Victoria Forms
This Form was created in Word using VF Creator.Created: 27/11/2017 by the VF Creator team.VF Creator turns documents created in Word into online forms.You can view/edit eForm features, after installing the VF Creator add-in. A new VF Creator ribbon will be available which allows you to create/edit eForms.Please visit VF-Creator/ to start creating online forms in Word.-20696370485Form00Form1040Department of the Treasury—Internal Revenue Service (99)U.S. Individual Income Tax Return2017OMB No. 1545-0074 IRS Use ONLY – Do not write or staple in this space.For the year Jan 1-Dec. 31, 2015, or other tax year beginning: , ending See separate instructions.Your first name and initialLast nameYour social security numberIf a joint return, spouse’s first name and initial Last nameSpouse’s social security numberHome address (number and street). If you have a P.O. box, see instructions.Apt. no.Make sure the SSN(s) above-12700-431800and on line 6c are correct.City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).Presidential Election CampaignCheck here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund. You Spouse Foreign country nameForeign province/state/countryForeign postal codeFiling StatusCheck only one box.1Single45Head of household (with qualifying person). (See instructions.) Ifthe qualifying person is a child but not your dependent, enter this84879614320607143752349500child’s name here. Qualifying widow(er) with dependent child2Married filing jointly (even if only one had income)3Married filing separately. Enter spouse’s SSN above7680323333700and full name here. Exemptions6aYourself. If someone can claim you as a dependent, do not check box 6a . . . . . . . . }Boxes checked on 6a and 6b bSpouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24796833178800If more than four dependents, see instructions and check here cDependents: (2) Dependent’s social security number(3) Dependent’s relationship to you(4) X if child under age 17qualifying for child tax credit(see instructions)No. of children on 6c who:? lived with you? did not live with you due to divorce or separation (see instructions)(1) First nameLast nameDependents on 6cnot entered above d Total number of exemptions claimed . . . . . . . . . . . . . . . . . . . . . . . . . Income7Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . 7Attach Form(s)W-2 here. Alsoattach FormsW-2G and1099-R if taxwas withheld.If you did not get a W-2, see instructions.8aTaxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . .8a bTax-exempt interest. Do not include on line 8a . . 8b9aOrdinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . .9aQualified dividends . . . . . . . . . . . . . 9b10Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . .1011Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1112Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . .1213Capital gain or (loss). Attach Schedule D if required. If not required, check here 1314Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . 1415aIRA distributions . . . . 15a b Taxable amount 15b16aPensions and annuities . 16a b Taxable amount16b17Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . .1718Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . 1819Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . .1920aSocial security benefits20a b Taxable amount20b21Other income. List type and amount 216264283778300Total Income 22Adjusted Gross Income23Educator expenses . . . . . . . . . . . . . 2324Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ2425Health savings account deduction. Attach Form 88892526Moving expenses. Attach Form 3903 . . . . . . 2627Deductible part of self-employment tax. Attach Schedule SE2728Self-employed SEP, SIMPLE, and qualified plans2829Self-employed health insurance deduction . . . . 2930Penalty on early withdrawal of savings . . . . . . 3031a13560423968800Alimony paid b Recipient’s SSN 31a32IRA deduction . . . . . . . . . . . . . . . 3233Student loan interest deduction . . . . . . . .3334Tuition and fees. Attach Form 8917 . . . . . . .3435Domestic production activities deduction. Attach Form 890335Lines 23 through 25 combined363925888831400Subtracting line 36 from line 22. This is your adjusted gross income 37For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.Cat. No. 11320BForm 1040 (2017)858520-1027907600-126753-55004800966001-8221900Form 1040 (2017)Page 238Amount from line 37 (adjusted gross income) 38Tax and Credits39aCheck if:{You were born before Jan 2, 1951,Blind.}Total boxes checked 39aSpouse was born before Jan 2, 1951,Blind. bIf your spouse itemizes on a separate return or you were a dual-status alien,check here 39b -546108255Standard Deduction for – People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions.All others:Single or Married filing separately, $6,300Married filing jointly or Qualifying widow(er), $12,600Head of household, $9,25000Standard Deduction for – People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions.All others:Single or Married filing separately, $6,300Married filing jointly or Qualifying widow(er), $12,600Head of household, $9,250-2476582550925033144498751205698506890887338040Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . . 4041Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . 4142Exemptions. If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see instructions4243Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, result will be 0 . 4344Tax (see instructions). Check is any from: a Form(s) 8814 b Form 4972 c 4445Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . . . . 4546Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . 4647Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4748Foreign tax credit. Attach Form 116 if required . . . . 4849Credit for child and dependent care expenses. Attach Form 24414950Education credits from Form 8863, line 19 . . . . .5051Retirement savings contributions credit. Attach Form 8880 5152Child tax credit. Attach Schedule 8812, if required . . 5253Residential energy credits. Attach Form 5695 . . . .5354Other credits from Form: a 3800 b 8801 c 5455Add lines 48 through 54. These are your total credits . . . . . . . . . . . . . . . . .555636506154897300Subtract line 55 from line 47. If line 55 is more than line 47, result will be 0 . . . . . 56Other Taxes57Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . .5758Unreported social security and Medicare tax from Form: a 4137 b 8919 . . . . .5859Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . .5960aHousehold employment taxes from Schedule H . . . . . . . . . . . . . . . . . . .60a bFirst-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . . .60b61Health care: individual responsibility (see instructions) Full-year coverage . . . . . .6162Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 626336573014699000Add lines 56 through 62. This is your Total tax . . . . . . . . . . . . . . . . 63148762455140014876251339If you have a qualifying child, attach Schedule EIC00If you have a qualifying child, attach Schedule EIC8395293461780922020346710924575487631Payments64Federal income tax withheld from Forms W-2 and 1099 64652015 estimated tax payments and amount applied from 2014 return6566aEarned income credit (EIC) . . . . . . . . . . .66a bNontaxable combat pay election66b67Additional child tax credit. Attach Schedule 8812 . . . .6768American opportunity credit from Form 8863, line 8 . . .6869Net premium tax credit. Attach Form 8962 . . . . . .6970Amount paid with request for extension to file . . . . .7071Excess social security and tier 1 RRTA tax withheld . .7172Credit for federal tax on fuels. Attach Form 4136 . . . .7273Credits from Form: a 2439 b Reserved c 8885 d 737436569653770500Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . . 74RefundDirect deposit?See instructions7536639502857500If line 74 is more than line 63, this is the amount you overpaid7576a32289755842000Amount of line 75 you want refunded to you. If Form 8888 is attached, check here 76a-679454191000 bRouting number -615954467300 c Type: CheckingSavings-704855270500 dAccount number7721488573463400Amount of line 75 you want applied to your 2016 estimated tax77Amount you owe7836499803045900Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions7879Estimated tax penalty (see instructions) . . . . . . . 77Third Party DesigneeDo you want to allow another person to discuss this return with the IRS (see instructions)?Yes. Complete belowNoDesignee’s namePhone numberPersonal identification number (PIN)Sign Here82372116859200Joint return? See instructions.Keep a copy for your recordsUnder 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.Your signatureDateYour occupationDaytime phone numberSpouse’s signature. If a join return both must signDateSpouse’s occupationIf the IRS sent you an Identity Protection Pin, enter it here (see inst. ) Paid preparer use onlyPreparer’s namePreparer’s signatureDateCheck if self-employedPTIN Firm’s nameFirm’s EINFirm’s addressPhone no.form1040Form 1040 (2017) ................
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