//11FORM 1040 U.S. INDIVIDUAL INCOME TAX RETURN 1990 * 01-NLABEL | 2| SSN: YNAME*E | 2| SNAME*E | 2|  | 2| CITY*-N$1 to Presidential Election Campaign Fund? [ ] YES [ ] NO. ,Y8 ,N$1 from spouse to Election Campaign Fund? [ ] YES [ ] NO. ,Y8 ,N=NFILING 1. [ ] Single,1STATUS: 2. [ ] Married filing joint return,2 3. [ ] Married filing separate:,3- 4. [ ] Head of household:,4- 5. [ ] Qualifying widow(er): (year spouse died: 19__),5?=EXEMPTIONS=C6a. [ ] Yourself 6b. [ ] Spouse No.checked.[ ]L |Chk if|Dependent's| |Mths| No. children6c. Dependent's Name |Undr 2| SSN | Relation. |Home| with you...[ ]L> -|-|- |- |----| | [ ] | | | | No. children not".; | [ ] | | | | with you...[ ] !"".#;$L? | [ ] | | | |&'"(.);* | [ ] | | | | No. other..[ ],-"../;0L@ | [ ] | | | |23"4.5;6 | [ ] | | | |89":.;;< -86d. Check if claiming dependent under pre-1985 agreement...[ ]>A6e. Total number of exemptions.*[ ]LB=INCOME=G 7. Wages, salaries, tips.( ) ( ). 7.|0P5QER 8a Taxable interest income.!8a.|ES 8b Tax-exempt interest.8b.| |2T 9. Dividend income.) 9.|EU10. Taxable refunds of state and local taxes.10.|EV11. Alimony received.(11.|EW12. Business income or loss.!12.|EX13. Capital gain or loss.$13.|EY14. Capital gain distribution not reported on line 13.14.|EZ15. Other gains or losses.( )..15.|7[E\16a Total IRA distributions.16a.| |Taxable.16b.|)]E^17a Total pensions and annuities..17a.| |Taxable.17b.|)_E`18. Rents, royalties, partnerships.18.|Ec19. Farm income or loss.%19.|Ed20. Unemployment compensation.20.|Ee21a. Social security benefits.( )..21a.| |Taxable.21b.| g)fEh22. Other income: ( ). 22.|Z1*Em23. Total income.,23.|En=ADJUSTMENTS=B24a. Your IRA deduction.24a.| |6r24b. Spouse's IRA deduction.24b.| |6s25. Deduction for self-employment tax.25.| |6t26. Self-employed health insurance deduction..26.| |6v27. Keogh plans and SEP payments. 27.| |6y28. Penalty on early withdrawals of savings...28.| |6z29. Alimony paid.29.| |6{ Recipient's SSN: | ||30. TOTAL ADJUSTMENTS...( ).30.|}+~E31. ADJUSTED GROSS INCOME.#31.|E=N2FORM 1040 (1990) 8Page 2NAME*;=NTAXES: :|32. Amount from line 31.%32.|E33a. Check if: [ ] You're 65 [ ] Blind [ ] Spouse 65 [ ] Blind| +: Add the number of boxes checked.33a. [ ]|>33b. If someone can claim you as a dependent, check here.....[ ] |?33c. If married filing separate return and spouse itemizes...[ ] |?34. Standard or itemized deduction.34.|E Check if deduction is from Schedule A [ ] |535. Subtract line 34 from line 32.35.|E36. Multiply $2050 by total exemptions claimed on line 6e....36.|E37. Taxable income. Subtract line 36 from line 35. 37.|E38. Tax from a.[ ] Tables, b.[ ] Schedules, c.[ ] Form 8615..38.| 1E Amount, if any, from Form(s) 8814.....d. ( ) |039. Additional taxes: [ ] Form 4970 or [ ] Form 4972.39.|,E40. Add lines 38 and 39.%40.|E=CREDITS=F41. Credit for child care. ( )..41.| |*642. Credit for elderly or disabled.....( )..42.| |*643. Foreign tax credit.43.| |644. General business credit.44.| |6 [ ] Form 3800 or [ ] Form ____ | | $45. Credit for prior year minimum tax.45.| |646. Add lines 41 through 45.!46.|E47. Subtract line 46 from line 40.47.|E=OTHER TAXES=B48. Self-employment tax. ( ). 48.|'E49. Alternative minimum tax.!49.|E50. Tax from recapture of investment credit.50.|E [ ] Form 4255 or [ ] Form 8611 | 51. Social security tax on tips.51.|E52. Tax on IRA qualified retirement plan.52.|E53. Advanced earned income credit payments from W-2. 53.|E54. Total tax. Add lines 47 through 53.54.|E=PAYMENTS=E55. Fed tax withheld (Chk if any 1099 [ ])....55.| |)656. 1990 est tax or amt applied from 1989.....56.| |657. Earned income credit....( ).57.| |EIC*658. Amount paid with Form 4868.58.| |659. Excess social security and RRTA withheld..59.| |660. Credit for federal tax on special fuels...60.| |661. Regulated investment company credit.61.| |662. Total payments.*62.|E=NREFUND OR AMOUNT DUE: +|63. Amount OVERPAID.)63.|E64. Amount to be REFUNDED TO YOU.64.|E65. Amount to be applied to 1991 taxes.65.| |666. AMOUNT YOU OWE.*66.|E 1| |# 67. Penalty for underpayment of est. tax.67.| |# 6=N Your occupation:/ Spouse's Occupation:/=N This cannot be filed with your tax return. You must transfer these figures to an official 1040 provided by the IRS or use one of the other AM-Tax printing options (dot-matrix 1040, overlays, pre-printed forms, laser 1040) to produce an IRS-acceptable 1040.//21N9010401*" XF1040 YNAME*B SNAME* B CITY*6 ,Y? , ? ,N6 ,Y? , ? ,N,1,2,3@,4(,57N%(4@N> %!("4#@$&%'((4)@*N?,%-(.4/@02%3(445@6N@8%9(:4;@>>E7EEE'4.E)4EE-5-55$),55EE4EE)4EEEEE55NEI*"EICHLD*5-EIC*5555EEE5E*588@,YDBPREP*8>