Form 1040 U.S. Individual Income Tax Return 2004

Summary: This is an example of Form 1040 (2004) with items included as described in the text. Additionally, these line items are completed:

Under Label (See instructions on page 16.) Use the I.R.S. label. Otherwise, please print or type.:

Your first name and initial field contains Charles

Last name field contains Woods

Your social security number field contains 123-00-4567

If a joint return, spouse's first name and initial field contains Lily

Last name field contains Woods

Spouse's social security number field contains 567-00-1234

Home address (number and street). If you have a P.O. box, see page 16. field contains 6925 Country Road

City, town or post office, state, and ZIP code. If you have a foreign address, see page 16. field contains Anytown, Virginia 22306

Presidential Election Campaign (See page 16): 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: Yes checkbox checked

Spouse: Yes checkbox checked

Under Filing Status Check only one box.:

2. Married filing jointly (even if only one had income) checkbox checked

Under Exemptions:

6a. Yourself. If someone can claim you as a dependent, do not check box 6a checkbox checked

6b. Spouse checkbox checked

Boxes checked on 6a and 6b field contains 2

6d. Total number of exemptions claimed field contains 2

Under Income:

22. Add the amounts in the far right column for lines 7 through 21. This is your total income field contains 132,982

Under Adjusted Gross Income:

36. Subtract line 35 from line 22. This is your adjusted gross income field contains 132,982

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