Skylar and Walter Black have been married for 5 years They live at 883 Scrub Brush Street, Apt 52B, Las Vegas, NV 89125 Skylar is a homemaker and Walter is a high school teacher His W 2 form is located on the next tab Skylar's Social Security number is 222 43 7690 and Walt's is 700 01 0002 The Blacks incurred the following expenses during their move from Maine to Nevada in January of 2017 Cost of moving furniture $4,775 Travel (2,988 miles at $0 17) 508 Lodging en route 520 Meals en route 90 House hunting trip before the move 750 The school district reimbursed Walter $550 for moving expenses These are reflected on his W 2 Walters previous job, as a high school teacher in Maine, was only 5 miles from his home Skylar was unemployed prior to the move The Blacks own a ski condo located at 123 Buncombe Lane, Brian Head, UT 84719 The condo was rented for 183 days during 2017 and used by the Blacks for 17 days Pertinent information about the condo rental is as follows Rental income $16,000 Mortgage interest reported on Form 1098 8,600 Homeowners' association dues 5,200 Utilities 1,200 Maintenance 3,800 Depreciation (assume fully depreciated) 0 The above amounts do not reflect any allocation between rental and personal use of the condo The Blacks are active managers of the condo Required Complete Form 1040 and the schedules and forms provided for the Blacks If an amount box does not require an entry or the answer is zero, enter 0 Do not round any percentages If required, round your answers to the nearest dollar If required, enter a loss as a negative number on the tax form Do not enter deductions as negative numbers Note Special instructions for Form 8582 If required, use the minus sign to enter a loss as a negative number on the lines 1d, 4 and 16 However, per the instructions on the tax return, enter all numbers in Part II as positive amounts Walter's earnings from teaching are a Employee's social security number 700 01 0002 OMB No 1545 0008 Safe, accurate, FAST Use IRS e file Visit the IRS website at www irs gov efile b Employer identification number (EIN) 31 1238967 1 Wages, tips, other compensation 50,674 00 2 Federal income tax withheld 4,700 00 c Employer's name, address, and ZIP code Las Vegas School District 2234 Vegas Valley Drive Las Vegas, NV 89169 3 Social security wages 50,674 00 4 Social security tax withheld 3,141 79 5 Medicare wages and tips 50,674 00 6 Medicare tax withheld 734 77 7 Social security tips 8 Allocated tips d Control number 9 Verification code 10 Dependent care benefits e Employee's first name and initial Last name Walter Black 883 Scrub Brush Street, Apt 52B Las Vegas, NV 89125 Suff 11 Nonqualified plans 12a See instructions for box 12 C o d e P 550 00 13 Statutory employee Retirement plan Third party sick pay 12b C o d e DD 7,800 00 14 Other 12c C o d e 12d C o d e f Employee's address and ZIP code 15 State NV Employer's state ID number 16 State wages, tips, etc 17 State income tax 18 Local wages, tips, etc 19 Local income tax 20 Locality name Form W 2 Wage and Tax Statement 2017 Department of the TreasuryInternal Revenue Service Copy BTo Be Filed With Employee's FEDERAL Tax Return This information is being furnished to the Internal Revenue Service Complete Form 1040 for Walter and Skylar Black Form 1040 Department of the TreasuryInternal Revenue Service (99) U S Individual Income Tax Return 2017 OMB No 1545 0074 IRS Use Only For the year Jan 1Dec 31, 2017, or other tax year beginning , 2017, ending , 20 See separate instructions Your first name and initial Walter Last name Black Your social security number 700 01 0002 If a joint return, spouse's first name and initial Skylar Last name Black Spouse's social security number 222 43 7690 Home address (number and street) If you have a P O box, see instructions 883 Scrub Brush Street Apt no 52 B Make sure the SSN(s) above and 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) Las Vegas, NV 89125 Presidential Election Campaign Check 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 name Foreign province state country Foreign postal code Filing Status Exemptions 6a Yourself If someone can claim you as a dependent, do not check box 6a Boxes checked on 6a and 6b b Spouse No of children on 6c who lived with you c Dependents (2) Dependent's social security number (3) Dependent's relationship to you (4) If child under age 17 qualifying for child tax credit (see instructions) (1) First name Last name did not live with you due to divorce or separation (see instructions) If more than four dependents, see instructions and check here Dependents on 6c not entered above Add numbers on lines above d Total number of exemptions claimed Income Attach Form(s) W 2 here Also attach Forms W 2G and 1099 R if tax was withheld If you did not get a W 2, see instructions 7 Wages, salaries, tips, etc Attach Form(s) W 2 7 8a Taxable interest Attach Schedule B if required 8a b Tax exempt interest Do not include on line 8a 8b 9a Ordinary dividends Attach Schedule B if required 9a b Qualified dividends 9b 10 Taxable refunds, credits, or offsets of state and local income taxes 10 11 Alimony received 11 12 Business income or (loss) Attach Schedule C or C EZ 12 13 Capital gain or (loss) Attach Schedule D if required If not required, check here 13 14 Other gains or (losses) Attach Form 4797 14 15a IRA distributions 15a b Taxable amount 15b 16a Pensions and annuities 16a b Taxable amount 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc Attach Schedule E 17 18 Farm income or (loss) Attach Schedule F 18 19 Unemployment compensation 19 20a Social security benefits 20a b Taxable amount 20b 21 Other income List type and amount 21 22 Combine the amounts in the far right column for lines 7 through 21 This is your total income 22 Adjusted Gross Income 23 Educator expenses 23 24 Certain business expenses of reservists, performing artists, and fee basis government officials Attach Form 2106 or 2106 EZ 24 25 Health savings account deduction Attach Form 8889 25 26 Moving expenses Attach Form 3903 26 27 Deductible part of self employment tax Attach Schedule SE 27 28 Self employed SEP, SIMPLE, and qualified plans 28 29 Self employed health insurance deduction 29 30 Penalty on early withdrawal of savings 30 31a Alimony paid b Recipient's SSN 31a 32 IRA deduction 32 33 Student loan interest deduction 33 34 Reserved for future use 34 35 Domestic production activities deduction Attach Form 8903 35 36 Add lines 23 through 35 36 37 Subtract line 36 from line 22 This is your adjusted gross income 37 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions Cat No 11320B Form 1040 (2017) Form 1040 (2017) Walter and Skylar Black 700 01 0002 Page 2 38 Amount from line 37 (adjusted gross income) 38 Tax and Credits 39a Check if You were born before January 2, 1953, Blind Spouse was born before January 2, 1953, Blind Total boxes checked 39a b If your spouse itemizes on a separate return or you were a dual status alien, check here 39b Standard 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, $6,350 Married filing jointly or Qualifying widow(er), $12,700 Head of household, $9,350 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) 40 41 Subtract line 40 from line 38 41 42 Exemptions If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d Otherwise, see instructions 42 43 Taxable income Subtract line 42 from line 41 If line 42 is more than line 41, enter 0 43 44 Tax (see instructions) Check if any from a Form(s) 8814 b Form 4972 c 44 45 Alternative minimum tax (see instructions) Attach Form 6251 45 46 Excess advance premium tax credit repayment Attach Form 8962 46 47 Add lines 44, 45, and 46 47 48 Foreign tax credit Attach Form 1116 if required 48 49 Credit for child and dependent care expenses Attach Form 2441 49 50 Education credits from Form 8863, line 19 50 51 Retirement savings contributions credit Attach Form 8880 51 52 Child tax credit Attach Schedule 8812, if required 52 53 Residential energy credit Attach Form 5695 53 54 Other credits from Form a 3800 b 8801 c 54 55 Add lines 48 through 54 These are your total credits 55 56 Subtract line 55 from line 47 If line 55 is more than line 47, enter 0 56 Other Taxes 57 Self employment tax Attach Schedule SE 57 58 Unreported social security and Medicare tax from Form a 4137 b 8919 58 59 Additional tax on IRAs, other qualified retirement plans, etc Attach Form 5329 if required 59 60a Household employment taxes from Schedule H 60a b First time homebuyer credit repayment Attach Form 5405 if required 60b 61 Health care individual responsibility (see instructions) Full year coverage 61 62 Taxes from a Form 8959 b Form 8960 c Instructions enter code(s) 62 63 Add lines 56 through 62 This is your total tax 63 Payments 64 Federal income tax withheld from Forms W 2 and 1099 64 If you have a qualifying child, attach Schedule EIC 65 2017 estimated tax payments and amount applied from 2016 return 65 66a Earned income credit (EIC) 66a b Nontaxable combat pay election 66b 67 Additional child tax credit Attach Schedule 8812 67 68 American opportunity credit from Form 8863, line 8 68 69 Net premium tax credit Attach Form 8962 69 70 Amount paid with request for extension to file 70 71 Excess social security and tier 1 RRTA tax withheld 71 72 Credit for federal tax on fuels Attach Form 4136 72 73 Credits from Form a 2439 b Reserved c 8885 d 73 74 Add lines 64, 65, 66a, and 67 through 73 These are your total payments 74 Refund 75 If line 74 is more than line 63, subtract line 63 from line 74 This is the amount you overpaid 75 76a Amount of line 75 you want refunded to you If Form 8888 is attached, check here 76a Direct deposit See instructions b Routing number c Type Checking Savings d Account number 77 Amount of line 75 you want applied to your 2018 estimated tax 77 Amount You Owe 78 Amount you owe Subtract line 74 from line 63 For details on how to pay, see instructions 78 79 Estimated tax penalty (see instructions) 79 Third Party Designee Do you want to allow another person to discuss this return with the IRS (see instructions) Yes Complete below No Designee's name Phone no Personal identification number (PIN) Sign Here Joint return See instructions Keep a copy for your records Under 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 accurately list all amounts and sources of income I received during the tax year Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge Your signature Date Your occupation Teacher Daytime phone number Spouse's signature If a joint return, both must sign Date Spouse's occupation Homemaker If the IRS sent you an Identity Protection PIN, enter it here (see inst ) Paid Preparer Use Only Print Type preparer's name Preparer's signature Date Check if self employed PTIN Firm's name Firm's EIN Firm's address Phone no Go to www irs gov Form1040 for instructions and the latest information Form 1040 (2017)

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Skylar and Walter Black have been married for 5 years. They live at 883 Scrub Brush Street, Apt. 52B, Las Vegas, NV 89125. Skylar is

Skylar and Walter Black have been married for 5 years. They live at 883 Scrub Brush Street, Apt. 52B, Las Vegas, NV 89125. Skylar is a homemaker and Walter is a high school teacher. His W-2 form is located on the next tab. Skylar's Social Security number is 222-43-7690 and Walt's is 700-01-0002.

The Blacks incurred the following expenses during their move from Maine to Nevada in January of 2017:

Cost of moving furniture	$4,775
Travel (2,988 miles at $0.17)	508
Lodging en route	520
Meals en route	90
House-hunting trip before the move	750

The school district reimbursed Walter $550 for moving expenses. These are reflected on his W-2. Walter’s previous job, as a high school teacher in Maine, was only 5 miles from his home. Skylar was unemployed prior to the move.

The Blacks own a ski condo located at 123 Buncombe Lane, Brian Head, UT 84719. The condo was rented for 183 days during 2017 and used by the Blacks for 17 days. Pertinent information about the condo rental is as follows:

Rental income	$16,000
Mortgage interest reported on Form 1098	8,600
Homeowners' association dues	5,200
Utilities	1,200
Maintenance	3,800
Depreciation (assume fully depreciated)	0

The above amounts do not reflect any allocation between rental and personal use of the condo. The Blacks are active managers of the condo.

Required:
Complete Form 1040 and the schedules and forms provided for the Blacks.

If an amount box does not require an entry or the answer is zero, enter "0".

Do not round any percentages.

If required, round your answers to the nearest dollar.

If required, enter a "loss" as a negative number on the tax form. Do not enter deductions as negative numbers.

Note: Special instructions for Form 8582: If required, use the minus sign to enter a "loss" as a negative number on the lines 1d, 4 and 16. However, per the instructions on the tax return, enter all numbers in Part II as positive amounts.

Walter's earnings from teaching are:

a Employee's social security number
700-01-0002

OMB No. 1545-0008

Safe, accurate,
FAST! Use

IRS e ~ file

Visit the IRS website at
www.irs.gov/efile

Employer identification number (EIN)
31-1238967

Wages, tips, other compensation
50,674.00

Federal income tax withheld
4,700.00

Employer's name, address, and ZIP code
Las Vegas School District
2234 Vegas Valley Drive
Las Vegas, NV 89169

Social security wages
50,674.00

Social security tax withheld
3,141.79

Medicare wages and tips
50,674.00

Medicare tax withheld
734.77

Social security tips

Allocated tips

Control number

Verification code

Dependent care benefits

Employee's first name and initial Last name
Walter Black
883 Scrub Brush Street, Apt# 52B
Las Vegas, NV 89125

Suff.

Nonqualified plans

12a

See instructions for box 12

C
o
d
e

550.00

Statutory employee	Retirement plan	Third-party sick pay
☐	☒	☐

12b

C
o
d
e

7,800.00

Other

12c

C
o
d
e

12d

C
o
d
e

Employee's address and ZIP code

15State NV	Employer's state ID number	16	State wages, tips, etc.	17	State income tax	18	Local wages, tips, etc.	19	Local income tax	20	Locality name

Form W-2

Wage and Tax
Statement

2017

Department of the Treasury—Internal Revenue Service

Copy B–To Be Filed With Employee's FEDERAL Tax Return.

This information is being furnished to the Internal Revenue Service.

Complete Form 1040 for Walter and Skylar Black.

Form
1040

Department of the Treasury—Internal Revenue Service (99)
U.S. Individual Income Tax Return

2017

OMB No. 1545-0074

IRS Use Only

For the year Jan. 1–Dec. 31, 2017, or other tax year beginning

, 2017, ending

, 20

See separate instructions.

Your first name and initial
Walter

Last name
Black

Your social security number
700-01-0002

If a joint return, spouse's first name and initial
Skylar

Last name
Black

Spouse's social security number
222-43-7690

Home address (number and street). If you have a P.O. box, see instructions.
883 Scrub Brush Street

Apt. no.
52 B

▲ Make sure the SSN(s) above and 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).
Las Vegas, NV 89125

Presidential Election Campaign
Check 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 name

Foreign province/state/country

Foreign postal code

Filing Status

Exemptions	6a		Yourself. If someone can claim you as a dependent, do notcheck box 6a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				}	Boxes checked on 6a and 6b
	b		Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .					No. of children on 6c who: • lived with you
	c	Dependents:		(2)Dependent's social security number	(3)Dependent's relationship to you	(4) ✔ If child under age 17 qualifying for child tax credit (see instructions)
	(1) First name		Last name					• did not live with you due to divorce or separation (see instructions)
If more than four dependents, see instructions and check here ► ▢
								Dependents on 6c not entered above

								Add numbers on lines above ►
	d	Total number of exemptions claimed . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Income Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld. If you did not get a W-2, see instructions.	7	Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				7
	8a	Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				8a
	b	Tax-exempt interest. Do not include on line 8a . . . . . . . . .		8b
	9a	Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				9a
	b	Qualified dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		9b
	10	Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . .				10
	11	Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				11
	12	Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . . . . . . . . .				12
	13	Capital gain or (loss). Attach Schedule D if required. If not required, check here ► ▢				13
	14	Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				14
	15a	IRA distributions . . . . . . . . . . .	15a	b Taxable amount . .		15b
	16a	Pensions and annuities . . . . . .	16a	b Taxable amount . .		16b
	17	Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E				17
	18	Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				18
	19	Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				19
	20a	Social security benefits	20a	b Taxable amount . .		20b
	21	Other income. List type and amount _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _				21
	22	Combine the amounts in the far right column for lines 7 through 21. This is your total income ► . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				22
Adjusted Gross Income	23	Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		23
	24	Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ		24
	25	Health savings account deduction. Attach Form 8889 . . . . .		25
	26	Moving expenses. Attach Form 3903 . . . . . . . . . . . . . . . . . .		26
	27	Deductible part of self-employment tax. Attach Schedule SE		27
	28	Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . .		28
	29	Self-employed health insurance deduction . . . . . . . . . . . . .		29
	30	Penalty on early withdrawal of savings . . . . . . . . . . . .		30
	31a	Alimony paid b Recipient's SSN ► ________		31a
	32	IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		32
	33	Student loan interest deduction . . . . . . . . . . . . . . . . . . . . .		33
	34	Reserved for future use . . . . . . . . . . . . . . . . .		34
	35	Domestic production activities deduction. Attach Form 8903		35
	36	Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .				36
	37	Subtract line 36 from line 22. This is your adjusted gross income . . . . . . . . . . .			►	37

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 11320B

Form 1040 (2017)

Form 1040 (2017)

Walter and Skylar Black

700-01-0002

Page 2

Amount from line 37 (adjusted gross income)

Tax and Credits

39a

Check
if:

{

▢ You were born before January 2, 1953, ▢ Blind.
▢ Spouse was born before January 2, 1953, ▢ Blind.

}

Total boxes
checked ► 39a

If your spouse itemizes on a separate return or you were a dual-status alien, check here ► 39b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

▢

Standard 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, $6,350

Married filing jointly or Qualifying widow(er), $12,700

Head of household, $9,350

Itemized deductions (from Schedule A) or your standard deduction (see left margin)

Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-.

Tax (see instructions). Check if any from: a ▢ Form(s) 8814 b ▢ Form 4972 c ▢ _____

Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . . . . . . .

Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . . . .

Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

►

Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . . .

Credit for child and dependent care expenses. Attach Form 2441

Education credits from Form 8863, line 19 . . . . . . . . . . . . . . .

Retirement savings contributions credit. Attach Form 8880 . . .

Child tax credit. Attach Schedule 8812, if required . . . . . . . .

Residential energy credit. Attach Form 5695 . . . . . . . . . . .

Other credits from Form: a ▢ 3800 b ▢ 8801 c ▢ ________

Add lines 48 through 54. These are your total credits . . . . . . . . . . . . . . . . . . . . . .

Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . . .

►

Other
Taxes

Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unreported social security and Medicare tax from Form: a ▢ 4137 b ▢ 8919 . . . . . .

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required

60a

Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . .

60a

First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . .

60b

Health care: individual responsibility (see instructions)

Full-year coverage

☒

Taxes from: a ▢ Form 8959 b ▢ Form 8960 c ▢ Instructions; enter code(s) _ _ _ _ _ _

Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

►

Payments	64	Federal income tax withheld from Forms W-2 and 1099 . . . . . .		64
If you have a qualifying child, attach Schedule EIC.	65	2017 estimated tax payments and amount applied from 2016 return		65
	66a	Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . . .		66a
	b	Nontaxable combat pay election . . . . . .	66b
	67	Additional child tax credit. Attach Schedule 8812 . . . . . . . . . . .		67
	68	American opportunity credit from Form 8863, line 8 . . . . . . . .		68
	69	Net premium tax credit. Attach Form 8962 . . . . . . . . . . . . . . .		69
	70	Amount paid with request for extension to file . . . . . . . . . . .		70
	71	Excess social security and tier 1 RRTA tax withheld . . . . . . . . .		71
	72	Credit for federal tax on fuels. Attach Form 4136 . . . . . . . . . .		72
	73	Credits from Form: a ▢ 2439 b ▢ Reserved c ▢ 8885 d ▢		73
	74	Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . . . . .			►	74

Refund

If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid

76a

Amount of line 75 you want refunded to you. If Form 8888 is attached, check here ►

▢

76a

Direct deposit? See instructions.

► b

Routing number

► c Type: ▢ Checking ▢ Savings

► d

Account number

Amount of line 75 you want applied to your 2018 estimated tax ►

Amount
You Owe

Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

►

Estimated tax penalty (see instructions) . . . . . . . . . . . . . . . . . . . .

Third Party Designee

Do you want to allow another person to discuss this return with the IRS (see instructions)? ▢ Yes. Complete below. ▢ No

Designee's
name

►

Phone
no.

►

Personal identification
number (PIN) ►

Sign
Here

Joint return? See instructions. Keep a copy for your records.

Under 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 accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

▶

Your signature

Date

Your occupation
Teacher

Daytime phone number

Spouse's signature. If a joint return, bothmust sign.

Date

Spouse's occupation
Homemaker

If the IRS sent you an Identity Protection PIN, enter it here (see inst.)

Paid Preparer Use Only	Print/Type preparer's name	Preparer's signature	Date	Check ▢ if self-employed	PTIN
	Firm's name ►			Firm's EIN ►
	Firm's address ►			Phone no.
Go to www.irs.gov/Form1040 for instructions and the latest information.			Form 1040 (2017)