Jose and Dora Hernandez are married filing jointly. They are 50 and 45 years old, respectively. Their address is 32010 Lake Street, Atlanta, GA 30294. Additional information about Mr. and Mrs. Hernandez is as follows:

Social security numbers:
Jose: 412-34-5670									Dora: 412-34-5671
Date of birth: 4/23/1966									Date of birth: 7/12/1971
W-2 for Jose shows these amounts:									W-2 for Dora shows these amounts:
Wages (box 1)	=	$	45,800.00						Wages (box 1)	=	$	31,000.00
Federal W/H (box 2)	=	$	6,160.00						Federal W/H (box 2)	=	$	3,650.00
Social security wages (box 3)	=	$	45,800.00						Social security wages (box 3)	=	$	31,000.00
Social security W/H (box 4)	=	$	2,839.60						Social security W/H (box 4)	=	$	1,922.00
Medicare wages (box 5)	=	$	45,800.00						Medicare wages (box 5)	=	$	31,000.00
Medicare W/H (box 6)	=	$	664.10						Medicare W/H (box 6)	=	$	449.50

Form 1099-INT for Jose and Dora shows this amount:

Box 1 = $300.00 from City Bank.

Dependent: Daughter Adela is 5 years old. Her date of birth is 3/15/2011. Her social security number is 412-34-5672.

Jose is a store manager, and Dora is a receptionist.

Prepare the tax return for Mr. and Mrs. Hernandez using the appropriate form. They are entitled to a $1,000 child tax credit (this credit is discussed in Chapter 9). For now, enter the credit on the appropriate line of the form. Both Jose and Dora want to contribute to the presidential election campaign. Mr. and Mrs. Hernandez had qualifying health care coverage at all times during the tax year. (List the names of the taxpayers in the order in which they appear in the problem. Input all the values as positive numbers.)

Use the appropriate Tax Tables.

Page 1 of Form 1040A. Use provided information and follow instructions on form.

Form 1040A - U.S. Individual Income Tax Return			(99)	2016		IRS Use Only - Do not write in this space.
Your first name and initial			Last name			Your social security number (Enter as xxx-xx-xxxx)
Jose			Hernandez			412-34-5670
If a joint return, spouse's first name and initial			Last name			Spouse's social security number (Enter as xxx-xx-xxxx)
Dora			Hernandez			412-34-5671
Home address (number and street). If you have a P.O. box, see instructions.					Apt. no.	? Make sure the SSN(s) above and on line 6c are correct.
32010 Lake Street
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below.						Presidential Election Campaign
Atlanta, GA 30294						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.
Foreign country name			Foreign province		Foreign postal code
						Youcheckbox unchecked1 of 1	Spousecheckbox unchecked1 of 1
Filing Status	1 Single	radio button unchecked1 of 5	4 Head of household (with qualifying person). If the qualifying person is a child but not your				radio button unchecked2 of 5
Check only one box.	2 Married filing jointly	radio button checked3 of 5	dependent, enter this child's name here. ?
	3 Married filing	radio button unchecked4 of 5	5 Qualifying widow(er) with dependent child				radio button unchecked5 of 5
	separately
Exemptions	6a Yourself	checkbox checked1 of 1			Boxes checked on 6a and 6b
	b Spouse	checkbox checked1 of 1			No. of children on 6c who:
	c Dependents:		(2) Dependent's social security number (Enter as xxx-xx-xxxx)	(3) Dependent's relationship to you	(4) X if child under age 17 qualifying for child tax credit.	? Lived with you
	(1) First name	Last name				? Did not live with you
If more than four dependents, see instructions.	Adela	Hernandez	412-34-5672	Daughter	checkbox checked1 of 1	Dependents on 6c not entered above
					checkbox unchecked1 of 1
					checkbox unchecked1 of 1
					checkbox unchecked1 of 1	Add numbers on lines above ?
	d Total number of exemptions claimed						0
Income	7 Wages, salaries, tips, etc. Attach Form(s) W-2					7
	8a Taxable interest. Attach Schedule B if required					8a
Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld.	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 Capital gain distributions (see instructions).					10
	11a IRA distributions	11a		11b Taxable amount (see instructions).		11b
	12a Pensions and	12a		12b Taxable amount (see instructions).		12b
	Annuities
	13 Unemployment compensation and Alaska Permanent Fund dividends.					13
	14a Social security	14a		14b Taxable amount (see instructions).		14b
	benefits
	15 Add lines 7 through 14b (far right column). This is your total income ?					15	0
Adjusted Gross Income	16 Educator expenses (see instructions).			16
	17 IRA deduction (see instructions).			17
	18 Student loan interest deduction (see instructions).			18
	19 Tuition and fees. Attach Form 8917.			19
	20 Add lines 16 through 19. These are your total adjustments.					20	0
	21 Subtract line 20 from line 15. This is your adjusted gross income.					21	0
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.						Cat. No. 11327A	Form 1040A (2016)
UYA

Page 2 of Form 1040A. Some information does not carry over from Page 1

Form 1040 (2016)	Jose	Hernandez	Dora	Hernandez	412-34-5670		Page 2
Tax, credits, and payments	22 Amount from line 21 (adjusted gross income)					22	0
	23a Check if:	You were born before Jan. 2, 1952checkbox unchecked1 of 2		Total boxes checked	?23a
		Spouse was born before Jan. 2, 1952checkbox unchecked1 of 2
	b If your spouse itemizes on a separate return or you were a dual-status alien, check here				?23b	checkbox unchecked1 of 1
Standard deduction for-	24 Enter your standard deduction.					24
	25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-.					25	0
	26 Exemptions. Multiply $4,050 by the number on line 6d.					26
? Single or Married filing separately, $6,300	27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is your taxable income.					? 27	0
	28 Tax, including any alternative minimum tax (see instructions).				28
	29 Excess advance premium tax credit repayment. Attach Form 8962				29
? Married filing jointly or Qualifying widow(er), $12,600	30 Add lines 28 and 29					30	0
	31 Credit for child and dependent care expenses. Attach Form 2441				31
	32 Credit for the elderly or the disabled. Attach Schedule R				32
? Head of household, $9,300	33 Education credits from Form 8863, line 19				33
	34 Retirement savings contributions credit. Attach Form 8880				34
	35 Child tax credit. Attach Schedule 8812, if required				35
	36 Add lines 31 through 35. These are your total credits					36	0
	37 Subtract line 36 from line 30. If line 36 is more than line 30, enter -0-					37	0
If you have a qualifying child, attach schedule EIC	38 Health care: individual responsibility (see instructions)			Full-year coverage	checkbox unchecked1 of 1	38
	39 Add line 37 and line 38. This is your total tax					39	0
	40 Federal income tax withheld from Forms W-2 and 1099.				40
	41 2016 estimated tax payments and amount applied from 2015 return				41
	42a Earned income credit (EIC)				42a
	b Nontaxable combat pay election			42b
	43 Additional child tax credit. Attach Schedule 8812				43
	44 American opportunity credit from Form 8863, line 8				44
	45 Net premium tax credit. Attach Form 8962				45
	46 Add lines 40, 41, 42a, 43, 44, and 45. These are your total payments				?	46	0
Refund	47 If line 46 is more than line 39, subtract line 39 from line 46. This is the amount you overpaid					47	0
	48a Amount of line 47 you want refunded to you. If Form 8888 is attached, check here ?				checkbox unchecked1 of 1	48a	0
Direct deposit? See instructions and fill in 48b, 48c, and 48d or Form 8888.	?b Routing number			? c Type:	Checkingcheckbox unchecked1 of 1
	?d Account number				Savingscheckbox unchecked1 of 1
	49 Amount of line 47 you want applied to your 2017 estimated tax.				49
Amount You Owe	50 Amount you owe. Subtract line 46 from line 39. For details on how to pay, see instructions. ?					50
	51 Estimated tax penalty (see instructions)				51
Third party	Do you want to allow another person to discuss this return with the IRS (see instructions)?
Designee	Designee's			Phone		Personal identification
	name ?			no. ?		number (PIN) ?
Sign Here	Under penalties or 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 recieved during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.
Joint return? See instructions.
	Your signature		Date	Your occupation		Daytime phone number
Keep a copy for your records.
	Spouse's signature. If a joint return, both must sign		Date	Spouse's occupation		If the IRS sent you an ID Protection PIN, enter it
						here (see inst.)
Paid preparer use only	Print/type preparer's name		Preparer's signature		Date	Self-employed?	PTIN
	Firm's name ?					Firm's EIN ?
	Firm's address ?					Phone no.
UYA						Form 1040A (2016)