach Schedule C or C-EZ

	

withheld.

13

Capital gain or (loss). Attach Schedule D if required. If not required, check here 14	Other gains or (losses). Attach Form 4797

If you did not

15aTotal IRA distributions 16aTotal pensions and annuities

b Taxable amount (see page 23) b Taxable amount (see page 23)

get a W-2,

see page 21.

Enclose, but do

17	Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
18	Farm income or (loss). Attach Schedule F
19	Unemployment compensation

	

not attach, any

payment. Also,

please use

20a Social security benefits

20a

b Taxable amount (see page 25)

Form 1040-V.

21Other income. List type and amount (see page 27)

22	Add the amounts in the far right column for lines 7 through 21. This is your total income

Adjusted

23	IRA deduction (see page 27)

	

Gross

24	Student loan interest deduction (see page 28)
25	Archer MSA deduction. Attach Form 8853
26	Moving expenses. Attach Form 3903

	

Income

	

27One-half of self-employment tax. Attach Schedule SE 28Self-employed health insurance deduction (see page 30) 29Self-employed SEP, SIMPLE, and qualified plans 30	Penalty on early withdrawal of savings

	

31a Alimony paid	b Recipient’s SSN

32	Add lines 23 through 31a

	

32

33	Subtract line 32 from line 22. This is your adjusted gross income

	

33

Form 1040 (2001)

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 72.

Cat. No. 11320B

Your first name and initial

Last name

Your social security number

If a joint return, spouse’s first name and initial

Spouse’s social security number

Last name

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social security number	(3) Dependent’s
relationship to
you	(4)	if qualifying
child for child tax credit (see page 20)	
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Form 1040 (2001)

Page 2

Tax and

34 Amount from line 33 (adjusted gross income)

	

34

Credits

35a Check if:

You were 65 or older,

Blind;

Spouse was 65 or older,

Blind.

Add the number of boxes checked above and enter the total here

35a

Standard

Deduction

b If you are married filing separately and your spouse itemizes deductions, or you were a dual-status alien, see page 31 and check here

for—

	

35b

•	People who 36 checked any

Itemized deductions (from Schedule A) or your standard deduction (see left margin) Subtract line 36 from line 34

36

box on line

37

	

35a or 35b or

who can be

38

If line 34 is $99,725 or less, multiply $2,900 by the total number of exemptions claimed on line 6d. If line 34 is over $99,725, see the worksheet on page 32

claimed as a

	

see page 31.

dependent,

39

Taxable income. Subtract line 38 from line 37. If line 38 is more than line 37, enter -0-

•	All others:

40

Tax (see page 33). Check if any tax is from a

Form(s) 8814b

Form 4972

Single,

41

Alternative minimum tax (see page 34). Attach Form 6251 Add lines 40 and 41

	

$4,550

Head of

42

household,

43

Foreign tax credit. Attach Form 1116 if required

$6,650

44

Credit for child and dependent care expenses. Attach Form 2441 Credit for the elderly or the disabled. Attach Schedule R Education credits. Attach Form 8863

jointly or

Married filing

45

Qualifying

46

	

widow(er),

$7,600

47

Rate reduction credit. See the worksheet on page 36 Child tax credit (see page 37)

Married

48

	

filing

49

Adoption credit. Attach Form 8839

	

separately,

$3,800

50

Other credits from: a

Form 3800

b

Form 8396

c

Form 8801

d

Form (specify)

51

Add lines 43 through 50. These are your total credits

	

51

52

Subtract line 51 from line 42. If line 51 is more than line 42, enter -0-

	

Other

53

Self-employment tax. Attach Schedule SE

	

54

55

56

	

57

Taxes

Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 Tax on qualified plans, including IRAs, and other tax-favored accounts. Attach Form 5329 if required Advance earned income credit payments from Form(s) W-2
Household employment taxes. Attach Schedule H
Add lines 52 through 57. This is your total tax

58

	

Payments 59

Federal income tax withheld from Forms W-2 and 1099

60	2001 estimated tax payments and amount applied from 2000 return

If you have a61a Earned income credit (EIC)

	

child, attach

Schedule EIC.

qualifying

b Nontaxable earned income

61b

62

Excess social security and RRTA tax withheld (see page 51) Additional child tax credit. Attach Form 8812

63

	

64

Amount paid with request for extension to file (see page 51)

65

Other payments. Check if from a

Form 2439 b

Form 4136

66

Add lines 59, 60, 61a, and 62 through 65. These are your total payments

66

Refund

67	If line 66 is more than line 58, subtract line 58 from line 66. This is the amount you overpaid

Direct

68aAmount of line 67 you want refunded to you

	

deposit? See

b Routing number

c Type:

Checking

Savings

page 51 and

fill in 68b,

d Account number

68c, and 68d. 69

Amount of line 67 you want applied to your 2002 estimated tax

69

Amount

70

Amount you owe. Subtract line 66 from line 58. For details on how to pay, see page 52

You Owe

71

Estimated tax penalty. Also include on line 70

	

71

Third Party

Do you want to allow another person to discuss this return with the IRS (see page 53)?

Yes. Complete the following.

No

Designee

Designee’s

Phone

Personal identification

name

no.

number (PIN)

Sign

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.

Here

Joint return?

Your signature

Date

Your occupation

Daytime phone number

See page 19.

Keep a copy

for your

Spouse’s signature. If a joint return, both must sign.

Date

Spouse’s occupation

records.

Paid

Preparer’s

Date

Check if

self-employed

Preparer’s SSN or PTIN

Preparer’s

signature

Firm’s name (or

Use Only

yours if self-employed),

address, and ZIP code

Form 1040 (2001)

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EIN		
Phone no.	()