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~ ~4 <br />'{$ <br />~ ~~yry-Interne] Revenue Service <br />~ <: :;.. <br />u me'Tax Return for Single and <br />olnt Fllers With No Dependents c~n 1996 <br />,'Ypur firs! name and Initial st name <br />;~f~i~riG ~ GI~?/ <br />1 <br />'' e ~ol~t retum, spouse's first name and initial Last na ~ <br />! .~~ <br />~ <br />OMB No. 1545-0675 <br />~ Your social security number <br />~ <br />5~~~ d`/ g3g~- <br />~ KS <br />y~ - labe~ <br />~; ' h@~e <br />_ <br />~ PCeddenti8l <br />Election <br />; Campaign <br />'($ee page 7J Fbme address (number and street). ~If''°u have a P.O. box, s page 7. Apt. no. <br />~ ySo ~Q h ~~'I Gr/ee ~~ <br />City, town or post oNice, state, and ZIP code. If you have a foreign address, see page 7. <br />~~h ~y~ , o~ 9~yo/ <br />Note: CideEking "Yes" will not change your t¢x or reduce your refund. <br />Do you want $3 to go to this fund? - <br /> <br />If a joint return, does your spouse want $3 to go to this fund? - <br />f <br />~ Income <br />1 Total wages, salaries, and tips. This <br /> should be shown in box 1 of your <br />Attach W-2 form(s). Attach your W-2 form(s). 1 <br />Copy B of <br />Form(s) <br />W-2 here. 2 Taxable interest income of $400 or less. If the total is <br />Enclose, but over $400, you cannot use Form 1040EZ. 2 <br />do not attach, <br />any payment <br />with your 3 Unemployment compensation (see page 9). g <br />return. 4 Add lines 1, 2, and 3. This is your adjusted gross <br /> income. If under $9,500, see page 9 to find out if you can <br /> claim the earned income credit on line 8. 4 <br />ote: You 5 Can your parents (or someone else) claim you on their return? <br />must check Z'es. Enter amount No. If single, enter 6,550.00. <br />Yes or No. from worksheet If married, enter 11,800.00 . <br />~ on back. See back for explanation. 5 <br /> 6 Subtract line 5 from line 4. If line 5 is larger than <br /> line 4, enter 0. This is your taxable income. - 6 <br />Payments 7 Enter your Federal income ta7c withheld from box 2 of <br />and tax your W-2 form(s). '7 <br /> 8 Earned income credit (see page 9). Enter type <br />' and amount of nont~able earned income below. <br />; 1y,pe $ 8 <br />I 9 Add lines 7 and 8(do not include nontaxable earned <br />~ income). These are your total payments. g <br />' 10 Tax. Use the amount on line 6 to find your tax in the <br />~ tax table on pages 20-24 of the booklet. Then, enter the <br />i tax from the table on this line. 10 <br />Refund 11a If line 9 is larger than line 10, subtract line 10 from <br />~Iave it sent line 9. This is your refund. lla <br />lirectly to ~ b Routing number <br />tour bank <br />~ccount! See - c Type d Account <br />~age 13 and Checking Savings number <br />ill in llb, c, ~ <br />nd d. <br />-mount ~ If line 10 is larger than line 9, subtract line 9 from line <br />OU OWg 10. This is the amount you owe. See page 13 for details <br />on how to pay and what to write on your payment. 12 <br />~ave read this return. Under penalties of perjury, I declare that to the best of my knowledge and belief, the <br />kurn is true, cocrect, and accurately lists all amounts and sources of income I received during the tax year. <br />~gn ~ Your signature Spouse.'s si~nature if joint return <br />lere <br />p Copy ('or Date Your cecupati n Date Spouse's occupation <br />r records. ,J <br />7~/.5 '9~ 57`~ a~~ <br />rp • <br />Spouse's social security number <br />/ , ~ <br />3 ~l3 0~ <br />~- <br />_-' <br />3 ~-/3 0 0 <br />G .3~~s o ~ o <br />~ ~ ~ <br />fo8 f 3 <br />1G 8 j 3 <br />d ~ ~ <br />`o~ 1 3 <br />~ <br />~:.. <br />(1ff'ri .1 <br />L.! S E' <br />Ur~~, <br />~ , <br />Form104~EZ(1996) <br />rlvacy Act and Paperwork Reduction Act Notice, see page 5. Cat. No. 14090A <br />