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Publication 3194 contains reproducible cop

forms. These forms may be reproduced and 

the Internal Revenue Service.

The following forms are included in this publicatio

Form 1040, U.S. Individual Income Tax Return

Form 1040A, U.S. Individual Income Tax Return

Form 1040EZ, Income Tax Return for Single and 

Filers With No Dependents

Form 1040 Sch. A&B, Itemized Deductions/lntere

Ordinary Dividends

Form 1040 Sch. C, Profit or Loss From Business

Form 1040 Sch. D, Capital Gains and Losses

Form 1040 Sch. E, Supplemental Income and Lo

Form 1040 Sch. EIC, Earned Income Credit

Form 1040 Sch. SE, Self-Employment Tax

Form 1040X, Amended U.S. Individual Income Ta

Form 2106, Employee Business Expenses

Form 2441, Child and Dependent Care Expenses

Form 4868, Application for Automatic Extension o

File U.S. Individual Income Tax Return

Form 8283, Noncash Charitable Contributions

Form 8812, Additional Child Tax Credit

Form 8863, Education Credits (Hope and Lifetime 

Credits)

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see inside for additional information about other s

tax material and assistance.

Publication 3194

Laminated

Tax Forms

The IRS Mission

Provide America’s taxpayers

top quality service by helping

them understand and meet

their tax responsibilities and

by applying the tax law with

integrity and fairness to all.

Department of the Treasury

Internal Revenue Service

Catalog Number 26674W

www. irs.gov

pub 3194 70% 12-7-03 1 12/8/03, 10:43 AM

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Internal Revenue Service

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Publication 2053-B (Rev. 10-2003)

Catalog Number 30494A

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Department of the Treasury—Internal Revenue Service 1040 U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2003, or other tax year beginning , 2003, ending , 20 OMB No. 1545-0074

Your first name and initial Last name Your social security number

(See

instructions

on page 19.)

L

A

B

E

L

H

E

R

E

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Use the IRS

label.

Otherwise,

please print

or type.

Home address (number and street). If you have a P.O. box, see page 19. Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 19.

Presidential

Election Campaign

1 Single

Filing Status 2 Married filing jointly (even if only one had income)

Check only

one box.

3

Qualifying widow(er) with dependent child. (See page 20.)

6a Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax

Exemptions return, do not check box 6a

b Spouse

(4) if qualifying

child for child tax

credit (see page 21)

c Dependents: (2) Dependent’s

social security number

(3) Dependent’s

relationship to (1) First name Last name you

If more than five

dependents,

see page 21.

d Total number of exemptions claimed

7 Wages, salaries, tips, etc. Attach Form(s) W-2 7

Income 8a Taxable interest. Attach Schedule B if required 8a

b Tax-exempt interest. Do not include on line 8a 8b Attach 

Forms W-2 and

W-2G here.

Also attach

Form(s) 1099-R

if tax was

withheld.

9a Ordinary dividends. Attach Schedule B if required 9a

10 Taxable refunds, credits, or offsets of state and local income taxes (see page 23) 10

11 Alimony received 11

12 Business income or (loss). Attach Schedule C or C-EZ 12

Enclose, but do

not attach, any

payment. Also,

please use

Form 1040-V.

13a Capital gain or (loss). Attach Schedule D if required. If not required, check here  13a

14 Other gains or (losses). Attach Form 4797 14

15a IRA distributions 15a 15b b Taxable amount (see page 25)

16a Pensions and annuities 16a b Taxable amount (see page 25) 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 (see page 27) 20b

21 21

22 Add the amounts in the far right column for lines 7 through 21. This is your total income  22

IRA deduction (see page 29) 24

23

26

25

One-half of self-employment tax. Attach Schedule SE

27

Self-employed health insurance deduction (see page 33)

26

28

27

Self-employed SEP, SIMPLE, and qualified plans

29

28

Penalty on early withdrawal of savings

30

29

Alimony paid b Recipient’s SSN 

Add lines 23 through 32a 33

30

Subtract line 33 from line 22. This is your adjusted gross income 

31

Adjusted

Gross

Income

34

If you did not

get a W-2,

see page 22. Form

Married filing separately. Enter spouse’s SSN above

and full name here. 

Cat. No. 11320B





Label

Form 1040 (2003)

IRS Use Only—Do not write or staple in this space.

Head of household (with qualifying person). (See page 20.) If

the qualifying person is a child but not your dependent, enter

this child’s name here. 

Other income. List type and amount (see page 27)

Moving expenses. Attach Form 3903

24

25

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 77.

No. of boxes

checked on

6a and 6b

No. of children

on 6c who:

Dependents on 6c

not entered above

Add numbers

on lines

above 

● lived with you

● did not live with

you due to divorce

or separation

(see page 21)

32a 32a

Student loan interest deduction (see page 31)

31

33

  Important!

Yes No

Note. Checking “Yes” will not change your tax or reduce your refund.

Do you, or your spouse if filing a joint return, want $3 to go to this fund? 

You must enter

your SSN(s) above.

No Yes

You Spouse

(See page 19.)

(99)

Tuition and fees deduction (see page 32)

34

4

5

Educator expenses (see page 29) 23

2003

b Qualified dividends (see page 23) 9b

b If box on 13a is checked, enter post-May 5 capital gain distributions 13b
Itemized deductions (from Schedule A) or your standard deduction (see left margin)

Add lines 61 through 67. These are your total payments 

Form 1040 (2003) Page 2

35 Amount from line 34 (adjusted gross income) 35

Check

if:

36a

Tax and

Credits

36a

Single or

Married filing

separately,

$4,750

If you are married filing separately and your spouse itemizes deductions, or

you were a dual-status alien, see page 34 and check here 

b

36b

37 37

38 Subtract line 37 from line 35 38

39

If line 35 is $104,625 or less, multiply $3,050 by the total number of exemptions claimed on

line 6d. If line 35 is over $104,625, see the worksheet on page 35

39

40 Taxable income. Subtract line 39 from line 38. If line 39 is more than line 38, enter -0- 40

41 41

45

46

51

Education credits. Attach Form 8863

44

49

Other credits. Check applicable box(es):

48

53

54

Add lines 44 through 52. These are your total credits

48

Subtract line 53 from line 43. If line 53 is more than line 43, enter -0- 

53

Self-employment tax. Attach Schedule SE

54

Other

Taxes

55

69

Social security and Medicare tax on tip income not reported to employer. Attach Form 4137

Tax on qualified plans, including IRAs, and other tax-favored accounts. Attach Form 5329 if required 57

56

58

Add lines 54 through 59. This is your total tax 

59 59

61 Federal income tax withheld from Forms W-2 and 1099 61

62 2003 estimated tax payments and amount applied from 2002 return 62

Payments

63

Amount paid with request for extension to file (see page 56) 66

65

Excess social security and tier 1 RRTA tax withheld (see page 56) 64

66

68

67 Other payments from:

70a 70a

71 71

If line 68 is more than line 60, subtract line 60 from line 68. This is the amount you overpaid

72 72

Amount of line 69 you want refunded to you 

Refund

73

Amount of line 69 you want applied to your 2004 estimated tax 

Estimated tax penalty (see page 58)

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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

73

You were born before January 2, 1939, Blind.

Spouse was born before January 2, 1939, Blind.

a Form 3800

b Form 8801 c Specify

a Form 2439 b Form 4136

57

Household employment taxes. Attach Schedule H

58

67

Amount

You Owe

Sign

Here Your signature Date

Keep a copy

for your

records.

Spouse’s signature. If a joint return, both must sign. Date

Date Preparer’s SSN or PTIN Preparer’s signature Check if

self-employed

Paid

Preparer’s

Use Only

Firm’s name (or

yours if self-employed),

address, and ZIP code

EIN

Phone no.







Your occupation

Tax (see page 36). Check if any tax is from:

Amount you owe. Subtract line 68 from line 60. For details on how to pay, see page 57 

b

Direct deposit?

See page 56

and fill in 70b,

70c, and 70d.

Routing number

Account number

c Checking Savings

a Form(s) 8814 Form 4972

b

d





68

47

44

Retirement savings contributions credit. Attach Form 8880

55

56

Advance earned income credit payments from Form(s) W-2

69



Child tax credit (see page 40)

Credits from:

47

51

49

Additional child tax credit. Attach Form 8812

64

65

Head of

household,

$7,000

Married filing

jointly or

Qualifying

widow(er),

$9,500

Standard

Deduction

for—

Joint return?

See page 20.

Daytime phone number

( )

Earned income credit (EIC)

Credit for the elderly or the disabled. Attach Schedule R

42

43

45

Alternative minimum tax (see page 38). Attach Form 6251

Add lines 41 and 42 

Credit for child and dependent care expenses. Attach Form 2441

46

If you have a

qualifying

child, attach

Schedule EIC.

42

43

63

Spouse’s occupation

( )

Form 1040 (2003)

● People who

checked any

box on line

36a or 36b or

who can be

claimed as a

dependent,

see page 34.

● All others:

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 58)? Third Party

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

52

Foreign tax credit. Attach Form 1116 if required

52

a Form 8396 b Form 8859

50 Adoption credit. Attach Form 8839 50

60 60

Type:

c Form 8885

Total boxes  checked 
Form Department of the Treasury—Internal Revenue Service

1040A U.S. Individual Income Tax Return 2003

OMB No. 1545-0085

Your social security number

Your first name and initial Last name Label

L

A

B

E

L

H

E

R

E

(See page 19.)

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Use the

IRS label. Home address (number and street). If you have a P.O. box, see page 20. Apt. no.

You must enter your

SSN(s) above.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 20.

Filing

status

No. of boxes

checked on

6a and 6b

Yourself. If your parent (or someone else) can claim you as a

dependent on his or her tax return, do not check box 6a. Exemptions 6a

b Spouse No. of children

on 6c who: (4) if qualifying

child for child

tax credit (see

page 23)

(2) Dependent’s social

security number

c ● lived with

you

● did not live

with you due

to divorce or

separation

(see page 23)

If more than six

dependents,

see page 21.

Dependents

on 6c not

entered above

d

Add numbers

on lines

Total number of exemptions claimed. above

7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7

8a Taxable interest. Attach Schedule 1 if required. 8a

b Tax-exempt interest. Do not include on line 8a. 8b

Attach

Form(s) W-2

here. Also

attach

Form(s)

1099-R if tax

was withheld.

9a Ordinary dividends. Attach Schedule 1 if required. 9a

IRA

distributions.

11a Taxable amount

(see page 25).

11b

Enclose, but do

not attach, any

payment.

11a 11b

Taxable amount

(see page 26).

12a Pensions and 12b

annuities. 12a 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 13

14a Taxable amount

(see page 28).

Social security

benefits.

14b

14a 14b

15 Add lines 7 through 14b (far right column). This is your total income. 15

17 IRA deduction (see page 28). 17

Student loan interest deduction (see page 31).

Income

18

Add lines 16 through 19. These are your total adjustments. 20

Subtract line 20 from line 15. This is your adjusted gross income. 

18

21

Dependents:



Check only

one box.

If you did not

get a W-2, see

page 24.

Form 1040A (2003)

IRS Use Only—Do not write or staple in this space.

(3) Dependent’s

relationship to

(1) First name Last name you

20

21

Adjusted

gross 

income

 Important! 

Cat. No. 11327A

Otherwise,

please print

or type.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 57.

(99)

10a Capital gain distributions (see page 25). 10a

Presidential

Election Campaign

(See page 20.) Yes No

Note. Checking “Yes” will not change your tax or reduce your refund.

Do you, or your spouse if filing a joint return, want $3 to go to this fund? No Yes

You Spouse

19 Tuition and fees deduction (see page 31). 19

1 Single

2 Married filing jointly (even if only one had income)

3

Qualifying widow(er) with dependent child (See page 21.) Married filing separately. Enter spouse’s SSN above and

full name here. 

Head of household (with qualifying person). (See page 20.)

If the qualifying person is a child but not your dependent,

enter this child’s name here. 

4

5

16 Educator expenses (see page 28). 16

b Qualified dividends (see page 25). 9b

b Post-May 5 capital gain distributions (see page 25). 10b
Single or

Married filing

separately,

$4,750

30

22 Enter the amount from line 21 (adjusted gross income). 22

Total boxes

checked 

Check You were born before January 2, 1939, Blind

if:

23a

Spouse was born before January 2, 1939, Blind 23a

b

23b

If you are married filing separately and your spouse itemizes

deductions, see page 32 and check here 

Tax,

credits,

and

payments

24 24

25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25

26 Multiply $3,050 by the total number of exemptions claimed on line 6d. 26

Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.

This is your taxable income. 

27

27

28 Tax, including any alternative minimum tax (see page 33). 28

31 Education credits. Attach Form 8863. 31

35

36 Subtract line 35 from line 28. If line 35 is more than line 28, enter -0-. 36

37 Advance earned income credit payments from Form(s) W-2. 37

Add lines 36 and 37. This is your total tax. 38

Federal income tax withheld from Forms W-2

and 1099.

39

39

2003 estimated tax payments and amount

applied from 2002 return. 40

Add lines 39 through 42. These are your total payments. 43

If line 43 is more than line 38, subtract line 38 from line 43.

This is the amount you overpaid.

44

45a

Refund

Amount of line 44 you want applied to your

2004 estimated tax.

46

46

Amount you owe. Subtract line 43 from line 38. For details on how

to pay, see page 51. 

47

47

48 Estimated tax penalty (see page 52). 48

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 the taxpayer) is based on all information of which the preparer has any knowledge.



Enter your standard deduction (see left margin).

Form 1040A (2003)

44

45a Amount of line 44 you want refunded to you. 

38

Credit for child and dependent care expenses.

Attach Schedule 2.

29

29

Adoption credit. Attach Form 8839.

33 33

Retirement savings contributions credit. Attach

Form 8880.

32

32

Credit for the elderly or the disabled. Attach

Schedule 3.

30

35 Add lines 29 through 34. These are your total credits.

40

42

43

Additional child tax credit. Attach Form 8812. 42

Routing

number

Account

number

Checking Savings b

c

d

Amount

you owe

Direct

deposit?

See page 50

and fill in

45b, 45c,

and 45d.



41 Earned income credit (EIC). 41

Page 2

Form 1040A (2003)

If you have

a qualifying

child, attach

Schedule

EIC.

Sign

here

Your signature Date

Keep a copy

for your

records.

Spouse’s signature. If a joint return, both must sign. Date

Date Preparer’s SSN or PTIN Preparer’s

signature Check if

self-employed

Paid

preparer’s

use only

Firm’s name (or

yours if self-employed),

address, and ZIP code

EIN

Phone no.







Your occupation Joint return?

See page 20.

Daytime phone number

( )

Spouse’s occupation

( )

Head of

household,

$7,000

Married filing

jointly or

Qualifying

widow(er),

$9,500

Standard

Deduction

for—

● People who

checked any

box on line

23a or 23b or

who can be

claimed as a

dependent,

see page 32.

● All others:

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 52)? Third party

designee Phone

no. ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

34 34

Child tax credit (see page 37).

Type:
Do you, or your spouse if a joint return, want $3 to go to this fund? 

Taxable interest. If the total is over $1,500, you cannot use Form 1040EZ.

Department of the Treasury—Internal Revenue Service

Form Income Tax Return for Single and 1040EZ Joint Filers With No Dependents 2003 OMB No. 1545-0675

Note. Checking “Yes” will not change your tax or reduce your refund.

Presidential

Election

Campaign 

(page 12)

Wages, salaries, and tips. This should be shown in box 1 of your Form(s) W-2.

Attach your Form(s) W-2.

1

1

Attach

Form(s) W-2

here.

Enclose, but

do not attach,

any payment.

2 2

Add lines 1, 2, and 3. This is your adjusted gross income.

5 Can your parents (or someone else) claim you on their return? Note. You

must check

Yes or No.

Yes. No.

5

Subtract line 5 from line 4. If line 5 is larger than line 4, enter -0-.

This is your taxable income. 

6

6

Payments

and tax

Earned income credit (EIC).

7 7

Tax. Use the amount on line 6 above to find your tax in the tax table on pages

24–28 of the booklet. Then, enter the tax from the table on this line.

10

10

Refund

11a 11a

If line 10 is larger than line 9, subtract line 9 from line 10. This is

the amount you owe. For details on how to pay, see page 20. 

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 23.

Income

Cat. No. 11329W



4 4

12

12

Add lines 7 and 8. These are your total payments. 

8 8

9 9

Federal income tax withheld from box 2 of your Form(s) W-2.

Unemployment compensation and Alaska Permanent Fund dividends

(see page 14).

3

3

Amount

you owe

b Routing number

Account number

c Type: Checking

Enter amount from

worksheet on back.

If single, enter $7,800.

If married filing jointly, enter $15,600.

See back for explanation.

Have it directly

deposited! See

page 19 and fill

in 11b, 11c,

and 11d.

 d



Form 1040EZ (2003)

(99)

Yes No Yes No

You Spouse

Savings

Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct, and

accurately lists all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based

on all information of which the preparer has any knowledge.

Sign

here

Your signature Date

Keep a copy

for your

records.

Spouse’s signature. If a joint return, both must sign. Date

Date Preparer’s SSN or PTIN Preparer’s

signature Check if

self-employed

Paid

preparer’s

use only Firm’s name (or

yours if self-employed),

address, and ZIP code

EIN

Phone no.







Your occupation Joint return?

See page 11.

Daytime phone number

( )

Spouse’s occupation

( )

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 20)? Third party

designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

Your first name and initial Last name Your social security number

L

A

B

E

L

H

E

R

E

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see page 12. Apt. no.

You must enter your

SSN(s) above.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 12.

Important! 



Label

(See page 12.)

Use the IRS

label.

Otherwise,

please print

or type.



If line 9 is larger than line 10, subtract line 10 from line 9. This is your refund. 
Form 1040EZ (2003)

● You (and your spouse if married filing jointly) were under age 65 and not blind at the end of

2003. If you were born on January 1, 1939, you are considered to be age 65 at the end of 2003.

Use ● Your filing status is single or married filing jointly.

this

form if

● Your taxable income (line 6) is less than $50,000.

● You do not claim any dependents.

● You had only wages, salaries, tips, taxable scholarship or fellowship grants, unemployment

compensation, or Alaska Permanent Fund dividends, and your taxable interest was not over

$1,500. But if you earned tips, including allocated tips, that are not included in box 5 and box 7

of your W-2, you may not be able to use Form 1040EZ (see page 13). If you are planning to use

Form 1040EZ for a child who received Alaska Permanent Fund dividends, see page 14.

If you are not sure about your filing status, see page 11. If you have questions about dependents, use

TeleTax topic 354 (see page 6). If you cannot use this form, use TeleTax topic 352 (see page 6).

Filling in

your

return

If you received a scholarship or fellowship grant or tax-exempt interest income, such as on

municipal bonds, see the booklet before filling in the form. Also, see the booklet if you received a

Form 1099-INT showing Federal income tax withheld or if Federal income tax was withheld from

your unemployment compensation or Alaska Permanent Fund dividends.

Remember, you must report all wages, salaries, and tips even if you do not get a Form W-2 from

your employer. You must also report all your taxable interest, including interest from banks, savings

and loans, credit unions, etc., even if you do not get a Form 1099-INT.

Use this worksheet to figure the amount to enter on line 5 if someone can claim you (or your

spouse if married filing jointly) as a dependent, even if that person chooses not to do so. To find

out if someone can claim you as a dependent, use TeleTax topic 354 (see page 6).

Worksheet

for

dependents

who

checked

“ Yes” on

line 5

A .

A . Amount, if any, from line 1 on front

B . Minimum standard deduction B . 750.00

C. Enter the larger of line A or line B here C.

D.

D. Maximum standard deduction. If single, enter $4,750; if married

filing jointly, enter $9,500

E . Enter the smaller of line C or line D here. This is your standard

deduction E .

Mailing

return

Mail your return by April 15, 2004. Use the envelope that came with your booklet. If you do not

have that envelope or if you moved during the year, see the back cover for the address to use.

● You did not receive any advance earned income credit payments.

F. Exemption amount.

G . Add lines E and F. Enter the total here and on line 5 on the front

If you checked “No” on line 5 because no one can claim you (or your spouse if married filing

jointly) as a dependent, enter on line 5 the amount shown below that applies to you.

● Single, enter $7,800. This is the total of your standard deduction ($4,750) and your exemption

($3,050).

● Married filing jointly, enter $15,600. This is the total of your standard deduction ($9,500), your

exemption ($3,050), and your spouse’s exemption ($3,050).

F.

G .

● If single, enter -0-.

● If married filing jointly and—

—only one of you can be claimed as a dependent, enter $3,050.

For tips on how

to avoid common

mistakes, see

page 21.

—both you and your spouse can be claimed as dependents, enter -0-.

● You do not claim a deduction for educator expenses, the student loan interest deduction, or the

tuition and fees deduction.

+ 250.00 Enter total 

(keep a copy for

your records)

Form 1040EZ (2003)

Page 2

● You do not claim an education credit, the retirement savings contributions credit, or the health

coverage tax credit.
SCHEDULES A&B OMB No. 1545-0074 Schedule A—Itemized Deductions

(Form 1040) (Schedule B is on back)

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.  See Instructions for Schedules A and B (Form 1040).

Attachment

Sequence No. 07

Name(s) shown on Form 1040 Your social security number

Medical Caution. Do not include expenses reimbursed or paid by others.

and 

Dental

Expenses

1 Medical and dental expenses (see page A-2) 1

2 2

3 Multiply line 2 by 7.5% (.075) 3

4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- 4

Taxes You 5 State and local income taxes 5

Paid 6 Real estate taxes (see page A-2) 6

8 Other taxes. List type and amount 

(See

page A-2.)

8

9 Add lines 5 through 8 9

Interest 10 Home mortgage interest and points reported to you on Form 1098

You Paid

10

Home mortgage interest not reported to you on Form 1098. If paid

to the person from whom you bought the home, see page A-3

and show that person’s name, identifying no., and address 

11

(See

page A-3.)

11

12

Points not reported to you on Form 1098. See page A-3

for special rules

12

13 Investment interest. Attach Form 4952 if required. (See

page A-4.) 13

14 Add lines 10 through 13 14

Gifts to 

Charity 15

15 Gifts by cash or check. If you made any gift of $250 or

more, see page A-4

16

Other than by cash or check. If any gift of $250 or more,

see page A-4. You must attach Form 8283 if over $500

16

17 Carryover from prior year 17

18 Add lines 15 through 17 18

19 Casualty or theft loss(es). Attach Form 4684. (See page A-5.)

Casualty and 

Theft Losses 19

Unreimbursed employee expenses—job travel, union

dues, job education, etc. Attach Form 2106 or 2106-EZ

if required. (See page A-5.) 

Job Expenses 20

and Most

Other

Miscellaneous

Deductions

22 Other expenses—investment, safe deposit box, etc. List

type and amount 

(See

page A-5.)

23 Add lines 20 through 22

24 Enter amount from Form 1040, line 35

25 Multiply line 24 by 2% (.02)

26 Subtract line 25 from line 23. If line 25 is more than line 23, enter -0- 26

Other 27 Other—from list on page A-6. List type and amount  

Miscellaneous

Deductions 27

Total 28

Itemized

Deductions 28

For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule A (Form 1040) 2003

24

20

22

23

If you made a

gift and got a

benefit for it,

see page A-4.

25

Enter amount from Form 1040, line 35

No. Your deduction is not limited. Add the amounts in the far right column

for lines 4 through 27. Also, enter this amount on Form 1040, line 37.

Yes. Your deduction may be limited. See page A-6 for the amount to enter.

Cat. No. 11330X



Note.

Personal

interest is

not

deductible.



7 Personal property taxes 7

21 Tax preparation fees 21

Is Form 1040, line 35, over $139,500 (over $69,750 if married filing separately)?

(99)

2003
Schedules A&B (Form 1040) 2003 OMB No. 1545-0074 Page 2

Name(s) shown on Form 1040. Do not enter name and social security number if shown on other side. Your social security number

Attachment Schedule B—Interest and Ordinary Dividends Sequence No. 08

Part I

Interest

(See page B-1

and the

instructions for

Form 1040,

line 8a.)

Amount List name of payer. If any interest is from a seller-financed mortgage and the

buyer used the property as a personal residence, see page B-1 and list this

interest first. Also, show that buyer’s social security number and address 

1

Note. If you

received a Form

1099-INT, Form

1099-OID, or

substitute

statement from

a brokerage firm,

list the firm’s

name as the

payer and enter

the total interest

shown on that

form.

1

2 Add the amounts on line 1 2

3

Excludable interest on series EE and I U.S. savings bonds issued after 1989.

Attach Form 8815

3

4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a  4

Part II

Ordinary

Dividends

Amount

(See page B-1

and the

instructions for

Form 1040,

line 9a.)

5 List name of payer 

Note. If you

received a Form

1099-DIV or

substitute

statement from

a brokerage firm,

list the firm’s

name as the

payer and enter

the ordinary

dividends shown

on that form.

5

6 Add the amounts on line 5. Enter the total here and on Form 1040, line 9a  6

For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule B (Form 1040) 2003

Note. If line 4 is over $1,500, you must complete Part III.

Note. If line 6 is over $1,500, you must complete Part III.

You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; or (b) had

Part III a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.

Foreign

Accounts

and Trusts

Yes No

At any time during 2003, did you have an interest in or a signature or other authority over a financial

account in a foreign country, such as a bank account, securities account, or other financial

account? See page B-2 for exceptions and filing requirements for Form TD F 90-22.1

7a

b If “Yes,” enter the name of the foreign country  

(See

page B-2.) During 2003, did you receive a distribution from, or were you the grantor of, or transferor to, a

foreign trust? If “Yes,” you may have to file Form 3520. See page B-2

8
SCHEDULE C OMB No. 1545-0074

(Form 1040)

Profit or Loss From Business

(Sole Proprietorship)

 Partnerships, joint ventures, etc., must file Form 1065 or 1065-B. Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040 or 1041.  See Instructions for Schedule C (Form 1040). Sequence No. 09

Name of proprietor Social security number (SSN)

A Principal business or profession, including product or service (see page C-2 of the instructions) B Enter code from pages C-7, 8, & 9



C Business name. If no separate business name, leave blank. D Employer ID number (EIN), if any

Accounting method:

E

F

G Yes No

H

Did you “materially participate” in the operation of this business during 2003? If “No,” see page C-3 for limit on losses

If you started or acquired this business during 2003, check here 

Income

Gross receipts or sales. Caution. If this income was reported to you on Form W-2 and the “Statutory

employee” box on that form was checked, see page C-3 and check here 

1

1

2 Returns and allowances 2

3 Subtract line 2 from line 1 3

4 Cost of goods sold (from line 42 on page 2) 4

5 Gross profit. Subtract line 4 from line 3 5

6 Other income, including Federal and state gasoline or fuel tax credit or refund (see page C-3) 6

7 Gross income. Add lines 5 and 6  7

Expenses. Enter expenses for business use of your home only on line 30.

8

21 Repairs and maintenance 21

8 Advertising

22 Supplies (not included in Part III) 22

23

9

23 Taxes and licenses

10

24 Travel, meals, and entertainment:

Car and truck expenses

(see page C-3)

9

24a

11

a Travel

10 Commissions and fees

12 Depletion 12

Meals and

entertainment

b

Depreciation and section 179

expense deduction (not included

in Part III) (see page C-4)

13

Enter nondeductible amount included on line 24b

(see page C-5)

c

13

14 Employee benefit programs

(other than on line 19)

24d

14

d Subtract line 24c from line 24b

25

15

25 Utilities

15 Insurance (other than health)

26 Wages (less employment credits) 26

16 Interest:

a Mortgage (paid to banks, etc.) 16a

Other expenses (from line 48 on

page 2)

27

b Other 16b

17

Legal and professional

services

17

18 Office expense 18

19 Pension and profit-sharing plans 19

20 Rent or lease (see page C-5):

a Vehicles, machinery, and equipment 20a

b Other business property 20b

28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns  28

31

31

32a All investment is at risk.

32

Some investment is not

at risk.

32b

For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule C (Form 1040) 2003

(1) Cash (2) Accrual (3) Other (specify) 

Business address (including suite or room no.) 

City, town or post office, state, and ZIP code

Cat. No. 11334P

29

30

Tentative profit (loss). Subtract line 28 from line 7

Expenses for business use of your home. Attach Form 8829

29

30



Part I

Part II

27

Net profit or (loss). Subtract line 30 from line 29.

● If a profit, enter on Form 1040, line 12, and also on Schedule SE, line 2 (statutory employees,

see page C-6). Estates and trusts, enter on Form 1041, line 3.

● If a loss, you must go to line 32.

If you have a loss, check the box that describes your investment in this activity (see page C-6).

● If you checked 32a, enter the loss on Form 1040, line 12, and also on Schedule SE, line 2

(statutory employees, see page C-6). Estates and trusts, enter on Form 1041, line 3.

● If you checked 32b, you must attach Form 6198.



(99)

2003

Contract labor

(see page C-4)

11
Schedule C (Form 1040) 2003 Page 2

Cost of Goods Sold (see page C-6)

Inventory at beginning of year. If different from last year’s closing inventory, attach explanation 35

33

Purchases less cost of items withdrawn for personal use 36

34

Cost of labor. Do not include any amounts paid to yourself 37

35

Materials and supplies 38

36

Other costs 39

37

Add lines 35 through 39 40

38

Inventory at end of year 41

39

Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4

40

42

Part IV

Part III

Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on

line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 on page

C-4 to find out if you must file Form 4562.

41

When did you place your vehicle in service for business purposes? (month, day, year)  .

42

Of the total number of miles you drove your vehicle during 2003, enter the number of miles you used your vehicle for:

a Business b Commuting c Other

45 Do you (or your spouse) have another vehicle available for personal use?

46 Was your vehicle available for personal use during off-duty hours?

47a Do you have evidence to support your deduction?

b If “Yes,” is the evidence written?

Yes No

Other Expenses. List below business expenses not included on lines 8–26 or line 30.

48 Total other expenses. Enter here and on page 1, line 27

/ /

Yes No

Yes No

Yes No

48

Part V

Method(s) used to

value closing inventory: Cost b Other (attach explanation)

Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If

“Yes,” attach explanation

a Lower of cost or market c

Yes No

43

44

Schedule C (Form 1040) 2003
*Include in column (g) all gains and losses from column (f) from sales, exchanges, or conversions (including installment payments received) after

May 5, 2003. However, do not include gain attributable to unrecaptured section 1250 gain, “collectibles gains and losses” (as defined on page

D-8 of the instructions) or eligible gain on qualified small business stock (see page D-4 of the instructions).

OMB No. 1545-0074 SCHEDULE D Capital Gains and Losses (Form 1040)  Attach to Form 1040.  See Instructions for Schedule D (Form 1040).

Department of the Treasury

Internal Revenue Service

Attachment

 Use Schedule D-1 to list additional transactions for lines 1 and 8. Sequence No. 12

Name(s) shown on Form 1040 Your social security number

Short-Term Capital Gains and Losses—Assets Held One Year or Less

(f) Gain or (loss) for

the entire year

Subtract (e) from (d)

(e) Cost or other basis

(see page D-6 of

the instructions)

(a) Description of property

(Example: 100 sh. XYZ Co.)

(d) Sales price

(see page D-6 of

the instructions)

(c) Date sold

(Mo., day, yr.)

1

Enter your short-term totals, if any, from

Schedule D-1, line 2

2

Total short-term sales price amounts.

Add lines 1 and 2 in column (d)

3

3

5

Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684,

6781, and 8824

5

6

6

Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts

from Schedule(s) K-1

7b

Short-term capital loss carryover. Enter the amount, if any, from line 8 of your

2002 Capital Loss Carryover Worksheet

Net short-term capital gain or (loss). Combine lines 1 through 6 in column (f)

Long-Term Capital Gains and Losses—Assets Held More Than One Year

8

Enter your long-term totals, if any, from

Schedule D-1, line 9

9

10 Total long-term sales price amounts.

Add lines 8 and 9 in column (d) 10

11

Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and

long-term gain or (loss) from Forms 4684, 6781, and 8824

11

12

12

13

Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts

from Schedule(s) K-1

14

Capital gain distributions. See page D-2 of the instructions

15 15

14

16

Long-term capital loss carryover. Enter the amount, if any, from line 13 of your

2002 Capital Loss Carryover Worksheet ( )

Combine lines 8 through 13 in column (g). If zero or less, enter -0-

Net long-term capital gain or (loss). Combine lines 8 through 14 in column (f)

Next: Go to Part III on the back.

16

For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 11338H Schedule D (Form 1040) 2003

( )

4

4

Part I

Part II

b

13

(b) Date

acquired

(Mo., day, yr.)

2

9

(99)

(a) Description of property

(Example: 100 sh. XYZ Co.)

(c) Date sold

(Mo., day, yr.)

(b) Date

acquired

(Mo., day, yr.)

2003

(g) Post-May 5 gain

or (loss)*

(see below)

Combine lines 1 through 5 in column (g). If the result is a loss, enter the result.

Otherwise, enter -0-. Do not enter more than zero

7a

(f) Gain or (loss) for

the entire year

Subtract (e) from (d)

(g) Post-May 5 gain

or (loss)*

(see below)

7a ( )

(e) Cost or other basis

(see page D-6 of

the instructions)

(d) Sales price

(see page D-6 of

the instructions)
Schedule D (Form 1040) 2003

Taxable Gain or Deductible Loss

Combine lines 7b and 16 and enter the result. If a loss, enter -0- on line 17b and go to line 18.

If a gain, enter the gain on Form 1040, line 13a, and go to line 17b below

17a

17a

18 ( )

Part III

Page 2

18

Next:

If line 17a is a loss, enter here and on Form 1040, line 13a, the smaller of (a) that loss or

(b) ($3,000) (or, if married filing separately, ($1,500)) (see page D-7 of the instructions)

Part IV Tax Computation Using Maximum Capital Gains Rates

Enter your unrecaptured section 1250 gain, if any, from line 18 of the worksheet on page D-7

22

23

24

25

Add lines 22 and 23

26

27

31

33

34

41

42

43

Subtract line 41 from line 40

25

26

27

28

29

30

37

32

21 Enter your taxable income from Form 1040, line 40

22

● If line 16 of Schedule D is a gain or you have qualified dividends on Form 1040, line

9b, complete Part IV below.

Amount from line 4g of Form 4952 (investment interest expense)

Enter the amount from line 27

Subtract line 29 from line 28. If zero or less, enter -0- and go to line 40

Enter the smaller of line 30 or line 31

Multiply line 32 by 5% (.05)

Enter the smaller of line 21 or line 26

Enter the amount from line 30 (if line 30 is blank, enter -0-)

19

39

34

35

36

47

44

Add lines 17b and 23*

Schedule D (Form 1040) 2003

● Otherwise, skip the rest of Schedule D and complete the rest of Form 1040.

Next: ● If you have qualified dividends on Form 1040, line 9b, complete Form 1040 through

line 40, and then complete Part IV below (but skip lines 19 and 20).

● Otherwise, skip Part IV below and complete the rest of Form 1040.

20

If lines 19 and 20 are zero, go to line 21. Otherwise, complete the worksheet on page D-11 of the instructions to figure

the amount to enter on lines 35 and 53 below, and skip all other lines below.

24

Enter the smaller of line 16 or line 17a, but not less than zero

Enter your qualified dividends from Form 1040, line 9b 23

Subtract line 25 from line 24. If zero or less, enter -0-

If line 27 is more than line 28, skip lines 29– 39 and go to line 40.

32

Add lines 17b and 23*

35

Subtract line 32 from line 30

38

36

Enter your qualified 5-year gain, if any, from

line 8 of the worksheet on page D-10

45

46

47

Enter the amount from line 32 (if line 32 is blank, enter -0-)

Subtract line 44 from line 43

Enter the smaller of line 42 or line 45

49

40

If lines 26 and 30 are the same, skip lines 40– 49 and go to line 50.

20 Enter your 28% rate gain, if any, from line 7 of the worksheet on page D-8 of the instructions

Subtract line 26 from line 21. If zero or less, enter -0-

28 Enter the smaller of line 21 or:

29

30

37

Enter the smaller of line 34 or line 35

38

Multiply line 36 by 8% (.08)

39

Subtract line 36 from line 34

40

Multiply line 38 by 10% (.10)

48

49

50

Multiply line 48 by 20% (.20)

Multiply line 46 by 15% (.15)

Subtract line 46 from line 42

51

Figure the tax on the amount on line 27. Use the Tax Table or Tax Rate Schedules, whichever applies

52

53

Add lines 33, 37, 39, 47, 49, and 50

Figure the tax on the amount on line 21. Use the Tax Table or Tax Rate Schedules, whichever applies

Tax on all taxable income. Enter the smaller of line 51 or line 52 here and on Form 1040, line 41

b Combine lines 7a and 15. If zero or less, enter -0-. Then complete Form 1040 through line 40 17b

19

21

31

33

41

42

43

44

45

46

48

50

51

52

53

● $56,800 if married filing jointly or qualifying widow(er);

● $28,400 if single or married filing separately; or

● $38,050 if head of household 

If lines 30 and 32 are the same, skip lines 34– 39 and go to line 40.

If line 16 or line 17a is zero or less, skip lines 19 and 20 and go to line 21. Otherwise, go to line 19.

*If lines 23 and 25 are more than zero, see Lines 31 and 43 on page D-9 for the amount to enter.
SCHEDULE E OMB No. 1545-0074 Supplemental Income and Loss (Form 1040) (From rental real estate, royalties, partnerships,

S corporations, estates, trusts, REMICs, etc.)

 Attach to Form 1040 or Form 1041.  See Instructions for Schedule E (Form 1040). Department of the Treasury

Internal Revenue Service

Attachment 

Sequence No. 13

Name(s) shown on return Your social security number

Income or Loss From Rental Real Estate and Royalties Note. If you are in the business of renting personal property, use

Schedule C or C-EZ (see page E-2). Report farm rental income or loss from Form 4835 on page 2, line 40.

1 Show the kind and location of each rental real estate property:

A

B

C

2 Yes No

A

B

C

Properties Totals

(Add columns A, B, and C.) Income: A B C

3 Rents received 3 3

4 Royalties received 4 4

Expenses:

5 Advertising 5

6 Auto and travel (see page E-4) 6

7 Cleaning and maintenance 7

8 Commissions 8

9 Insurance 9

10 Legal and other professional fees 10

11

Mortgage interest paid to banks,

etc. (see page E-4) 12

11

12

Other interest

12

13

Repairs

13

14

Supplies

14

15

Taxes

15

16

Utilities

16

17 17

18 Other (list) 

18

19 Add lines 5 through 18 19 19

Depreciation expense or depletion

(see page E-4)

20

20 20

21 Total expenses. Add lines 19 and 20 21

Income or (loss) from rental real

estate or royalty properties.

Subtract line 21 from line 3 (rents)

or line 4 (royalties). If the result is

a (loss), see page E-4 to find out

if you must file Form 6198

22

22

Deductible rental real estate loss.

Caution. Your rental real estate

loss on line 22 may be limited. See

page E-4 to find out if you must

file Form 8582. Real estate

professionals must complete line

43 on page 2

23

23 ( ) ( ) ) (

24 Income. Add positive amounts shown on line 22. Do not include any losses 24

25 ( ) 25 Losses. Add royalty losses from line 22 and rental real estate losses from line 23. Enter total losses here

26 Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result

here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter this amount on Form

1040, line 17. Otherwise, include this amount in the total on line 41 on page 2 26

For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 11344L Schedule E (Form 1040) 2003

Part I

Management fees

(99)

For each rental real estate property

listed on line 1, did you or your family

use it during the tax year for personal

purposes for more than the greater of:

● 14 days or

● 10% of the total days rented at

fair rental value?

(See page E-3.)

2003
Schedule E (Form 1040) 2003 Attachment Sequence No. 13 Page 2

Name(s) shown on return. Do not enter name and social security number if shown on other side. Your social security number

Income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for

which any amount is not at risk, you must check column (e) on line 28 and attach Form 6198. See page E-1.

(b) Enter P for

partnership; S

for S corporation

(c) Check if

foreign

partnership

(d) Employer

identification

number

28 (a) Name

(e) Check if

any amount is

not at risk

A

B

C

D

Passive Income and Loss Nonpassive Income and Loss

(h) Nonpassive loss

from Schedule K– 1

(g) Passive income 

from Schedule K– 1

(j) Nonpassive income 

from Schedule K– 1

(f) Passive loss allowed

(attach Form 8582 if required)

(i) Section 179 expense

deduction from Form 4562

A

B

C

D

29a Totals

b Totals

30 Add columns (g) and (j) of line 29a 30

31 ( ) 31 Add columns (f), (h), and (i) of line 29b

Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the

result here and include in the total on line 41 below

32

32

Income or Loss From Estates and Trusts

(b) Employer

identification number 33 (a) Name

A

B

Passive Income and Loss Nonpassive Income and Loss

(e) Deduction or loss

from Schedule K– 1

(d) Passive income

from Schedule K– 1

(f) Other income from

Schedule K– 1

(c) Passive deduction or loss allowed

(attach Form 8582 if required)

A

B

34a Totals

b Totals

35 Add columns (d) and (f) of line 34a 35

36 ( ) 36 Add columns (c) and (e) of line 34b

37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and

include in the total on line 41 below 37

Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)—Residual Holder

(c) Excess inclusion from

Schedules Q, line 2c

(see page E-6)

(e) Income from 

Schedules Q, line 3b

(d) Taxable income (net loss)

from Schedules Q, line 1b

(b) Employer

identification number 38 (a) Name

39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below 39

Summary

40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below 40

41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Form 1040, line 17  41

Reconciliation of Farming and Fishing Income. Enter your gross

farming and fishing income reported on Form 4835, line 7; Schedule

K-1 (Form 1065), line 15b; Schedule K-1 (Form 1120S), line 23; and

Schedule K-1 (Form 1041), line 14 (see page E-6)

42

42

Part III

Part V

Part IV

Part II

Reconciliation for Real Estate Professionals. If you were a real estate

professional (see page E-1), enter the net income or (loss) you reported

anywhere on Form 1040 from all rental real estate activities in which

you materially participated under the passive activity loss rules

43

43

Schedule E (Form 1040) 2003

27 Are you reporting losses not allowed in prior years due to the at-risk or basis limitations, passive losses

not reported on Form 8582, or unreimbursed partnership expenses? Yes No

If you answered “Yes,” see page E-5 before completing this section.

Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
 OMB No. 1545-0074

SCHEDULE EIC Earned Income Credit (Form 1040A or 1040)

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 43

Qualifying Child Information

For Paperwork Reduction Act Notice, see Form 1040A

or 1040 instructions.

Cat. No. 13339M Schedule EIC (Form 1040A or 1040) 2003

Before you begin: See the instructions for Form 1040A, line 41, or Form 1040, line 63, to make sure that

(a) you can take the EIC and (b) you have a qualifying child.

Qualifying Child Information

● It will take us longer to process your return and issue your refund if you do not fill in all lines that apply

for each qualifying child.

3

2a

4

5

1 Child’s name

Child’s SSN

Child’s relationship to you

Number of months child lived with

you in the United States during 2003

months

Yes.

months

If the child was born before 1985—

Was the child permanently and totally

disabled during any part of 2003?

b

Yes.

First name Last name First name Last name

Name(s) shown on return Your social security number

(99)

EIC

1040A

1040

Complete and attach to Form 1040A or 1040

only if you have a qualifying child.

● Be sure the child’s name on line 1 and social security number (SSN) on line 2a agree with the child’s

social security card. Otherwise, at the time we process your return, we may reduce or disallow your

EIC. If the name or SSN on the child’s social security card is not correct, call the Social Security

Administration at 1-800-772-1213.

Child 1 Child 2

If you have more than two qualifying children, you

only have to list two to get the maximum credit.

The child must have an SSN as defined on page 43

of the Form 1040A instructions or page 47 of the

Form 1040 instructions unless the child was born and

died in 2003. If your child was born and died in 2003

and did not have an SSN, enter “Died” on this line

and attach a copy of the child’s birth certificate.

No. No.

Go to line 4. Go to line 4. Continue Continue

Yes. Yes. No. No.

Continue Continue The child is not a

qualifying child.

The child is not a

qualifying child.

● If the child lived with you for more than half of

2003 but less than 7 months, enter “7”.

● If the child was born or died in 2003 and your

home was the child’s home for the entire time he

or she was alive during 2003, enter “12”.

Do not enter more than 12 months. Do not enter more than 12 months.

You may also be able to take the additional child tax credit if your child (a) was under age 17 at the end of 2003, (b) is

claimed as your dependent on line 6c of Form 1040A or Form 1040, and (c) is a U.S. citizen or resident alien. For more

details, see the instructions for line 42 of Form 1040A or line 65 of Form 1040.

. . . . . . . . . .

● If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up

to 10 years. See back of schedule for details.

(for example, son, daughter, grandchild,

niece, nephew, foster child, etc.)

2003

Was the child under age 24 at the end

of 2003 and a student?

a

b Child’s year of birth

If born after 1984, skip lines 3a

and 3b; go to line 4.

Year

If born after 1984, skip lines 3a

and 3b; go to line 4.

Year
Schedule EIC (Form 1040A or 1040) 2003 Page 2

A qualifying child is a child who is your . . .

was at the end of 2003 . . .

who . . .

Son, daughter, adopted child, stepchild, or a descendant of any of them (for

example, your grandchild)

Under age 19

or

Under age 24 and a student

or

Any age and permanently and totally disabled

Lived with you in the United States for more than half of

2003. If the child did not live with you for the required

time, see Exception to “Time Lived With You” Condition

on page 42 of the Form 1040A instructions or page 46 of

the Form 1040 instructions.

Qualifying Child

Note. If the child was married or meets the conditions to be a

qualifying child of another person (other than your spouse if filing a

joint return), special rules apply. For details, see page 43 of the Form

1040A instructions or page 47 of the Form 1040 instructions.

Purpose of Schedule

The purpose of this schedule is to give the IRS

information about your qualifying child after you have

figured your earned income credit (EIC).

To figure the amount of your credit or to have the IRS

figure it for you, see the instructions for Form 1040A,

line 41, or Form 1040, line 63.

Brother, sister, stepbrother, stepsister, or a descendant of any of them (for

example, your niece or nephew) whom you cared for as you would your own

child

Taking the EIC When Not Eligible. If you take the

EIC even though you are not eligible and it is

determined that your error is due to reckless or

intentional disregard of the EIC rules, you will not be

allowed to take the credit for 2 years even if you are

otherwise eligible to do so. If you fraudulently take the

EIC, you will not be allowed to take the credit for

10 years. You may also have to pay penalties.

AND

AND

Do you want part of the EIC added to your take-home pay in

2004? To see if you qualify, get Form W-5 from your employer,

call the IRS at 1-800-TAX-FORM (1-800-829-3676), or go to

www.irs.gov.

+$

Foster child (any child placed with you by an authorized placement agency

whom you cared for as you would your own child)

or

or
SCHEDULE SE OMB No. 1545-0074

(Form 1040) Self-Employment Tax

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040.  See Instructions for Schedule SE (Form 1040). Sequence No. 17

Name of person with self-employment income (as shown on Form 1040) Social security number of person

with self-employment income 

Who Must File Schedule SE

You must file Schedule SE if:

● You had net earnings from self-employment from other than church employee income (line 4 of Short Schedule SE or line 4c of

Long Schedule SE) of $400 or more or

Exception. If your only self-employment income was from earnings as a minister, member of a religious order, or Christian Science

practitioner and you filed Form 4361 and received IRS approval not to be taxed on those earnings, do not file Schedule SE. Instead,

write “Exempt–Form 4361” on Form 1040, line 55.

Section A—Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE.

Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form

1065), line 15a

1

1

Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),

line 15a (other than farming); and Schedule K-1 (Form 1065-B), box 9. Ministers and members

of religious orders, see page SE-1 for amounts to report on this line. See page SE-2 for other

income to report

2

2

3 Combine lines 1 and 2 3

Net earnings from self-employment. Multiply line 3 by 92.35% (.9235). If less than $400,

do not file this schedule; you do not owe self-employment tax 

4

4

5 Self-employment tax. If the amount on line 4 is: 

For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule SE (Form 1040) 2003

● You had church employee income of $108.28 or more. Income from services you performed as a minister or a member of a

religious order is not church employee income (see page SE-1).

Cat. No. 11358Z

Deduction for one-half of self-employment tax. Multiply line 5 by

50% (.5). Enter the result here and on Form 1040, line 28

● $87,000 or less, multiply line 4 by 15.3% (.153). Enter the result here and on 

Form 1040, line 55.

● More than $87,000, multiply line 4 by 2.9% (.029). Then, add $10,788.00 to the

result. Enter the total here and on Form 1040, line 55.

May I Use Short Schedule SE or Must I Use Long Schedule SE?

Did You Receive Wages or Tips in 2003?

Was the total of your wages and tips subject to social security

or railroad retirement tax plus your net earnings from

self-employment more than $87,000?

Did you receive tips subject to social security or Medicare tax

that you did not report to your employer?

Are you using one of the optional methods to figure your net

earnings (see page SE-3)?

Are you a minister, member of a religious order, or Christian

Science practitioner who received IRS approval not to be taxed

on earnings from these sources, but you owe self-employment

tax on other earnings?

Did you receive church employee income reported on Form

W-2 of $108.28 or more?

You May Use Short Schedule SE Below You Must Use Long Schedule SE on page 2





Yes



No Yes







No

No

No

No

Yes



Yes



Yes



Yes



 







No

Note. Even if you had a loss or a small amount of income from self-employment, it may be to your benefit to file Schedule SE and

use either “optional method” in Part II of Long Schedule SE (see page SE-3).

6

5

6



(99)

2003
Schedule SE (Form 1040) 2003 Attachment Sequence No. 17 Page 2

Name of person with self-employment income (as shown on Form 1040) Social security number of person

with self-employment income 

Section B—Long Schedule SE

A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you

had $400 or more of other net earnings from self-employment, check here and continue with Part I 

Note. If your only income subject to self-employment tax is church employee income, skip lines 1 through 4b. Enter -0- on line

4c and go to line 5a. Income from services you performed as a minister or a member of a religious order is not church employee

income. See page SE-1.

Self-Employment Tax

1 Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form

1065), line 15a. Note. Skip this line if you use the farm optional method (see page SE-4) 1

2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),

line 15a (other than farming); and Schedule K-1 (Form 1065-B), box 9. Ministers and members

of religious orders, see page SE-1 for amounts to report on this line. See page SE-2 for other

income to report. Note. Skip this line if you use the nonfarm optional method (see page SE-4) 2

3 Combine lines 1 and 2 3

4a If line 3 is more than zero, multiply line 3 by 92.35% (.9235). Otherwise, enter amount from line 3 4a

b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here 4b

c Combine lines 4a and 4b. If less than $400, do not file this schedule; you do not owe self-employment

tax. Exception. If less than $400 and you had church employee income, enter -0- and continue  4c

6

87,000 00 Maximum amount of combined wages and self-employment earnings subject to social security

tax or the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2003

5a

7

Total social security wages and tips (total of boxes 3 and 7 on Form(s)

W-2) and railroad retirement (tier 1) compensation. If $87,000 or more,

skip lines 8b through 10, and go to line 11 8a

b Unreported tips subject to social security tax (from Form 4137, line 9) 8b

c Add lines 8a and 8b 8c

8a

9 Subtract line 8c from line 7. If zero or less, enter -0- here and on line 10 and go to line 11  9

10 10

Self-employment tax. Add lines 10 and 11. Enter here and on Form 1040, line 55

Optional Methods To Figure Net Earnings (see page SE-3)

14 Maximum income for optional methods 14 1,600 00

Enter the smaller of: two-thirds (2⁄3) of gross farm income1 (not less than zero) or $1,600. Also

include this amount on line 4b above

15

15

16 Subtract line 15 from line 14 16

Nonfarm Optional Method. You may use this method only if:

17

17

3

From Sch. C, line 31; Sch. C-EZ, line 3; Sch. K-1 (Form 1065), line 15a; and Sch. K-1 (Form 1065-B), box 9. 1From Sch. F, line 11, and Sch. K-1 (Form 1065), line 15b. 4

From Sch. C, line 7; Sch. C-EZ, line 1; Sch. K-1 (Form 1065), line 15c; and Sch. K-1 (Form 1065-B), box 9. 2From Sch. F, line 36, and Sch. K-1 (Form 1065), line 15a.

Multiply the smaller of line 6 or line 9 by 12.4% (.124)

Multiply line 6 by 2.9% (.029)

Enter your church employee income from Form W-2. See page SE-1

for definition of church employee income

Multiply line 5a by 92.35% (.9235). If less than $100, enter -0-

Net earnings from self-employment. Add lines 4c and 5b

5a

b 5b

6

7

11

12

11

12

Farm Optional Method. You may use this method only if:

Enter the smaller of: two-thirds (2⁄3) of gross nonfarm income4 (not less than zero) or the amount

on line 16. Also include this amount on line 4b above

Part I

Part II

Caution. You may use this method no more than five times.

● You had net earnings from self-employment of at least $400 in 2 of the prior 3 years.

● Your net nonfarm profits3 were less than $1,733 and also less than 72.189% of your gross nonfarm

income4 and

Deduction for one-half of self-employment tax. Multiply line 12 by

50% (.5). Enter the result here and on Form 1040, line 28

● Your net farm profits2 were less than $1,733.

● Your gross farm income1 was not more than $2,400 or

13

13

Schedule SE (Form 1040) 2003
Department of the Treasury—Internal Revenue Service

Amended U.S. Individual Income Tax Return OMB No. 1545-0091

Form

(Rev. November 2003)  See separate instructions.

This return is for calendar year  , or fiscal year ended  , .

Your first name and initial Last name Your social security number

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Home address (no. and street) or P.O. box if mail is not delivered to your home Apt. no. Phone number

( )

Please print or type

For Paperwork Reduction Act

Notice, see page 6.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 2 of the instructions.

A

B Has the original return been changed or audited by the IRS or have you been notified that it will be? Yes No

C Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date.

On original return  Single Married filing jointly Married filing separately Head of household Qualifying widow(er)

On this return  Single Married filing jointly Married filing separately Head of household* Qualifying widow(er)

B. Net change—

amount of increase

or (decrease)—

explain in Part II

A. Original amount or

as previously adjusted

(see page 2) Income and Deductions (see pages 2–6)

C. Correct

amount

1 Adjusted gross income (see page 3) 1

2 Itemized deductions or standard deduction (see page 3) 2

3 Subtract line 2 from line 1 3

4 Exemptions. If changing, fill in Parts I and II on the back 4

5 Taxable income. Subtract line 4 from line 3 5

6 Tax (see page 4). Method used in col. C 6

7 Credits (see page 4) 7

8 Subtract line 7 from line 6. Enter the result but not less than zero 8

9 Other taxes (see page 4) 9

Tax Liability

10 Total tax. Add lines 8 and 9 10

11

11 Federal income tax withheld and excess social security and

tier 1 RRTA tax withheld. If changing, see page 4

12

12 Estimated tax payments, including amount applied from prior

year’s return

13 Earned income credit (EIC) 13

15 Credits from Form 2439, Form 4136, or Form 8885 15

16 Amount paid with request for extension of time to file (see page 4) 16

Payments

17 Amount of tax paid with original return plus additional tax paid after it was filed 17

18 Total payments. Add lines 11 through 17 in column C 18

Refund or Amount You Owe

19 Overpayment, if any, as shown on original return or as previously adjusted by the IRS 19

20 Subtract line 19 from line 18 (see page 5) 20

21 Amount you owe. If line 10, column C, is more than line 20, enter the difference and see page 5 21

22 22

Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying schedules

and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer (other than

taxpayer) is based on all information of which the preparer has any knowledge.

Sign

Here

Your signature Date Spouse’s signature. If a joint return, both must sign. Date

Preparer’s Date Preparer’s SSN or PTIN

signature Check if

self-employed Paid

Preparer’s

Use Only Firm’s name (or

yours if self-employed),

address, and ZIP code

EIN

Phone no. ( )



Cat. No. 11360L







Joint return?

See page 2.

Keep a copy for

your records.

Form 1040X (Rev. 11-2003)

Use Part II on the back to explain any changes

23 Amount of line 22 you want refunded to you 23

24 Amount of line 22 you want applied to your estimated tax 24

If the name or address shown above is different from that shown on the original return, check here 

If line 10, column C, is less than line 20, enter the difference

1040X

* If the qualifying person is a child but not your dependent, see page 2.

14 Additional child tax credit from Form 8812 14
Form 1040X (Rev. 11-2003) Page 2

Exemptions. See Form 1040 or 1040A instructions. A. Original

number of

exemptions

reported or as

previously

adjusted

If you are not changing your exemptions, do not complete this part.

If claiming more exemptions, complete lines 25–31.

If claiming fewer exemptions, complete lines 25–30.

C. Correct

number of

exemptions

B. Net change

25 Yourself and spouse 25

Caution. If your parents (or someone else) can claim you as a dependent

(even if they chose not to), you cannot claim an exemption for yourself.

26 Your dependent children who lived with you 26

Your dependent children who did not live with you due to divorce or

separation

27

27

28 Other dependents 28

29 Total number of exemptions. Add lines 25 through 28 29

30

30

No. of your

children on line

31 who:

31 Dependents (children and other) not claimed on original (or adjusted) return:

(b) Dependent’s social

security number

(c) Dependent’s

relationship to you (a)

● did not live

with you due to

divorce or

separation (see

page 5) 

Dependents

on line 31 not

entered above 

Explanation of Changes to Income, Deductions, and Credits

Enter the line number from the front of the form for each item you are changing and give the reason for each

change. Attach only the supporting forms and schedules for the items changed. If you do not attach the required

information, your Form 1040X may be returned. Be sure to include your name and social security number on any

attachments.

If the change relates to a net operating loss carryback or a general business credit carryback, attach the schedule or form

that shows the year in which the loss or credit occurred. See page 2 of the instructions. Also, check here 

Presidential Election Campaign Fund. Checking below will not increase your tax or reduce your refund.

If you did not previously want $3 to go to the fund but now want to, check here 

If a joint return and your spouse did not previously want $3 to go to the fund but now wants to, check here 

Part III

Part I

Part II

Multiply the number of exemptions claimed on line 29 by the amount listed

below for the tax year you are amending. Enter the result here and on line 4.

Tax

year

Exemption

amount

But see the instructions for

line 4 on page 3 if the

amount on line 1 is over:

First name Last name

● lived with

you 

2003

2002

2001

2000

$3,050

3,000

2,900

2,800

$104,625

103,000

99,725

96,700

(d) if qualifying

child for child tax

credit (see page 5)

Form 1040X (Rev. 11-2003)
OMB No. 1545-0139 Employee Business Expenses Form 2106

 See separate instructions.

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Attachment

Sequence No. 54

Your name Occupation in which you incurred expenses Social security number

Employee Business Expenses and Reimbursements

Column A Column B

Step 1 Enter Your Expenses Meals and

Entertainment

Other Than Meals

and Entertainment

1

Vehicle expense from line 22 or line 29. (Rural mail carriers: See

instructions.)

1

2

Parking fees, tolls, and transportation, including train, bus, etc., that

did not involve overnight travel or commuting to and from work

2

Travel expense while away from home overnight, including

lodging, airplane, car rental, etc. Do not include meals and

entertainment

3

3

Business expenses not included on lines 1 through 3. Do not

include meals and entertainment

4

4

5 Meals and entertainment expenses (see instructions) 5

Total expenses. In Column A, add lines 1 through 4 and enter the

result. In Column B, enter the amount from line 5

6

6

Note: If you were not reimbursed for any expenses in Step 1, skip line 7 and enter the amount from line 6 on line 8.

Step 2 Enter Reimbursements Received From Your Employer for Expenses Listed in Step 1

Enter reimbursements received from your employer that were not

reported to you in box 1 of Form W-2. Include any reimbursements

reported under code “L” in box 12 of your Form W-2 (see

instructions)

7

7

Step 3 Figure Expenses To Deduct on Schedule A (Form 1040)

8

Subtract line 7 from line 6. If zero or less, enter -0-. However, if

line 7 is greater than line 6 in Column A, report the excess as

income on Form 1040, line 7

8

Note: If both columns of line 8 are zero, you cannot deduct

employee business expenses. Stop here and attach Form

2106 to your return.

9

9

10

In Column A, enter the amount from line 8. In Column B, multiply

line 8 by 50% (.50). (Employees subject to Department of

Transportation (DOT) hours of service limits: Multiply meal

expenses by 65% (.65) instead of 50%. For details, see

instructions.)

Add the amounts on line 9 of both columns and enter the total here. Also, enter the total on

Schedule A (Form 1040), line 20. (Fee-basis state or local government officials, qualified

performing artists, and individuals with disabilities: See the instructions for special rules on

where to enter the total.)  10

For Paperwork Reduction Act Notice, see instructions. Cat. No. 11700N Form 2106 (2003)

Part I

(99)

2003
Form 2106 (2003) Page 2

Vehicle Expenses

Section A—General Information (You must complete this section if you

are claiming vehicle expenses.) (a) Vehicle 1 (b) Vehicle 2

11 Enter the date the vehicle was placed in service 11 / /

12 Total miles the vehicle was driven during 2003 12 miles miles

13 Business miles included on line 12 13 miles miles

14 Percent of business use. Divide line 13 by line 12 14 % %

15 Average daily roundtrip commuting distance 15 miles miles

16 Commuting miles included on line 12 16 miles miles

17 Other miles. Add lines 13 and 16 and subtract the total from line 12 17 miles miles

18 Do you (or your spouse) have another vehicle available for personal use? Yes No

19 Was your vehicle available for personal use during off-duty hours? Yes No

Yes No

21 If “Yes,” is the evidence written? Yes No

20 Do you have evidence to support your deduction?

Section B—Standard Mileage Rate (See the instructions for Part II to find out whether to complete this section or

Section C.)

22 Multiply line 13 by 36¢ (.36) 22

Section C—Actual Expenses (a) Vehicle 1 (b) Vehicle 2

Gasoline, oil, repairs, vehicle

insurance, etc.

23

23

24a Vehicle rentals 24a

b Inclusion amount (see instructions) 24b

c Subtract line 24b from line 24a 24c

Value of employer-provided

vehicle (applies only if 100% of

annual lease value was included

on Form W-2—see instructions)

25

25

26 Add lines 23, 24c, and 25 26

Multiply line 26 by the

percentage on line 14

27

27

28

Depreciation. Enter amount

from line 38 below

28

29 Add lines 27 and 28. Enter total

here and on line 1 29

Section D—Depreciation of Vehicles (Use this section only if you owned the vehicle and are completing Section C

for the vehicle.)

(a) Vehicle 1 (b) Vehicle 2

Enter cost or other basis (see

instructions)

30

30

Enter section 179 deduction

and special allowance (see

instructions)

31

31

Multiply line 30 by line 14 (see

instructions if you claimed the

section 179 deduction or special

allowance)

32

32

Enter depreciation method and

percentage (see instructions)

33

33

Multiply line 32 by the percentage

on line 33 (see instructions)

34

34

35 Add lines 31 and 34 35

Enter the applicable limit explained

in the line 36 instructions

36

36

Multiply line 36 by the

percentage on line 14

37

37

Enter the smaller of line 35 or

line 37. Also enter this amount

on line 28 above

38

38

Part II

/ /

Form 2106 (2003)
OMB No. 1545-0068 Child and Dependent Care Expenses Form 2441

 Attach to Form 1040.

Department of the Treasury

Internal Revenue Service

Attachment

 See separate instructions. Sequence No. 21

Name(s) shown on Form 1040 Your social security number

Persons or Organizations Who Provided the Care—You must complete this part. 

(If you need more space, use the bottom of page 2.)

(b) Address

(number, street, apt. no., city, state, and ZIP code)

(d) Amount paid

(see instructions)

(c) Identifying number

(SSN or EIN) 1 (a) Care provider’sname

Credit for Child and Dependent Care Expenses

2

Add the amounts in column (c) of line 2. Do not enter more than $3,000 for one qualifying

person or $6,000 for two or more persons. If you completed Part III, enter the amount

from line 26

Enter your earned income

3

3

If married filing jointly, enter your spouse’s earned income (if your spouse was a student

or was disabled, see the instructions); all others, enter the amount from line 4

4 4

Enter the smallest of line 3, 4, or 5

5

5

6

7 Enter the amount from Form 1040, line 35 7



Decimal

amount is

If line 7 is:

Decimal

amount is

If line 7 is:

But not

Over over

But not

Over over

$0—15,000 .35 $29,000—31,000 .27

15,000—17,000 .34 31,000—33,000 .26

17,000—19,000 .33 33,000—35,000 .25

19,000—21,000 .32 35,000—37,000 .24

21,000—23,000 .31 37,000—39,000 .23

23,000—25,000 .30

Multiply line 6 by the decimal amount on line 8. If you paid 2002 expenses in 2003, see

the instructions 

9

For Paperwork Reduction Act Notice, see page 3 of the instructions. Form 2441 (2003)

Before you begin: You need to understand the following terms. See Definitions on page 1 of the instructions.

Cat. No. 11862M

Part I

Part II

Enter on line 8 the decimal amount shown below that applies to the amount on line 7

Did you receive

dependent care benefits? Yes

No

8

Complete only Part II below.

Complete Part III on the back next.





Caution. If the care was provided in your home, you may owe employment taxes. See the instructions for Form 1040, line 59.

.

(99)

Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions.

(a) Qualifying person’s name

First Last

(b) Qualifying person’s social

security number

(c) Qualified expenses you

incurred and paid in 2003 for the

person listed in column (a)

8

6

● Dependent Care Benefits ● Qualifying Person(s) ● Qualified Expenses ● Earned Income

10 Enter the amount from Form 1040, line 43, minus any amount on Form 1040, line 44 

Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10

here and on Form 1040, line 45

11

9

10

11

25,000—27,000

27,000—29,000

.29

.28

39,000—41,000

41,000—43,000

43,000—No limit

.22

.21

.20

2003
Form 2441 (2003) Page 2

Dependent Care Benefits

Enter the total amount of dependent care benefits you received for 2003. This amount

should be shown in box 10 of your W-2 form(s). Do not include amounts that were

reported to you as wages in box 1 of Form(s) W-2

Enter the amount forfeited, if any (see the instructions)

Subtract line 13 from line 12

Enter the total amount of qualified expenses incurred

in 2003 for the care of the qualifying person(s)

13

15

Enter the smaller of line 14 or 15 16

14

Enter your earned income

15

17

Enter the amount shown below that

applies to you.

18

Enter the smallest of line 16, 17, or 18

16

19

Excluded benefits. Enter here the smaller of the following:

17

20

● The amount from line 19 or

● $5,000 ($2,500 if married filing separately and you

were required to enter your spouse’s earned

income on line 18).

Taxable benefits. Subtract line 20 from line 14. Also, include this amount on Form 1040,

line 7. On the dotted line next to line 7, enter “DCB”

18

21

Part III



To claim the child and dependent care

credit, complete lines 22–26 below.

22

23

24

19

20

21

22 Enter $3,000 ($6,000 if two or more qualifying persons)

Subtract line 23 from line 22. If zero or less, stop. You cannot take the credit.

Exception. If you paid 2002 expenses in 2003, see the instructions for line 9

Enter the smaller of line 24 or 25. Also, enter this amount on line 3 on the front of this

form and complete lines 4–11

Enter the amount from line 20

26

23

24

26

13

14

12

12

Complete line 2 on the front of this form. Do not include in column (c) any benefits shown

on line 20 above. Then, add the amounts in column (c) and enter the total here

25

25

Form 2441 (2003)

● If married filing jointly, enter your

spouse’s earned income (if your spouse

was a student or was disabled, see the

instructions for line 5).

● If married filing separately, see the

instructions for the amount to enter.

● All others, enter the amount from line 17.Application for Automatic Extension of Time OMB No. 

To File U.S. Individual Income Tax Return Form 4868

Department of the Treasury

Internal Revenue Service

Your social security number

Your name(s) (see instructions)

Spouse’s social security number

Address (see instructions)

City, town or post office, state, and ZIP code

For Privacy Act and Paperwork Reduction Act Notice, see page 4. Cat. No. 13141W

1

2 3

4 Estimate of total tax liability for 2003 $

Total 2003 payments

Balance due. Subtract 5 from 4

5

6

 DETACH HERE 

If you are requesting a Gift or GST tax return extension, check

this box 

Part III

Part IV

Part I

Part II

Identification Individual Income Tax

Gift/GST Tax—If you are not filing a gif

tax return, go to Part V now. See the instr

Total

7 Your gift or GST tax payment $

8 Your spouse’s gift/GST tax payment

9 Total liability. Add lines 6, 7, and 8 $

10 Amount you are paying This form also extends the time for filing a gift or generation-skipping

transfer (GST) tax return if you file a calendar (not fiscal) year income

tax return. Enter your gift or GST tax payment(s) in Part IV and:

For calendar year 2003, or other tax year beginning , 2003, ending , .

Complete ONLY If Filing Gift/GST Tax Return Part V

Caution:

Form 

If you think you may owe tax and wish to make a payment,

you may pay by electronic funds withdrawal using option 1 or 2

below or you may pay by credit card using option 3.

pyy

may owe tax when you file your return, you will need to estimate

your total tax liability and subtract how much you have already

paid (lines 4, 5, and 6 below).

E-file by Phone—February 2–April 15

Anyone who filed a tax return for 2002 can file Form 4868 by

phone. The telephone system will accept extensions any time

from February 2 through April 15, 2004, and your extension will

be good through August 16, 2004. Filing by telephone is

advantageous because it is free and you get a confirmation

number.

E-file Using Your Personal

Computer or Through a Tax

Professional

Refer to your tax software package or tax preparer for ways to

file electronically. Be sure to have a copy of last year’s tax return

Card, Discover® Card, MasterCard®card, or Visa® card

payment must be at least $1. You may pay by phone 

Internet through one of the service providers listed be

Official Payments Co

1-888-PAY-1040sm

(1-888-729-1040)

1-888-658-5465 (Customer Service)

www.PAY1040.com

Link2Gov Corporation

1-800-2PAY-TAXsm 

(1-800-272-9829)

1-877-754-4413 (Cust

www.officialpayment

Confirmation Number

If you file electronically, you will receive a confirmation nu

you that your Form 4868 has been accepted. Enter the c

File a Paper Form 4868

If you wish to file on paper instead of electronically, f

Form 4868 below and mail it to the address shown o

page 4.

Form 709 or 709-A. Although an extension of time 

income tax return also extends the time to file Form 7

709-A, you cannot make payments of the gift or GST 

credit card. To make a payment of the gift or GST tax

check or money order to the Internal Revenue Service 

where the donor’s gift tax return will be filed. Enter “2

709” and the donor’s name and social security numb

payment.

number here and keep it for

1

2

Each service provider will charge a convenience fee 

the amount of the tax payment you are making. Fees 

between service providers. You will be told what the 

during the transaction and will have the option to con

cancel the transaction. You may also obtain the conv

by calling the providers’ toll-free automated customer 

numbers or visiting their websites. Do not add the co

fee to your tax payment.

Only for gift/GST tax extension! Checking box(es) may result in

correspondence if Form 709 or 709-A is not filed.

your records 

If you wish to make a payment by electronic funds withdrawal,

you will be asked for the adjusted gross income (AGI) from your

2002 tax return. Your AGI for that year is located on line 35 of

your Form 1040; line 21 of your 1040A; line 4 of your 1040EZ;

line 34 of your 1040NR; line 10 of your 1040NR-EZ; or line I of

your TeleFile Tax Record. If you choose, you may also file your

extension by phone and mail a payment to the address shown in

the middle column on page 4.

Call toll free 1-888-796-1074

20

If your spouse is requesting a Gift or GST tax return extension,

check this box 
You do not have to explain why you are asking for the

extension. We will contact you only if your request is denied.

Caution: Although you are not required to make a payment

of the tax you estimate as due, Form 4868 does not extend

the time to pay taxes. If you do not pay the amount due by

the regular due date, you will owe interest. You may also be

charged penalties. For more details, see Interest on this

page and Late Payment Penalty on page 3. Any remittance

you make with your application for extension will be treated

as a payment of tax.

Do not file Form 4868 if you want the IRS to figure your

tax or you are under a court order to file your return by the

regular due date.

Form 709 or 709-A. Generally, an extension of time to file

your 2003 calendar year income tax return also extends the

time to file a gift or generation-skipping transfer (GST) tax

return for 2003. Special rules apply if the donor dies during

the year in which the gifts were made. See the Instructions

for Form 709.

If you need an additional extension, see If You Need

Additional Time on this page.

Interest

You will owe interest on any tax not paid by the re

date of your return. The interest runs until you pay 

Even if you had a good reason for not paying on t

will still owe interest.

Do not attach a copy of Form 4868 to your retu

Filing Your Tax Return

You may file your tax return any time before the ex

expires.

When To File Form 4868

File Form 4868 by April 15, 2004. Fiscal year taxpayers, file

Form 4868 by the regular due date of the return.

If you are a U.S. citizen or resident “out of the country”

(defined on this page) on the regular due date of your return,

you are allowed 2 extra months to file your return. For a

calendar year return, this is June 15, 2004. File this form if

you need an additional 2 months to file your return. Write

“Taxpayer Abroad” across the top of Form 4868.

If the automatic 4-month extension (until August 1

for most calendar year taxpayers) does not give yo

time, you can ask for additional time later. But you 

to give a good reason, and it must be approved by 

To ask for the additional time, you must either:

If You Need Additional Time

1. File Form 2688, Application for Additional Ext

Time To File U.S. Individual Income Tax Return or

2. Explain your reason in a letter. Mail it to the a

the right column under Where To File a Paper Fo

on page 4.

File Form 4868 before you file Form 2688 or wr

asking for more time. Only in cases of undue hard

the IRS approve your request for an additional ext

without receiving Form 4868 first. Ask early for this 

time. Then, you can still file your return on time if y

request is not approved.

g

the return.
If you and your spouse each filed a separate Fo

but later file a joint return for 2003, enter the total 

both Forms 4868 on the appropriate line of your jo

If you and your spouse jointly file Form 4868 but 

separate returns for 2003, you may enter the total 

paid with Form 4868 on either of your separate ret

you and your spouse may divide the payment in a

amounts. Be sure each separate return has the so

security numbers of both spouses.

A penalty is usually charged if your return is filed after the

due date (including extensions). The penalty is usually 5% of

the amount due for each month or part of a month your

return is late. Generally, the maximum penalty is 25%. If your

return is more than 60 days late, the minimum penalty is

$100 or the balance of the tax due on your return, whichever

is smaller. You might not owe the penalty if you have a good

reason for filing late. Attach a statement to your return

your actual 2003 tax liability is paid before the regular due

date of your return through withholding, estimated tax

payments, or with Form 4868.

Late Filing Penalty

● Form 1040EZ, line 9.

● Form 1040NR-EZ, line 21.

● Form 1040NR, line 61.

If you find you cannot pay the amount shown on 

you can still get the extension. But you should pay 

as you can to limit the amount of interest you will 

you may be charged the late payment penalty on t

tax from the regular due date of your return. See L

Payment Penalty on this page.

Enter the amount of gift and GST tax you (or yo

are paying on these lines. If your spouse files a se

Form 4868, do not check the box in Part II for you

enter on your form only the total gift and GST tax 

paying. Pay in full with this form to avoid interest a

penalties.

Part IV—Gift/GST Tax

Line 6—Balance Due

Line 5—Total 2003 Payments

Part V—Total

Enter the total of line 6 (and 7 and 8, if applicable) 

If you are paying your entire estimate of tax liability

and 10 should both be the same.

Subtract line 5 from line 4. If line 5 is more than lin

zero.

Fill in this part only if you or your spouse plan to f

709 or 709-A and you are also using Form 4868 to 

an extension of time to file your 2003 calendar ye

tax return. Do not include income tax on lines 7 a

Caution: Make your estimate as accurate as you c

information you have. If we later find that the estim

not reasonable, the extension will be null and void.

If you expect this amount to be zero, enter zero

● Form 1040EZ, line 10.

● Form 1040NR, line 56.

● Form 1040NR-EZ, line 17.

● Form 1040, line 68 (excluding line 66).

● Form 1040A, line 43.

● Form 1040EZ, line 9.

● Form 1040NR-EZ, line 21.

● Form 1040NR, line 67 (excluding line 61).

Enter on line 5 the total payments from:

Note: For Forms 1040A, 1040EZ, and 1040NR-EZ

include on line 5 the amount you are paying with t

Form 4868.

● Form 1040, line 60.

● Form 1040A, line 38.

Line 4—Estimate of Total Tax Liability for 2003

If you plan to file jointly, enter on line 2 the social security

number (SSN) that you will show first on your return. Enter

your spouse’s SSN on line 3.

Part III—Individual Income Tax

If you are filing Form 1040NR or 1040NR-EZ, and do not

have (and are not eligible to obtain) an SSN, enter your

IRS-issued individual taxpayer identification number (ITIN).

For information on obtaining an ITIN, get Form W-7,

Application for IRS Individual Taxpayer Identification Number.

Enter on line 4 the total tax liability you expect to report on

your 2003:

If you changed your mailing address after you filed your

last return, you should use Form 8822, Change of Address,

to notify the IRS of the change. Showing a new address on

Form 4868 will not update your record. You can get IRS

forms by calling 1-800-TAX-FORM (1-800-829-3676). You

can also download forms from the IRS website at

www.irs.gov.

Specific Instructions

If you changed your name after you filed your last return

because of marriage, divorce, etc., be sure to report this to

your local Social Security Administration office before filing

Form 4868. This prevents delays in processing your

extension request.

Part I—Identification

How To Complete Form 4868

Enter your name(s) and address. If you plan to file a joint

return, include both spouses’ names in the order in which

they will appear on the return.

If you want correspondence regarding this extension to be

sent to you at an address other than your own or to an agent

acting for you, include the agent’s name, if any, and enter

that address instead.

Caution: Skip Parts II and IV unless you are requesting an

extension of time to file a gift or GST tax return.
Printed on recycled paper

Privacy Act and Paperwork Reduction Act Notice. We ask for the

information on this form to carry out the Internal Revenue laws of the United

States. We need this information so that our records will reflect your intention

to file your individual income tax return within 4 months after the regular due

date. If you choose to apply for an automatic extension of time to file, you are

required by Internal Revenue Code section 6081 to provide the information

requested on this form. Under section 6109, you must disclose your social

security number (SSN) or individual taxpayer identification number (ITIN).

Routine uses of this information include giving it to the Department of Justice

for civil and criminal litigation, and to cities, states, and the District of

Columbia for use in administering their tax laws. We may also disclose this

information to other countries under a tax treaty, or to Federal and state

agencies to enforce Federal nontax criminal laws and to combat terrorism. If

you fail to provide this information in a timely manner or provide incomplete or

false information, you may be liable for penalties and interest.

The time needed to complete and file this form will vary depen

individual circumstances. The estimated average time is: Record

min.; Learning about the law or the form, 13 min.; Preparing t

min.; and Copying, assembling, and sending the form to the I

If you have comments concerning the accuracy of these time 

suggestions for making this form simpler, we would be happy to 

you. You can write to the Tax Products Coordinating Committee

Distribution Center, Rancho Cordova, CA 95743-0001. Do not se

to this address. Instead, see Where To File a Paper Form 4868 

You are not required to provide the information requested on 

subject to the Paperwork Reduction Act unless the form displays 

control number. Books or records relating to a form or its instruc

retained as long as their contents may become material in the ad

of any Internal Revenue law. Generally, tax returns and return inf

confidential, as required by Internal Revenue Code section 6103.

If you owe tax and wish to have the money electronically

withdrawn from your account, you will be asked to make the

following declaration:

I authorize the U.S. Treasury and its designated Financial Agent to

initiate an ACH electronic funds withdrawal entry to the financial

institution account indicated for payment of my Federal taxes owed,

and the financial institution to debit the entry to this account. This

authorization is to remain in full force and effect until I notify the U.S.

Treasury Financial Agent to terminate the authorization. To revoke a

payment, I must contact the U.S. Treasury Financial Agent at

1-888-353-4537 no later than 2 business days prior to the payment

(settlement) date. I also authorize the financial

● Make your check or money order payable to the 

States Treasury.” Do not send cash.

● Do not staple or attach your payment to the form

● Write your social security number, daytime phon

and “2003 Form 4868” on your check or money or

Paying by Check or Money Order

● When paying by check or money order with For

use the addresses in the middle column under Wh

a Paper Form 4868 below.

py y 

Where To File a Paper Form 4868

If you live in:

And you are 

payment, send 

Internal Revenue S

Alabama, Florida, Georgia, Mississippi, North Carolina, Rhode Island,

South Carolina, West Virginia Atla

Maine, Massachusetts, New Hampshire, New York, Vermont Ando

Delaware, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota,

Missouri, Nebraska, North Dakota, South Dakota, Wisconsin Kansas C

Connecticut, District of Columbia, Maryland, New Jersey,

Pennsylvania Philadelp

Arkansas, Colorado, Kentucky, Louisiana, New Mexico, Oklahoma,

Tennessee, Texas Au

Ohio, Virginia Memp

Alaska, California, Hawaii, Idaho, Montana, Nevada, Oregon,

Washington, Wyoming Fres

Guam:

Permanent residents

Department of Revenue 

Govern

P.O. Box 23607 G

Virgin Islands:

Permanent residents

V.I. Bureau of Int

9601 

Charlotte Amalie, St. Tho

American Samoa or Puerto Rico (or if excluding income under Internal

Revenue Code section 933); are a nonpermanent resident of Guam or

the Virgin Islands; have an APO, FPO, or foreign address; are a

dual-status alien; or file Form 2555, 2555-EZ, or 4563

Philadelphia, P

And you are making a payment, send

Form 4868 with your payment to IRS:

P.O. Box 105073 Atlanta, GA 30348-5073

P.O. Box 37003 Hartford, CT 06176-0003

P.O. Box 970028 St. Louis, MO 63197-0028

P.O. Box 80109 Cincinnati, OH 45280-0009

P.O. Box 660575 Dallas, TX 75266-0575

P.O. Box 105050 Atlanta, GA 30348-5050

P.O. Box 7122 San Francisco, CA 94120-7122

P.O. Box 80109 Cincinnati, OH 45280-0009

Send Form 4868 and payments to:

Send Form 4868 and payments to:

Arizona, Utah P.O. Box 1236 Charlotte, NC 28201-1236 Fres
Form 8283 Noncash Charitable Contributions OMB No. 1545-0908

(Rev. October 1998) © Attach to your tax return if you claimed a total deduction

of over $500 for all contributed property. Attachment

Sequence No. 55 Department of the Treasury

Internal Revenue Service © See separate instructions.

Name(s) shown on your income tax return Identifying number

Note: Figure the amount of your contribution deduction before completing this form. See your tax return instructions.

Section A—List in this section only items (or groups of similar items) for which you claimed a deduction of $5,000 or

less. Also, list certain publicly traded securities even if the deduction is over $5,000 (see instructions).

Information on Donated Property—If you need more space, attach a statement.

(b) Description of donated property (a) Name and address of the

donee organization 1

D

Note: If the amount you claimed as a deduction for an item is $500 or less, you do not have to complete columns (d), (e), and (f).

(h) Method used to determine the fair

market value

(f) Donor’s cost

or adjusted basis

(e) How acquired

by donor

(d) Date acquired

by donor (mo., yr.)

(c) Date of the

contribution (g) Fair market value

A

B

E

Other Information—Complete line 2 if you gave less than an entire interest in property listed in Part I.

Complete line 3 if conditions were attached to a contribution listed in Part I.

2 If, during the year, you contributed less than the entire interest in the property, complete lines a–e.

a

b Total amount claimed as a deduction for the property listed in Part I:

c Name and address of each organization to which any such contribution was made in a prior year (complete only if different

from the donee organization above):

Name of charitable organization (donee)

Address (number, street, and room or suite no.)

City or town, state, and ZIP code

d For tangible property, enter the place where the property is located or kept ©

e Name of any person, other than the donee organization, having actual possession of the property ©

If conditions were attached to any contribution listed in Part I, answer questions a – c and attach the required

statement (see instructions).

3

Yes No Is there a restriction, either temporary or permanent, on the donee’s right to use or dispose of the donated

property? 

a

b

c

For Paperwork Reduction Act Notice, see page 4 of separate instructions. Form 8283 (Rev. 10-98)

C

D

A

B

C

E

Part I

Part II

Enter the letter from Part I that identifies the property © . If Part II applies to more than one property, attach a

separate statement.

Cat. No. 62299J

(1)

(2) For any prior tax years © .

For this tax year © .

Did you give to anyone (other than the donee organization or another organization participating with the donee

organization in cooperative fundraising) the right to the income from the donated property or to the possession

of the property, including the right to vote donated securities, to acquire the property by purchase or otherwise,

or to designate the person having such income, possession, or right to acquire?

Is there a restriction limiting the donated property for a particular use?
Form 8283 (Rev. 10-98) Page 2

Name(s) shown on your income tax return Identifying number

Section B—Appraisal Summary—List in this section only items (or groups of similar items) for which you claimed a

deduction of more than $5,000 per item or group. Exception. Report contributions of certain publicly

traded securities only in Section A.

If you donated art, you may have to attach the complete appraisal. See the Note in Part I below.

Information on Donated Property—To be completed by the taxpayer and/or appraiser.

4 Check type of property:

Art* (contribution of $20,000 or more) Real Estate Gems/Jewelry

Art* (contribution of less than $20,000) Coin Collections Books Other

*Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antique furniture, decorative arts, textiles, carpets, silver, rare

manuscripts, historical memorabilia, and other similar objects.

(c) Appraised fair

market value

(b) If tangible property was donated, give a brief summary of the overall

physical condition at the time of the gift

(a) Description of donated property (if you need

more space, attach a separate statement)

5

A

C

D

See instructions (g) For bargain sales, enter

amount received

(f) Donor’s cost or 

adjusted basis

(e) How acquired 

by donor

(d) Date acquired 

by donor (mo., yr.) (i) Average trading price of securities (h) Amount claimed as a 

deduction

A

B

C

D

Taxpayer (Donor) Statement—List each item included in Part I above that the appraisal identifies as

having a value of $500 or less. See instructions.

I declare that the following item(s) included in Part I above has to the best of my knowledge and belief an appraised value of not more than $500

(per item). Enter identifying letter from Part I and describe the specific item. See instructions. ©

Signature of taxpayer (donor) © Date ©

Declaration of Appraiser

I declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any

of the foregoing persons, or married to any person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or

party to the transaction, I performed the majority of my appraisals during my tax year for other persons.

Also, I declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications

as described in the appraisal, I am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based

on a percentage of the appraised property value. Furthermore, I understand that a false or fraudulent overstatement of the property value as

described in the qualified appraisal or this appraisal summary may subject me to the penalty under section 6701(a) (aiding and abetting the

understatement of tax liability). I affirm that I have not been barred from presenting evidence or testimony by the Director of Practice.

Sign

Here Signature © Title © Date of appraisal ©

Business address (including room or suite no.) Identifying number

City or town, state, and ZIP code

Donee Acknowledgment—To be completed by the charitable organization.

This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated

property as described in Section B, Part I, above on ©

(Date)

Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section

B, Part I (or any portion thereof) within 2 years after the date of receipt, it will file Form 8282, Donee Information Return, with the

IRS and give the donor a copy of that form. This acknowledgment does not represent agreement with the claimed fair market value.

Name of charitable organization (donee) Employer identification number

Address (number, street, and room or suite no.) City or town, state, and ZIP code

Authorized signature Title Date

B

Stamp Collections

Part III

Part IV

Part I

Part II

Note: If your total art contribution deduction was $20,000 or more, you must attach a complete copy of the signed appraisal. See instructions.

Does the organization intend to use the property for an unrelated use? © Yes No
OMB No. 1545-1620 8812 Additional Child Tax Credit Form

Complete and attach to Form 1040 or Form 1040A. Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 47

Name(s) shown on return Your social security number

For Paperwork Reduction Act Notice, see back of form. Cat. No. 10644E Form 8812 (2003)

3

2

4

6

Enter the total of the withheld social security and Medicare taxes from Form(s)

W-2, boxes 4 and 6. If married filing jointly, include your spouse’s amounts

with yours. If you worked for a railroad, see the instructions on back

Add lines 7 and 8

1

Enter the total of the amounts from Form 1040, lines

28 and 56, plus any uncollected social security and

Medicare or tier 1 RRTA taxes included on line 60.

Enter -0-.

Enter the total of the amounts from Form 1040, lines

63 and 64.

Enter the total of the amount from Form 1040A, line

41, plus any excess social security and tier 1 RRTA

taxes withheld that you entered to the left of line 43

(see the instructions on back).

Enter the amount from line 3 of your Child Tax Credit Worksheet on page 41 of the Form 1040 instructions

or page 38 of the Form 1040A instructions. If you used Pub. 972, enter the amount from line 10 of the

worksheet on page 4 of the publication

Enter the amount from Form 1040, line 49, or Form 1040A, line 33

Subtract line 2 from line 1. If zero, stop; you cannot take this credit

8

9



6

1040A filers:

1040 filers:

1040 filers:

1040A filers:

1

2

13

1040

1040A

. . . . . . . . . .

Enter this amount on

Form 1040, line 65, or

Form 1040A, line 42.





8812

1040

1040A

. . . . . . . . . .

3

Enter your total taxable earned income. See the instructions on back

5 Is the amount on line 4 more than $10,500?

No.

Yes. Subtract $10,500 from the amount on line 4. Enter the result

Leave line 5 blank and enter -0- on line 6.

4

5

Multiply the amount on line 5 by 10% (.10) and enter the result

7

Next. Do you have three or more qualifying children?

No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the

smaller of line 3 or line 6 on line 13.

Yes.

7

8

9

10

10

11 Subtract line 10 from line 9. If zero or less, enter -0- 11

12 Enter the larger of line 6 or line 11 here 12

Next, enter the smaller of line 3 or line 12 on line 13.

13 This is your additional child tax credit

Part III

Part I

Part II

All Filers

Certain Filers Who Have Three or More Qualifying Children

Your Additional Child Tax Credit

If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on

line 13. Otherwise, go to line 7.

2003
Form 8812 (2003) Page 2

Instructions

Purpose of Form

Use Form 8812 to figure your additional child tax credit.

Taxable Earned Income

Paperwork Reduction Act Notice. We ask for the information on

this form to carry out the Internal Revenue laws of the United

States. You are required to give us the information. We need it to

ensure that you are complying with these laws and to allow us to

figure and collect the right amount of tax.

You are not required to provide the information requested on a

form that is subject to the Paperwork Reduction Act unless the

form displays a valid OMB control number. Books or records

relating to a form or its instructions must be retained as long as

their contents may become material in the administration of any

Internal Revenue law. Generally, tax returns and return information

are confidential, as required by Internal Revenue Code section

6103.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated average time

is: Recordkeeping, 6 min.; Learning about the law or the form,

5 min.; Preparing the form, 28 min.; Copying, assembling, and

sending the form to the IRS, 20 min.

If you have comments concerning the accuracy of these time

estimates or suggestions for making this form simpler, we would

be happy to hear from you. See the Instructions for Form 1040 or

Form 1040A.

The additional child tax credit may give you a refund

even if you do not owe any tax.

Railroad Employees

If you worked for a railroad, include the following taxes in the

total on Form 8812, line 7.

● Tier 1 tax withheld from your pay. This tax should be shown in

box 14 of your Form(s) W-2 and identified as “Tier 1 tax.”

● If you were an employee representative, 50% of the total tier 1

tax and tier 1 Medicare tax you paid for 2003.

Any refund you receive as a result of taking the additional child

tax credit will not be used to determine if you are eligible for the

following programs, or how much you can receive from them.

● Temporary Assistance for Needy Families (TANF).

● Medicaid and supplemental security income (SSI).

● Food stamps and low-income housing.

Effect of Credit on Welfare Benefits

First, complete the Child Tax Credit Worksheet that applies to you.

See the instructions for Form 1040, line 49, or Form 1040A, line

33. If you meet the condition given in the TIP at the end of your

Child Tax Credit Worksheet, use Form 8812 to see if you can take

the additional child tax credit.

Who Should Use Form 8812

2. Are you claiming the earned income credit (EIC) on Form

1040, line 63, or Form 1040A, line 41?

Yes. Use the following chart to find the amount to enter on

Form 8812, line 4.

IF you are

filing Form . . . AND you completed . . .

THEN enter on Form

8812, line 4, the amount

from . . .

1040A

1040

Step 5 on page 42 of your

1040A instructions

Worksheet B on page 49 of

your 1040 instructions

Step 5 on page 46 of your

1040 instructions (but not

Worksheet B)

Step 5, Earned Income

Worksheet B, line 4b.*

Step 5, Earned Income

No. 1040 filers: Go to question 3.

1040A filers: Skip question 3 and go to question 4.

Yes. Use Pub. 972 to figure the amount to enter on

Form 8812, line 4.

4. Does the amount on line 7 of Form 1040 or Form 1040A

include any of the following amounts?

● Taxable scholarship or fellowship grants not reported on a Form

W-2.

● Amounts paid to an inmate in a penal institution for work (put

“PRI” and the amount paid in the space next to line 7 of Form

1040 or 1040A).

No. Enter the amount from line 7 of Form 1040 or Form

1040A on Form 8812, line 4.

Yes. Subtract the total of those amounts from the amount on

line 7 of Form 1040 or Form 1040A. (If an amount is

included in more than one of the above categories,

include it only once in figuring the total amount to

subtract.) Enter the result on Form 8812, line 4.

1040A Filers

If you, or your spouse if filing a joint return, had more than one

employer for 2003 and total wages of over $87,000, figure any

excess social security and tier 1 railroad retirement (RRTA) taxes

withheld. See the instructions for Form 1040A, line 43. Include any

excess on Form 8812, line 10.

* If you were a member of the clergy, subtract the following from the amount on line

4b: (a) the rental value of a home or the nontaxable portion of an allowance for a

home furnished to you (including payments for utilities) and (b) the value of meals

and lodging provided to you, your spouse, and your dependents for your employer’s

convenience.

● Amounts received as a pension or annuity from a nonqualified

deferred compensation plan or a nongovernmental section 457 plan

(put “DFC” and the amount received in the space next to line 7 of

Form 1040 or 1040A). This amount may be reported in box 11 of

your Form W-2. If you received such an amount but box 11 is

blank, contact your employer for the amount received as a pension

or annuity.

● Amounts from Form 2555, line 41, or Form 2555-EZ,

line 18.

1. Did you, or your spouse if filing a joint return, have net

earnings from self-employment and use either optional method to

figure those net earnings?

No. Go to question 2.

Yes. Use Pub. 972 to figure the amount to enter on

Form 8812, line 4.

3. Were you, or your spouse if filing a joint return,

self-employed, or are you filing Schedule SE because you were a

member of the clergy or you had church employee income, or are

you filing Schedule C or C-EZ as a statutory employee?

No. Go to question 4.
OMB No. 1545-1618 Education Credits

Form 8863

 See instructions. Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 50

Name(s) shown on return Your social security number

Hope Credit. Caution: You cannot take the Hope credit for more than 2 tax years for the same student.

1

2

3

Lifetime Learning Credit

Form 8863 (2003)

Part I

Part II

3

(a) Student’s name

(as shown on page 1

of your tax return)

Cat. No. 25379M

Add the amounts in columns (d) and (f)

Tentative Hope credit. Add the amounts on line 2, columns (d) and (f). If you are taking

the lifetime learning credit for another student, go to Part II; otherwise, go to Part III 

8

Add the amounts on line 4, column (c), and enter the total

9

9

Enter the smaller of line 5 or $10,000

10

Subtract line 10 from line 9. If zero or less, stop; you cannot take

any education credits

10

12

16

17

4

11

11

15

For Paperwork Reduction Act Notice, see page 3.

(f) Enter one-half

of the amount in

column (e)

(e) Subtract

column (d) from

column (c)

(d) Enter the

smaller of the

amount in

column (c) or

$1,000

(c) Qualified

expenses (see

instructions). Do

not enter more

than $2,000 for

each student.

2

Caution: You

cannot take the

Hope credit and

the lifetime learning

credit for the same

student in the

same year.

(a) Student’s name (as shown on page 1

of your tax return)

First name Last name

(c) Qualified

expenses (see

instructions)

Tentative lifetime learning credit. Multiply line 6 by 20% (.20) and go to Part III 

5

6

7

5

6

7

Part III Allowable Education Credits

8 Tentative education credits. Add lines 3 and 7

Enter: $103,000 if married filing jointly; $51,000 if single, head of

household, or qualifying widow(er)

Enter the amount from Form 1040, line 35*, or Form 1040A, line 22

If line 11 is equal to or more than line 12, enter the amount from line 8 on line 14 and

go to line 15. If line 11 is less than line 12, divide line 11 by line 12. Enter the result as

a decimal (rounded to at least three places)

13

14 Multiply line 8 by line 13 

15 Enter the amount from Form 1040, line 43, or Form 1040A, line 28 

Enter the total, if any, of your credits from Form 1040, lines 44 through 46, or 

Form 1040A, lines 29 and 30

16

Subtract line 16 from line 15. If zero or less, stop; you cannot take any education

credits 

17

18 Education credits. Enter the smaller of line 14 or line 17 here and on Form 1040,

line 47, or Form 1040A, line 31  18

14

13  .

(Hope and Lifetime Learning Credits)

(b) Student’s

social security

number (as

shown on page 1

of your tax return)

(b) Student’s social security

number (as shown on page

1 of your tax return)

Enter: $20,000 if married filing jointly; $10,000 if single, head of

household, or qualifying widow(er) 12

*See Pub. 970 for the amount to enter if you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico.

 Attach to Form 1040 or Form 1040A.

Last name

First name

2003

Caution: You cannot take both an education credit and the tuition and fees deduction (Form 1040, line 26, or Form 1040A, 

line 19) for the same student in the same year.
Form 8863 (2003) Page 2

General Instructions

Purpose of Form

Use Form 8863 to figure and claim your education

credits. The education credits are:

● The Hope credit and

● The lifetime learning credit.

Who Can Take the Credits

You cannot take the education credits if any of the

following apply.

● Your filing status is married filing separately.

● Your adjusted gross income on Form 1040, line 35, or

Form 1040A, line 22, is (a) $103,000 or more if married

filing jointly or (b) $51,000 or more if single, head of

household, or qualifying widow(er).

● You are claimed as a dependent on another person’s

tax return, such as your parent’s return (but see the Note

above).

See Pub. 970, Tax Benefits for Education, for more

information about these credits.

Rules That Apply to Both Credits

What Expenses Qualify?

Generally, qualified expenses are amounts paid in 2003

for tuition and fees required for the student’s enrollment

or attendance at an eligible educational institution. It does

not matter whether the expenses were paid in cash, by

check, by credit card, or with borrowed funds.

● Course-related books, supplies, equipment, and

nonacademic activities, except for fees required to be

paid to the institution as a condition of enrollment or

attendance.

● Room and board, insurance, medical expenses

(including student health fees), transportation, or other

similar personal, living, or family expenses.

● Any course or other education involving sports, games,

or hobbies, unless such course or other education is part

of the student’s degree program or (for the lifetime

learning credit only) helps the student to acquire or

improve job skills.

If you or the student take a deduction for higher

education expenses, such as on Schedule A or Schedule

C (Form 1040), you cannot use those expenses when

figuring your education credits.

Qualified expenses do not include amounts paid for:

Tax-Free Educational Assistance and Refunds of

Qualified Expenses

You must reduce the total of your qualified expenses by

any tax-free educational assistance and by any refunds of

qualified expenses. If the refund or tax-free assistance is

received in the same year in which the expenses were

paid or in the following year before you file your tax

return, reduce your qualified expenses by the amount

received and figure your education credits using the

reduced amount of qualified expenses. If the refund or

tax-free assistance is received after you file your return

for the year in which the expenses were paid, you must

figure the amount by which your education credits would

have been reduced if the refund or tax-free assistance

had been received in the year for which you claimed the

education credits. Include that amount as an additional

tax for the year the refund or tax-free assistance was

received on the tax line of your tax return (line 41 of the

2003 Form 1040 or line 28 of the 2003 Form 1040A).

Enter the amount and “ECR” next to that line.

Example. You paid $2,250 tuition on December 26, 2002,

and your child began college on January 29, 2003. You

filed your 2002 tax return on February 1, 2003, and

claimed a Hope credit of $1,500. After you filed your

return, your child dropped two courses (but maintained

one-half of a full-time workload), and you received a

refund of $750. You must refigure your 2002 Hope credit

using $1,500 of qualified expenses instead of $2,250. The

refigured credit is $1,250. You must include the difference

of $250 on line 41 of your 2003 Form 1040 or line 28 of

your 2003 Form 1040A.

Tax-free educational assistance includes a tax-free

scholarship or Pell grant or tax-free employer-provided

educational assistance.

You may be able to take the credits if you, your spouse,

or a dependent you claim on your tax return was a

student enrolled at or attending an eligible educational

institution. The credits are based on the amount of

qualified expenses paid for the student in 2003 for

academic periods beginning in 2003 and the first 3

months of 2004.

Note: If a student is claimed as a dependent on another

person’s tax return, only the person who claims the

student as a dependent may claim the credits for the

student’s qualified expenses. If a student is not claimed as

a dependent on another person’s tax return, only the

student may claim the credits.

Generally, qualified expenses paid on behalf of the

student by someone other than the student (such as a

relative) are treated as paid by the student. Also, qualified

expenses paid (or treated as paid) by a student who is

claimed as a dependent on your tax return are treated as

paid by you. Therefore, you are treated as having paid

expenses that were paid from your dependent student’s

earnings, gifts, inheritances, savings, etc.

● You are taking a deduction for tuition and fees on Form

1040, line 26, or Form 1040A, line 19, for the same

student.

Additional Information

A Change To Note

The maximum lifetime learning credit has increased to

$2,000.

● You (or your spouse) were a nonresident alien for any

part of 2003 and the nonresident alien did not elect to be

treated as a resident alien.

Any qualified expenses used to figure the

education credits may not be taken into account

in determining the amount of a distribution from

a Coverdell ESA or a qualified state tuition

program that is excluded from gross income.

Qualified expenses must be reduced by any

expenses paid directly or indirectly using

tax-free educational assistance. See Tax-Free

Educational Assistance and Refunds of

Qualified Expenses on this page.
Form 8863 (2003) Page 3

Paperwork Reduction Act Notice. We ask for the

information on this form to carry out the Internal Revenue

laws of the United States. You are required to give us the

information. We need it to ensure that you are complying

with these laws and to allow us to figure and collect the

right amount of tax.

You are not required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or its

instructions must be retained as long as their contents

may become material in the administration of any Internal

Revenue law. Generally, tax returns and return information

are confidential, as required by Internal Revenue Code

section 6103.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is: Recordkeeping, 12 min.; Learning

about the law or the form, 8 min.; Preparing the form,

32 min.; Copying, assembling, and sending the form to

the IRS, 33 min.

If you have comments concerning the accuracy of

these time estimates or suggestions for making this form

simpler, we would be happy to hear from you. See the

Instructions for Form 1040 or Form 1040A.

Specific Instructions

Part I

Hope Credit

Line 1

Complete columns (a) through (f) on line 1 for each

student who qualifies for and for whom you elect to take

the Hope credit.

Column (c)

Enter only qualified expenses paid for the student in 2003

for academic periods beginning after 2002 but before

April 1, 2004, as explained earlier. If the student’s

expenses are more than $2,000, enter $2,000.

Note: If you have more than three students who qualify

for the Hope credit, write “See attached” next to line 1

and attach a statement with the required information for

each additional student. Include the totals from line 1,

columns (d) and (f), for all students in the amount you

enter in columns (d) and (f) on line 2.

Part II

Lifetime Learning Credit

Line 4

Complete columns (a) through (c) for each student for

whom you are taking the lifetime learning credit.

Column (c)

Enter only qualified expenses paid for the student in 2003

for academic periods beginning after 2002 but before

April 1, 2004, as explained earlier.

Note: If you are taking the lifetime learning credit for more

than five students, write “See attached” next to line 4 and

attach a statement with the required information for each

additional student. Include the totals from line 4, column

(c), in the amount you enter on line 5.

You cannot take the lifetime learning credit for

any student for whom you are taking the Hope

credit.

The maximum lifetime learning credit for 2003 is $2,000,

regardless of the number of students.

● The student was taking at least one-half the normal

full-time workload for his or her course of study for at

least one academic period beginning in 2003.

● The student has not been convicted of a felony for

possessing or distributing a controlled substance.

If a student does not meet all of the above

conditions, you may be able to take the lifetime

learning credit for part or all of that student’s

qualified expenses instead.

● The student was enrolled in 2003 in a program that

leads to a degree, certificate, or other recognized

educational credential.

An eligible educational institution is generally any

accredited public, nonprofit, or proprietary (private)

college, university, vocational school, or other

postsecondary institution. Also, the institution must be

eligible to participate in a student aid program

administered by the Department of Education. Virtually all

accredited postsecondary institutions meet this definition.

You may be able to take a credit of up to $1,500 for

qualified expenses (defined earlier) paid for each student

who qualifies for the Hope credit. You can take the Hope

credit for a student if all of the following apply.

● As of the beginning of 2003, the student had not

completed the first 2 years of postsecondary education

(generally, the freshman and sophomore years of college),

as determined by the eligible educational institution. For

this purpose, do not include academic credit awarded

solely because of the student’s performance on

proficiency examinations.

What Is an Eligible Educational Institution?

● The Hope credit was not claimed for that student’s

expenses in more than one prior tax year.

You cannot use any amount paid in 2002 or

2004 to figure your 2003 education credits.

Qualified expenses paid in 2003 for an academic period

that begins in the first 3 months of 2004 can be used in

figuring your 2003 education credits. For example, if you

pay $2,000 in December 2003 for qualified tuition for the

2004 winter quarter that begins in January 2004, you can

use that $2,000 in figuring your 2003 education credits (if

you meet all the other requirements).

Prepaid Expenses
LINE NEGATIVE S/S

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