Publication 929: Tax Rules for Children and Dependents;

This is archived information that pertains only to the 2004 Tax Year. If you
are looking for information for the current tax year, go to the Tax Prep Help Area.

Form 1040A United States Individual Income Tax Return 2004. Summary: This is an example of Form 1040A (2004) with these line items completed as would pertain to the text.

Under “Label”:

“Your first name and initial” field contains Sara L

“Last name” field contains Brown

“Your social security number” field contains 111-00-1111

“Home address (number and street). If you have a Post Office box, see page 18.” field contains 1040A Main Street

“City, town or post office, state, and ZIP code. If you have a foreign address, see page 18.” field contains Hometown Arizona 85240

“Presidential Election Campaign (See page 18.)”

“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

Under “Filing Status”:

“1. Single” checkbox checked

Under “Exemptions”:

“6d. Total number of exemptions claimed. Add numbers on line above” field contains 0

Under “Income”:

“7. Wages, salaries, tips, etc. Attach Form(s) W-2.” field contains 1,550

“8a. Taxable interest. Attach Schedule 1 if required.” field contains 1,050

“9. Ordinary dividends. Attach Schedule 1 if required.” field contains 1,050

“10. Capital gain distributions (see page 27).” field contains 700

“15. Add lines 7 through 14b (far right column). This is your total income” field contains 4,350

Under “Adjusted gross income”:

“21. Subtract line 20 from line 15. This is your adjusted gross income.” field contains 4,350