Department 

Of the 

Treasury 

Internal 

Revenue 

Service 

Mark W. Everson 

Commissioner 

Mark J. Mazur 

Director, 

Research, Analysis and 

Statistics 

Thomas B. Petska 

Director, 

Statistics of Income Division 

David P. Paris 

Chief, 

Individual Statistics Branch 

For further information contact: 

Jeff Hartzok, Chief 

Individual Returns Analysis Section 

Statistics of Income Division 

PO Box 2608 

Washington, DC 20013-2608 

2004 Estimated 

Data Line Counts 

Individual Income 

Tax Returns 

(Rev. 1-2007) 

This 2004 Statistics of Income (SOI) count package indicates the 

estimates of frequencies of the entries on the lines of the forms 

and schedules filed with individual tax returns as shown on the 

2004 Individual SOI Complete Report weighted file. It is based 

on returns filed in Processing Year 2005 that were sampled 

statistically and then weighted to estimate the entire 2004 Tax 

Year. 

Changes for the Tax Year 2004 edition include: The exclusion 

of form 8839: qualified adoption expenses, form 4970: tax on 

accumulation distribution of trusts, and form 2555EZ: foreign 

earned income exclusion. Three additional forms are also 

included and are enumerated on the Contents page. 

Variations of the three basic forms: 1040, 1040A, and 1040EZ, 

include electronically filed returns. The form variations were 

categorized into the basic forms according to the data reported on 

the return. For example, if a return was filed electronically and its 

characteristics indicate that it would otherwise have been filed on 

paper as a 1040 or 1040A, then it would be classified as such 

statistically. 

2004 Complete Report estimates: 

132,266,042 Total, all individual returns filed 

 80,603,689 1040 returns 

 30,572,631 1040A returns 

 21,049,722 1040EZ returns 

 

Estimates of returns filed electronically: 

 68,380,152 Total, all individual returns filed 

 34,900,171 1040 returns 

 20,771,324 1040A returns 

 12,708,657 1040EZ returns 
Tax Year 2004 Totals for Forms and Schedules

Limitations and Guidelines

Description of the Sample

Line Item Counts are reported for:

 All Returns filed

 Form 1040 only Form 4952

 Electronically filed returns Form 4972

 Form 1040A Form 5329

 Form 1040EZ Form 5884

 Schedule 1 Form 6251

 Schedule 2 Form 6252

 Schedule 3 Form 6781

 Schedules A & B Form 8283

 Schedule C Form 8396

 Schedule C-EZ Form 8582

 Schedule D Form 8586

 Schedule E Form 8606

 Schedule EIC Form 8609-A

 Schedule F Form 8615

 Schedule R Form 8801

 Schedule SE Form 8812

 Form 2106 Form 8814

 * Form 2106-EZ Form 8815

 Form 2439 Form 8824

 Form 2441 Form 8844

 Form 3468 Form 8853

 Form 3800 Form 8863

 Form 4136 * Form 8880 

 Form 4562 Form 8884

 Form 4684 Form 8885

 Form 4797 * Form 8889

 Form 4835 

 * New Form for Tax Year 2004 Edition

This publication was prepared by Kyle Mudry and Justin Bryan, 

Economists with the Individual Returns Analysis Section.

Contents
 Totals for Forms and Schedules from Estimated Data Line Counts for Tax Year 2004

All returns filed 132,226,042

Form 1040 80,603,689

Form 1040A 30,572,631

Form 1040EZ 21,049,722

Form 1040A-schedule 1, interest/dividends 1,682,943 tabulated within Schedule B total

Form 1040A-schedule 2, child care credit 2,077,401 (similar to Form 2441)

Form 1040A-schedule 3, elderly credit 224,609 (similar to Schedule R)

Schedule A, itemized deductions 46,750,287

Schedule B, interest & dividends 21,795,323 includes schedule 1, Form 1040A

Schedule C, sole-prop business 20,591,869

Schedule C-EZ 3,708,646 tabulated within Schedule C total

Schedule D, capital gain/loss 23,145,237

Schedule E, supplemental income 16,232,654

Schedule EIC, earned income credit 17,579,707

Schedule F, profit or loss from farming 2,022,298

Schedule R, elderly or disabled 224,609 includes schedule 3, Form 1040A

Schedule SE, self employed tax 15,972,387

Form 2106, employee business expense 7,483,103 

Form 2106-EZ 3,664,428

Form 2439, undistributed long term capital gains 3,320

Form 2441, child care expenses 7,009,732 includes schedule 2, Form 1040A

Form 3468, investment credit 12,170

Form 3800, general business credit 396,009

Form 4136, fuels tax credit 345,020

Form 4562, depreciation expense 11,892,467

Form 4684, casualties and thefts 299,958

Form 4797, sales of business property 3,112,605 

Form 4835, farm rental 638,394

Form 4952, investment interest 1,678,254

Form 4972, lump-sum distributions 9,884

Form 5329, retirement plans tax 1,356,839

Form 5884, work opportunity credit 11,321

Form 6251, alternative minimum tax 7,081,490

Form 6252, installment sale income 844,445

Form 6781, gains/losses from contracts, etc 187,380

Form 8283, noncash charitable contributions 6,542,778

Form 8396, mortgage interest credit 55,151

Form 8582, passive activity loss limit 3,117,470

Form 8586, low income housing 114,230

Form 8606, nondeductible IRA's 1,513,402

Form 8609-A, annual statement 795 only those filed with Form 8586

Form 8615, under age 14 tax 140,523

Form 8801, prior year minimum tax credit 1,041,410

Form 8812, additional child tax credit 14,663,827

Form 8814, parent's report for child 120,541

Form 8815, exclusion of bond interest 25,448

Form 8824, like-kind exchanges 219,675

Form 8844, empowerment zone credit 35,372

Form 8853, medical savings account 103,067

Form 8863, education, hope & lifetime learning credits 7,324,897

Form 8880, credit for qualified retirement savings contri 5,507,608

Form 8884, New York lib. zone bus. employee credit 1,177

Form 8885, health coverage tax credit 16,314

Form 8889, health savings accounts 121,466
Limitations and Guidelines for 

The 2004 Data Line Counts 

Since the line counts used in this package are obtained from the Tax Year 2004 Individual SOI 

Complete Report File, they are subject to the same limitations as the data that are included in the 

Complete Report File. These limitations are derived from the fact that these data are statistically 

sampled, meaning that the line counts included in this package are estimates based on samples, and 

should not be mistaken for actual counts of the entire population. While most forms and items are 

present often enough to provide accurate estimates, some less popular items should be used with a 

high degree of caution. 

The sample used in this study is one of a large number of samples that could have been selected 

using the same sample design. The estimates calculated from these different samples would vary. 

The sample estimate and an estimate of its standard error permit the construction of interval 

estimates with prescribed confidence that the interval includes the population value. Shown below are 

95 percent confidence intervals for selected Form 1040 items: (For example, the population value of 

number of returns for salaries and wages, with 95 percent confidence, is between 112,066,755 and 

112,672,869.) These confidence intervals correspond to the estimates for all Individual Income Tax 

Returns filed for Tax Year 2004. 

95 Percent Confidence Intervals for Selected Items on all Form 1040's

Item Line number on 1040

Salaries and wages 7 ( 112,066,755 112,672,869 )

Taxable interest 8a ( 57,210,712 58,001,064 )

Tax-exempt interest 8b ( 4,286,130 , 4,547,572 )

Ordinary dividends 9a ( 30,356,370 , 31,017,986 )

State income tax refunds 10 ( 23,311,101 , 23,931,491 )

Alimony received 11 ( 397,733 , 481,483 )

Capital gain distributions 13 (margin write in) ( 2,746,818 , 3,009,708 )

Total taxable IRA distributions 15b ( 8,704,192 , 9,123,500 )

Total pension and annuities 16a ( 24,809,862 , 25,450,174 )

Taxable pension and annuities 16b ( 22,815,201 , 23,431,579 )

Unemployment compensation 19 ( 8,863,173 , 9,326,649 )

Social security benefits 20a ( 14,507,908 , 15,011,270 )

Taxable social security benefits 20b ( 11,471,865 , 11,911,853 )

Net operating loss 21 (margin write in) ( 279,511 , 311,115 )

Educator expenses 23 ( 3,257,087 . 3,547,849 )

IRA deduction 25 ( 3,199,544 , 3,461,982 )

95% confidence interval
Limitations and Guidelines for 2004 Data Line Counts 

95 Percent Confidence Intervals for Selected Items on all Form 1040's--Continued

Item Line number on 1040

Student loan interest deduction 26 ( 7,307,423 , 7,747,075 )

Tuition and fees deduction 27 ( 4,538,536 . 4,881,970 )

Moving expenses 29 ( 1,013,699 , 1,179,173 )

One-half of self-employment tax 30 ( 15,754,824 , 16,085,582 )

Self-employed health insurance deduction 31 ( 3,778,641 , 3,988,733 )

Keogh and self-employed SEP and SIMPLE plan 32 ( 1,150,237 , 1,252,427 )

Penalty on early withdrawal of savings 33 ( 713,643 , 847,011 )

Alimony paid 34a ( 522,137 , 625,865 )

Total adjustments 35 ( 31,832,554 , 32,475,376 )

Adjusted gross income 36 ( 131,636,882 , 132,205,726 )

Total standard deduction 38 (margin write in) ( 83,654,473 , 84,379,033 )

Additional standard deduction 38 (margin write in) ( 10,746,088 , 11,224,070 )

Total itemized deductions 39 ( 45,990,132 , 46,680,342 )

Taxable income 42 ( 102,395,636 , 103,080,282 )

Tax 43 ( 102,379,325 , 103,063,861 )

95% confidence interval

Forms whose line entries have weak estimates (implying a returns sampled count less than 

50) are listed below. When there is a line entry reporting less than 10 in the sample the frequency is 

removed and the line is identified with a single asterisk (*). 

Form 2439 

Form 4972 

Form 8396 

Form 8609-A 

Form 8815 

Form 8885 
Description of the Sample 

For the Estimated Data Line Counts

This section describes the sample design and 

selection, the method of estimation, the sampling 

variability of the estimates, and the methodology of 

computing confidence intervals. 

Domain of Study

The statistics in this report are estimates from a 

probability sample of unaudited Individual Income 

Tax Returns, Forms 1040, 1040A, and 1040EZ 

(including electronic returns) filed by U.S. citizens 

and residents during Calendar Year 2005. 

All returns processed during 2005 were 

subjected to sampling except tentative and amended 

returns. Tentative returns were not subjected to 

sampling because the revised returns may have been 

sampled later, while amended returns were excluded 

because the original returns had already been 

subjected to sampling. A small percentage of 

returns were not identified as tentative or amended 

until after sampling. These returns, along with 

those that contained no income information, were 

excluded in calculating estimates. 

The estimates in this report are intended to 

represent all returns filed for Tax Year 2004. While 

most of the returns processed during Calendar Year 

2005 were for Tax Year 2004, the remaining returns 

were mostly for prior years, and a few for noncalendar years ending during 2005 and 2006. 

Returns for prior years were used in place of 2004 

returns received and processed after December 31, 

2005. This was done based on the assumption that 

the characteristics of returns due, but not yet 

processed, can best be represented by the returns for 

previous income years that were processed in 2005. 

Sample Design and Selection

The sample design is a stratified probability 

sample, in which the population of tax returns is 

classified into subpopulations, called strata, and a 

sample is randomly selected independently from 

each stratum. Strata are defined by: 

1. Nontaxable with adjusted gross income or 

expanded income of $200,000 or more and no 

alternative minimum tax. 

2. High combined business and farm total receipts 

of $50,000,000 or more. 

3. Presence or absence of special Forms or 

Schedules (Form 2555, Form 1116, Form 1040 

Schedule C, and Form 1040 Schedule F). 

4. Indexed positive or negative income. Sixty 

variables are used to derive positive and 

negative incomes. These positive and negative 

income classes are deflated using the ChainType Price Index for the Gross Domestic 

Product to represent a base year of 1991. 

Indexing of positive and negative income is 

done by dividing each by the ratio of the Chain 

Type Price Index for the Gross Domestic 

Product for the fourth quarter of 2003 to the 

fourth quarter of the base year of 1991. The 

indices were calculated using the Gross 

Domestic Product (GDP) Chain-type Price 
Description of the Sample 

Index found in the table titles “Quantity and 

Price Indexes for Gross Domestic Product” 

released to the public on November 30, 2004 on 

the BEA website (http://www.bea.doc.gov/). 

5. Potential usefulness of the return for tax policy 

modeling. Thirty-two variables are used to 

determine how useful the return is for tax 

modeling purposes. 

Tax data processed to the IRS Individual Master 

File at the Enterprise Computing Center at 

Martinsburg during Calendar Year 2005 were used 

to assign each taxpayer’s record to the appropriate 

stratum and to determine whether or not the record 

should be included in the sample. Records are 

selected for the sample either if they possess certain 

combinations of the four ending digits of the social 

security number, or if their ending five digits of an 

eleven-digit number generated by a mathematical 

transformation of the SSN is less than or equal to 

the stratum sampling rate times 100,000. 

Data Capture and Cleaning

Data capture for the SOI sample begins with the 

designation of a sample of administrative records. 

While the sample was being selected, the process 

was continually monitored for sample selection and 

data collection errors. In addition, a small 

subsample of returns was selected and 

independently reviewed, analyzed, and processed 

for a quality evaluation. 

The administrative data and controlling 

information for each record designated for this 

sample was loaded onto an online database at the 

Cincinnati Submission Processing Center. 

Computer data for the selected administrative 

records were then used to identify inconsistencies, 

questionable values, and missing values as well as 

any additional variables that an editor needed to 

extract for each record. The editors use a hardcopy 

of the taxpayer’s return to enter the required 

information onto the online system. 

After the completion of service center review, data 

were further validated, tested, and balanced. 

Adjustments and imputations for selected fields 

based on prior year data and other available 

information were used to make each record 

After the completion of service center review, data 

were further validated, tested, and balanced. 

Adjustments and imputations for selected fields 

based on prior year data and other available 

information were used to make each record 

internally consistent. Finally, prior to publication, 

all statistics and tables were reviewed for accuracy 

and reasonableness in light of provisions of the tax 

law, taxpayer reporting variations and limitations, 

economic conditions, and comparability with other 

statistical series. 

Some returns designated for the sample were not 

available for SOI processing because other areas of 

IRS needed the return at the same time. For Tax 

Year 2004, 0.03 percent of the sample returns were 

unavailable. 

Method of Estimation

Weights were obtained by dividing the 

population count of returns in a stratum by the 

number of sample returns for that stratum. The 

weights were adjusted to correct for misclassified 

returns. These weights were applied to the sample 

data to produce all of the estimates in this report. 
Total of all

Returns Filed

Department of the Treasury—Internal Revenue Service

1040 U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2004, or other tax year beginning , 2004, ending , 20 OMB No. 1545-0074

Your first name and initial Last name Your social security number

(See

instructions

on page 16.)

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 16. Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 16.

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 17)

6a Yourself. If someone can claim you as a dependent, do not check box 6a

Exemptions b Spouse

(4) if qualifying

child for child tax

credit (see page 18)

c Dependents: (2) Dependent’s

social security number

(3) Dependent’s

relationship to (1) First name Last name you

If more than four

dependents, see

page 18.

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 Form(s)

W-2 here. Also

attach Forms

W-2G and

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 20) 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.

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

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

15a IRA distributions 15a 15b b Taxable amount (see page 22)

16a Pensions and annuities 16a b Taxable amount (see page 22) 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 24) 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 26) 25

23

27

26

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

29

Self-employed health insurance deduction (see page 30)

27

30

29

Self-employed SEP, SIMPLE, and qualified plans

31

30

Penalty on early withdrawal of savings

32

31

Alimony paid b Recipient’s SSN 

Add lines 23 through 34a 35

32

Subtract line 35 from line 22. This is your adjusted gross income 

33

Adjusted

Gross

Income

36

If you did not

get a W-2,

see page 19. Form

Married filing separately. Enter spouse’s SSN above

and full name here. 

Cat. No. 11320B





Label

Form 1040 (2004)

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

Head of household (with qualifying person). (See page 17.) 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 24)

Moving expenses. Attach Form 3903

25

26

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 75.

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 18)

34a 34a

Student loan interest deduction (see page 28)

33

35

 

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 16.)

(99)

Tuition and fees deduction (see page 29)

36

4

5

Educator expenses (see page 26) 23

b Qualified dividends (see page 20) 9b

2004

24 Certain business expenses of reservists, performing artists, and

fee-basis government officials. Attach Form 2106 or 2106-EZ 24

28 Health savings account deduction. Attach Form 8889 28
Total of all

Returns Filed

Married filing

jointly or

Qualifying

widow(er),

$9,700

Head of

household,

$7,150

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

Add lines 63, 64, 65a, and 66 through 69. These are your total payments 

Form 1040 (2004) Page 2

37 Amount from line 36 (adjusted gross income) 37

Check

if:

38a

Tax and

Credits

38a

Single or

Married filing

separately,

$4,850

b If your spouse itemizes on a separate return or you were a dual-status alien, see page 31 and check here  38b

39 39

40 Subtract line 39 from line 37 40

41

If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on

line 6d. If line 37 is over $107,025, see the worksheet on page 33

41

42 Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0- 42

43 43

48

52

Education credits. Attach Form 8863

47

Other credits. Check applicable box(es):

46

55

56

Add lines 46 through 54. These are your total credits

Subtract line 55 from line 45. If line 55 is more than line 45, enter -0- 

55

Self-employment tax. Attach Schedule SE

56

Other

Taxes

57

71

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

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59

58

60

Add lines 56 through 61. This is your total tax 

61 61

63 Federal income tax withheld from Forms W-2 and 1099 63

64 2004 estimated tax payments and amount applied from 2003 return 64 Payments

65a

Amount paid with request for extension to file (see page 54) 68

67

Excess social security and tier 1 RRTA tax withheld (see page 54) 66

68

70

69 Other payments from:

72a 72a

73 73

If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid

74 74

Amount of line 71 you want refunded to you 

Refund

75

Amount of line 71 you want applied to your 2005 estimated tax 

Estimated tax penalty (see page 55)

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.

75

You were born before January 2, 1940, Blind.

Spouse was born before January 2, 1940, Blind.

a Form 3800

b Form 8801 c Specify

a Form 2439 b Form 4136

59

Household employment taxes. Attach Schedule H

60

69

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 33). Check if any tax is from:

Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55 

b

Direct deposit?

See page 54

and fill in 72b,

72c, and 72d.

Routing number

Account number

c Checking Savings

a Form(s) 8814 Form 4972

b

d





70

53

Retirement savings contributions credit. Attach Form 8880

57

58

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

71



Child tax credit (see page 37)

Credits from:

51

Additional child tax credit. Attach Form 8812

66

67

Standard

Deduction

for—

Joint return?

See page 17.

Daytime phone number

( )

Earned income credit (EIC)

Credit for the elderly or the disabled. Attach Schedule R

44

45

Alternative minimum tax (see page 35). Attach Form 6251

Add lines 43 and 44 

Credit for child and dependent care expenses. Attach Form 2441

49

If you have a

qualifying

child, attach

Schedule EIC.

44

45

65a

Spouse’s occupation

( )

Form 1040 (2004)

● People who

checked any

box on line

38a or 38b or

who can be

claimed as a

dependent,

see page 31.

● All others:

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 56)? Third Party

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

54

Foreign tax credit. Attach Form 1116 if required

54

a Form 8396 b Form 8859

50

Adoption credit. Attach Form 8839

62 62

Type:

c Form 8885

Total boxes  checked 

50

48

52

47

46

53

51

49

b Nontaxable combat pay election  65b
Total for form

1040 ONLY

Department of the Treasury—Internal Revenue Service

1040 U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2004, or other tax year beginning , 2004, ending , 20 OMB No. 1545-0074

Your first name and initial Last name Your social security number

(See

instructions

on page 16.)

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 16. Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 16.

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 17)

6a Yourself. If someone can claim you as a dependent, do not check box 6a

Exemptions b Spouse

(4) if qualifying

child for child tax

credit (see page 18)

c Dependents: (2) Dependent’s

social security number

(3) Dependent’s

relationship to (1) First name Last name you

If more than four

dependents, see

page 18.

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 Form(s)

W-2 here. Also

attach Forms

W-2G and

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 20) 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.

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

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

15a IRA distributions 15a 15b b Taxable amount (see page 22)

16a Pensions and annuities 16a b Taxable amount (see page 22) 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 24) 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 26) 25

23

27

26

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

29

Self-employed health insurance deduction (see page 30)

27

30

29

Self-employed SEP, SIMPLE, and qualified plans

31

30

Penalty on early withdrawal of savings

32

31

Alimony paid b Recipient’s SSN 

Add lines 23 through 34a 35

32

Subtract line 35 from line 22. This is your adjusted gross income 

33

Adjusted

Gross

Income

36

If you did not

get a W-2,

see page 19. Form

Married filing separately. Enter spouse’s SSN above

and full name here. 

Cat. No. 11320B





Label

Form 1040 (2004)

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

Head of household (with qualifying person). (See page 17.) 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 24)

Moving expenses. Attach Form 3903

25

26

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 75.

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 18)

34a 34a

Student loan interest deduction (see page 28)

33

35

 

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 16.)

(99)

Tuition and fees deduction (see page 29)

36

4

5

Educator expenses (see page 26) 23

b Qualified dividends (see page 20) 9b

2004

24 Certain business expenses of reservists, performing artists, and

fee-basis government officials. Attach Form 2106 or 2106-EZ 24

28 Health savings account deduction. Attach Form 8889 28
Total for form

1040 ONLY

Married filing

jointly or

Qualifying

widow(er),

$9,700

Head of

household,

$7,150

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

Add lines 63, 64, 65a, and 66 through 69. These are your total payments 

Form 1040 (2004) Page 2

37 Amount from line 36 (adjusted gross income) 37

Check

if:

38a

Tax and

Credits

38a

Single or

Married filing

separately,

$4,850

b If your spouse itemizes on a separate return or you were a dual-status alien, see page 31 and check here  38b

39 39

40 Subtract line 39 from line 37 40

41

If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on

line 6d. If line 37 is over $107,025, see the worksheet on page 33

41

42 Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0- 42

43 43

48

52

Education credits. Attach Form 8863

47

Other credits. Check applicable box(es):

46

55

56

Add lines 46 through 54. These are your total credits

Subtract line 55 from line 45. If line 55 is more than line 45, enter -0- 

55

Self-employment tax. Attach Schedule SE

56

Other

Taxes

57

71

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

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59

58

60

Add lines 56 through 61. This is your total tax 

61 61

63 Federal income tax withheld from Forms W-2 and 1099 63

64 2004 estimated tax payments and amount applied from 2003 return 64 Payments

65a

Amount paid with request for extension to file (see page 54) 68

67

Excess social security and tier 1 RRTA tax withheld (see page 54) 66

68

70

69 Other payments from:

72a 72a

73 73

If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid

74 74

Amount of line 71 you want refunded to you 

Refund

75

Amount of line 71 you want applied to your 2005 estimated tax 

Estimated tax penalty (see page 55)

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.

75

You were born before January 2, 1940, Blind.

Spouse was born before January 2, 1940, Blind.

a Form 3800

b Form 8801 c Specify

a Form 2439 b Form 4136

59

Household employment taxes. Attach Schedule H

60

69

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 33). Check if any tax is from:

Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55 

b

Direct deposit?

See page 54

and fill in 72b,

72c, and 72d.

Routing number

Account number

c Checking Savings

a Form(s) 8814 Form 4972

b

d





70

53

Retirement savings contributions credit. Attach Form 8880

57

58

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

71



Child tax credit (see page 37)

Credits from:

51

Additional child tax credit. Attach Form 8812

66

67

Standard

Deduction

for—

Joint return?

See page 17.

Daytime phone number

( )

Earned income credit (EIC)

Credit for the elderly or the disabled. Attach Schedule R

44

45

Alternative minimum tax (see page 35). Attach Form 6251

Add lines 43 and 44 

Credit for child and dependent care expenses. Attach Form 2441

49

If you have a

qualifying

child, attach

Schedule EIC.

44

45

65a

Spouse’s occupation

( )

Form 1040 (2004)

● People who

checked any

box on line

38a or 38b or

who can be

claimed as a

dependent,

see page 31.

● All others:

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 56)? Third Party

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

54

Foreign tax credit. Attach Form 1116 if required

54

a Form 8396 b Form 8859

50

Adoption credit. Attach Form 8839

62 62

Type:

c Form 8885

Total boxes  checked 

50

48

52

47

46

53

51

49

b Nontaxable combat pay election  65b
Electronically

Filed Returns

Department of the Treasury—Internal Revenue Service

1040 U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2004, or other tax year beginning , 2004, ending , 20 OMB No. 1545-0074

Your first name and initial Last name Your social security number

(See

instructions

on page 16.)

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 16. Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 16.

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 17)

6a Yourself. If someone can claim you as a dependent, do not check box 6a

Exemptions b Spouse

(4) if qualifying

child for child tax

credit (see page 18)

c Dependents: (2) Dependent’s

social security number

(3) Dependent’s

relationship to (1) First name Last name you

If more than four

dependents, see

page 18.

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 Form(s)

W-2 here. Also

attach Forms

W-2G and

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 20) 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.

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

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

15a IRA distributions 15a 15b b Taxable amount (see page 22)

16a Pensions and annuities 16a b Taxable amount (see page 22) 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 24) 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 26) 25

23

27

26

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

29

Self-employed health insurance deduction (see page 30)

27

30

29

Self-employed SEP, SIMPLE, and qualified plans

31

30

Penalty on early withdrawal of savings

32

31

Alimony paid b Recipient’s SSN 

Add lines 23 through 34a 35

32

Subtract line 35 from line 22. This is your adjusted gross income 

33

Adjusted

Gross

Income

36

If you did not

get a W-2,

see page 19. Form

Married filing separately. Enter spouse’s SSN above

and full name here. 

Cat. No. 11320B





Label

Form 1040 (2004)

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

Head of household (with qualifying person). (See page 17.) 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 24)

Moving expenses. Attach Form 3903

25

26

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 75.

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 18)

34a 34a

Student loan interest deduction (see page 28)

33

35

 

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 16.)

(99)

Tuition and fees deduction (see page 29)

36

4

5

Educator expenses (see page 26) 23

b Qualified dividends (see page 20) 9b

2004

24 Certain business expenses of reservists, performing artists, and

fee-basis government officials. Attach Form 2106 or 2106-EZ 24

28 Health savings account deduction. Attach Form 8889 28
Electronically

Filed Returns

Married filing

jointly or

Qualifying

widow(er),

$9,700

Head of

household,

$7,150

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

Add lines 63, 64, 65a, and 66 through 69. These are your total payments 

Form 1040 (2004) Page 2

37 Amount from line 36 (adjusted gross income) 37

Check

if:

38a

Tax and

Credits

38a

Single or

Married filing

separately,

$4,850

b If your spouse itemizes on a separate return or you were a dual-status alien, see page 31 and check here  38b

39 39

40 Subtract line 39 from line 37 40

41

If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on

line 6d. If line 37 is over $107,025, see the worksheet on page 33

41

42 Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0- 42

43 43

48

52

Education credits. Attach Form 8863

47

Other credits. Check applicable box(es):

46

55

56

Add lines 46 through 54. These are your total credits

Subtract line 55 from line 45. If line 55 is more than line 45, enter -0- 

55

Self-employment tax. Attach Schedule SE

56

Other

Taxes

57

71

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

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59

58

60

Add lines 56 through 61. This is your total tax 

61 61

63 Federal income tax withheld from Forms W-2 and 1099 63

64 2004 estimated tax payments and amount applied from 2003 return 64 Payments

65a

Amount paid with request for extension to file (see page 54) 68

67

Excess social security and tier 1 RRTA tax withheld (see page 54) 66

68

70

69 Other payments from:

72a 72a

73 73

If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid

74 74

Amount of line 71 you want refunded to you 

Refund

75

Amount of line 71 you want applied to your 2005 estimated tax 

Estimated tax penalty (see page 55)

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.

75

You were born before January 2, 1940, Blind.

Spouse was born before January 2, 1940, Blind.

a Form 3800

b Form 8801 c Specify

a Form 2439 b Form 4136

59

Household employment taxes. Attach Schedule H

60

69

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 33). Check if any tax is from:

Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55 

b

Direct deposit?

See page 54

and fill in 72b,

72c, and 72d.

Routing number

Account number

c Checking Savings

a Form(s) 8814 Form 4972

b

d





70

53

Retirement savings contributions credit. Attach Form 8880

57

58

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

71



Child tax credit (see page 37)

Credits from:

51

Additional child tax credit. Attach Form 8812

66

67

Standard

Deduction

for—

Joint return?

See page 17.

Daytime phone number

( )

Earned income credit (EIC)

Credit for the elderly or the disabled. Attach Schedule R

44

45

Alternative minimum tax (see page 35). Attach Form 6251

Add lines 43 and 44 

Credit for child and dependent care expenses. Attach Form 2441

49

If you have a

qualifying

child, attach

Schedule EIC.

44

45

65a

Spouse’s occupation

( )

Form 1040 (2004)

● People who

checked any

box on line

38a or 38b or

who can be

claimed as a

dependent,

see page 31.

● All others:

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 56)? Third Party

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

54

Foreign tax credit. Attach Form 1116 if required

54

a Form 8396 b Form 8859

50

Adoption credit. Attach Form 8839

62 62

Type:

c Form 8885

Total boxes  checked 

50

48

52

47

46

53

51

49

b Nontaxable combat pay election  65b
Head of household (with qualifying person). (See page 19.)

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

enter this child’s name here.  Married filing separately. Enter spouse’s SSN above and

full name here. 

Form Department of the Treasury—Internal Revenue Service

1040A 2004 U.S. Individual Income Tax Return

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 18.)

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 18. 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 18.

Filing

status

Boxes

checked on

6a and 6b

Yourself. If someone can claim you as a dependent, 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 21)

(2) Dependent’s social

security number

c ● lived with

you

● did not live

with you due

to divorce or

separation

(see page 21)

If more than six

dependents,

see page 20.

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 23).

11b

Enclose, but do

not attach, any

payment.

11a 11b

Taxable amount

(see page 24).

12a Pensions and 12b

annuities. 12a 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 13

14a Taxable amount

(see page 26).

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 26). 17

Student loan interest deduction (see page 29).

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 22.

Form 1040A (2004)

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)

10 Capital gain distributions (see page 23). 10

Presidential

Election Campaign

(See page 18.)  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 29). 19

1 Single

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

3

Qualifying widow(er) with dependent child (see page 19)

4

5

16 Educator expenses (see page 26). 16

b Qualified dividends (see page 23). 9b
If you have

a qualifying

child, attach

Schedule

EIC.

Single or

Married filing

separately,

$4,850

30

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

Total boxes

checked 

Check You were born before January 2, 1940, Blind

if:

23a

Spouse was born before January 2, 1940, Blind 23a

b

23b

If you are married filing separately and your spouse itemizes

deductions, see page 30 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 If line 22 is $107,025 or less, multiply $3,100 by the total number of

exemptions claimed on line 6d. If line 22 is over $107,025, see the

worksheet on page 32. 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 31). 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

39 Federal income tax withheld from Forms W-2 and 1099. 39

2004 estimated tax payments and amount

applied from 2003 return. 40

Add lines 39, 40, 41a, and 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

2005 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 51). 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 (2004)

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

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.

Routing

number

Account

number

Checking Savings  b

c

 d

Amount

you owe

Direct

deposit?

See page 50

and fill in

45b, 45c,

and 45d.



41a Earned income credit (EIC). 41a

Page 2

Form 1040A (2004)

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 18.

Daytime phone number

( )

Spouse’s occupation

( )

Head of

household,

$7,150

Married filing

jointly or

Qualifying

widow(er),

$9,700

Standard

Deduction

for—

● People who

checked any

box on line

23a or 23b or

who can be

claimed as a

dependent,

see page 31.

● 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

Retirement savings contributions credit. Attach

Form 8880.

Type:

Child tax credit (see page 36).

42

b Nontaxable combat pay election. 41b
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 2004 OMB No. 1545-0675

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

Presidential

Election

Campaign 

(page 11)

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

24–32 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 19. 

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

Income

Cat. No. 11329W



4 4

12

12

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

8a 8a

9 9

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

Unemployment compensation and Alaska Permanent Fund dividends

(see page 13).

3

3

Amount

you owe

b Routing number

Account number

c Type: Checking

Enter amount from

worksheet on back.

If single, enter $7,950.

If married filing jointly, enter $15,900.

See back for explanation.

Have it directly

deposited! See

page 18 and fill

in 11b, 11c,

and 11d.

d





Form 1040EZ (2004)

(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 19)? 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 11. 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 11.

Important! 



Label

(See page 11.)

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. 

b Nontaxable combat pay election. 8b
(99)

Schedule 1 Department of the Treasury—Internal Revenue Service

Interest and Ordinary Dividends

for Form 1040A Filers

(Form 1040A)

2004 

Name(s) shown on Form 1040A You

Part I

Interest

(See back

of schedule

and the

instructions

for Form

1040A,

line 8a.)

Note. If you received a Form 1099-INT, Form 1099-OID, or substitute statem

brokerage firm, enter the firm’s name and the total interest shown on t

1 List name of payer. If any interest is from a seller-financed mortgage

and the buyer used the property as a personal residence, see back of

schedule and list this interest first. Also, show that buyer’s social

security number and address. 

1

2 Add the amounts on line 1. 2

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

after 1989. Attach Form 8815.

3

3

Subtract line 3 from line 2. Enter the result here and on Form 1040A,

line 8a.

4

4

Part II

Ordinary

dividends

Note. If you received a Form 1099-DIV or substitute statement from a broker

enter the firm’s name and the ordinary dividends shown on that form.

(See back

of schedule

and the

instructions

for Form

1040A, 

line 9a.)

5 List name of payer. 

5

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

line 9a. 6

For Paperwork Reduction Act Notice, see Form 1040A instructions. Cat. No. 12075R Schedul
(99)

(d) Amount paid

(see instructions)

(c) Identifying

number (SSN or EIN)

(b) Address (number, street, apt. no., Part I city, state, and ZIP code)(a) Care provider’s

1 name

Persons or

organizations

who provided

the care

You must

complete this

part.

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

2 Part II

Credit for child

and dependent

care expenses

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.

3

3

4 4

5

5

6 6

7

Enter your earned income. See the instructions.

8

8

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.

9

9

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

amount on line 7.

Decimal

amount is

If line 7 is:

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 2003

expenses in 2004, see the instructions.

For Paperwork Reduction Act Notice, see Form 1040A instructions. Schedule 2 (Form 1040A) 2004

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

Cat. No. 10749I

Schedule 2 Department of the Treasury—Internal Revenue Service

Child and Dependent Care

Expenses for Form 1040A Filers (Form 1040A)

2004 OMB No. 1545-0085

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

Decimal

amount is

If line 7 is:

But not

Over over

Enter the amount from Form 1040A, line 22.

Enter the smallest of line 3, 4, or 5.

7

Did you receive

dependent care benefits? Yes

No 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. If you do, you

must use Form 1040. See Schedule H and its instructions for details.

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

the instructions.

(a) Qualifying person’s name (b) Qualifying person’s social

security number

(c) Qualified expenses

you incurred and paid

in 2004 for the person

listed in column (a) First Last

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

10 Enter the amount from Form 1040A, line 28.

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

or line 10 here and on Form 1040A, line 29.

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

10

11
Schedule 2 (Form 1040A) 2004

Enter the total amount of dependent care benefits you received

for 2004. This amount should be shown in box 10 of your Form(s)

W-2. Do not include amounts that were reported to you as wages

in box 1 of Form(s) W-2.

Part III 12

12

Enter the amount forfeited, if any. See the instructions.

Subtract line 13 from line 12.

13 13

14

Enter the total amount of qualified expenses

incurred in 2004 for the care of the qualifying

person(s).

14

15

Enter the smaller of line 14 or 15.

15

16

Enter your earned income. See the instructions.

16

17

Enter the amount shown below that applies to

you.

17

18

18

19

Excluded benefits. Enter here the smaller of the following:

● The amount from line 19 or

19

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

enter your spouse’s earned income on line 18).

20

Taxable benefits. Subtract line 20 from line 14. Also, include this

amount on Form 1040A, line 7. In the space to the left of line 7, enter

“DCB.”

20

Dependent

care benefits

21

21

Enter the smallest of line 16, 17, or 18.

22

23

24

25

To claim the child and dependent care

credit, complete lines 22–26 below.

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

Enter the amount from line 20.

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

the credit. Exception. If you paid 2003 expenses in 2004, see the

instructions for line 9.

Complete line 2 on the front of this schedule. 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.

22

23

24

25

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

on the front of this schedule and complete lines 4–11. 26

Page 2

Schedule 2 (Form 1040A) 2004

● 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.
Due to your continued disabled condition, you were unable to engage in any

substantial gainful activity in 2004, check this box 

(99)

Schedule 3 Department of the Treasury—Internal Revenue Service

Credit for the Elderly or the Disabled

for Form 1040A Filers (Form 1040A) 2004 OMB No. 1545-0085

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

You may be able to take this credit and reduce your tax if by the end of 2004:

or

In most cases, the IRS can figure the credit for you. See the instructions.

Part I If your filing status is:

1 You were 65 or older 1

Check the

box for your

filing status

and age You were under 65 and you retired on permanent

and total disability

2

2

3 Both spouses were 65 or older 3

4 Both spouses were under 65, but only one spouse

retired on permanent and total disability 4

5 Both spouses were under 65, and both retired on

permanent and total disability 5 Married filing

jointly 6 One spouse was 65 or older, and the other spouse

was under 65 and retired on permanent and total

disability 6

7 One spouse was 65 or older, and the other spouse

was under 65 and not retired on permanent and

total disability 7

8 You were 65 or older and you lived apart from

your spouse for all of 2004 8

Married filing

separately 9 You were under 65, you retired on permanent and

total disability, and you lived apart from your

spouse for all of 2004 9

If: 1 You filed a physician’s statement for this disability for 1983 or an earlier year,

or you filed or got a statement for tax years after 1983 and your physician signed

line B on the statement, and

Part II

Statement of

permanent

and total

disability

2

Complete this part

only if you checked

box 2, 4, 5, 6,

or 9 above.

For Paperwork Reduction Act Notice, see Form 1040A instructions. Schedule 3 (Form 1040A) 2004

● You were age 65 or older ● You were under age 65, you retired on permanent

and total disability, and you received taxable

disability income.

Single,

Head of household, or

Qualifying widow(er)

And by the end of 2004: Check only one box:

Cat. No. 12064K

Yes

No

Skip Part II and complete Part III on the back.

Complete Parts II and III.

Did you check

box 1, 3, 7, or

8?





● If you did not check this box, have your physician complete the statement on

page 4 of the instructions. You must keep the statement for your records.

● If you checked this box, you do not have to get another statement for 2004.

But you must also meet other tests. See the separate instructions for Schedule 3.

TIP
Schedule 3 (Form 1040A) 2004

10 If you checked (in Part I): Enter: Part III Box 1, 2, 4, or 7 $5,000

Figure your

credit

Box 3, 5, or 6 $7,500

10

11

● Box 6, add $5,000 to the taxable disability income of the spouse

who was under age 65. Enter the total.

11

If you completed line 11, enter the smaller of line 10 or line 11; all

others, enter the amount from line 10.

12

12

Enter the following pensions, annuities, or

disability income that you (and your spouse if

filing a joint return) received in 2004.

13

Nontaxable part of social security benefits

and

a

Nontaxable part of railroad retirement benefits

treated as social security (see the instructions). 13a

Nontaxable veterans’ pensions

and

b

13b

Add lines 13a and 13b. (Even though these

income items are not taxable, they must be

included here to figure your credit.) If you did not

receive any of the types of nontaxable income

listed on line 13a or 13b, enter -0- on line 13c.

c

13c

14 Enter the amount from Form 1040A, line 22. 14

15 If you checked (in Part I): Enter:

Box 1 or 2 $7,500

Box 3, 4, 5, 6, or 7 $10,000

Box 8 or 9 $5,000 15

Subtract line 15 from line 14. If zero or less,

enter -0-.

16

16

17 Enter one-half of line 16. 17

18 Add lines 13c and 17. 18

Subtract line 18 from line 12. If zero or less, stop; you cannot take

the credit. Otherwise, go to line 20.

19

19

20 Multiply line 19 by 15% (.15). 20

● Box 2, 4, or 9, enter your taxable disability income.

● Box 5, add your taxable disability income to your spouse’s taxable

disability income. Enter the total.

For more details on what to include on line 11, see

the instructions.

Did you check

box 2, 4, 5, 6,

or 9 in Part I?

You must complete line 11.

Enter the amount from line 10

on line 12 and go to line 13.

Yes

No 



Box 8 or 9 $3,750

Page 2

Schedule 3 (Form 1040A) 2004

Any other pension, annuity, or disability benefit

that is excluded from income under any other

provision of law (see the instructions).

If you checked (in Part I):

21

21

Credit for the elderly or the disabled. Enter the smaller of line 20

or line 21 here and on Form 1040A, line 30. 22

TIP

22

Enter the amount from Form 1040A, line 28, minus any amount on

Form 1040A, line 29.
SCHEDULES A&B O

Schedule A—Itemized Deductions

(Form 1040) (Schedule B is on back)

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

A

S

Name(s) shown on Form 1040 Your so

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

5

Taxes You 5 State and local (check only one box):

Paid

6 Real estate taxes (see page A-3) 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-4

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-4

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-6.) 

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 37

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 

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 37

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 39.

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 37, over $142,700 (over $71,350 if married filing separately)?

(99)

 See Instructions for Schedules A and B (Form 1040).

a Income taxes, or

b General sales taxes (see page A-2) 
Schedules A&B (Form 1040) 2004 OMB No. 1

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

Schedule B—Interest and Ordinary Dividends 

Part I

Interest

(See page B-1

and the

instructions for

Form 1040,

line 8a.)

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

(See page B-2

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 

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

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

Foreign

Accounts

and Trusts

At any time during 2004, did you have an interest in or a signature or other authority over a fin

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

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 2004, did you receive a distribution from, or were you the grantor of, or transfero

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 2004? If “No,” see page C-3 for limit on losses

If you started or acquired this business during 2004, 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) 2004

(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)

11 Contract labor (see page C-4)

2004
Schedule C (Form 1040) 2004 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 2004, 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) 2004
SCHEDULE C-EZ OMB No. 1545-0074

(Form 1040)

Net Profit 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 on back. Sequence No. 09A

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

Business address (including suite or room no.). Address not required if same as on Form 1040, page 1.

C

E

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

employee” box on that form was checked, see Statutory Employees in the instructions for

Schedule C, line 1, on page C-3 and check here  1

2 Total expenses (see instructions). If more than $5,000, you must use Schedule C 2

3

3 Net profit. Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on

Form 1040, line 12, and also on Schedule SE, line 2. (Statutory employees do not report this

amount on Schedule SE, line 2. Estates and trusts, enter on Form 1041, line 3.)

For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 14374D Schedule C-EZ (Form 1040) 2004

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

You May Use

Schedule C-EZ

Instead of

Schedule C

Only If You:

And You:

● Use the cash method of accounting.

● Had only one business as a sole

proprietor.

● Had business expenses of $5,000 or

less. ● Are not required to file Form 4562,

Depreciation and Amortization, for

this business. See the instructions

for Schedule C, line 13, on page

C-4 to find out if you must file.

● Do not deduct expenses for

business use of your home.

● Do not have prior year unallowed

passive activity losses from this

business.

 

Name of proprietor Social security number (SSN)

General Information

A Principal business or profession, including product or service B Enter code from pages C-7, 8, & 9



Figure Your Net Profit

Part I

Part II

● Did not have a net loss from your

business.

● Had no employees during the year.

1

● Did not have an inventory at any

time during the year.

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

8a Do you have evidence to support your deduction? Yes No

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

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

5 Of the total number of miles you drove your vehicle during 2004, enter the number of miles you used your vehicle for:

Business b Commuting c Other

4

Part III Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 2.

a

b

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

2004
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)

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

7

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

Carryover Worksheet on page D-6 of the instructions

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-1 of the instructions

14

15

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

Carryover Worksheet on page D-6 of the instructions ( )

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

Part III on the back 15

For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule D (Form 1040) 2004 Cat. No. 11338H

( )

44

Part I

Part II

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.)

(e) Cost or other basis

(see page D-6 of

the instructions)

(d) Sales price

(see page D-6 of

the instructions)

2004

7

(f) Gain or (loss)

Subtract (e) from (d)
Schedule D (Form 1040) 2004

Summary

Combine lines 7 and 15 and enter the result. If line 16 is a loss, skip lines 17 through 20, and

go to line 21. If a gain, enter the gain on Form 1040, line 13, and then go to line 17 below

16

16

18

Part III

Page2

18 Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet on page D-7 of the

instructions 



Are lines 18 and 19 both zero or blank?

19

Schedule D (Form 1040) 2004

21

Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet on

page D-8 of the instructions



20

21 If line 16 is a loss, enter here and on Form 1040, line 13, the smaller of:

19

● The loss on line 16 or

● ($3,000), or if married filing separately, ($1,500) 

Yes. Complete Form 1040 through line 42, and then complete the Qualified Dividends and

Capital Gain Tax Worksheet on page 34 of the Instructions for Form 1040. Do not complete

lines 21 and 22 below.

No. Complete Form 1040 through line 42, and then complete the Schedule D Tax Worksheet

on page D-9 of the instructions. Do not complete lines 21 and 22 below.

22 Do you have qualified dividends on Form 1040, line 9b?

Yes. Complete Form 1040 through line 42, and then complete the Qualified Dividends and

Capital Gain Tax Worksheet on page 34 of the Instructions for Form 1040.

No. Complete the rest of Form 1040.

( )

17 Are lines 15 and 16 both gains?

Yes. Go to line 18.

No. Skip lines 18 through 21, and go to line 22.

Note. When figuring which amount is smaller, treat both amounts as positive numbers.


O

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

Department of the Treasury

Internal Revenue Service

Qualifying Child Information

For Paperwork Reduction Act Notice, see Form 1040A

or 1040 instructions.

Cat. No. 13339M Schedule EIC (Form 1

Before you begin: See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 65a a

65b, to make sure that (a) you can take the EIC and (b) you have a qualifying chi

Qualifying Child Information

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

for each qualifying child.

4

2

5

6

1 Child’s name

Child’s SSN

Child’s relationship to you

Number of months child lived with

you in the United States during 2004

months

Yes.

If the child was born before 1986—

Was the child permanently and totally

disabled during any part of 2004?

b

Yes.

First name Last name First name La

Name(s) shown on return Your so

(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 2 agree wit

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

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

Administration at 1-800-772-1213.

Child 1 Child 

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 42

of the Form 1040A instructions or page 44 of the

Form 1040 instructions unless the child was born and

died in 2004. If your child was born and died in 2004

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

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

No. 

Go to line 5. Go to line 5. Continue 

Yes. Yes. No. 

Continue Continue The child is not a

qualifying child.

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

2004 but less than 7 months, enter “7.”

● If the child was born or died in 2004 and your

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

or she was alive during 2004, enter “12.”

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

You may also be able to take the additional child tax credit if your child (a) was under age 17 at the end o

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

details, see the instructions for line 42 of Form 1040A or line 67 of Form 1040.

. . . . . . . . . .

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

to 10 years. See back of schedule for details.

(for example, son, daughter, grandchild,

niece, nephew, foster child, etc.)

Was the child under age 24 at the end

of 2004 and a student?

a

Child’s year of birth

If born after 1985, skip lines 4a

and 4b; go to line 5.

Year

If born after 1985

and 4b; go to line 

Year

3

CAUTION

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SCHEDULE E O

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

Name(s) shown on return Your so

Income or Loss From Rental Real Estate and Royalties Note. If you are in the business of renting pe

Schedule C or C-EZ (see page E-3). Report farm rental income or loss from Form 4835 on page 2, line 40.

1 List the type and location of each rental real estate property:

A

B

C

2 

Properties 

(Add 

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 

Part I

Management fees

(99)

For each rental real estate property

listed on line 1, did you or your fam

use it during the tax year for person

purposes for more than the greater 

● 14 days or

● 10% of the total days rented at

fair rental value?

(See page E-3.)
Schedule E (Form 1040) 2004 Attachment Sequence No. 13 

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

Income or Loss From Partnerships and S Corporations Note. If you report a loss from a

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

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) 

(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

iden

33 (a) Name

A

B

Passive Income and Loss Nonpassive Income and 

(e) Deduction or loss

from Schedule K–1

(d) Passive income

from Schedule K–1

(f) O

S

(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)—Resid

(c) Excess inclusion from

Schedules Q, line 2c

(see page E-6)

(e

Sche

(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), box 14, code B; Schedule K-1 (Form 1120S),

box 17, code N; 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 

27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed

loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? 

If you answered “Yes,” see page E-6 before completing this section.

Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
SCHEDULE F OMB No. 1545-0074 Profit or Loss From Farming

(Form 1040)  Attach to Form 1040, Form 1041, Form 1065, or Form 1065-B.

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 14

Name of proprietor Social security number (SSN)

A Principal product. Describe in one or two words your principal crop or activity for the current tax year. B Enter code from Part IV

D Employer ID number (EIN), if any

C Accounting method: Accrual Cash

E Did you “materially participate” in the operation of this business during 2004? If “No,” see page F-2 for limit on passive losses. Yes No

Farm Income—Cash Method. Complete Parts I and II (Accrual method taxpayers complete Parts II and III, and line 11 of Part I.)

Do not include sales of livestock held for draft, breeding, sport, or dairy purposes; report these sales on Form 4797.

(1)

1 Sales of livestock and other items you bought for resale

(2)

2 Cost or other basis of livestock and other items reported on line 1

3 Subtract line 2 from line 1 3

4 Sales of livestock, produce, grains, and other products you raised 4

5a Total cooperative distributions (Form(s) 1099-PATR) 5a 5b 5b Taxable amount

6a Agricultural program payments (see page F-2) 6a 6b 6b Taxable amount

7 Commodity Credit Corporation (CCC) loans (see page F-3):

a CCC loans reported under election 7a

b CCC loans forfeited 7b 7c Taxable amount 7c

8 Crop insurance proceeds and certain disaster payments (see page F-3):

a Amount received in 2004 8a 8b 8b Taxable amount

c If election to defer to 2005 is attached, check here  8d Amount deferred from 2003 8d

9 Custom hire (machine work) income 9

10 Other income, including Federal and state gasoline or fuel tax credit or refund (see page F-3) 10

Gross income. Add amounts in the right column for lines 3 through 10. If accrual method taxpayer, enter the

amount from page 2, line 51 

11

11

Farm Expenses—Cash and Accrual Method. Do not include personal or living expenses such as taxes, insurance,

repairs, etc., on your home.

Labor hired (less employment credits)

12

24 24

Pension and profit-sharing

plans

Chemicals

12 25

Rent or lease (see page F-5):

Conservation expenses

(see page F-4)

13

26a

13

Vehicles, machinery, and equipment

a

26b

14

14

Custom hire (machine work) b Other (land, animals, etc.)

26

Repairs and maintenance

15

Depreciation and section 179

expense deduction not claimed

elsewhere (see page F-4)

27 27

Seeds and plants purchased 28

15

28

29 Storage and warehousing 29

Supplies purchased

16

Employee benefit programs other

than on line 25

30

16

30

17 Taxes 31

17

31

18 Utilities 32

Fertilizers and lime

18 32

19 Veterinary, breeding, and medicine

Freight and trucking

19 33

Other expenses (specify):

34a

20

Gasoline, fuel, and oil

20

a

34b

21 21

Insurance (other than health) b

23 Interest: c 34c

a Mortgage (paid to banks, etc.) 23a d 34d

b Other 23b e 34e

35 Total expenses. Add lines 12 through 34f  35

36 Net farm profit or (loss). Subtract line 35 from line 11. If a profit, enter on Form 1040, line 18, and also on

Schedule SE, line 1. If a loss, you must go on to line 37 (estates, trusts, and partnerships, see page F-6) 36

37a All investment is at risk. 37 If you have a loss, you must check the box that describes your investment in this activity (see page F-6).

37b Some investment is not at risk. ● If you checked 37a, enter the loss on Form 1040, line 18, and also on Schedule SE, line 1.

● If you checked 37b, you must attach Form 6198.

For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule F (Form 1040) 2004

 See Instructions for Schedule F (Form 1040).

Car and truck expenses (see

page F-4—also attach Form 4562)

Cat. No. 11346H

Feed purchased

22 22

f 34f

25

33

34

1

2



Part I

Part II



(99)

2004
Schedule F (Form 1040) 2004 Page 2

Farm Income—Accrual Method (see page F-6)

Do not include sales of livestock held for draft, breeding, sport, or dairy purposes; report these sales on Form

4797 and do not include this livestock on line 46 below.

38 Sales of livestock, produce, grains, and other products during the year 38

39a Total cooperative distributions (Form(s) 1099-PATR) 39a 39b Taxable amount 39b

40a Agricultural program payments 40a 40b 40b Taxable amount

Commodity Credit Corporation (CCC) loans:

a CCC loans reported under election 41a

b CCC loans forfeited 41b 41c Taxable amount 41c

Crop insurance proceeds

41

42

Custom hire (machine work) income

42

43

Other income, including Federal and state gasoline or fuel tax credit or refund

43

44

Add amounts in the right column for lines 38 through 44

44

Inventory of livestock, produce, grains, and other products at beginning of

the year

45

Cost of livestock, produce, grains, and other products purchased during

the year

46

46

47

Add lines 46 and 47

47

48

Inventory of livestock, produce, grains, and other products at end of year

48

Cost of livestock, produce, grains, and other products sold. Subtract line 49 from line 48* 50

49

51 Gross income. Subtract line 50 from line 45. Enter the result here and on page 1, line 11  51

*If you use the unit-livestock-price method or the farm-price method of valuing inventory and the amount on line 49 is larger than the amount on

line 48, subtract line 48 from line 49. Enter the result on line 50. Add lines 45 and 50. Enter the total on line 51.

Principal Agricultural Activity Codes

Select one of the following codes and enter the six-digit

number on page 1, line B.

50

45

49

Part IV

Part III

File Schedule C (Form 1040), Profit or Loss From

Business, or Schedule C-EZ (Form 1040), Net

Profit From Business, instead of Schedule F if:

● Your principal source of income is from providing

agricultural services such as soil preparation,

veterinary, farm labor, horticultural, or management

for a fee or on a contract basis or

● You are engaged in the business of breeding, raising, and

caring for dogs, cats, or other pet animals.

Crop Production

111100 Oilseed and grain farming

111210 Vegetable and melon farming

111300 Fruit and tree nut farming

111400 Greenhouse, nursery, and floriculture production

111900 Other crop farming

Animal Production

112111 Beef cattle ranching and farming

112112 Cattle feedlots

112120 Dairy cattle and milk production

112210 Hog and pig farming

112300 Poultry and egg production

112400 Sheep and goat farming

112510 Animal aquaculture

112900 Other animal production

Forestry and Logging

113000 Forestry and logging (including forest nurseries

and timber tracts)

These codes for the Principal Agricultural Activity classify farms

by the type of activity they are engaged in to facilitate the

administration of the Internal Revenue Code. These six-digit

codes are based on the North American Industry Classification

System (NAICS).

Schedule F (Form 1040) 2004

CAUTION
(Form 1040) Credit for the Elderly or the Disabled

Attachment

 Attach to Form 1040.  See Instructions for Schedule R (Form 1040). Sequence No. 16

Your social security number

You may be able to take this credit and reduce your tax if by the end of 2004:

● You were age 65 or older or

You filed a physician’s statement for this disability for 1983 or an earlier year, or you filed or got a

statement for tax years after 1983 and your physician signed line B on the statement, and

If:

Due to your continued disabled condition, you were unable to engage in any substantial gainful activity

in 2004, check this box 

● If you checked this box, you do not have to get another statement for 2004.

OMB No. 1545-0074 Schedule R

For Paperwork Reduction Act Notice, see Form 1040 instructions.

Department of the Treasury

Internal Revenue Service

Name(s) shown on Form 1040

But you must also meet other tests. See page R-1.

In most cases, the IRS can figure the credit for you. See page R-1.

Check the Box for Your Filing Status and Age

Statement of Permanent and Total Disability (Complete only if you checked box 2, 4, 5, 6, or 9 above.)

1

Schedule R (Form 1040) 2004

2

If your filing status is:

1 You were 65 or older 1

2 You were under 65 and you retired on permanent and total disability 2

3 Both spouses were 65 or older 3

4 Both spouses were under 65, but only one spouse retired on

permanent and total disability 4

5 Both spouses were under 65, and both retired on permanent and total

disability 5

Married filing

jointly

6 One spouse was 65 or older, and the other spouse was under 65 and

retired on permanent and total disability 6

7 One spouse was 65 or older, and the other spouse was under 65 and

not retired on permanent and total disability 7

8 You were 65 or older and you lived apart from your spouse for all of

Married filing 2004 8

separately

9 You were under 65, you retired on permanent and total disability, and

you lived apart from your spouse for all of 2004 9

Did you check

box 1, 3, 7,

or 8?

Single,

Head of household, or 

Qualifying widow(er)

And by the end of 2004: Check only one box:

Cat. No. 11359K

Part I

Part II

● You were under age 65, you retired on permanent and total disability, and

you received taxable disability income.

Yes Skip Part II and complete Part III on back.

No Complete Parts II and III.





● If you did not check this box, have your physician complete the statement on page R-4. You must

keep the statement for your records.

(99)

2004

TIP
Schedule R (Form 1040) 2004 Page 2

Figure Your Credit

Box 1, 2, 4, or 7 $5,000

10 Enter:

10

● Box 6, add $5,000 to the taxable disability income of the

spouse who was under age 65. Enter the total.

11

If you completed line 11, enter the smaller of line 10 or line 11; all others, enter the

amount from line 10

12

12

Enter the following pensions, annuities, or disability income that

you (and your spouse if filing a joint return) received in 2004.

13

a Nontaxable part of social security benefits and

13a Nontaxable part of railroad retirement benefits

treated as social security (see page R-3).

b Nontaxable veterans’ pensions and

13b Any other pension, annuity, or disability benefit that

is excluded from income under any other provision

of law (see page R-3).

Add lines 13a and 13b. (Even though these income items are

not taxable, they must be included here to figure your credit.)

If you did not receive any of the types of nontaxable income

listed on line 13a or 13b, enter -0- on line 13c

c

13c

14

Enter the amount from Form 1040,

line 37

14

15

15

Subtract line 15 from line 14. If zero or

less, enter -0-

16

16

17 Enter one-half of line 16 17

18 Add lines 13c and 17 18

Subtract line 18 from line 12. If zero or less, stop; you cannot take the credit. Otherwise,

go to line 20

19

19

24

20 Multiply line 19 by 15% (.15)

Did you check

box 2, 4, 5, 6,

or 9 in Part I?

Box 3, 5, or 6 $7,500

Box 8 or 9 $3,750

If you checked (in Part I):

Box 1 or 2 $7,500

Enter:

Box 3, 4, 5, 6, or 7 $10,000

Box 8 or 9 $5,000

If you checked (in Part I):

Part III







● Box 2, 4, or 9, enter your taxable disability income.

● Box 5, add your taxable disability income to your spouse’s

taxable disability income. Enter the total.

For more details on what to include on line 11, see page R-3.

11

If you checked (in Part I):



Yes You must complete line 11.

No Enter the amount from line 10

on line 12 and go to line 13.







Schedule R (Form 1040) 2004

21 Enter the amount from Form 1040, line 45

23 Subtract line 22 from line 21

Add the amounts from Form 1040, lines 46 and 47, and enter

the total

22

Credit for the elderly or the disabled. Enter the smaller of line 20 or line 23 here and

on Form 1040, line 48

24

22

21

20

23

TIP
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 57.

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), box 14, code A

1

1

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

box 14, code A (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) 2004

● 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 30

● $87,900 or less, multiply line 4 by 15.3% (.153). Enter the result here and on 

Form 1040, line 57.

● More than $87,900, multiply line 4 by 2.9% (.029). Then, add $10,899.60 to the

result. Enter the total here and on Form 1040, line 57.

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

Did You Receive Wages or Tips in 2004?

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 $87,900?

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)

2004
Schedule SE (Form 1040) 2004 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), box 14, code A. 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), box

14, code A (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, stop; you do not owe self-employment tax. Exception.

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

6

87,900 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 2004

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 $87,900 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 57

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 (a) your net nonfarm profits3 were less

than $1,733 and also less than 72.189% of your gross nonfarm income4 and (b) you had net earnings

from self-employment of at least $400 in 2 of the prior 3 years.

17

17

3 From Sch. C, line 31; Sch. C-EZ, line 3; Sch. K-1 (Form 1065), box 14, code A; and

Sch. K-1 (Form 1065-B), box 9.

1 From Sch. F, line 11, and Sch. K-1 (Form 1065),

box 14, code B.

4 From Sch. C, line 7; Sch. C-EZ, line 1; Sch. K-1 (Form 1065), box 14, code C; and Sch.

K-1 (Form 1065-B), box 9.

2 From Sch. F, line 36, and Sch. K-1 (Form 1065),

box 14, code A.

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

Farm Optional Method. You may use this method only if (a) your gross farm income1 was not more

than $2,400 or (b) your net farm profits2 were less than $1,733.

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.

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

50% (.5). Enter the result here and on Form 1040, line 30 13

13

Schedule SE (Form 1040) 2004

12
O

Employee Business Expenses Form 2106

 See separate instructions.

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Your name Occupation in which you incurred expenses Social s

Employee Business Expenses and Reimbursements

Column A C

Step 1 Enter Your Expenses M

Ent

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 

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 incurred while away from home on business by 70% (.70)

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. (Reservists, qualified performing artists, fee-basis state or

local government officials, 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 

Part I

(99)
Form 2106 (2004) 

Vehicle Expenses

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

are claiming vehicle expenses.) (a) Vehicle 1 

11 Enter the date the vehicle was placed in service 11 

12 Total miles the vehicle was driven during 2004 12 miles 

13 Business miles included on line 12 13 miles 

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

15 Average daily roundtrip commuting distance 15 miles 

16 Commuting miles included on line 12 16 miles 

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

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

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

21 If “Yes,” is the evidence written? 

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 

Section C.)

22 Multiply line 13 by 37.5¢ (.375) 22

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

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 (see instructions) 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 comp

for the vehicle.)

(a) Vehicle 1 (b) Vehic

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

/ /
OMB No. 1545-1441 2106-EZ Unreimbursed Employee Business Expenses Form

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Attachment

Sequence No. 54A

Your name Occupation in which you incurred expenses Social security number

1

Vehicle expense using the standard mileage rate. Complete Part II and multiply line 8a by 37.5¢

(.375)

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

4 Business expenses not included on lines 1 through 3. Do not include meals and entertainment 4

5

Meals and entertainment expenses: $ × 50% (.50) (Employees subject to

Department of Transportation (DOT) hours of service limits: Multiply meal expenses incurred

while away from home on business by 70% (.70) instead of 50%. For details, see instructions.)

5

Total expenses. Add lines 1 through 5. Enter here and on line 20 of Schedule A (Form 1040).

(Armed Forces reservists, fee-basis state or local government officials, qualified performing

artists, and individuals with disabilities: See the instructions for special rules on where to enter

this amount.)

6

6

Cat. No. 20604Q Form 2106-EZ (2004)

Part I

Part II

Figure Your Expenses

You May Use This Form Only if All of the Following Apply.

● You are an employee deducting ordinary and necessary expenses attributable to your job. An ordinary expense is one that is

common and accepted in your field of trade, business, or profession. A necessary expense is one that is helpful and

appropriate for your business. An expense does not have to be required to be considered necessary.

● If you are claiming vehicle expense, you are using the standard mileage rate for 2004.

● You do not get reimbursed by your employer for any expenses (amounts your employer included in box 1 of your Form W-2 are

not considered reimbursements).

Information on Your Vehicle. Complete this part only if you are claiming vehicle expense on line 1.

7

8

a

9

10

11a

b

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

Of the total number of miles you drove your vehicle during 2004, enter the number of miles you used your vehicle for:

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

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

Do you have evidence to support your deduction?

If “Yes,” is the evidence written?

Business

Yes No

b Commuting c Other

Yes No

Yes No

Yes No

(99)

For Paperwork Reduction Act Notice, see page 4.

Caution: You can use the standard mileage rate for 2004 only if: (a) you owned the vehicle and used the standard mileage rate for the first year

you placed the vehicle in service or (b) you leased the vehicle and used the standard mileage rate for the portion of the lease period after 1997.

2004
VOID CORRECTED

2

OMB No. 1545-0145

Notice to Shareholder of Undistributed

Long-Term Capital Gains

1a

1b

Copy A

1d

Attach to

Form 1120-RIC

or Form 1120-REIT

For Instructions

and Paperwork

Reduction Act

Notice, see back of

Copies A and D.

Form 2439 Department of the Treasury - Internal Revenue ServiceCat. No. 11858E

Form 2439

Name, address, and ZIP code of RIC or REIT

Identification number of RIC or REIT

Shareholder’s identifying number

Shareholder’s name, address, and ZIP code

Total undistributed long-term capital gains

Unrecaptured section 1250 gain

Tax paid by the RIC or REIT on the box 1a gains

Section 1202 gain

For calendar year 2004, or other tax year of the

regulated investment company (RIC) or the

real estate investment trust (REIT)

beginning , 2004, and

ending ,

(99)

20

1c Collectibles (28%) gain

2004
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 32

Enter your earned income. See instructions

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 37 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 2003 expenses in 2004, see

the instructions

9

For Paperwork Reduction Act Notice, see page 4 of the instructions. Form 2441 (2004)

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 61.

.

(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 2004 for the

person listed in column (a)

8

6

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

9

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

10

11

10

11

Enter the amount from Form 1040, line 45, minus any amount on Form 1040, line 46

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

here and on Form 1040, line 47

2004
Form 2441 (2004) Page 2

Dependent Care Benefits

Enter the total amount of dependent care benefits you received in 2004. Amounts you

received as an employee should be shown in box 10 of your Form(s) W-2. Do not include

amounts reported as wages in box 1 of Form(s) W-2. If you were self-employed or a partner,

include amounts you received under a dependent care assistance program from your sole

proprietorship or partnership

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

Subtract line 13 from line 12

Enter the total amount of qualified expenses incurred

in 2004 for the care of the qualifying person(s)

13

15

Enter the smaller of line 14 or 15 16

14

Enter your earned income. See instructions

15

17

Enter the amount shown below that applies

to you.

18

Enter the smallest of line 16, 17, or 18

16

19

Enter the amount from line 12 that you received from your sole proprietorship or

partnership. If you did not receive any such amounts, enter -0-

17

20

Taxable benefits. Subtract line 26 from line 21. If zero or less, enter -0-. Also, include

this amount on Form 1040, line 7. On the dotted line next to line 7, enter “DCB”

18

27

Part III

To claim the child and dependent care

credit, complete lines 28–32 below.

28

29

30

19

20

27

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

Subtract line 29 from line 28. If zero or less, stop. You cannot take the credit.

Exception. If you paid 2003 expenses in 2004, see the instructions for line 9

Enter the smaller of line 30 or 31. Also, enter this amount on line 3 on the front of this

form and complete lines 4–11

Add lines 23 and 26

32

29

30

32

13

14

12

12

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

line 29 above. Then, add the amounts in column (c) and enter the total here

31

31

Form 2441 (2004)

● 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.



21 Subtract line 20 from line 14

Enter $5,000 ($2,500 if married filing separately and you were required to enter your

spouse’s earned income on line 18)

22

Deductible benefits. Enter the smallest of line 19, 20, or 22. Also, include this amount

on the appropriate line(s) of your return (see the instructions)

23

24 Enter the smaller of line 19 or 22

25 Enter the amount from line 23

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

24

25

21

22

23

26
OMB No. 1545-0155 Investment Credit

Form 3468

Department of the Treasury  Attach to your tax return.

Internal Revenue Service

Attachment

Sequence No. 52

Name(s) shown on return Identifying number

Current Year Credit

1b

1

c

Energy credit. Enter the basis of energy property placed in

service during the tax year (see instructions)

2

2

4 4

5

Allowable Credit (See Who must file Form 3800 to find out if you complete Part II or file Form 3800.)

For Paperwork Reduction Act Notice, see page 4. Form 3468 (2004)

Part I

Part II

Rehabilitation credit (see instructions for requirements that must be met):

b Pre-1936 buildings × 10% (.10)

Certified historic structures × 20% (.20)

3

× 10% (.10)

Reforestation credit. Enter the amortizable basis of qualified

timber property acquired before 10/23/04 (see instructions) × 10% (.10)

Credit from cooperatives. Enter the unused investment credit from cooperatives

5 Current year credit. Add lines 1b through 4

1c

3

Cat. No. 12276E

Check this box if you are electing under section 47(d)(5) to take your qualified rehabilitation

expenditures into account for the tax year in which paid (or, for self-rehabilitated property, when

capitalized). See instructions. Note: This election applies to the current tax year and to all later

tax years. You may not revoke this election without IRS consent 

a

Enter the amount of qualified rehabilitation expenditures and multiply by the percentage shown:

e Rehabilitation credit from an electing large partnership (Schedule K-1 (Form 1065-B), box 9) 1e

6

f

Foreign tax credit 9a

Credits from Form 1040, lines 47 through 53 9b

9a

9d

c Possessions tax credit (Form 5735, line 17 or 27)

d Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 9a through 9e 9f

Net income tax. Subtract line 9f from line 8. If zero, skip lines 11 through 14 and enter -0- on line 15 10

7 Alternative minimum tax: Enter the alternative minimum tax (AMT) from the following line of the

appropriate form or schedule 7

10

Tentative minimum tax (see instructions)

11

13

12 Enter 25% (.25) of the excess, if any, of line 11 over $25,000 (see instructions)

Subtract line 14 from line 10. If zero or less, enter -0-

14 14

Credit allowed for the current year. Enter the smaller of line 5 or line 15 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 15 is smaller than line 5, see instructions. 16

b

9c

6 Regular tax before credits:

8 Add lines 6 and 7 8

11

Enter the greater of line 12 or line 13

12

13

e

Net regular tax. Subtract line 9f from line 6. If zero or less, enter -0-

15 15

16

(99)

Enter the assigned NPS project number or the pass-through entity’s

employer identification number (see instructions)

Enter the date that the NPS approved the Request for Certification of

Completed Work (see instructions)

Enter the date on which the 24- or

60-month measuring period begins

Enter the adjusted basis of the building as of the beginning date above

(or the first day of your holding period, if later)

Enter the amount of the qualified rehabilitation expenditures incurred,

or treated as incurred, during the period on line 1d(1) above

$

$

(1)

(2)

(1)

(2)

(3)

d

/ /

/ /

$

$

and ends

$

$

/ /

9e

2004

● Individuals. Enter the amount from Form 1040, line 43

● Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A, Part

I, line 1; or the applicable line of your return

● Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines

1a and 1b, or the amount from the applicable line of your return

● Individuals: Form 6251, line 35

● Corporations: Form 4626, line 14

● Estates and trusts: Form 1041, Schedule I, line 56 O

General Business Credit

Form 3800

Department of the Treasury

Internal Revenue Service  Attach to your tax return. 

 See instructions on pages 3 and 4.

Name(s) shown on return Identifying 

Current Year Credit

1a

2

3 3

4 4

5 5

6

8

7

Passive activity credits included on line 2 (see instructions)

Subtract line 3 from line 2

Passive activity credits allowed for 2004 (see instructions)

Carryforward of general business credit to 2004. See instructions for the schedule to attach

Carryback of general business credit from 2005 (see instructions)

Current year credit. Add lines 4 through 7

Allowable Credit

For Paperwork Reduction Act Notice, see page 2. 

Part II

Part I

2

b

d

e

f

g

6

Cat. No. 12392F

Current year credit. Add lines 1a through 1t

q

h

i

j

k

l

1h

1i

1j

1k

1p

1a

1b

1d

1e

1f

1g

Current year investment credit (Form 3468)

Current year work opportunity credit (Form 5884)

Current year credit for alcohol used as fuel (Form 6478)

Current year credit for increasing research activities (Form 6765)

Current year low-income housing credit (Form 8586)

Current year disabled access credit (Form 8826)

Current year enhanced oil recovery credit (Form 8830)

Current year renewable electricity production credit (Form 8835, Section A only)

Current year Indian employment credit (Form 8845)

Current year credit for employer social security and Medicare taxes paid on certain employee tips (Form 8846)

Current year credit for contributions to selected community development corporations (Form 8847)

Current year trans-Alaska pipeline liability fund credit (see instructions)

1q

p

Current year orphan drug credit (Form 8820) 1l

c Current year welfare-to-work credit (Form 8861) 1c

8

7

1r r

Current year general credits from an electing large partnership (Schedule K-1 (Form 1065-B))

Credit allowed for the current year. Enter the smaller of line 8 or line 18 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 19 is smaller than line 8, see instructions.

Individuals, estates, and trusts: See instructions if claiming the research credit. C corporations:

See Schedule A if claiming any regular investment credit carryforward and the line 19 instructions

if there has been an ownership change, acquisition, or reorganization

19

19

9

f

Foreign tax credit 12a

Credits from Form 1040, lines 47 through 53

12a

c Possessions tax credit (Form 5735, line 17 or 27) 12c

d Credit for fuel from a nonconventional source 12d

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 12a through 12e 12f

10

Net income tax. Subtract line 12f from line 11. If zero, skip lines 14 through 17 and enter -0- on line 18

10 Alternative minimum tax (see instructions)

Tentative minimum tax (see instructions)

14

11

Enter 25% (.25) of the excess, if any, of line 14 over $25,000 (see instructions)

13

Subtract line 17 from line 13. If zero or less, enter -0-

17

16

b 12b

Regular tax before credits (see instructions)

Add lines 9 and 10

Enter the greater of line 15 or line 16

15

16

e 12e

14 Net regular tax. Subtract line 12f from line 9. If zero or less, enter -0-

18

9

15

17

18

11

13

(99)

m Current year new markets credit (Form 8874) 1m

n Current year credit for small employer pension plan startup costs (Form 8881) 1n

o Current year credit for employer-provided child care facilities and services (Form 8882) 1o

t

s

Current year biodiesel fuels credit (Form 8864)

Current year low sulfur diesel fuel production credit (Form 8896)

1t

1s
OMB No. 1545-0162 Credit for Federal Tax Paid on Fuels

Form 4136

Department of the Treasury

Internal Revenue Service

Attachment

 Attach this form to your income tax return. Sequence No. 23

Name (as shown on your income tax return) Taxpayer identification number

Cat. No. 12625R Form 4136 (2004)

2 Nontaxable Use of Aviation Gasoline

375

10% gasohol

7.7% gasohol

5.7% gasohol

Nontaxable Use of Gasoline and Gasohol

(b)

Rate

(c)

Gallons

(d)

Amount of credit

Off-highway business use of gasoline $

1

(e)

CRN

362

3 Nontaxable Use of Undyed Diesel Fuel

Use of gasoline on a farm for farming purposes

e

d

f

a

b

c Other nontaxable use of gasoline

 See the Instructions on page 3.

(a) Type

of use

Claimant certifies that the diesel fuel did not contain visible evidence of dye.

Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and

check here 

For Paperwork Reduction Act Notice, see the instructions.

(b)

Rate

(c)

Gallons

(d)

Amount of credit

Use in commercial aviation (other than foreign trade) $

(e)

CRN

354

Other nontaxable use

a

b

(a) Type

of use

Claimant has the name and address of the person(s) who sold the diesel fuel to the claimant and the date(s) of the purchase(s) and if

exported, the required proof of export.

Caution: Claims cannot be made on line 3 for diesel fuel used

on a farm for farming purposes. Only registered ultimate

vendors may make those claims (see line 6).

(b)

Rate

(c)

Gallons

(d)

Amount of credit

$

(e)

CRN

(a) Type

of use

Nontaxable use

Use in certain intercity and local buses

a

b

c

Use in trains

350

353

$

4

$

$

$





360 

.184

.184

.184

.184

.132

.14396

.15436

.15

.194

.194

.244

.244

.20

.17

359

376

324

Nontaxable Use of Undyed Kerosene

Claimant certifies that the kerosene did not contain visible evidence of dye.

Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed explanation and check

here 

Claimant has the name and address of the person(s) who sold the kerosene to the claimant and the date(s) of the purchase(s) and if

exported, the required proof of export.

Caution: Claims cannot be made on line 4 for kerosene used

on a farm for farming purposes or for kerosene sold from a

blocked pump. Only registered ultimate vendors may make

those claims (see line 7).

(b)

Rate

(c)

Gallons

(d)

Amount of credit

$

(e)

CRN

(a) Type

of use

Nontaxable use

$ 346 .244

.244

Caution: ● You cannot claim any amounts on Form 4136 that you claimed on Form 8849 or Schedule C (Form 720).

● Sales by gasoline wholesale distributors cannot be claimed on Form 4136. Instead, use Schedule 4 (Form 8849)

or Schedule C, line 11 (Form 720) to make these claims.

2004
$

Form 4136 (2004) Page 2

10

10 Total income tax credit claimed. Add lines 1 through 9, column (d). Enter here and on

Form 1040, line 69 (also check box b on line 69); Form 1120, line 32g; Form 1120-A, line

28g; Form 1120S, line 23c; Form 1041, line 24g; or the proper line of other returns. 

6 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Claimant certifies that the diesel fuel did not contain visible evidence of dye.

Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and check here 

Claimant sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the

buyer to take the claim; and obtained the required certificate from the buyer and has no reason to believe any information in the

certificate is false. See the instructions for additional information to be submitted.

UV Registration No. 

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use on a farm for farming purposes 360

Use by a state or local government

a

b

$

$

7 Sales by Registered Ultimate Vendors of Undyed Kerosene

Claimant certifies that the kerosene did not contain visible evidence of dye.

Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed explanation and check here 

Claimant sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the buyer

to take the claim; and obtained the required certificate (for lines 7a and 7b) from the buyer and has no reason to believe any information

in the certificate is false, or has the Regulations section 48.6427-10(e)(4) statement, if required, for line 7c. See the instructions for

additional information to be submitted.

UV Registration No. 

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use on a farm for farming purposes

346

Use by a state or local government

a

b

$

$

c Sales from a blocked pump

8 Nontaxable Use of Liquefied Petroleum Gas (LPG) in Certain Buses

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use in certain intercity and local buses

352

Use in qualified local buses or school buses

a

b

$

$

9 Gasohol Blending

Claimant bought gasoline taxed at the full rate and blended it with alcohol to make gasohol. The gasohol was sold or used in

claimant’s trade or business. For each batch of gasohol, claimant has the required information relating to the purchase of the

gasoline and alcohol used to make the gasohol and to support the amount claimed.

(a)

Rate (b)

Gasoline

(d)

Amount of credit

(col. (a)  col. (b))

(e)

CRN

10% gasohol

357

7.7% gasohol

a

b

$

$

c 5.7% gasohol

(c)

Alcohol

Gallons of





UP Registration No. 

.244

.244

.244

.244

.244

.062

.136

.03734

.02804

.02031

Form 4136 (2004)

Nontaxable Use of Aviation Fuel

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use in commercial aviation (other than foreign trade)

Other nontaxable use 369

a

b

$

$ .175

.219

.044

5

355

377

361

356

363

c Other nontaxable uses
OMB No. 1545-0172 Depreciation and Amortization

Form 4562 (Including Information on Listed Property)

Department of the Treasury

Internal Revenue Service

Attachment

 See separate instructions. Sequence No. 67

Name(s) shown on return Business or activity to which this form relates Identifying number

Election To Expense Certain Property Under Section 179

Note: If you have any listed property, complete Part V before you complete Part I.

1 Maximum amount. See page 2 of the instructions for a higher limit for certain businesses 1 $102,000

2 Total cost of section 179 property placed in service (see page 3 of the instructions) 2

3 Threshold cost of section 179 property before reduction in limitation 3 $410,000

4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- 4

Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing

separately, see page 3 of the instructions

5

5

(a) Description of property (b) Cost (business use only) (c) Elected cost

6

7 Listed property. Enter the amount from line 29 7

8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 8

9 Tentative deduction. Enter the smaller of line 5 or line 8 9

10 Carryover of disallowed deduction from line 13 of your 2003 Form 4562 10

11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11

12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 12

13 Carryover of disallowed deduction to 2005. Add lines 9 and 10, less line 12  13

Note: Do not use Part II or Part III below for listed property. Instead, use Part V.

MACRS Depreciation (Do not include listed property.) (See page 5 of the instructions.)

(b) Month and

year placed in

service

(c) Basis for depreciation

(business/investment use

only—see instructions)

(d) Recovery

period (a) (e) Convention (f) Method (g) Depreciation deduction

Section B—Assets Placed in Service During 2004 Tax Year Using the General Depreciation System

19a 3-year property

b 5-year property

c 7-year property

d 10-year property

e 15-year property

f 20-year property

Residential rental 27.5 yrs. MM S/L

property

h

27.5 yrs. MM S/L

Nonresidential real MM S/L

property

i

MM S/L

Section C—Assets Placed in Service During 2004 Tax Year Using the Alternative Depreciation System

20a Class life S/L

b 12-year 12 yrs. S/L

c 40-year 40 yrs. MM S/L

Special Depreciation Allowance and Other Depreciation (Do not include listed property.)

17 MACRS deductions for assets placed in service in tax years beginning before 2004 17

15 Property subject to section 168(f)(1) election (see page 4 of the instructions) 15

16 Other depreciation (including ACRS) (see page 4 of the instructions) 16

Summary (see page 8 of the instructions)

21 Listed property. Enter amount from line 28 21

Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21.

Enter here and on the appropriate lines of your return. Partnerships and S corporations—see instr.

22

22

23 For assets shown above and placed in service during the current year,

enter the portion of the basis attributable to section 263A costs 23

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 12906N Form 4562 (2004)

Part IV

Part I

Part II

Part III

 Attach to your tax return.

39 yrs.

Section A

18 If you are electing under section 168(i)(4) to group any assets placed in service during the tax year

into one or more general asset accounts, check here 

Classification of property

g 25-year property 25 yrs. S/L

Special depreciation allowance for qualified property (other than listed property) placed in service

during the tax year (see page 3 of the instructions)

14

14

2004
Form 4562 (2004) Page 2

Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and

property used for entertainment, recreation, or amusement.)

Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only

24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable.

Section A—Depreciation and Other Information (Caution: See page 9 of the instructions for limits for passenger automobiles.)

24a Do you have evidence to support the business/investment use claimed? Yes No 24b If “Yes,” is the evidence written? Yes No

(i)

Elected

section 179

cost

(h)

Depreciation

deduction

(g)

Method/

Convention

(f)

Recovery

period

(e)

Basis for depreciation

(business/investment

use only)

(d)

Cost or other

basis

(c)

Business/

investment

use

percentage

(b)

Date placed in

service

(a)

Type of property (list

vehicles first)

26 Property used more than 50% in a qualified business use (see page 8 of the instructions):

%

%

%

27 Property used 50% or less in a qualified business use (see page 8 of the instructions):

% S/L –

% S/L –

% S/L –

28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 28

29 Add amounts in column (i), line 26. Enter here and on line 7, page 1 29

Section B—Information on Use of Vehicles

(f)

Vehicle 6

(e)

Vehicle 5

(d)

Vehicle 4

(c)

Vehicle 3

(b)

Vehicle 2

(a)

Vehicle 1

Total business/investment miles driven

during the year (do not include commuting

miles—See page 2 of the instructions)

30

31 Total commuting miles driven during the year

Total other personal (noncommuting)

miles driven

32

Total miles driven during the year.

Add lines 30 through 32

33

Was the vehicle available for personal Yes No Yes No Yes No Yes No Yes No Yes No

use during off-duty hours?

34

Was the vehicle used primarily by a

more than 5% owner or related person?

35

Is another vehicle available for personal

use?

36

Section C—Questions for Employers Who Provide Vehicles for Use by Their Employees

Yes No Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,

by your employees?

37

Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees?

See page 10 of the instructions for vehicles used by corporate officers, directors, or 1% or more owners

38

39 Do you treat all use of vehicles by employees as personal use?

Do you provide more than five vehicles to your employees, obtain information from your employees about

the use of the vehicles, and retain the information received?

40

41 Do you meet the requirements concerning qualified automobile demonstration use? (See page 10 of the instructions.)

Note: If your answer to 37, 38, 39, 40, or 41 is “Yes,” do not complete Section B for the covered vehicles.

Amortization

(e)

Amortization

period or

percentage

(b)

Date amortization

begins

(c)

Amortizable

amount

(d)

Code

section

(f)

Amortization for

this year

(a)

Description of costs

42 Amortization of costs that begins during your 2004 tax year (see page 11 of the instructions):

43 Amortization of costs that began before your 2004 tax year 43

44 Total. Add amounts in column (f). See page 12 of the instructions for where to report 44

Complete this section for vehicles used by a sole proprietor, partner, or other “more than 5% owner,” or related person.

If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.

Part VI

Part V

Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are

not more than 5% owners or related persons (see page 10 of the instructions).

Form 4562 (2004)

Special depreciation allowance for qualified listed property placed in service during the tax

year and used more than 50% in a qualified business use (see page 8 of the instructions)

25

25
Casualties and Thefts

Form 4684  See separate instructions.

 Attach to your tax return. Department of the Treasury

Internal Revenue Service

 Use a separate Form 4684 for each casualty or theft. 

Name(s) shown on tax return Identifyi

SECTION A—Personal Use Property (Use this section to report casualties and thefts of property no

or business or for income-producing purposes.)

1 Description of properties (show type, location, and date acquired for each property). Use a separate line for each prop

from the same casualty or theft.

Property A

Property B

Property C

Property D

Properties

A B C

Cost or other basis of each property 2 2

Insurance or other reimbursement (whether or not

you filed a claim) (see instructions)

3

3

Note: If line 2 is more than line 3, skip line 4.

Gain from casualty or theft. If line 3 is more than

line 2, enter the difference here and skip lines 5

through 9 for that column. See instructions if line 3

includes insurance or other reimbursement you did

not claim, or you received payment for your loss in

a later tax year

4

4

5 5 Fair market value before casualty or theft

6 Fair market value after casualty or theft 6

7 Subtract line 6 from line 5 7

8 Enter the smaller of line 2 or line 7 8

9

Subtract line 3 from line 8. If zero or less,

enter -0-

9

10 Casualty or theft loss. Add the amounts on line 9 in columns A through D 10

11 Enter the smaller of line 10 or $100 11

12 Subtract line 11 from line 10 12

Caution: Use only one Form 4684 for lines 13 through 18.

13 Add the amounts on line 12 of all Forms 4684 13

14 Add the amounts on line 4 of all Forms 4684 14

15

15

16 If line 14 is less than line 13, enter the difference 16

17 Enter 10% of your adjusted gross income from Form 1040, line 37. Estates and trusts, see instructions 17

Subtract line 17 from line 16. If zero or less, enter -0-. Also enter the result on Schedule A (Form 1040), line 19.

Estates and trusts, enter the result on the “Other deductions” line of your tax return

18

18

For Paperwork Reduction Act Notice, see page 4 of the instructions. 

● If line 14 is more than line 13, enter the difference here and on Schedule D. Do not

complete the rest of this section (see instructions).

● If line 14 is less than line 13, enter -0- here and go to line 16.

● If line 14 is equal to line 13, enter -0- here. Do not complete the rest of this section.

Cat. No. 12997O

Form 4684 (2004) 

Name(s) shown on tax return. Do not enter name and identifying number if shown on other side. Identifyi

SECTION B—Business and Income-Producing Property

Casualty or Theft Gain or Loss (Use a separate Part l for each casualty or theft.)

19 Description of properties (show type, location, and date acquired for each property). Use a separate line for each prope

aged from the same casualty or theft.

Property A

Property B

Property C

Property D

Properties

A B C 

20 Cost or adjusted basis of each property 20

Insurance or other reimbursement (whether or not

you filed a claim). See the instructions for line 3

21

21

Note: If line 20 is more than line 21, skip line 22

Gain from casualty or theft. If line 21 is more than line

20, enter the difference here and on line 29 or line 34,

column (c), except as provided in the instructions for

line 33. Also, skip lines 23 through 27 for that column.

See the instructions for line 4 if line 21 includes

insurance or other reimbursement you did not claim, or

you received payment for your loss in a later tax year

22

22

Fair market value before casualty or theft 23 23

24 Fair market value after casualty or theft 24

25 Subtract line 24 from line 23 25

26 Enter the smaller of line 20 or line 25 26

Note: If the property was totally destroyed by

casualty or lost from theft, enter on line 26

the amount from line 20.

27 Subtract line 21 from line 26. If zero or less, enter -0- 27

28 Casualty or theft loss. Add the amounts on line 27. Enter the total here and on line 29 or line 34 (see instructions) 28

Summary of Gains and Losses (from separate Parts l) (b) Losses from casualties or thefts 

(i) Trade, business,

rental or royalty

property

(ii) Incomeproducing and

employee property

(a) Identify casualty or theft

Casualty or Theft of Property Held One Year or Less

29

30 Totals. Add the amounts on line 29 30

31 Combine line 30, columns (b)(i) and (c). Enter the net gain or (loss) here and on Form 4797, line 14. If Form 4797

is not otherwise required, see instructions 31

32 Enter the amount from line 30, column (b)(ii) here. Individuals, enter the amount from income-producing property

on Schedule A (Form 1040), line 27, and enter the amount from property used as an employee on Schedule A

(Form 1040), line 22. Estates and trusts, partnerships, and S corporations, see instructions 32

Casualty or Theft of Property Held More Than One Year

33 Casualty or theft gains from Form 4797, line 32 33

34

35 35 Total losses. Add amounts on line 34, columns (b)(i) and (b)(ii)

36 Total gains. Add lines 33 and 34, column (c) 36

37 Add amounts on line 35, columns (b)(i) and (b)(ii) 37

Note: Partnerships, enter the amount from line 38a, 38b, or line 39 on Form 1065, Schedule K, line 11.

S corporations, enter the amount from line 38a or 38b on Form 1120S, Schedule K, line 10.

38 If the loss on line 37 is more than the gain on line 36:

a Combine line 35, column (b)(i) and line 36, and enter the net gain or (loss) here. Partnerships (except electing

large partnerships) and S corporations, see the note below. All others, enter this amount on Form 4797,

line 14. If Form 4797 is not otherwise required, see instructions 38a

b Enter the amount from line 35, column (b)(ii) here. Individuals, enter the amount from income-producing property on

Schedule A (Form 1040), line 27, and enter the amount from property used as an employee on Schedule A (Form 1040),

line 22. Estates and trusts, enter on the “Other deductions” line of your tax return. Partnerships (except electing large

partnerships) and S corporations, see the note below. Electing large partnerships, enter on Form 1065-B, Part II, line 11 38b

If the loss on line 37 is less than or equal to the gain on line 36, combine lines 36 and 37 and enter here. Partnerships

(except electing large partnerships), see the note below. All others, enter this amount on Form 4797, line 3

39

39

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )( )

Part I

Part II

Printed on recycled paper 

Attachment Sequence No. 26
Sales of Business Property

(Also Involuntary Conversions and Recapture Amounts

Under Sections 179 and 280F(b)(2)) Department of the Treasury 

Internal Revenue Service

Attachment 

Attach to your tax return. Sequence No. 27

Name(s) shown on return Identifying number

Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From Other

Than Casualty or Theft—Most Property Held More Than 1 Year (see instructions)

Enter the gross proceeds from sales or exchanges reported to you for 2004 on Form(s) 1099-B or 1099-S (or substitute

statement) that you are including on line 2, 10, or 20 (see instructions)

1

1

(f) Cost or other

basis, plus

improvements and

expense of sale

(e) Depreciation

allowed or

allowable since

acquisition

(g) Gain or (loss)

Subtract (f) from the

sum of (d) and (e)

(c) Date sold

(mo., day, yr.)

(b) Date acquired

(mo., day, yr.)

(a) Description

of property

(d) Gross

sales price

2

3 Gain, if any, from Form 4684, line 39

4 Section 1231 gain from installment sales from Form 6252, line 26 or 37

Gain, if any, from line 32, from other than casualty or theft

5

Combine lines 2 through 6. Enter the gain or (loss) here and on the appropriate line as follows:

6

7

Partnerships (except electing large partnerships) and S corporations. Report the gain or (loss) following the instructions

for Form 1065, Schedule K, line 10, or Form 1120S, Schedule K, line 9. Skip lines 8, 9, 11, and 12 below.

All others. If line 7 is zero or a loss, enter the amount from line 7 on line 11 below and skip lines 8 and 9. If line

7 is a gain and you did not have any prior year section 1231 losses, or they were recaptured in an earlier year,

enter the gain from line 7 as a long-term capital gain on Schedule D and skip lines 8, 9, 11, and 12 below.

8 Nonrecaptured net section 1231 losses from prior years (see instructions)

9 Subtract line 8 from line 7. If zero or less, enter -0-. If line 9 is zero, enter the gain from line 7 on line 12 below. If

line 9 is more than zero, enter the amount from line 8 on line 12 below and enter the gain from line 9 as a long-term

capital gain on Schedule D (see instructions)

Ordinary Gains and Losses

Ordinary gains and losses not included on lines 11 through 16 (include property held 1 year or less):

Loss, if any, from line 7

10

Gain, if any, from line 7 or amount from line 8, if applicable

11

Gain, if any, from line 31

12

Net gain or (loss) from Form 4684, lines 31 and 38a

13

Ordinary gain from installment sales from Form 6252, line 25 or 36

14

15

Combine lines 10 through 16

16

b

If the loss on line 11 includes a loss from Form 4684, line 35, column (b)(ii), enter that part of the loss here. Enter

the part of the loss from income-producing property on Schedule A (Form 1040), line 27, and the part of the loss

from property used as an employee on Schedule A (Form 1040), line 22. Identify as from “Form 4797, line 18a.”

See instructions

Redetermine the gain or (loss) on line 17 excluding the loss, if any, on line 18a. Enter here and on Form 1040,

line 14

For Paperwork Reduction Act Notice, see page 8 of the instructions. Cat. No. 13086I Form 4797 (2004)

Part I

Part II

OMB No. 1545-0184

Section 1231 gain or (loss) from like-kind exchanges from Form 8824

Ordinary gain or (loss) from like-kind exchanges from Form 8824

17

3

4

5

6

7

8

11

12

13

14

15

16

17

18a

18b

(99)

9

( )

Form 4797 2004

a

For all except individual returns, enter the amount from line 17 on the appropriate line of your return and skip lines

a and b below. For individual returns, complete lines a and b below:

18

See separate instructions.
Form 4797 (2004) Page 2

Gain From Disposition of Property Under Sections 1245, 1250, 1252, 1254, and 1255

(c) Date sold

(mo., day, yr.)

(b) Date acquired

(mo., day, yr.) (a) Description of section 1245, 1250, 1252, 1254, or 1255 property:

A

B

C

D

These columns relate to the properties on lines 19A through 19D.  Property A Property B Property C Property D

Gross sales price (Note: See line 1 before completing.)

Cost or other basis plus expense of sale

19

Depreciation (or depletion) allowed or allowable

20

Adjusted basis. Subtract line 22 from line 21

21

Total gain. Subtract line 23 from line 20

22

If section 1245 property:

23

a Depreciation allowed or allowable from line 22

b Enter the smaller of line 24 or 25a

If section 1250 property: If straight line depreciation was used, enter

-0- on line 26g, except for a corporation subject to section 291.

24

a Additional depreciation after 1975 (see instructions)

Applicable percentage multiplied by the smaller of line 24

or line 26a (see instructions)

b

Subtract line 26a from line 24. If residential rental property

or line 24 is not more than line 26a, skip lines 26d and 26e

c

d Additional depreciation after 1969 and before 1976

e Enter the smaller of line 26c or 26d

f Section 291 amount (corporations only)

g Add lines 26b, 26e, and 26f

25

If section 1252 property: Skip this section if you did not

dispose of farmland or if this form is being completed for a

partnership (other than an electing large partnership).

a Soil, water, and land clearing expenses

b Line 27a multiplied by applicable percentage (see instructions)

c Enter the smaller of line 24 or 27b

If section 1254 property:

26

Intangible drilling and development costs, expenditures for

development of mines and other natural deposits, and

mining exploration costs (see instructions)

a

b Enter the smaller of line 24 or 28a

If section 1255 property:

27

Applicable percentage of payments excluded from income

under section 126 (see instructions)

a

b Enter the smaller of line 24 or 29a (see instructions)

Summary of Part III Gains. Complete property columns A through D through line 29b before going to line 30.

Total gains for all properties. Add property columns A through D, line 24

28

Add property columns A through D, lines 25b, 26g, 27c, 28b, and 29b. Enter here and on line 13

29

Subtract line 31 from line 30. Enter the portion from casualty or theft on Form 4684, line 33. Enter the portion

from other than casualty or theft on Form 4797, line 6

30

31

32

33

Recapture Amounts Under Sections 179 and 280F(b)(2) When Business Use Drops to 50% or Less

(see instructions)

(b) Section 

280F(b)(2)

(a) Section

179

Section 179 expense deduction or depreciation allowable in prior years

34 Recomputed depreciation. See instructions

35 Recapture amount. Subtract line 34 from line 33. See the instructions for where to report

Part IV

Part III

20

21

22

23

24

25a

26a

27a

28a

29a

26b

26c

26d

26e

26f

26g

27b

27c

28b

29b

25b

30

31

32

33

34

35

Form 4797 (2004)
OMB No. 1545-0187 Farm Rental Income and Expenses Form 4835 (Crop and Livestock Shares (Not Cash) Received by Landowner (or Sub-Lessor))

(Income not subject to self-employment tax) Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040. Sequence No. 37

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

Employer ID number (EIN), if any

A Did you actively participate in the operation of this farm during 2004 (see instructions)? Yes No

Gross Farm Rental Income—Based on Production. Include amounts converted to cash or the equivalent.

1 Income from production of livestock, produce, grains, and other crops 1

2a Cooperative distributions (Form(s) 1099-PATR) 2a 2b 2b Taxable amount

3a Agricultural program payments (see instructions) 3a 3b 3b Taxable amount

4 Commodity Credit Corporation (CCC) loans (see instructions):

a CCC loans reported under election 4a

b CCC loans forfeited 4b 4c Taxable amount 4c

5 Crop insurance proceeds and certain disaster payments (see instructions):

a Amount received in 2004 5a 5b Taxable amount 5b

c If election to defer to 2005 is attached, check here  5d Amount deferred from 2003 5d

6 Other income, including Federal and state gasoline or fuel tax credit or refund (see instructions) 6

Gross farm rental income. Add amounts in the right column for lines 1 through 6. Enter the

total here and on Schedule E (Form 1040), line 42 

7

7

Expenses—Farm Rental Property. Do not include personal or living expenses.

8

8

Vehicles, machinery, and

equipment (see instructions)

20

9

20

9 Chemicals

22 Rent or lease:

Conservation expenses (see

instructions)

10

10

a

11

22b

Custom hire (machine work)

b Other (land, animals, etc.)

11 23 Repairs and maintenance

12 Depreciation and section

179 expense deduction

not claimed elsewhere

23

Seeds and plants

purchased

24

25 Storage and warehousing 25

26

12

26 Supplies purchased

27 Taxes 27 Employee benefit programs

other than on line 21 (see

Schedule F instructions)

13

13 28 Utilities 28

29

14 Veterinary, breeding, and

medicine

14 Feed purchased 29

15 Fertilizers and lime 15

16 Other expenses (specify):

30a

16 Freight and trucking

a

17

30b

17 Gasoline, fuel, and oil

b

18

30c

18 Insurance (other than health)

c

30d

19 Interest:

d

30e

a Mortgage (paid to banks, etc.)

e

b Other 19b

Labor hired (less employment

credits) (see Schedule F

instructions)

31 Total expenses. Add lines 8 through 30g  31

Net farm rental income or (loss). Subtract line 31 from line 7. If the result is income, enter it

here and on Schedule E, line 40. If the result is a loss, you must go on to line 33

32

32

33a All investment is at risk. If line 32 is a loss, you must check the box that describes your investment in this activity (see

instructions)

33 33b Some investment is not at risk.

You may need to complete Form 8582 to determine your deductible loss, regardless of which

box you check (see instructions). However, if you checked box 33b, you must complete Form

6198 before going to Form 8582. In either case, enter the deductible loss here and on

Schedule E, line 40 33c

For Paperwork Reduction Act Notice, see instructions on back. Form 4835 (2004)

Part I

Part II

Car and truck expenses (see

Schedule F instructions). Also

attach Form 4562 

19a

30

22a

Cat. No. 13117W

f

g

30f

30g

21

21

24

2004

 See instructions on back.

Pension and profit-sharing

plans

(99)
OMB No. 1545-0191

Form 4952 Investment Interest Expense Deduction

 Attach to your tax return. Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 51

Name(s) shown on return Identifying number

1 Investment interest expense paid or accrued in 2004 (see instructions) 1

2 Disallowed investment interest expense from 2003 Form 4952, line 7 2

3 Total investment interest expense. Add lines 1 and 2 3

4a

Gross income from property held for investment (excluding any net

gain from the disposition of property held for investment)

4a

5 Investment expenses (see instructions) 5

6 Net investment income. Subtract line 5 from line 4h. If zero or less, enter -0- 6

Cat. No. 13177Y Form 4952 (2004)

General Instructions

Section references are to the Internal

Revenue Code unless otherwise noted.

Total Investment Interest Expense

Net Investment Income

Investment Interest Expense Deduction

b Qualified dividends included on line 4a

c Subtract line 4b from line 4a

d Net gain from the disposition of property held for investment

e Enter the smaller of line 4d or your net capital gain from the disposition

of property held for investment (see instructions)

f Subtract line 4e from line 4d

Disallowed investment interest expense to be carried forward to 2005. Subtract line 6 from

line 3. If zero or less, enter -0-

7

8 Investment interest expense deduction. Enter the smaller of line 3 or 6. See instructions

4f

4b

4c

7

8

Part III

Part I

Part II

Purpose of Form

Use Form 4952 to figure the amount of

investment interest expense you can deduct

for 2004 and the amount you can carry

forward to future years. Your investment

interest expense deduction is limited to your

net investment income.

For more information, see Pub. 550,

Investment Income and Expenses.

Who Must File

If you are an individual, estate, or a trust, you

must file Form 4952 to claim a deduction for

your investment interest expense.

● You have no other deductible investment

expenses.

● Your investment interest expense is not

more than your investment income from

interest and ordinary dividends minus any

qualified dividends.

Allocation of Interest

Expense

If you paid or accrued interest on a loan and

used the loan proceeds for more than one

purpose, you may have to allocate the

interest. This is necessary because different

Specific Instructions

Part I—Total Investment

Interest Expense

Enter the investment interest expense paid or

accrued during the tax year, regardless of

when you incurred the indebtedness.

Investment interest expense is interest paid or

accrued on a loan or part of a loan that is

allocable to property held for investment (as

defined on this page).

Include investment interest expense

reported to you on Schedule K-1 from a

partnership or an S corporation. Include

amortization of bond premium on taxable

bonds purchased after October 22, 1986, but

before January 1, 1988, unless you elected to

offset amortizable bond premium against the

interest payments on the bond. A taxable

bond is a bond on which the interest is

includible in gross income.

Line 1

For Paperwork Reduction Act Notice, see back of form.

● You have no disallowed investment interest

expense from 2003.

Exception. You do not have to file Form 4952

if all of the following apply.

g Enter the amount from lines 4b and 4e that you elect to include in investment income (see

instructions)

h Investment income. Add lines 4c, 4f, and 4g 4h

4g

4d

4e

Property held for investment. Property held

for investment includes property that

produces income, not derived in the ordinary

course of a trade or business, from interest,

dividends, annuities, or royalties. It also

includes property that produces gain or loss,

not derived in the ordinary course of a trade

or business, from the disposition of property

that produces these types of income or is

held for investment. However, it does not

include an interest in a passive activity.

Investment interest expense does not

include any of the following:

● Home mortgage interest.

● Interest expense that is properly allocable

to a passive activity. Generally, a passive

activity is any business activity in which you

do not materially participate and any rental

activity. See the Instructions for Form 8582,

Passive Activity Loss Limitations, for details.

● Any interest expense that is capitalized,

such as construction interest subject to

section 263A.

● Interest expense related to tax-exempt

interest income under section 265.

● Interest expense, disallowed under section

264, on indebtedness with respect to life

insurance, endowment, or annuity contracts

issued after June 8, 1997, even if the

proceeds were used to purchase any

property held for investment.

Exception. A working interest in an oil or

gas property that you held directly or through

an entity that did not limit your liability is

property held for investment, but only if you

did not materially participate in the activity.

2004

(99)

rules apply to investment interest, personal

interest, trade or business interest, home

mortgage interest, and passive activity

interest. See Pub. 535, Business Expenses.

Part II—Net Investment

Income

Gross income from property held for

investment includes income, unless derived in

the ordinary course of a trade or business,

from interest, ordinary dividends (except

Alaska Permanent Fund dividends), annuities,

and royalties.

Line 4a
Cat. No. 13187U

OMB No. 1545-0193

Form 4972 Tax on Lump-Sum Distributions

(From Qualified Plans of Participants Born Before January 2, 1936)

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040 or Form 1041. Sequence No. 28

Name of recipient of distribution Identifying number

Complete this part to see if you can use Form 4972

Yes No

1

1

2

Was this a distribution of a plan participant’s entire balance (excluding deductible voluntary employee

contributions and certain forfeited amounts) from all of an employer’s qualified plans of one kind (pension,

profit-sharing, or stock bonus)? If “No,” do not use this form

2

3

4

3 Was this distribution paid to you as a beneficiary of a plan participant who was born before 

January 2, 1936?

5a

5a Did you use Form 4972 after 1986 for a previous distribution from your own plan? If “Yes,” do not use this

form for a 2004 distribution from your own plan

Complete this part to choose the 20% capital gain election (see instructions)

Capital gain part from Form 1099-R, box 3 6

Multiply line 6 by 20% (.20)  7

Complete this part to choose the 10-year tax option (see instructions)

Ordinary income from Form 1099-R, box 2a minus box 3. If you did not complete Part II, enter

the taxable amount from Form 1099-R, box 2a 8

9

10

11

12

14

15

16

17

18

22

For Paperwork Reduction Act Notice, see instructions. Form 4972 (2004)

Did you roll over any part of the distribution? If “Yes,” do not use this form

Death benefit exclusion for a beneficiary of a plan participant who died before August 21, 1996

Total taxable amount. Subtract line 9 from line 8

Current actuarial value of annuity from Form 1099-R, box 8. If none, enter -0-

Part III

Part I

Part II

6

7

8

9

10

11

12

14

15

16

17

18

22

19

20

21

13

19

20

21

If you also choose to use Part III, go to line 8. Otherwise, include the amount from line 7 in the

total on Form 1040, line 43, or Form 1041, Schedule G, line 1b, whichever applies.

13

If you are receiving this distribution as a beneficiary of a plan participant who died, did you use Form 4972

for a previous distribution received for that participant after 1986? If “Yes,” do not use the form for this

distribution 5b

Adjusted total taxable amount. Add lines 10 and 11. If this amount is $70,000 or more, skip

lines 13 through 16, enter this amount on line 17, and go to line 18

Divide line 11 by line 12 and enter the result as a decimal (rounded

to at least three places)

Multiply line 16 by the decimal on line 20

Subtract line 21 from line 11

Multiply line 12 by 50% (.50), but do not enter more than $10,000

Subtract $20,000 from line 12. If line 12 is

$20,000 or less, enter -0-

Multiply line 14 by 20% (.20)

Minimum distribution allowance. Subtract line 15 from line 13

Subtract line 16 from line 12

Federal estate tax attributable to lump-sum distribution

Subtract line 18 from line 17. If line 11 is zero, skip lines 20 through 22 and go to line 23

.

If you answered “No” to both questions 3 and 4, do not use this form.

4 Were you (a) a plan participant who received this distribution, (b) born before January 2, 1936, and (c) a

participant in the plan for at least 5 years before the year of the distribution?

b

Multiply line 19 by 10% (.10) 23

Tax on amount on line 23. Use the Tax Rate Schedule in the instructions 24

25

Multiply line 24 by ten (10). If line 11 is zero, skip lines 26 through 28, enter this amount on line

29, and go to line 30

Multiply line 22 by 10% (.10) 26

27

Tax on amount on line 26. Use the Tax Rate Schedule in the

instructions

Multiply line 27 by ten (10) 28

Subtract line 28 from line 25. Multiple recipients, see instructions  29

23

24

25

26

27

28

29

30

30

Tax on lump-sum distribution. Add lines 7 and 29. Also include this amount in the total on

Form 1040, line 43, or Form 1041, Schedule G, line 1b, whichever applies 

2004

(99)
Additional Taxes on Qualified Plans OMB No. 1545-0203 5329 (Including IRAs) and Other Tax-Favored Accounts Form

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 29

 Attach to Form 1040.

Name of individual subject to additional tax. If married filing jointly, see instructions. Your social security number

Home address (number and street), or P.O. box if mail is not delivered to your home

City, town or post office, state, and ZIP code If this is an amended

return, check here 

Enter your excess contributions from line 16 of your 2003 Form 5329 (see instructions). If zero,

go to line 15

13

14 14

If your traditional IRA contributions for 2004 are less than your

maximum allowable contribution, see instructions. Otherwise, enter -0-

15

2004 traditional IRA distributions included in income (see instructions)

15

2004 distributions of prior year excess contributions (see instructions)

Add lines 10, 11, and 12

Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter -0-

Excess contributions for 2004 (see instructions)

Additional Tax on Early Distributions

Complete this part if you took a taxable distribution, before you reached age 591⁄2 , from a qualified retirement plan (including

an IRA) or modified endowment contract (unless you are reporting this tax directly on Form 1040—see above). You may also

have to complete this part to indicate that you qualify for an exception to the additional tax on early distributions or for certain

Roth IRA distributions (see instructions).

1 Early distributions included in income. For Roth IRA distributions, see instructions 1

Early distributions included on line 1 that are not subject to the additional tax (see instructions).

Enter the appropriate exception number from the instructions: 

2

2

3 Amount subject to additional tax. Subtract line 2 from line 1 3

4 Additional tax. Enter 10% (.10) of line 3. Include this amount on Form 1040, line 59 4

For Paperwork Reduction Act Notice, see page 5 of the instructions. Cat. No. 13329Q Form 5329 (2004)

Apt. no.

Part I

Part II

If you only owe the additional 10% tax on early distributions, you may be able to report this tax directly

on Form 1040, line 59, without filing Form 5329. See the instructions for Form 1040, line 59.

Fill in Your Address Only

If You Are Filing This

Form by Itself and Not

With Your Tax Return



Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have

to include 25% of that amount on line 4 instead of 10% (see instructions).

5 5

6

7

8

6

7

8

Additional Tax on Certain Distributions From Education Accounts

Distributions included in income from Coverdell ESAs and QTPs

9

10

Distributions included on line 5 that are not subject to the additional tax (see instructions)

11

Amount subject to additional tax. Subtract line 6 from line 5

12

Additional tax. Enter 10% (.10) of line 7. Include this amount on Form 1040, line 59

9

10

11

12

Part III Additional Tax on Excess Contributions to Traditional IRAs

Complete this part if you contributed more to your traditional IRAs for 2004 than is allowable or you had an amount

on line 17 of your 2003 Form 5329.

Total excess contributions. Add lines 14 and 15 16

Additional tax. Enter 6% (.06) of the smaller of line 16 or the value of your traditional IRAs on December

31, 2004 (including 2004 contributions made in 2005). Include this amount on Form 1040, line 59 17

16

17

Complete this part if you included an amount in income, on Form 1040, line 21, from a Coverdell education savings

account (ESA) or a qualified tuition program (QTP).

 See separate instructions.

13

(99)

2004

Part IV Additional Tax on Excess Contributions to Roth IRAs

Enter your excess contributions from line 24 of your 2003 Form 5329 (see instructions). If zero, go to line 23

If your Roth IRA contributions for 2004 are less than your maximum

allowable contribution, see instructions. Otherwise, enter -0-

18 18

19

Complete this part if you contributed more to your Roth IRAs for 2004 than is allowable or you had an amount on line

25 of your 2003 Form 5329.

20 2004 distributions from your Roth IRAs (see instructions)

21 Add lines 19 and 20

22 Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter -0-

23 Excess contributions for 2004 (see instructions)

24 Total excess contributions. Add lines 22 and 23

Additional tax. Enter 6% (.06) of the smaller of line 24 or the value of your Roth IRAs on December 31,

2004 (including 2004 contributions made in 2005). Include this amount on Form 1040, line 59

25

21

22

23

24

25

19

20
Form 5329 (2004) Page 2

Additional Tax on Excess Accumulation in Qualified Retirement Plans (Including IRAs)

Minimum required distribution for 2004 (see instructions) 44

Amount actually distributed to you in 2004 45

Subtract line 45 from line 44. If zero or less, enter -0- 46

Additional tax. Enter 50% (.50) of line 46. Include this amount on Form 1040, line 59 47

Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge

and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature Date

Date Preparer’s SSN or PTIN Preparer’s

signature

Check if selfemployed

Firm’s name (or yours

if self-employed),

address, and ZIP code

EIN

Phone no.

 





Signature. Complete only if you are filing this form by itself and not with your tax return.

Please

Sign

Here

Paid

Preparer’s

Use Only

Additional Tax on Excess Contributions to Archer MSAs

Enter the excess contributions from line 40 of your 2003 Form 5329 (see instructions). If zero,

go to line 39

Additional tax. Enter 6% (.06) of the smaller of line 40 or the value of your Archer MSAs on

December 31, 2004 (including 2004 contributions made in 2005). Include this amount on Form

1040, line 59

38

47

34

39

26

27

Part VI

Part V

34

35

Additional Tax on Excess Contributions to Coverdell ESAs

Enter the excess contributions from line 32 of your 2003 Form 5329 (see instructions). If zero,

go to line 31

If the contributions to your Coverdell ESAs for 2004 were less than the

maximum allowable contribution, see instructions. Otherwise, enter -0-

36

37

26

35

39

40

41

44

45

46

36

37

38

If the contributions to your Archer MSAs for 2004 are less than the

maximum allowable contribution, see instructions. Otherwise, enter -0-

2004 distributions from your Archer MSAs from Form 8853, line 10

Add lines 35 and 36

Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter -0-

Excess contributions for 2004 (see instructions)

Total excess contributions. Add lines 38 and 39

Complete this part if you or your employer contributed more to your Archer MSAs for 2004 than is allowable or you

had an amount on line 41 of your 2003 Form 5329.

Complete this part if you did not receive the minimum required distribution from your qualified retirement plan.

Complete this part if the contributions to your Coverdell ESAs for 2004 were more than is allowable or you had an

amount on line 33 of your 2003 Form 5329.

28 2004 distributions from your Coverdell ESAs (see instructions)

29 Add lines 27 and 28 29

30 Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter -0- 30

27

28

31 Excess contributions for 2004 (see instructions) 31

32 Total excess contributions. Add lines 30 and 31 32

33 Additional tax. Enter 6% (.06) of the smaller of line 32 or the value of your Coverdell ESAs on

December 31, 2004 (including 2004 contributions made in 2005). Include this amount on Form

1040, line 59 33

40

41

Form 5329 (2004)

( )

Additional Tax on Excess Contributions to Health Savings Accounts (HSAs)

Complete this part if contributions to your HSAs were more than is allowable.

Part VII

42 Excess contributions for 2004 (see instructions) 42

43

Additional tax. Enter 6% (.06) of the smaller of line 42 or the value of your HSAs on December 31, 2004

(including 2004 contributions made in 2005). Include this amount on Form 1040, line 59

43

Part VIII
OMB No. 1545-0219

Form 5884 Work Opportunity Credit

Department of the Treasury

Internal Revenue Service  Attach to your tax return. Attachment

Sequence No. 77

Name(s) shown on return Identifying number

Current Year Credit (Members of a controlled group, see instructions.)

1 Enter the total qualified first-year wages paid or incurred during the tax year, and multiply by

the percentage shown, for services of employees who are certified as members of a targeted

group and:

1a

2 Add lines 1a and 1b. You must subtract this amount from your deduction for salaries and wages 2

If you are a— Then enter the total of the current year credits from—

Schedule K-1 (Form 1120S), box 13, code G, H, or J

Schedule K-1 (Form 1065), box 15, code G, H, or J

Schedule K-1 (Form 1041), line 14

Written statement from cooperative

a Shareholder

b Partner

c Beneficiary

d Patron

Work

opportunity

credits from

pass-through

entities:

3

3

Current year credit. Add lines 2 and 3. (S corporations, partnerships, estates, trusts,

cooperatives, regulated investment companies, and real estate investment trusts, see

instructions.)

4

4

Allowable Credit (See Who must file Form 3800 to find out if you complete Part II or file Form 3800.)

Form 5884 (2004)

Part I

Part II



Cat. No. 13570D

Worked for you at least 120 hours but fewer than 400 hours $  25% (.25)

Worked for you at least 400 hours $  40% (.40)

a

b 1b

For Paperwork Reduction Act Notice, see page 3.

● Individuals. Enter the amount from Form 1040, line 43

5

Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A,

Part I, line 1; or the applicable line of your return

●

●

8a 8a

b Credits from Form 1040, lines 47 through 53 8b

Foreign tax credit

Possessions tax credit (Form 5735, line 17 or 27)

Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 8a through 8e 8f

Net income tax. Subtract line 8f from line 7. If zero, skip lines 10 through 13 and enter -0- on line 14 9

6 Alternative minimum tax:

● Individuals. Enter the amount from Form 6251, line 35

● Corporations. Enter the amount from Form 4626, line 14 6

● Estates and trusts. Enter the amount from Form 1041, Schedule I, line 56

9

Tentative minimum tax (see instructions)

10 10

Enter 25% (.25) of the excess, if any, of line 10 over $25,000 (see instructions)

12

Subtract line 13 from line 9. If zero or less, enter -0-

13 13

Credit allowed for the current year. Enter the smaller of line 4 or line 14 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 14 is smaller than line 4, see instructions 15



5 Regular tax before credits:

7 Add lines 5 and 6 7

11

Enter the greater of line 11 or line 12

11

12

c

d

e

8c

8d

Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a

and 1b, or the amount from the applicable line of your return

Net regular tax. Subtract line 8f from line 5. If zero or less, enter -0-

14 14



15

8e

f

2004
OMB No. 1545-0227

Form 6251 Alternative Minimum Tax—Individuals

 See separate instructions.

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040 or Form 1040NR. Sequence No. 32

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

17

Alternative Minimum Taxable Income (See instructions for how to complete each line.)

1 If filing Schedule A (Form 1040), enter the amount from Form 1040, line 40, and go to line 2. Otherwise,

enter the amount from Form 1040, line 37, and go to line 7. (If less than zero, enter as a negative amount.)

2

3

Medical and dental. Enter the smaller of Schedule A (Form 1040), line 4, or 21⁄2% of Form 1040, line 37

4

Miscellaneous deductions from Schedule A (Form 1040), line 26

Taxes from Schedule A (Form 1040), line 9

5

6 If Form 1040, line 37, is over $142,700 (over $71,350 if married filing separately), enter the amount from line

9 of the Itemized Deductions Worksheet on page B-1 of the Instructions for Schedules A & B (Form 1040)

7

8

12

18

13

14

19

20

21

29

30

31

32

Exemption. (If this form is for a child under age 14, see page 6 of the instructions.)

33

Subtract line 29 from line 28. If zero or less, enter -0- here and on lines 33 and 35 and stop here

● If you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends

on Form 1040, line 9b; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (as refigured

for the AMT, if necessary), complete Part III on the back and enter the amount from line 55 here.

Alternative minimum tax foreign tax credit (see page 7 of the instructions)

Tentative minimum tax. Subtract line 32 from line 31

Tax from Form 1040, line 43 (minus any tax from Form 4972 and any foreign tax credit from Form 1040,

line 46). If you used Schedule J to figure your tax, the amounts for lines 43 and 46 of Form 1040 must

be refigured without using Schedule J (see page 8 of the instructions)

For Paperwork Reduction Act Notice, see page 8 of the instructions. Cat. No. 13600G Form 6251 (2004)

Enter the home mortgage interest adjustment, if any, from line 6 of the worksheet on page 2 of the instructions

1

2

3

4

5

6

7

8

9

10

11

12

13

30

29

31

32

33

34

( )

IF your filing status is . . .

AND line 28 is

not over . . .

THEN enter on

line 29 . . .

Single or head of household $112,500 $40,250

9

10

11

34

Alternative Minimum Tax

Alternative minimum tax. Subtract line 34 from line 33. If zero or less, enter -0-. Enter here and on Form

1040, line 44

Part I

Part II

16

Married filing jointly or qualifying widow(er) 150,000 58,000

Married filing separately 75,000 29,000

If line 28 is over the amount shown above for your filing status, see page 6 of the instructions.

15

35

35



(99)

Tax refund from Form 1040, line 10 or line 21 ( )

Investment interest expense (difference between regular tax and AMT) 

Depletion (difference between regular tax and AMT)

Net operating loss deduction from Form 1040, line 21. Enter as a positive amount

Interest from specified private activity bonds exempt from the regular tax

Qualified small business stock (7% of gain excluded under section 1202)

Exercise of incentive stock options (excess of AMT income over regular tax income)

Estates and trusts (amount from Schedule K-1 (Form 1041), line 9)

Electing large partnerships (amount from Schedule K-1 (Form 1065-B), box 6) 

Disposition of property (difference between AMT and regular tax gain or loss)

Depreciation on assets placed in service after 1986 (difference between regular tax and AMT)

Passive activities (difference between AMT and regular tax income or loss)

Loss limitations (difference between AMT and regular tax income or loss) 

Circulation costs (difference between regular tax and AMT)

Long-term contracts (difference between AMT and regular tax income)

22 Mining costs (difference between regular tax and AMT)

23 Research and experimental costs (difference between regular tax and AMT) 

24 Income from certain installment sales before January 1, 1987

25 Intangible drilling costs preference

26 Other adjustments, including income-based related adjustments

27 Alternative tax net operating loss deduction

28 Alternative minimum taxable income. Combine lines 1 through 27. (If married filing separately and line

28 is more than $191,000, see page 6 of the instructions.)

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

( )

( )

● All others: If line 30 is $175,000 or less ($87,500 or less if married filing separately), multiply line 30 by 26% (.26).

Otherwise, multiply line 30 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the result. 

2004
36 Enter the amount from Form 6251, line 30 36

Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax

Worksheet in the instructions for Form 1040, line 43, or the amount from line

13 of the Schedule D Tax Worksheet on page D-9 of the instructions for

Schedule D (Form 1040), whichever applies (as refigured for the AMT, if

necessary) (see page 8 of the instructions)

Enter the amount from Schedule D (Form 1040), line 19 (as refigured for the

AMT, if necessary) (see page 8 of the instructions)

If you did not complete a Schedule D Tax Worksheet for the regular tax or

the AMT, enter the amount from line 37. Otherwise, add lines 37 and 38, and

enter the smaller of that result or the amount from line 10 of the Schedule

D Tax Worksheet (as refigured for the AMT, if necessary)

Subtract line 40 from line 36

If line 41 is $175,000 or less ($87,500 or less if married filing separately), multiply line 41 by 26% (.26).

Otherwise, multiply line 41 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the

result 

Enter the smaller of line 45 or line 46

Add lines 42, 48, 50, and 52

If line 36 is $175,000 or less ($87,500 or less if married filing separately), multiply line 36 by 26% (.26).

Otherwise, multiply line 36 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the

result

Enter the smaller of line 53 or line 54 here and on line 31

37

38

39

40

41

42

43

46

48

54

55

39

40

41

42

47

37

38

Form 6251 (2004) Page 2

Tax Computation Using Maximum Capital Gains Rates

Enter the smaller of line 36 or line 39

Multiply line 49 by 15% (.15) 

Form 6251 (2004)

Part III

49

50

51

Multiply line 47 by 5% (.05) 

52

Enter the smaller of line 36 or line 37

47

46

50

48

Subtract line 47 from line 46

Subtract line 46 from line 40

Multiply line 51 by 25% (.25) 

53

49

If line 38 is zero or blank, skip lines 51 and 52 and go to line 53. Otherwise, go to line 51.

51

52

53

54

55

44



Enter:

● $58,100 if married filing jointly or qualifying widow(er),

● $29,050 if single or married filing separately, or

● $38,900 if head of household.

45 45

44

43

Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax

Worksheet in the instructions for Form 1040, line 43, or the amount from line

14 of the Schedule D Tax Worksheet on page D-9 of the instructions for

Schedule D (Form 1040), whichever applies (as figured for the regular tax). If

you did not complete either worksheet for the regular tax, enter -0-

Subtract line 44 from line 43. If zero or less, enter -0-
OMB No. 1545-0228 Installment Sale Income

Form 6252  Attach to your tax return.

Department of the Treasury

Internal Revenue Service

 Use a separate form for each sale or other disposition of

property on the installment method.

Attachment

Sequence No. 79

Name(s) shown on return Identifying number

Description of property 

Date acquired (month, day, year)  / / Date sold (month, day, year) 

Was the property sold to a related party (see instructions) after May 14, 1980? If “No,” skip line 4 Yes No

Was the property you sold to a related party a marketable security? If “Yes,” complete Part III. If “No,”

complete Part III for the year of sale and the 2 years after the year of sale Yes No

Gross Profit and Contract Price. Complete this part for the year of sale only.

1

Selling price including mortgages and other debts. Do not include interest whether stated or unstated

Mortgages, debts, and other liabilities the buyer assumed or took

the property subject to (see instructions)

2a

3

Subtract line 6 from line 5

4

Cost or other basis of property sold

5 5

Depreciation allowed or allowable

6

6

Adjusted basis. Subtract line 9 from line 8

7 7

Commissions and other expenses of sale

8 8

Income recapture from Form 4797, Part III (see instructions)

9 9

Add lines 10, 11, and 12

10 10

Subtract line 13 from line 5. If zero or less, do not complete the rest of this form (see instructions)

11

If the property described on line 1 above was your main home, enter the amount of your excluded

gain (see instructions). Otherwise, enter -0-

11

12

Gross profit. Subtract line 15 from line 14

12

13

Subtract line 13 from line 6. If zero or less, enter -0-

13

Contract price. Add line 7 and line 17

14 14

Installment Sale Income. Complete this part for the year of sale and any year you receive a payment or

have certain debts you must treat as a payment on installment obligations.

15

Gross profit percentage. Divide line 16 by line 18. For years after the year of sale, see instructions

15

16

If this is the year of sale, enter the amount from line 17. Otherwise, enter -0-

16

17

Payments received during year (see instructions). Do not include interest, whether stated or unstated

17

18

Add lines 20 and 21

18

Payments received in prior years (see instructions). Do not include

interest, whether stated or unstated

19 19

20

Installment sale income. Multiply line 22 by line 19

20

21

Enter the part of line 24 that is ordinary income under the recapture rules (see instructions)

21

Subtract line 25 from line 24. Enter here and on Schedule D or Form 4797 (see instructions)

22 22

Related Party Installment Sale Income. Do not complete if you received the final payment this tax year.

Name, address, and taxpayer identifying number of related party

Did the related party resell or dispose of the property (“second disposition”) during this tax year?

If the answer to question 28 is “Yes,” complete lines 30 through 37 below unless one of the following conditions is

met. Check the box that applies.

The second disposition was more than 2 years after the first disposition (other than dispositions

of marketable securities). If this box is checked, enter the date of disposition (month, day, year)  / /

The first disposition was a sale or exchange of stock to the issuing corporation.

The second disposition was an involuntary conversion and the threat of conversion occurred after the first disposition.

The second disposition occurred after the death of the original seller or buyer.

It can be established to the satisfaction of the Internal Revenue Service that tax avoidance was not a principal purpose

for either of the dispositions. If this box is checked, attach an explanation (see instructions).

23

Selling price of property sold by related party (see instructions)

23

24 24

Enter contract price from line 18 for year of first sale

25 25

Enter the smaller of line 30 or line 31

26 26

Total payments received by the end of your 2004 tax year (see instructions)

27

Subtract line 33 from line 32. If zero or less, enter -0-

28

Multiply line 34 by the gross profit percentage on line 19 for year of first sale

29

Enter the part of line 35 that is ordinary income under the recapture rules (see instructions)

30

Subtract line 36 from line 35. Enter here and on Schedule D or Form 4797 (see instructions)

30

For Paperwork Reduction Act Notice, see page 4. Form 6252 (2004)

Part II

Part I

Part III

Yes No

Cat. No. 13601R

b

a

b

c

d

e

31

32

33

34

35

36

37

31

32

33

34

35

36

37

/ /

2004
OMB No. 1545-0644 Gains and Losses From Section 1256

Contracts and Straddles Form 6781

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 82  Attach to your tax return.

Name(s) shown on tax return Identifying number

A Mixed straddle election

B Straddle-by-straddle identification election

C Mixed straddle account election

D Net section 1256 contracts loss election

Section 1256 Contracts Marked to Market

(a) Identification of account (b) (Loss)

1

2 Add the amounts on line 1 in columns (b) and (c)

4

5

Form 1099-B adjustments. See instructions and attach schedule

Combine lines 3 and 4

If you have a net section 1256 contracts loss and you checked box D above, enter the amount of that loss

to be carried back, as a positive number

6

7 Combine lines 5 and 6

Short-term capital gain or (loss). Multiply line 7 by 40% (.40). Enter here and include on the appropriate line

of Schedule D (see instructions)

8

Long-term capital gain or (loss). Multiply line 7 by 60% (.60). Enter here and include on the appropriate line

of Schedule D (see instructions)

9

Gains and Losses From Straddles. Attach a separate schedule listing each straddle and its components.

Section A—Losses From Straddles

(h) Recognized

loss. If column (f)

is more than (g),

enter difference.

Otherwise, enter

-0-

(f) Loss.

If column (e)

is more than

(d), enter

difference.

Otherwise,

enter -0-

(e) Cost or

other basis

plus

expense of

sale

(g)

Unrecognized

gain on

offsetting

positions

(c) Date 

closed out

or sold

(b) Date 

entered

into or

acquired

(d) Gross

sales price (a) Description of property

10

( )

11a Enter the short-term portion of losses from line 10, column (h), here and include on the appropriate line of

Schedule D (see instructions)

( )

Enter the long-term portion of losses from line 10, column (h), here and include on the appropriate line of

Schedule D (see instructions)

b

Section B—Gains From Straddles

(f) Gain. If column

(d) is more than (e),

enter difference.

Otherwise, enter -0-

12

Enter the short-term portion of gains from line 12, column (f), here and include on the appropriate line of

Schedule D (see instructions)

13a

b Enter the long-term portion of gains from line 12, column (f), here and include on the appropriate line of

Schedule D (see instructions)

Unrecognized Gains From Positions Held on Last Day of Tax Year. Memo Entry Only (see instructions)

(e) Unrecognized gain. 

If column (c) is more 

than (d), enter difference.

Otherwise, enter -0-

(d) Cost or other basis 

as adjusted

(c) Fair market value on last

business day of tax year

14

Form 6781 (2004)

Part I

Part II

Part III

(e) Cost or other

basis plus expense of

sale

(c) Date 

closed out

or sold

(b) Date 

entered

into or

acquired

(d) Gross

sales price (a) Description of property

(a) Description of property (b) Date 

acquired

Cat. No. 13715G

Check all applicable boxes (see instructions).

(c) Gain

Note: If line 5 shows a net gain, skip line 6 and enter the gain on line 7. Partnerships and S corporations, see

instructions.

For Paperwork Reduction Act Notice, see page 4.

13a

11a

11b

13b

3

4

5

6

7

8

9

2004

3 Net gain or (loss). Combine line 2, columns (b) and (c)

2 ( )
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
Mortgage Interest Credit O

Form 8396 (For Holders of Qualified Mortgage Credit Certificates Issued by

State or Local Governmental Units or Agencies) Department of the Treasury 

Internal Revenue Service

A

 Attach to Form 1040. S

Name(s) shown on Form 1040 Your socia

Enter the address of your main home to which the qualified mortgage certificate relates if it is different from the address shown on Form 1040

Current Year Mortgage Interest Credit

Interest paid on the certified indebtedness amount. If someone else (other than your spouse

if filing jointly) also held an interest in the home, enter only your share of the interest paid

1

1

2 

Enter the certificate credit rate shown on your mortgage credit certificate. Do not enter the

interest rate on your home mortgage

2

If line 2 is 20% or less, multiply line 1 by line 2. If line 2 is more than 20%, or you refinanced

your mortgage and received a reissued certificate, see the instructions for the amount to enter.

3

3

4 Enter any 2001 credit carryforward from line 18 of your 2003 Form 8396 4

5 Enter any 2002 credit carryforward from line 16 of your 2003 Form 8396 5

6 Enter any 2003 credit carryforward from line 19 of your 2003 Form 8396 6

7 Add lines 3 through 6 7

8 Enter the amount from Form 1040, line 45 8

9 Enter the total of the amounts from Form 1040, lines 46 through 51 9

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

11

11

12

Current year mortgage interest credit. Enter the smaller of line 7 or line 10. Also include

this amount in the total on Form 1040, line 53, and check box a on that line

12

Mortgage Interest Credit Carryforward to 2005. (Complete only if line 11 is less than li

13 13

Add lines 3 and 4

14 14

Enter the amount from line 7

15

Enter the larger of line 11 or line 12

15

16 16

Subtract line 14 from line 13

17

2003 credit carryforward to 2005. Enter the smaller of line 6 or line 15

17

18 18

Subtract line 16 from line 15

19

2002 credit carryforward to 2005. Enter the smaller of line 5 or line 17

19 2004 credit carryforward to 2005. Subtract line 11 from line 3. If zero or less, enter -0-

Part I

Part II

For Paperwork Reduction Act Notice, see back of form. Cat. No. 62502X 

You must reduce your deduction for home mortgage interest on Schedule A (Form 1040)

by the amount on line 3.

 See instructions on back.
Caution: See the instructions for Worksheets 1, 2, and 3 on pages 7 and 8 before completing Part 

Rental Real Estate Activities With Active Participation (For the definition of active participation

see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.)

Combine lines 3a, 3b, and 3c

Combine lines 1d, 2c, and 3d. If the result is net income or zero, all losses are allowed, including

any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete Form 8582.

Report the losses on the forms and schedules normally used

Note: Enter all numbers in Part II as positive amounts. See page 8 for an example.

Subtract line 7 from line 6

10

Combine lines 1a, 1b, and 1c

Part I

Part II

Part III

O

Passive Activity Loss Limitations Form 8582

 See separate instructions. Department of the Treasury

Internal Revenue Service  Attach to Form 1040 or Form 1041.

A

S

Name(s) shown on return Iden

2004 Passive Activity Loss

1a

Activities with net income (enter the amount from Worksheet 1,

column (a))

1a

1b

Activities with net loss (enter the amount from Worksheet 1,

column (b))

b

1c

Prior years unallowed losses (enter the amount from Worksheet

1, column (c))

c

d 1d

All Other Passive Activities

3a

Activities with net income (enter the amount from Worksheet 3,

column (a))

3a

3b

Activities with net loss (enter the amount from Worksheet 3,

column (b))

b

3c

c

d

Prior years unallowed losses (enter the amount from Worksheet 3,

column (c))

4

4

Special Allowance for Rental Real Estate With Active Participation

5 Enter the smaller of the loss on line 1d or the loss on line 4 5

6 Enter $150,000. If married filing separately, see page 8 6

7 Enter modified adjusted gross income, but not less than zero (see page 8) 7

Note: If line 7 is greater than or equal to line 6, skip lines 8 and

9, enter -0- on line 10. Otherwise, go to line 8.

8 8

9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. If married filing separately, see page 8 9

Enter the smaller of line 5 or line 9 10

Special Allowance for Commercial Revitalization Deductions From Rental Real Esta

12

11

Add the income, if any, on lines 1a and 3a and enter the total

Total losses allowed from all passive activities for 2004. Add lines 10, 14, and 15. See

pages 10 and 11 of the instructions to find out how to report the losses on your tax return

For Paperwork Reduction Act Notice, see page 12 of the instructions. 

3d

Cat. No. 63704F

( )

( )

( )

( )

If line 4 is a loss and: ● Line 1d is a loss, go to Part II. 

(99)

Add lines 2a and 2b

2a Commercial revitalization deductions from Worksheet 2, column (a) 2a

2b

Prior year unallowed commercial revitalization deductions from

Worksheet 2, column (b)

b

c 2c

( )

( )

Commercial Revitalization Deductions From Rental Real Estate Activities

Caution: If your filing status is married filing separately and you lived with your spouse at any time during the yea

Part II or Part III. Instead, go to line 15.

If line 2c is a loss, go to Part III. Otherwise, go to line 15.

Note: Enter all numbers in Part III as positive amounts. See the example for Part II on page 8.

Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions

Enter the loss from line 4

Reduce line 12 by the amount on line 10

Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13

Part IV Total Losses Allowed

13

14

15

16

11

12

13

14

15

16

( 

● Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III. 

● Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III a
Cat. No. 63987I

OMB No. 1545-0984

Form 8586 Low-Income Housing Credit

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to your tax return. Sequence No. 36b

Name(s) shown on return Identifying number

Current Year Credit

1 Number of Forms 8609 attached 

2 Eligible basis of buildings (total from attached Schedules A (Form 8609), line 1) 2

3a Qualified basis of low-income buildings (total from attached Schedules A (Form 8609), line 3) 3a

b Has there been a decrease in the qualified basis of any buildings since the close of the preceding

(i) (ii) (iii) (iv)

4 Current year credit from attached Schedules A (Form 8609) (see instructions) 4

If you are a— Then enter the total of the current year credits from—

a Shareholder Schedule K-1 (Form 1120S), box 13, codes A and B

5 Low-income housing credits from pass-through entities (if more than one entity, see instructions):

5

6 Add lines 4 and 5. See instructions to find out if you complete lines 7 through 18 or file Form 3800 6

Allowable Credit

Form 8586 (2004)

Part I

EIN of pass-through entity

–

7 Current year credit or passive activity credit (see instructions) 7

tax year?

buildings that had a decreased basis. If you need more space, attach a schedule.

Yes No If “Yes,” enter the building identification numbers (BINs) of the

Part II

For Paperwork Reduction Act Notice, see back of form.

b Partner

c Beneficiary

Schedule K-1 (Form 1065), box 15, codes A and B, or

Schedule K-1 (Form 1065-B), box 8

Schedule K-1 (Form 1041), line 14

● Individuals. Enter the amount from Form 1040, line 43

8

Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A,

Part I, line 1; or the applicable line of your return

●

●

11a 11a

b Credits from Form 1040, lines 47 through 53 11b

Foreign tax credit

Possessions tax credit (Form 5735, line 17 or 27)

Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 11a through 11e 11f

12 Net income tax. Subtract line 11f from line 10. If zero, skip lines 13 through 16 and enter -0- on line 17 12

9 Alternative minimum tax:

● Individuals. Enter the amount from Form 6251, line 35

● Corporations. Enter the amount from Form 4626, line 14 9

● Estates and trusts. Enter the amount from Form 1041, Schedule I, line 56

15 Tentative minimum tax (see instructions):

15

13

Enter 25% (.25) of the excess, if any, of line 13 over $25,000 (see instructions)

16

Subtract line 16 from line 12. If zero or less, enter -0-

16

17

Credit allowed for the current year. Enter the smaller of line 7 or line 17 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 17 is smaller than line 7, see instructions 18



8 Regular tax before credits:

10 Add lines 8 and 9 10

14

Enter the greater of line 14 or line 15

c

d

e

11c

11d

Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a

and 1b, or the amount from the applicable line of your return

Net regular tax. Subtract line 11f from line 8. If zero or less, enter -0-

18

17



(99)

11e

f

13

14

 See instructions on back.

● Individuals. Enter the amount from Form 6251, line 33

● Corporations. Enter the amount from Form 4626, line 12

● Estates and trusts. Enter the amount from Form 1041,

Schedule I, line 54

2004

OMB No. 1545-1007

Form 8606 Nondeductible IRAs

 See separate instructions.

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040, Form 1040A, or Form 1040NR. Sequence No. 48

Name. If married, file a separate form for each spouse required to file Form 8606. See page 5 of the instructions. Your social security number

Home address (number and street, or P.O. box if mail is not delivered to your home) Apt. no. Fill in Your Address Only

if You Are Filing This

Form by Itself and Not

With Your Tax Return

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

1

1 Enter your nondeductible contributions to traditional IRAs for 2004, including those made for

2004 from January 1, 2005, through April 15, 2005 (see page 5 of the instructions)

2 Enter your total basis in traditional IRAs (see page 5 of the instructions) 2

3 Add lines 1 and 2

4

3

Enter those contributions included on line 1 that were made from January 1, 2005, through April

15, 2005

5

4

Subtract line 4 from line 3 5

6 Enter the value of all your traditional, SEP, and SIMPLE IRAs as of

December 31, 2004, plus any outstanding rollovers (see page 6 of

the instructions)

8

7

Enter the net amount you converted from traditional, SEP, and SIMPLE

IRAs to Roth IRAs in 2004. Do not include amounts converted that

you later recharacterized (see page 6 of the instructions). Also enter

this amount on line 16

9 9

10

Add lines 6, 7, and 8

10

 .

11

Divide line 5 by line 9. Enter the result as a decimal rounded to at

least 3 places. If the result is 1.000 or more, enter “1.000”

11 Multiply line 8 by line 10. This is the nontaxable portion of the amount

you converted to Roth IRAs. Also enter this amount on line 17

12

12

13

Multiply line 7 by line 10. This is the nontaxable portion of your

distributions that you did not convert to a Roth IRA

13

14

15

Subtract line 13 from line 3. This is your total basis in traditional IRAs for 2004 and earlier

years

Cat. No. 63966F Form 8606 (2004)



In 2004, did you take a

distribution from traditional,

SEP, or SIMPLE IRAs or

make a Roth IRA conversion?

No

Yes

Enter the amount from line 3 on

line 14. Do not complete the rest

of Part I.

Go to line 4.

Taxable amount. Subtract line 12 from line 7. Also include this amount on Form 1040, line 15b;

Form 1040A, line 11b; or Form 1040NR, line 16b





6

For Paperwork Reduction Act Notice, see page 8 of the instructions.

Part I Nondeductible Contributions to Traditional IRAs and Distributions From Traditional, SEP, and SIMPLE IRAs

Complete this part only if:

● You made nondeductible contributions to a traditional IRA for 2004,

● You took distributions from a traditional, SEP, or SIMPLE IRA in 2004 (other than a rollover, conversion,

recharacterization, or return of certain contributions) and you made nondeductible contributions to a traditional IRA

in 2004 or an earlier year, or

● You converted part, but not all, of your traditional, SEP, and SIMPLE IRAs to Roth IRAs in 2004 (excluding any portion

you recharacterized) and you made nondeductible contributions to a traditional IRA in 2004 or an earlier year.

Enter your distributions from traditional, SEP, and SIMPLE IRAs in

2004. Do not include rollovers, conversions to a Roth IRA, certain

returned contributions, or recharacterizations of traditional IRA

contributions (see page 6 of the instructions)

7

Add lines 11 and 12. This is the nontaxable portion of all your distributions

14

8

15

Note: You may be subject to an additional 10% tax on the amount on line 15 if you were under

age 591⁄2 at the time of the distribution (see page 7 of the instructions).

2004

(99)
Form 8606 (2004) Page 2

Under penalties of perjury, I declare that I have examined this form, including accompanying attachments, and to the best of my

knowledge and belief, it is true, correct, and complete. Sign Here Only if You

Are Filing This Form

by Itself and Not With

Your Tax Return  Your signature  Date

Part III

Complete this part if you converted part or all of your traditional, SEP, and SIMPLE IRAs to a Roth IRA in 2004 (excluding

any portion you recharacterized).

17

18

If you completed Part I, enter the amount from line 11. Otherwise, enter your basis in the amount

on line 16 (see page 7 of the instructions)

16

19 Enter your total nonqualified distributions from Roth IRAs in 2004 including any qualified first-time

homebuyer distributions (see page 7 of the instructions)

20 Qualified first-time homebuyer expenses (see page 7 of the instructions). Do not enter more

than $10,000

21 Subtract line 20 from line 19. If zero or less, enter -0- and skip lines 22 through 25

22 Enter your basis in Roth IRA contributions (see page 7 of the instructions)

19

Taxable amount. Subtract line 17 from line 16. Also include this amount on Form 1040,

line 15b; Form 1040A, line 11b; or Form 1040NR, line 16b

Form 8606 (2004)

Caution: If your modified adjusted gross income is over $100,000 or you are married filing separately and you lived with

your spouse at any time in 2004, you cannot convert any amount from traditional, SEP, or SIMPLE IRAs to Roth IRAs

for 2004. If you erroneously made a conversion, you must recharacterize (correct) it (see page 7 of the instructions).

Part II

16 If you completed Part I, enter the amount from line 8. Otherwise, enter the net amount you

converted from traditional, SEP, and SIMPLE IRAs to Roth IRAs in 2004. Do not include amounts

you later recharacterized back to traditional, SEP, or SIMPLE IRAs in 2004 or 2005 (see page 7

of the instructions)

17

18

Distributions From Roth IRAs

Complete this part only if you took a distribution from a Roth IRA in 2004 (other than a rollover, recharacterization, or

return of certain contributions—see page 7 of the instructions).

25 Taxable amount. Subtract line 24 from line 23. If zero or less, enter -0-. Also include this amount

on Form 1040, line 15b; Form 1040A, line 11b; or Form 1040NR, line 16b

20

21

25

2004 Conversions From Traditional, SEP, or SIMPLE IRAs to Roth IRAs

22

24 Enter your basis in Roth IRA conversions (see page 8 of the instructions)

23 Subtract line 22 from line 21. If zero or less, enter -0- and skip lines 24 and 25. If more than

zero, you may be subject to an additional tax (see page 8 of the instructions)

24

23
SCHEDULE A

(Form 8609)

OMB No. 1545-0988 Annual Statement

 Attach to Form 8609 and file with owner’s Federal income tax return.

(Rev. November 2003) Attachment Department of the Treasury

Internal Revenue Service

For Paperwork Reduction Act Notice, see instructions for Form 8609.

A Building owner’s name B Identifying number 

C Building identification number  

1 Eligible basis of building 1

2 .

2 Low-income portion (smaller of unit fraction or floor-space fraction) (if first year of the credit

period, see instructions)

3 Qualified basis of low-income building. Multiply line 1 by line 2 (see instructions for exceptions) 3

4 Part-year adjustment for disposition or acquisition during the tax year 4

5 Credit percentage 5 .

6 Multiply line 3 or line 4 by the percentage on line 5 6

7 Additions to qualified basis, if any 7

8 8

9 9 .

10 Multiply line 7 or line 8 by the percentage on line 9 10

11 Section 42(f)(3)(B) modification 11

12 Add lines 10 and 11 12

13 Credit for building before line 14 reduction. Subtract line 12 from line 6 13

14 Disallowed credit due to Federal grants (see instructions) 14

15

15 Credit allowed for building for tax year. Subtract line 14 from line 13, but do not enter more than

the amount shown on Form 8609, Part I, line 1b

16 Taxpayer’s proportionate share of credit for the year (see instructions) 16

17

18

17 Adjustments for deferred first-year credit (see instructions)

Taxpayer’s credit. Combine lines 16 and 17. Enter here and in Part I of Form 8586

General Instructions

Specific Instructions

Item B. If you are an individual, enter your

social security number. All others, enter your

employer identification number.

Item C. Enter the building identification

number (BIN) from Part I, item E, of

Form 8609.

Purpose of Schedule

Schedule A (Form 8609) must be filed by

the building owner each year of the

15-year compliance period.

Sequence No. 36a

Credit percentage. Enter one-third of the percentage on line 5

Cat No. 10614Q

18

Section references are to the Internal

Revenue Code unless otherwise noted.

Note: Some of the line numbers on the

November 2003, December 1988, and

March 1991 revisions of Form 8609 differ

from other revisions. In these cases, the

line references are shown in parentheses in

these instructions.

Schedule A (Form 8609) (Rev. 11-2003)

Line 1. Generally, the eligible basis of a

building for its entire 15-year compliance

period is the amount of eligible basis

entered on Form 8609, line 7b (Part II, line

1b, on the 1988 and 1991 revisions); line 7

on the 2003 revision.

Basis increases for buildings in certain

high-cost areas. In order to increase the

allocated credit for buildings in certain

high-cost areas, the housing credit agency

may increase the eligible basis of buildings

located in these areas (after adjustments, if

any, for Federal subsidies and grants). The

agency may make this increase under the

high-cost-area provisions of section

42(d)(5)(C).

For a building receiving separate

allocations for the existing building and for

rehabilitation expenditures, file a separate

Schedule A for each credit claimed.

Recapture of Credit

If the qualified basis of the building has

decreased from the qualified basis at the

close of the previous tax year, you may

have to recapture parts of the credits

allowed in previous years. See Form 8611,

Recapture of Low-Income Housing Credit.

If the agency used an earlier revision of

Form 8609 that did not have line 3b in Part

I to issue a 1990 credit allocation to which

the high-cost-area provisions were applied,

it should have notified you of the Part I

percentage increase in a separate

statement. Based on this statement,

The agency shows the increased

percentage of the eligible basis in Part I,

line 3b, of Form 8609. The eligible basis

entered on Form 8609 should reflect the

percentage increase.

Part-year adjustment for disposition or acquisition during the tax year

If the owner is a partnership, S corporation,

estate, or trust (pass-through entity), the

entity will complete and attach Form 8609

and Schedule A to its tax return. If you are a

partner, shareholder, or beneficiary in the

pass-through entity that owns the building,

file only Form 8586, Low-Income Housing

Credit, to claim the credit using the

information that the entity furnishes you on

Schedule K-1.

Do you have in your records the original Form 8609 issued by the housing credit agency (or a copy thereof) for the above

building? Yes No. If “No,” see instructions.

D

Did the above building qualify as a part of a qualified low-income housing project and meet the requirements of section 42

as of the end of your tax year? Yes No. If “No,” see instructions and stop here.

Was there a decrease in the qualified basis of the above building for this tax year? Yes No. If “Yes,” see

instructions. If “No” and the entire credit has been claimed in prior tax years, stop here.

E

F

Item D. You must have an original, signed

Form 8609 (or copy thereof) issued by a

housing credit agency assigning a BIN for

the building in order to claim the credit,

even if no allocation is required (in the

case of a building financed with

tax-exempt bonds). If filing electronically,

you must check “Yes” to certify that you

have the required Form 8609 in your

records. If filing on paper and attaching a

copy of the required Form 8609, please

also answer “Yes.”

Item E. If “No,” stop here and see Form

8611 to find out if you have to recapture

part of the credit allowed in prior years.

Item F. If “Yes,” see the instructions for

line 2 to figure the reduced qualified basis.

Also, see Form 8611 to find out if you have

If “No” and the entire credit has been

claimed in prior tax years (generally this

can occur after the 11th year for which the

credit has been claimed for the building),

do not complete lines 1 through 18.

to recapture part of the credit allowed in

prior years.

Note: Any building owner claiming credit

without receiving a Part I of Form 8609

that is completed, signed, and dated by an

authorized official of the housing credit

agency may have all credits disallowed.
O

Tax for Children Under Age 14

With Investment Income of More Than $1,600 Form 8615

Department of the Treasury

Internal Revenue Service

 Attach only to the child’s Form 1040, Form 1040A, or Form 1040NR.

Child’s name shown on return Child’s socia

Parent’s name (first, initial, and last). Caution: See instructions before completing. Parent’s 

Parent’s filing status (check one):

Child’s Net Investment Income

1 Enter the child’s investment income (see instructions) 1

If the child did not itemize deductions on Schedule A (Form 1040 or Form 1040NR), enter $1,600.

Otherwise, see instructions

2

2

Subtract line 2 from line 1. If zero or less, stop; do not complete the rest of this form but do

attach it to the child’s return

3

3

4

Enter the child’s taxable income from Form 1040, line 42; Form 1040A, line 27; or Form 1040NR,

line 39

4

Enter the smaller of line 3 or line 4. If zero, stop; do not complete the rest of this form but do

attach it to the child’s return

5

5

Tentative Tax Based on the Tax Rate of the Parent

Enter the parent’s taxable income from Form 1040, line 42; Form 1040A, line 27; Form 1040EZ,

line 6; TeleFile Tax Record, line K(1); Form 1040NR, line 39; or Form 1040NR-EZ, line 14. If zero

or less, enter -0-

6

6

Enter the total, if any, from Forms 8615, line 5, of all other children of the parent named

above. Do not include the amount from line 5 above

7

7

8 8 Add lines 5, 6, and 7 (see instructions). 

9

Enter the tax on the amount on line 8 based on the parent’s filing status above (see instructions).

If the Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or

Schedule J (Form 1040) is used to figure the tax, check here 

9

10 Enter the parent’s tax from Form 1040, line 43; Form 1040A, line 28, minus any alternative minimum

tax; Form 1040EZ, line 10; TeleFile Tax Record, line K(2); Form 1040NR, line 40; or Form 1040NR-EZ,

line 15. Do not include any tax from Form 4972 or 8814. If the Qualified Dividends and Capital Gain

Tax Worksheet, Schedule D Tax Worksheet, or Schedule J (Form 1040) was used to figure the tax,

check here  10

Subtract line 10 from line 9 and enter the result. If line 7 is blank, also enter this amount on line

13 and go to Part III

11

11

12a Add lines 5 and 7 12a

b Divide line 5 by line 12a. Enter the result as a decimal (rounded to at least three places) 12b 

13 Multiply line 11 by line 12b 13

Child’s Tax—If lines 4 and 5 above are the same, enter -0- on line 15 and go to line 16.

14 Subtract line 5 from line 4 14

15

15 Enter the tax on the amount on line 14 based on the child’s filing status (see instructions). If the

Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or

Schedule J (Form 1040) is used to figure the tax, check here 

16 Add lines 13 and 15 16

17

17 Enter the tax on the amount on line 4 based on the child’s filing status (see instructions). If the

Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or

Schedule J (Form 1040) is used to figure the tax, check here 

18 Enter the larger of line 16 or line 17 here and on the child’s Form 1040, line 43; Form 1040A,

line 28; or Form 1040NR, line 40 18

For Paperwork Reduction Act Notice, see the instructions. 

A B

C

Single

Cat. No. 64113U

Part III

Part I

Part II

(99)  See separate instructions.

Before you begin: If the child, the parent, or any of the parent’s other children under age 14 must use the 

Worksheet or has income from farming or fishing, see Pub. 929, Tax Rules for Children a

explains how to figure the child’s tax using the Schedule D Tax Worksheet or Schedule 

Married filing jointly Married filing separately Head of household Q
OMB No. 1545-1073

Form 8801

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040, 1040NR, or 1041. Sequence No. 74

Name(s) shown on return Identifying number

Net Minimum Tax on Exclusion Items

1 Combine lines 1, 6, and 10 of your 2003 Form 6251. Estates and trusts, see instructions 1

2 Enter adjustments and preferences treated as exclusion items (see instructions) 2

3 ( ) 3 Minimum tax credit net operating loss deduction (see instructions)

Combine lines 1, 2, and 3. If zero or less, enter -0- here and on line 15 and go to Part II. If more

than $191,000 and you were married filing separately for 2003, see instructions

4

4

5

Enter: $58,000 if married filing jointly or qualifying widow(er) for 2003; $40,250 if single or head

of household for 2003; or $29,000 if married filing separately for 2003. Estates and trusts, enter

$22,500

5

6

Enter: $150,000 if married filing jointly or qualifying widow(er) for 2003; $112,500 if single or head

of household for 2003; or $75,000 if married filing separately for 2003. Estates and trusts, enter

$75,000

6

7 Subtract line 6 from line 4. If zero or less, enter -0- here and on line 8 and go to line 9 7

8 Multiply line 7 by 25% (.25) 8

9

9 Subtract line 8 from line 5. If zero or less, enter -0-. If this form is for a child under age 14, see

instructions

10

Subtract line 9 from line 4. If zero or less, enter -0- here and on line 15 and go to Part II. Form

1040NR filers, see instructions

10

11

11 ● If for 2003 you reported capital gain distributions directly on Form 1040, line 13a; you reported

qualified dividends on Form 1040, line 9b (Form 1041, line 2b(2)); or you had a gain on both lines

16 and 17a of Schedule D (Form 1040) (lines 15a and 16a, column (2), of Schedule D (Form 1041)),

complete Part III of Form 8801 and enter the amount from line 58 here.

Minimum tax foreign tax credit on exclusion items (see instructions) 12

13

14

Tentative minimum tax on exclusion items. Subtract line 12 from line 11

14

15

Enter the amount from your 2003 Form 6251, line 34, or 2003 Form 1041, Schedule I, line 55

15 Net minimum tax on exclusion items. Subtract line 14 from line 13. If zero or less, enter -0-

16 16

Minimum Tax Credit and Carryforward to 2005

Enter the amount from your 2003 Form 6251, line 35, or 2003 Form 1041, Schedule I, line 56

17 17

18

Enter the amount from line 15 above

18

19

Subtract line 17 from line 16. If less than zero, enter as a negative amount

19

20

2003 minimum tax credit carryforward. Enter the amount from your 2003 Form 8801, line 26

20 Enter the total of your 2003 unallowed nonconventional source fuel credit and 2003 unallowed

qualified electric vehicle credit (see instructions)

21 21

22

Combine lines 18, 19, and 20. If zero or less, stop here and see instructions

22

23

Enter your 2004 regular income tax liability minus allowable credits (see instructions)

23

24 24

Enter the amount from your 2004 Form 6251, line 33, or 2004 Form 1041, Schedule I, line 54

25

Subtract line 23 from line 22. If zero or less, enter -0-

25

26

Minimum tax credit. Enter the smaller of line 21 or line 24. Also enter this amount on your 2004

Form 1040, line 54; Form 1040NR, line 49; or Form 1041, Schedule G, line 2d

26

Minimum tax credit carryforward to 2005. Subtract line 25 from line 21. Keep a record of this

amount because you may use it in future years

Cat. No. 10002S

Part II

Part I

Credit for Prior Year Minimum Tax—

Individuals, Estates, and Trusts

For Paperwork Reduction Act Notice, see page 4. Form 8801 (2004)

(99)

 See instructions on pages 3 and 4.

● All others: If line 10 is $175,000 or less ($87,500 or less if married filing separately for

2003), multiply line 10 by 26% (.26). Otherwise, multiply line 10 by 28% (.28) and subtract

$3,500 ($1,750 if married filing separately for 2003) from the result.

12

13



2004
Tax Computation Using Maximum Capital Gains Rates

27 Enter the amount from Form 8801, line 10 27

28

Enter the amount from line 26 of your 2003 Schedule D (Form 1040) (line 23 of the

2003 Schedule D (Form 1041)) or line 13 of your 2003 Schedule D Tax Worksheet*

28

29

Enter the amount from line 19 of your 2003 Schedule D (Form 1040),

or line 15d, column (2), of the 2003 Schedule D (Form 1041)

29

30

If you did not complete the 2003 Schedule D Tax Worksheet, enter the amount from

line 28. Otherwise, add lines 28 and 29, and enter the smaller of that result or the

amount from line 10 of your 2003 Schedule D Tax Worksheet

30

31

32

Enter the smaller of line 27 or line 30

32

33

Subtract line 31 from line 27

33

34

If line 32 is $175,000 or less ($87,500 or less if married filing separately for 2003), multiply line 32 by 26% (.26).

Otherwise, multiply line 32 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately for 2003) from the

result 

34

Enter:

● $56,800 if married filing jointly or qualifying widow(er) for 2003,

● $28,400 if single or married filing separately for 2003,

● $38,050 if head of household for 2003, or

● $1,900 for an estate or trust

37 Enter the smaller of line 27 or line 28 37

40

38

Form 8801 (2004) Page 2

Part III

41

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

your 2003 Schedule D (Form 1040), line 35

(2003 Schedule D (Form 1041), line 32)

42

Enter the smaller of line 38 or line 39. If line 38 is zero, go to line 48

Multiply line 40 by 5% (.05) 

Subtract line 40 from line 38. If zero or less, enter -0- and go to line 48

48

Subtract line 37 from line 31

49

Multiply line 54 by 25% (.25) 

Add lines 33, 41, 45, 47, 51, 53, and 55

39

42

46

53

51

Caution: If you did not complete Part IV of the 2003 Schedule D (Form 1040) (or Part V of the 2003 Schedule

D (Form 1041)) or the 2003 Schedule D Tax Worksheet, see the instructions before completing this part.

If line 29 is zero or blank, skip lines 54 and 55 and go to line 56. Otherwise, go to line 54.

Form 8801 (2004)

Enter the smaller of line 36 or line 37

45 Multiply line 44 by 8% (.08)  45

46 Subtract line 44 from line 42

47 Multiply line 46 by 10% (.10)  47

44

* The 2003 Schedule D Tax Worksheet is on page D-11 of the 2003 Instructions for Schedule D (Form 1040) (page 37 of the 2003 Instructions for Form 1041).

38

50

If line 27 is $175,000 or less ($87,500 or less if married filing separately), multiply line 27 by 26%

(.26). Otherwise, multiply line 27 by 28% (.28) and subtract $3,500 ($1,750 if married filing

separately) from the result

Enter the smaller of line 56 or line 57 here and on line 11 58

31

43

41

If you did not complete the 2003 Schedule D Tax Worksheet, enter the amount from

your 2003 Schedule D (Form 1040), line 43 (or 2003 Schedule D (Form 1041), line 40)

(or if that line is blank, the amount from your 2003 Schedule D (Form 1040), line 31 (or

2003 Schedule D (Form 1041), line 28)). Otherwise, enter the amount from line 32 of

the Schedule D Tax Worksheet* (or if that line is blank, the amount from line 20 of that

worksheet).

Enter the smaller of line 42 or line 43

Subtract line 40 from line 39

44

Subtract line 38 from line 37

Enter the smaller of line 48 or line 49

Multiply line 50 by 15% (.15) 

Subtract line 50 from line 49

Multiply line 52 by 20% (.20) 

39

40

43

48

49

50

52

55

54

56

57

51

52

53

54

55

56

58

57

35 Enter the amount from line 27 of your 2003 Schedule D (Form 1040) (line 24 of the

2003 Schedule D (Form 1041)) or line 14 of the 2003 Schedule D Tax Worksheet*,

whichever applies. If you did not complete either Part IV of the 2003 Schedule D

(Form 1040) (or Part V of the 2003 Schedule D (Form 1041)) or the 2003 Schedule

D Tax Worksheet, enter -0- 35

36 Subtract line 35 from line 34. If zero or less, enter -0- 36
Additional Child Tax Credit Form 8812

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

Internal Revenue Service

Name(s) shown on return Your social 

For Paperwork Reduction Act Notice, see back of form. 

Cat. No. 10644E

3

2

4a

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

30 and 58, plus any uncollected social security and

Medicare or tier 1 RRTA taxes included on line 62.

Enter -0-.

Enter the total of the amounts from Form 1040, lines

65a and 66.

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

41a, 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 1 of your Child Tax Credit Worksheet on page 38 of the Form 1040 instructions

or page 37 of the Form 1040A instructions. If you used Pub. 972, enter the amount from line 8 of the

worksheet on page 4 of the publication

Enter the amount from Form 1040, line 51, 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 t

Form 1

Form 1





8812

1040

1040A

. . . . . . . . . .

3

Enter your total earned income. See the instructions on back

5 Is the amount on line 4a more than $10,750?

No.

Yes. Subtract $10,750 from the amount on line 4a. Enter the result

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

4a

5

Multiply the amount on line 5 by 15% (.15) 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.

(99)

b Nontaxable combat pay included on line 4a 4b
OMB No. 1545-1128 Parents’ Election To Report

Child’s Interest and Dividends Form 8814

 See instructions on back. Department of the Treasury

Internal Revenue Service

Attachment

 Attach to parents’ Form 1040 or Form 1040NR. Sequence No. 40

Name(s) shown on your return Your social security number

Child’s name (first, initial, and last) Child’s social security number

If more than one Form 8814 is attached, check here 

Child’s Interest and Dividends To Report on Your Return

Enter your child’s taxable interest. If this amount is different from the amounts shown on the

child’s Forms 1099-INT and 1099-OID, see the instructions

1a

1a

b Enter your child’s tax-exempt interest. Do not include this

amount on line 1a 1b

2 Enter your child’s ordinary dividends, including any Alaska Permanent Fund dividends. If your

child received any ordinary dividends as a nominee, see the instructions

Enter your child’s capital gain distributions. If your child received any capital gain distributions

as a nominee, see the instructions

Add lines 1a, 2, and 3. If the total is $1,600 or less, skip lines 5 and 6 and go to line 7. If the

total is $8,000 or more, do not file this form. Your child must file his or her own return to report

the income

3

1,600 00

4

Base amount

4

5

Subtract line 5 from line 4. See the instructions for where to report this amount. Go to line 7

below  6

Tax on the First $1,600 of Child’s Interest and Dividends

Amount not taxed 800 00

9

7 7

Subtract line 7 from line 4. If the result is zero or less, enter -0-

No. Enter $80 here and see the Note below.

Tax. Is the amount on line 8 less than $800?

8 8

Yes. Multiply line 8 by 10% (.10). Enter the result here and see the Note below.

Note: If you checked the box on line C above, see the instructions. Otherwise, include the amount from line 9 in the tax you enter

on Form 1040, line 43, or Form 1040NR, line 40. Be sure to check box a on Form 1040, line 43, or Form 1040NR, line 40.

For Paperwork Reduction Act Notice, see page 3. Cat. No. 10750J Form 8814 (2004)



A B

C

3

6

2

5

Part I

Part II

9

Caution: The Federal income tax on your child’s income, including qualified dividends and capital gain distributions, may be less

if you file a separate tax return for the child instead of making this election. This is because you cannot take certain tax benefits

that your child could take on his or her own return. For details, see Tax benefits you may not take on page 2.

2004
Exclusion of Interest From Series EE and I 

U.S. Savings Bonds Issued After 1989 Form 8815

(For Filers With Qualified Higher Education Expenses)

 Attach to Form 1040 or Form 1040A.

Department of the Treasury

Internal Revenue Service 

Name(s) shown on return Your soc

(a)

Name of person (you, your spouse, or your dependent) who

was enrolled at or attended an eligible educational institution

1 (b)

Name and address of eligible educational ins

If you need more space, attach a statement.

Enter the total qualified higher education expenses you paid in 2004 for the person(s) listed in

column (a) of line 1. See the instructions to find out which expenses qualify

2

2

Enter the total of any nontaxable educational benefits (such as nontaxable scholarship or

fellowship grants) received for 2004 for the person(s) listed in column (a) of line 1 (see instructions)

3

3

4 Subtract line 3 from line 2. If zero or less, stop. You cannot take the exclusion 4

5 Enter the total proceeds (principal and interest) from all series EE and I U.S. savings bonds

issued after 1989 that you cashed during 2004 5

6 Enter the interest included on line 5 (see instructions) 6

If line 4 is equal to or more than line 5, enter “1.000.” If line 4 is less than line 5, divide line 4

by line 5. Enter the result as a decimal (rounded to at least three places)

7

7 

8 Multiply line 6 by line 7 8

9 Enter your modified adjusted gross income (see instructions) 9

Note: If line 9 is $74,850 or more if single or head of household, or

$119,750 or more if married filing jointly or qualifying widow(er), stop.

You cannot take the exclusion.

10

Enter: $59,850 if single or head of household; $89,750 if married filing

jointly or qualifying widow(er)

10

Subtract line 10 from line 9. If zero or less, skip line 12, enter -0- on

line 13, and go to line 14

11

11

Divide line 11 by: $15,000 if single or head of household; $30,000 if married filing jointly or

qualifying widow(er). Enter the result as a decimal (rounded to at least three places)

12

12 

13 Multiply line 8 by line 12 13

14 Excludable savings bond interest. Subtract line 13 from line 8. Enter the result here and on

Schedule B (Form 1040), line 3, or Schedule 1 (Form 1040A), line 3, whichever applies  14

Cat. No. 10822S 

Purpose of Form

1. You cashed qualified U.S. savings bonds in 2004 that were

issued after 1989.

2. You paid qualified higher education expenses in 2004 for

yourself, your spouse, or your dependents.

3. Your filing status is any status except married filing separately.

4. Your modified AGI (adjusted gross income) is less than: $74,850

if single or head of household; $119,750 if married filing jointly or

qualifying widow(er). See the instructions for line 9 to figure your

modified AGI.

U.S. Savings Bonds That Qualify for E

Who May Take the Exclusion

If you cashed series EE or I U.S. savings bonds in 2004 that were

issued after 1989, you may be able to exclude from your income

part or all of the interest on those bonds. Use this form to figure the

amount of any interest you may exclude.

You may take the exclusion if all four of the following apply.

To qualify for the exclusion, the bonds must be s

savings bonds issued after 1989 in your name, o

they may be issued in your name and your spous

must have been age 24 or older before the bond

bond bought by a parent and issued in the name 

under age 24 does not qualify for the exclusion b

child.

Section references are to the Internal Revenue Code.

General Instructions

For Paperwork Reduction Act Notice, see back of form.

Recordkeeping Requirements

● A written record of each post-1989 series EE o

cash. Your record must include the serial numbe

value, and total redemption proceeds (principal a

bond. You may use Form 8818, Optional Form T

Redemption of Series EE and I U.S. Savings Bon

1989.

● Bills, receipts, canceled checks, or other docu

paid qualified higher education expenses in 2004

Keep the following records to verify interest you 

(99)
Like-Kind Exchanges

Form 8824

(and section 1043 conflict-of-interest sales)

Department of the Treasury

Internal Revenue Service  Attach to your tax return. 

Name(s) shown on tax return Identifying 

Information on the Like-Kind Exchange

1 Description of like-kind property given up 

2 Description of like-kind property received 

3 Date like-kind property given up was originally acquired (month, day, year) 3 

4 Date you actually transferred your property to other party (month, day, year) 4 

5 

Date like-kind property you received was identified by written notice to another party (see

instructions for 45-day written notice requirement) (month, day, year)

5

6 Date you actually received the like-kind property from other party (month, day, year) (see instructions) 6 

7 Was the exchange of the property given up or received made with a related party, either directly or indirect

(such as through an intermediary) (see instructions)? If “Yes,” complete Part II. If “No,” go to Part III

8 Name of related party Related pa

Address (no., street, and apt., room, or suite no., city or town, state, and ZIP code)

Relationship to you

During this tax year (and before the date that is 2 years after the last transfer of property that was part of th

exchange), did the related party directly or indirectly (such as through an intermediary) sell or dispose of an

part of the like-kind property received from you in the exchange?

9

During this tax year (and before the date that is 2 years after the last transfer of property that was part of th

exchange), did you sell or dispose of any part of the like-kind property you received?

10

If both lines 9 and 10 are “No” and this is the year of the exchange, go to Part III. If both lines 9 and 10 are “No” 

year of the exchange, stop here. If either line 9 or line 10 is “Yes,” complete Part III and report on this year’s tax 

gain or (loss) from line 24 unless one of the exceptions on line 11 applies.

11 If one of the exceptions below applies to the disposition, check the applicable box:

The disposition was after the death of either of the related parties.

The disposition was an involuntary conversion, and the threat of conversion occurred after the exchan

You can establish to the satisfaction of the IRS that neither the exchange nor the disposition had tax 

principal purpose. If this box is checked, attach an explanation (see instructions).

Caution: If you transferred and received (a) more than one group of like-kind properties or (b) cash or other (not 

see Reporting of multi-asset exchanges in the instructions.

Note: Complete lines 12 through 14 only if you gave up property that was not like-kind. Otherwise, go to 

12 Fair market value (FMV) of other property given up 12

13 Adjusted basis of other property given up 13

Gain or (loss) recognized on other property given up. Subtract line 13 from line 12. Report the

gain or (loss) in the same manner as if the exchange had been a sale

14

14

15 Cash received, FMV of other property received, plus net liabilities assumed by other party, reduced

(but not below zero) by any exchange expenses you incurred (see instructions) 15

16 FMV of like-kind property you received 16

17 Add lines 15 and 16 17

Adjusted basis of like-kind property you gave up, net amounts paid to other party, plus any

exchange expenses not used on line 15 (see instructions)

18

18

19 Realized gain or (loss). Subtract line 18 from line 17 19

20 Enter the smaller of line 15 or line 19, but not less than zero 20

21 Ordinary income under recapture rules. Enter here and on Form 4797, line 16 (see instructions) 21

Basis of like-kind property received. Subtract line 15 from the sum of lines 18 and 23

22

22

For Paperwork Reduction Act Notice, see page 4. Cat. No. 12311A 

Part I

Realized Gain or (Loss), Recognized Gain, and Basis of Like-Kind Property Received

Note: If the property described on line 1 or line 2 is real or personal property located outside the United States, in

23

24 Deferred gain or (loss). Subtract line 23 from line 19. If a related party exchange, see instructions

Subtract line 21 from line 20. If zero or less, enter -0-. If more than zero, enter here and on Schedule

D or Form 4797, unless the installment method applies (see instructions)

Recognized gain. Add lines 21 and 22

25

23

24

25

a

b

c

Part III

Part II Related Party Exchange Information
OMB No. 1545-1444

Form 8844 Empowerment Zone and Renewal

Community Employment Credit

Department of the Treasury

Internal Revenue Service  Attach to your tax return. Attachment

Sequence No. 99

Name(s) shown on return Identifying number

Current Year Credit

1 Enter the total qualified wages paid or incurred during calendar year 2004 only (see instructions)

2 2

If you are a— Then enter the total of the current year credits from—

Schedule K-1 (Form 1120S), box 13, code G, H, or M

Schedule K-1 (Form 1065), box 15, code G, H, or M

Schedule K-1 (Form 1041), line 14

Written statement from cooperative

a Shareholder

b Partner

c Beneficiary

d Patron

5

5

6 6

7

9

Part I



Cat. No. 16145S

3

4

3

4

Add lines 1a and 1b. You must subtract this amount from your deduction for salaries and wages

Form 8844

credits from

pass-through

entities:

Add lines 2 and 3

Empowerment zone and renewal community employment credit included on line 4 from passive

activities (see instructions)

Subtract line 5 from line 4

Passive activity credit allowed for 2004 (see instructions)

Carryback of empowerment zone and renewal community employment credit from 2005 (see instructions)

Current year credit. Add lines 6 through 9. (S corporations, partnerships, estates, trusts, and

cooperatives, see instructions.)

10

10

9

7

For Paperwork Reduction Act Notice, see page 4. Form 8844 (2004)

8 Carryforward of empowerment zone and renewal community employment credit to 2004 8

Part II Allowable Credit

● Individuals. Enter the amount from Form 1040, line 43

11 Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A,

Part I, line 1; or the applicable line of your return

●

●

14a 14a

b Credits from Form 1040, lines 47 through 53 14b

14d

Foreign tax credit

d

e 14e

Possessions tax credit (Form 5735, line 17 or 27)

f

Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 14a through 14e 14f

Net income tax. Subtract line 14f from line 13. If zero, skip lines 16 through 22 and enter -0- on line 23 15

Alternative minimum tax:

12

Tentative minimum tax (see instructions)

16

11

Enter 25% (.25) of the excess, if any, of line 16 over $25,000 (see instructions)

13

20

c 14c

Regular tax before credits:

13

12

Enter the greater of line 18 or line 19

18

19

Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a and

1b, or the amount from the applicable line of your return

Net regular tax. Subtract line 14f from line 11. If zero or less, enter -0-

15



16

Multiply line 17 by 75% (.75)

17

18

19

20

17

a Qualified empowerment zone wages

b Qualified renewal community wages

1a

1b

$ X 20% (.20)

$ X 15% (.15)

Subtract line 20 from line 15. If zero or less, enter -0-

24

21

General business credit (see instructions)

Subtract line 22 from line 21

21

22

23

24

22

23

Credit allowed for the current year. Enter the smaller of line 10 or line 23 here and on Form 1040, line 54; Form

1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule G, line 2c; or the applicable line of your

return. If line 23 is smaller than line 10, see instructions

Add lines 11 and 12

Individuals. Enter the amount from Form 6251, line 35

Corporations. Enter the amount from Form 4626, line 14

Estates and trusts. Enter the amount from Form 1041, Schedule I, line 56

●

●

● 

2004
OMB No. 1545-1561 Archer MSAs and

Long-Term Care Insurance Contracts Form 8853

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Name(s) shown on Form 1040

Cat. No. 24091H Form 8853 (2004)

Archer MSA contributions you made for 2004, including those made from January 1, 2005, through

April 15, 2005, that were for 2004. Do not include rollovers (see page 4 of the instructions)

Archer MSA Distributions

8a Total distributions you and your spouse received in 2004 from all Archer MSAs (see page 4 of

the instructions)

Unreimbursed qualified medical expenses (see page 4 of the instructions)

c

11a

Taxable Archer MSA distributions. Subtract line 9 from line 8c. If zero or less, enter -0-. Also

include this amount in the total on Form 1040, line 21. On the dotted line next to line 21, enter

“MSA” and the amount 10

Limitation from the worksheet on page 3 of the instructions

Compensation (see page 3 of the instructions) from the employer maintaining the high deductible

health plan. (If self-employed, enter your earned income from the trade or business under which

the high deductible health plan was established.) 

Archer MSA deduction. Enter the smallest of line 4, 5, or 6. Also include this amount in the

total on Form 1040, line 35. On the dotted line next to line 35, enter “MSA” and the amount

6

7

5

7

8a

8b

Attachment

Sequence No. 39

Caution: If line 4 is more than line 7, you may have to pay an additional tax (see page 4 of the instructions).

b

Section A. Archer MSAs. If you have only a Medicare Advantage MSA, skip Section A and complete Section B.

For Paperwork Reduction Act Notice, see page 8 of the instructions.

4

5

6

 See separate instructions.

If any of the distributions included on line 10 meet any of the Exceptions to the Additional

15% Tax (see page 4 of the instructions), check here 

Additional 15% tax (see page 4 of the instructions). Enter 15% (.15) of the distributions included

on line 10 that are subject to the additional 15% tax. Also include this amount in the total on

Form 1040, line 62. On the dotted line next to line 62, enter “MSA” and the amount

4

If you are filing jointly and both you and your spouse have high deductible health plans with self-only

coverage, complete a separate Part II for each spouse (see page 2 of the instructions).

Archer MSA Contributions and Deductions. See page 2 of the instructions before completing this part.

Distributions included on line 8a that you rolled over to another Archer MSA or a health savings account.

Also include any excess contributions (and the earnings on those excess contributions) included on

line 8a that were withdrawn by the due date of your return (see page 4 of the instructions)

Subtract line 8b from line 8a 8c

9 9

10

b

11b

Social security number of MSA

account holder. If both spouses

have MSAs, see page 1 of the instructions 

3 Total employer contributions to your Archer MSA(s) for 2004

Section B. Medicare Advantage MSA Distributions. If you are filing jointly and both you and your spouse received

distributions in 2004 from a Medicare Advantage MSA, complete a separate Section B for each spouse

(see page 5 of the instructions).

Total distributions you received in 2004 from all Medicare Advantage MSAs (see page 5 of the

instructions)

Unreimbursed qualified medical expenses (see page 5 of the instructions)

Taxable Medicare Advantage MSA distributions. Subtract line 13 from line 12. If zero or less,

enter -0-. Also include this amount in the total on Form 1040, line 21. On the dotted line next

to line 21, enter “Med MSA” and the amount

Additional 50% tax (see page 5 of the instructions). Also include this amount in the total on

Form 1040, line 62. On the dotted line next to line 62, enter “Med MSA” and the amount

If any of the distributions included on line 14 meet any of the Exceptions to the Additional

50% Tax (see page 5 of the instructions), check here 

12

13

14

15a

b

12

13

14

15b

3

2004

(99)

Part I

1a Did you or your employer make contributions to your Archer MSA for 2004?

b

c

2a

b

c

If “Yes,” were you uninsured when the MSA was established (see page 2 of the instructions)?

If line 1a is “Yes,” indicate coverage under high deductible health plan: Self-Only or Family

If “Yes,” was your spouse uninsured when the MSA was established (see page 2 of the instructions)?

If line 2a is “Yes,” indicate coverage under high deductible health plan: Self-Only or Family

If married, did your spouse or spouse’s employer make contributions to your spouse’s Archer MSA for 2004?

1a

1b

2a

2b

Part II

Part III

Yes No

General Information. See page 2 of the instructions.
23

19

21

28

Section C. Long-Term Care (LTC) Insurance Contracts. See Filing Requirements for Section C on page 6 of

the instructions before completing this section.

16a Name of insured 

In 2004, did anyone other than you receive payments on a per diem or other periodic basis under a qualified

LTC insurance contract covering the insured or receive accelerated death benefits under a life insurance

policy covering the insured?

Was the insured a terminally ill individual? Yes No

17

Gross LTC payments received on a per diem or other periodic basis. Enter the total of the amounts

from box 1 of all Forms 1099-LTC you received with respect to the insured on which the “Per

diem” box in box 3 is checked

18

Accelerated death benefits received on a per diem or other periodic basis. Do not include any

amounts you received because the insured was terminally ill (see page 7 of the instructions)

19

Add lines 20 and 21

Note: If you checked “Yes” on line 17 above, see Multiple Payees

on page 7 of the instructions before completing lines 23 through 27.

20

Multiply $230 by the number of days in the LTC period

21

Costs incurred for qualified LTC services provided for the insured

during the LTC period (see page 7 of the instructions)

22

Enter the larger of line 23 or line 24

23

Reimbursements for qualified LTC services provided for the insured

during the LTC period

24

Per diem limitation. Subtract line 26 from line 25

Taxable payments. Subtract line 27 from line 22. If zero or less, enter -0-. Also include this

amount in the total on Form 1040, line 21. On the dotted line next to line 21, enter “LTC” and

the amount

Form 8853 (2004) Page 2

Yes No

22

24

26

Name of policyholder (as shown on Form 1040)

Note: If “Yes” and the only payments you received in 2004 were accelerated death benefits that were paid

to you because the insured was terminally ill, skip lines 19 through 27 and enter -0- on line 28.

b Social security number of insured 

25

Enter the part of the amount on line 19 that is from qualified LTC insurance contracts 20

Caution: If you received any reimbursements from LTC contracts

issued before August 1, 1996, see page 7 of the instructions.

Social security number

of policyholder 

27

Attachment Sequence No. 39

Caution: Do not use lines 20 through 28 to figure the taxable amount of benefits paid under an

LTC insurance contract that is not a qualified LTC insurance contract. Instead, if the benefits

are not excludable from your income (for example, if the benefits are not paid for personal injuries

or sickness through accident or health insurance), report the amount not excludable as income

on Form 1040, line 21.

25

26

27

28

Form 8853 (2004)

If more than one Section C is attached, check here 
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 (2004)

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

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: $105,000 if married filing jointly; $52,000 if single, head of

household, or qualifying widow(er)

Enter the amount from Form 1040, line 37*, 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 45, or Form 1040A, line 28 

18

Subtract line 16 from line 15. If zero or less, stop; you cannot take any education

credits 

Education credits. Enter the smaller of line 14 or line 17 here and on Form 1040,

line 49, or Form 1040A, line 31 

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

* If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter.

 Attach to Form 1040 or Form 1040A.

Last name

First name

Caution: You cannot take both an education credit and the tuition and fees deduction (Form 1040, line 27, or Form 1040A, 

line 19) for the same student in the same year.

2004

17

18

16

17

Enter the total, if any, of your credits from Form 1040, lines 46 through 48, or Form

1040A, lines 29 and 30

(99)
OMB No. 1545-1805

8880 Credit for Qualified Retirement Savings Contributions Form

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 129

 Attach to Form 1040 or Form 1040A. 

Name(s) shown on return Your social security number

For Paperwork Reduction Act Notice, see back of form. Form 8880 (2004)

Cat. No. 33394D

● The amount on Form 1040, line 37, or Form 1040A, line 22, is more than $25,000 ($37,500 if head of household;

$50,000 if married filing jointly).

You cannot take this credit if either of the following applies.

4

1

Traditional and Roth IRA contributions for 2004. Do not include rollover

contributions

1

3

2

5

6

7

8

9

10

11

12

13

14

Elective deferrals to a 401(k) or other qualified employer plan, voluntary

employee contributions, and 501(c)(18)(D) plan contributions for 2004

(see instructions) 

2

3 Add lines 1 and 2

Certain distributions received after 2001 and before the due date

(including extensions) of your 2004 tax return (see instructions). If

married filing jointly, include both spouses’ amounts in both columns.

See instructions for an exception 

4

5 Subtract line 4 from line 3. If zero or less, enter -0-

6 In each column, enter the smaller of line 5 or $2,000 

8 Enter the amount from Form 1040, line 37*, or Form 1040A, line 22

9 Enter the applicable decimal amount shown below:

Note: If line 9 is zero, stop; you cannot take this credit.

10 Multiply line 7 by line 9 

11 Enter the amount from Form 1040, line 45, or Form 1040A, line 28

Enter the total of your credits from Form 1040, lines 46 through 49, or

Form 1040A, lines 29 through 31

12

13 Subtract line 12 from line 11. If zero, stop; you cannot take this credit 

Credit for qualified retirement savings contributions. Enter the smaller of line 10 or line

13 here and on Form 1040, line 50, or Form 1040A, line 32

14

(a) You (b) Your spouse

● The person(s) who made the qualified contribution or elective deferral (a) was born after January 1, 1987, (b) is

claimed as a dependent on someone else’s 2004 tax return, or (c) was a student (see instructions).

7 Add the amounts on line 6. If zero, stop; you cannot take this credit 

*See Pub. 590 for the amount to enter if you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico.

If line 8 is— 

Enter on line 9—

Single, Married filing 

separately, or 

Qualifying widow(er)

Over— But not 

over—

Married 

filing jointly

Head of 

household

---

$15,000

$16,250

$22,500

$24,375

$25,000

$30,000

$32,500

$37,500

$50,000

$15,000

$16,250

$22,500

$24,375

$25,000

$30,000

$32,500

$37,500

$50,000

---

.5

.5

.5

.5

.5

.5

.2

.1

.1

.0

.5

.5

.5

.2

.1

.1

.1

.1

.0

.0

.5

.2

.1

.1

.1

.0

.0

.0

.0

.0

X .

And your filing status is—

 See instructions on back.

2004

CAUTION
O

Form 8884 New York Liberty Zone

Department of the Treasury

Internal Revenue Service  Attach to your tax return. 

Name(s) shown on return Identifying n

Current Year Credit (Members of a controlled group, see instructions.)

1 Enter the total qualified wages paid or incurred during the tax year to New York (NY) Liberty

Zone business employees for work performed during calendar year 2002 or 2003 who have:

1a

2 Add lines 1a and 1b. You must subtract this amount from your deduction for salaries and wages 2

If you are a— Then enter the NY Liberty Zone business employee credits from—

Schedule K-1 (Form 1120S), box 13, code G, H, or N

Schedule K-1 (Form 1065), box 15, code G, H, or N

Schedule K-1 (Form 1041), line 14

Written statement from cooperative

a Shareholder

b Partner

c Beneficiary

d Patron

NY Liberty Zone

business

employee credits

from pass-through

entities:

3

3

4 Add lines 2 and 3 4

Allowable Credit

Part I

Part II



Cat. No. 33946Z

Worked for you at least 120 hours but fewer than 400 hours $  25% (.25) =

Worked for you at least 400 hours $  40% (.40) =

a

b 1b

For Paperwork Reduction Act Notice, see page 4.

● Individuals. Enter the amount from Form 1040, line 43

11

Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A,

Part I, line 1; or the applicable line of your return

●

●

14a 14a

b Credits from Form 1040, lines 47 through 53 14b

Foreign tax credit

Possessions tax credit (Form 5735, line 17 or 27)

Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 14a through 14e 14f

Net income tax. Subtract line 14f from line 13. If zero, skip lines 16 through 19 and enter -0- on line 20 15

11

Alternative minimum tax:

● Individuals. Enter the amount from Form 6251, line 35

● Corporations. Enter the amount from Form 4626, line 14 12

● Estates and trusts. Enter the amount from Form 1041, Schedule I, line 56

Enter 25% (.25) of the excess, if any, of line 16 over $25,000 (see instructions)

16

Credit allowed for the current year. Enter the smaller of line 10 or line 20 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 20 is smaller than line 10, see instructions 21



10

Regular tax before credits:

12

Add lines 11 and 12 13

15

16

17

c

d

e

14c

14d

Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a

and 1b, or the amount from the applicable line of your return

Net regular tax. Subtract line 14f from line 11. If zero or less, enter -0-



20

14e

f

Business Employee Credit

NY Liberty Zone business employee credit included on line 4 from passive activities (see

instructions)

5

6 Subtract line 5 from line 4 6

7 NY Liberty Zone business employee passive activity credit allowed for 2004 (see instructions) 7

8

Carryback of NY Liberty Zone business employee credit from 2005 (see instructions)

8

9

Current year credit. Add lines 6 through 9. (S corporations, partnerships, estates, trusts,

cooperatives, regulated investment companies, and real estate investment trusts, see instructions.)

9

10

Subtract line 17 from line 15. If zero or less, enter -0-

17

General business credit (see instructions)

18 18

19

Subtract line 19 from line 18. If zero or less, enter -0-

19

20

Carryforward of NY Liberty Zone business employee credit to 2004

13

5

21
Form 8885 Health Coverage Tax Credit

Department of the Treasury

Internal Revenue Service

 Attach to Form 1040 or Form 1040NR.

Name of recipient (if both spouses are recipients, complete a separate form for each spouse) Recipient’s so

Cat. No. 34641D

Complete This Part To See if You Are Eligible To Take This Credit

1

Part I

Part II

Check the boxes below for each month in 2004 that all of the following statements were true on the first da

February March

Health Coverage Tax Credit

2 Amount paid for qualified health insurance coverage for all months checked on line 1 (see

instructions on page 4). Include advance payments, if any, from Form 1099-H, box 1

3 Enter the total amount of any (a) Archer MSA and health savings account distributions used

to pay amounts included on line 2 and (b) National Emergency Grants you received for health

insurance in 2004

4 Subtract line 3 from line 2. If zero or less, stop; you cannot take the credit

7 Health coverage tax credit. Subtract line 6 from line 5. If zero or less, enter -0-. Also include

on Form 1040, line 69, or Form 1040NR, line 63, and check box c on that line

For Paperwork Reduction Act Notice, see page 4.

Before you begin: See Definitions and Special Rules that begin on page 2.

5 Multiply line 4 by 65% (.65) and enter the result

6 Advance payments, if any, from Form 1099-H, box 1

January May June April

July November December August September October

Do not complete this form if you can be claimed as a dependent on someone else’s 2004 tax retu

● You were an eligible trade adjustment assistance (TAA) recipient, alternative TAA recipient, or Pension 

Corporation (PBGC) pension recipient.

● You were covered by a qualified health insurance plan for which you paid the premiums.

● You were not covered by, or eligible for coverage under, any employer-sponsored health insurance plan 

on page 3).

● You were not enrolled in Medicaid or State Children’s Health Insurance Program (SCHIP).

● You were not enrolled in the Federal Employees Health Benefits Program or eligible to receive benefit

military health system (TRICARE).

● You were not imprisoned under Federal, state, or local authority.

2

3

5

4

7

6

● You were not entitled to Medicare Part A or enrolled in Medicare Part B.

Note. You must attach invoices and proof of payment for any amounts

included on line 2 for which you did not receive an advance payment (see

instructions on page 4).

CAUTION
OMB No. 1545-1911

Form 8889 Health Savings Accounts (HSAs)

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Name(s) shown on Form 1040

Cat. No. 37621P Form 8889 (2004)

HSA contributions you made for 2004 (or those made on your behalf), including those made

from January 1, 2005, through April 15, 2005, that were for 2004. Do not include employer

contributions or rollovers (see page 2 of the instructions)

HSA Distributions. If you are filing jointly and both you and your spouse each have separate HSAs,

complete a separate Part II for each spouse.

12a Total distributions you received in 2004 from all HSAs (see page 5 of the instructions)

Unreimbursed qualified medical expenses (see page 5 of the instructions)

c

15a

Taxable HSA distributions. Subtract line 13 from line 12c. If zero or less, enter -0-. Also, include

this amount in the total on Form 1040, line 21. On the dotted line next to line 21, enter “HSA”

and the amount 14

Add lines 6 and 7

Subtract line 9 from line 8. If zero or less, enter -0- 

HSA deduction. Enter the smaller of line 2 or line 10 here and on Form 1040, line 28

6

7

8

11

12a

12b

Attachment

Sequence No. 138

b

For Paperwork Reduction Act Notice, see page 5 of the instructions.

4

5

10

 See separate instructions.

If any of the distributions included on line 14 meet any of the Exceptions to the Additional

10% Tax (see page 5 of the instructions), check here 

Additional 10% tax (see page 5 of the instructions). Enter 10% (.10) of the distributions included

on line 14 that are subject to the additional 10% tax. Also include this amount in the total on

Form 1040, line 62. On the dotted line next to line 62, enter “HSA” and the amount

HSA Contributions and Deduction. See page 2 of the instructions before completing this part. If you are

filing jointly and both you and your spouse each have separate HSAs, complete a separate Part I for each

spouse (see page 2 of the instructions).

Distributions included on line 12a that you rolled over to another HSA. Also include any excess

contributions (and the earnings on those excess contributions) included on line 12a that were

withdrawn by the due date of your return (see page 5 of the instructions)

Subtract line 12b from line 12a 12c

13 13

14

b

15b

Social security number of HSA

beneficiary. If both spouses have

HSAs, see page 2 of the instructions 

3

Part I

1

2

3

Part II

6

2004

If you were age 55 or older at the end of 2004, married, and you or your spouse had family

coverage under a high-deductible health plan at any time during 2004, enter the additional

contribution amount from the worksheet on page 4 of the instructions 7

Caution: If line 2 is more than line 11, you may have to pay an additional tax (see page 4 of the

instructions).

Before you begin: Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required.

Check the box to indicate your coverage under a high-deductible

health plan during 2004 (see page 2 of the instructions)  Self-only Family

If you were under age 55 at the end of 2004, and on the first day of every month during 2004, you

were an eligible individual with the same annual deductible and coverage, enter the smaller of:

● Your annual deductible (see page 3 of the instructions), or

● $2,600 ($5,150 for family coverage).

All others, enter the limit from the worksheet on page 3 of the instructions

Enter the amount you and your employer contributed to your Archer MSAs for 2004 from Form

8853, lines 3 and 4. If you or your spouse had family coverage under a high-deductible health

plan at any time during 2004, also include any amount contributed to your spouse’s Archer MSAs

Subtract line 4 from line 3. If zero or less, enter -0-

If you and your spouse each have separate HSAs and had family coverage under a

high-deductible health plan at any time during 2004, see the instructions on page 4 for the amount

to enter. All others, enter the amount from line 5

2

5

4

Employer contributions made to your HSAs for 2004

8

9

10

11

9
 THE FOLLOWING PAGES OF THE TEXT ARE THE 

CORRESPONDING DOLLAR AMOUNTS OF SELECTED 

LINES FILED (IN THOUSANDS OF DOLLARS). 
Total of all

Returns Filed

Department of the Treasury—Internal Revenue Service

1040 U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2004, or other tax year beginning , 2004, ending , 20 OMB No. 1545-0074

Your first name and initial Last name Your social security number

(See

instructions

on page 16.)

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 16. Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 16.

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 17)

6a Yourself. If someone can claim you as a dependent, do not check box 6a

Exemptions b Spouse

(4) if qualifying

child for child tax

credit (see page 18)

c Dependents: (2) Dependent’s

social security number

(3) Dependent’s

relationship to (1) First name Last name you

If more than four

dependents, see

page 18.

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 Form(s)

W-2 here. Also

attach Forms

W-2G and

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 20) 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.

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

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

15a IRA distributions 15a 15b b Taxable amount (see page 22)

16a Pensions and annuities 16a b Taxable amount (see page 22) 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 24) 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 26) 25

23

27

26

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

29

Self-employed health insurance deduction (see page 30)

27

30

29

Self-employed SEP, SIMPLE, and qualified plans

31

30

Penalty on early withdrawal of savings

32

31

Alimony paid b Recipient’s SSN 

Add lines 23 through 34a 35

32

Subtract line 35 from line 22. This is your adjusted gross income 

33

Adjusted

Gross

Income

36

If you did not

get a W-2,

see page 19. Form

Married filing separately. Enter spouse’s SSN above

and full name here. 

Cat. No. 11320B





Label

Form 1040 (2004)

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

Head of household (with qualifying person). (See page 17.) 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 24)

Moving expenses. Attach Form 3903

25

26

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 75.

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 18)

34a 34a

Student loan interest deduction (see page 28)

33

35

 

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 16.)

(99)

Tuition and fees deduction (see page 29)

36

4

5

Educator expenses (see page 26) 23

b Qualified dividends (see page 20) 9b

2004

24 Certain business expenses of reservists, performing artists, and

fee-basis government officials. Attach Form 2106 or 2106-EZ 24

28 Health savings account deduction. Attach Form 8889 28
Total of all

Returns Filed

Married filing

jointly or

Qualifying

widow(er),

$9,700

Head of

household,

$7,150

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

Add lines 63, 64, 65a, and 66 through 69. These are your total payments 

Form 1040 (2004) Page 2

37 Amount from line 36 (adjusted gross income) 37

Check

if:

38a

Tax and

Credits

38a

Single or

Married filing

separately,

$4,850

b If your spouse itemizes on a separate return or you were a dual-status alien, see page 31 and check here  38b

39 39

40 Subtract line 39 from line 37 40

41

If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on

line 6d. If line 37 is over $107,025, see the worksheet on page 33

41

42 Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0- 42

43 43

48

52

Education credits. Attach Form 8863

47

Other credits. Check applicable box(es):

46

55

56

Add lines 46 through 54. These are your total credits

Subtract line 55 from line 45. If line 55 is more than line 45, enter -0- 

55

Self-employment tax. Attach Schedule SE

56

Other

Taxes

57

71

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

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59

58

60

Add lines 56 through 61. This is your total tax 

61 61

63 Federal income tax withheld from Forms W-2 and 1099 63

64 2004 estimated tax payments and amount applied from 2003 return 64 Payments

65a

Amount paid with request for extension to file (see page 54) 68

67

Excess social security and tier 1 RRTA tax withheld (see page 54) 66

68

70

69 Other payments from:

72a 72a

73 73

If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid

74 74

Amount of line 71 you want refunded to you 

Refund

75

Amount of line 71 you want applied to your 2005 estimated tax 

Estimated tax penalty (see page 55)

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.

75

You were born before January 2, 1940, Blind.

Spouse was born before January 2, 1940, Blind.

a Form 3800

b Form 8801 c Specify

a Form 2439 b Form 4136

59

Household employment taxes. Attach Schedule H

60

69

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 33). Check if any tax is from:

Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55 

b

Direct deposit?

See page 54

and fill in 72b,

72c, and 72d.

Routing number

Account number

c Checking Savings

a Form(s) 8814 Form 4972

b

d





70

53

Retirement savings contributions credit. Attach Form 8880

57

58

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

71



Child tax credit (see page 37)

Credits from:

51

Additional child tax credit. Attach Form 8812

66

67

Standard

Deduction

for—

Joint return?

See page 17.

Daytime phone number

( )

Earned income credit (EIC)

Credit for the elderly or the disabled. Attach Schedule R

44

45

Alternative minimum tax (see page 35). Attach Form 6251

Add lines 43 and 44 

Credit for child and dependent care expenses. Attach Form 2441

49

If you have a

qualifying

child, attach

Schedule EIC.

44

45

65a

Spouse’s occupation

( )

Form 1040 (2004)

● People who

checked any

box on line

38a or 38b or

who can be

claimed as a

dependent,

see page 31.

● All others:

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 56)? Third Party

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

54

Foreign tax credit. Attach Form 1116 if required

54

a Form 8396 b Form 8859

50

Adoption credit. Attach Form 8839

62 62

Type:

c Form 8885

Total boxes  checked 

50

48

52

47

46

53

51

49

b Nontaxable combat pay election  65b
Total for form

1040 ONLY

Department of the Treasury—Internal Revenue Service

1040 U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2004, or other tax year beginning , 2004, ending , 20 OMB No. 1545-0074

Your first name and initial Last name Your social security number

(See

instructions

on page 16.)

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 16. Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 16.

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 17)

6a Yourself. If someone can claim you as a dependent, do not check box 6a

Exemptions b Spouse

(4) if qualifying

child for child tax

credit (see page 18)

c Dependents: (2) Dependent’s

social security number

(3) Dependent’s

relationship to (1) First name Last name you

If more than four

dependents, see

page 18.

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 Form(s)

W-2 here. Also

attach Forms

W-2G and

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 20) 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.

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

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

15a IRA distributions 15a 15b b Taxable amount (see page 22)

16a Pensions and annuities 16a b Taxable amount (see page 22) 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 24) 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 26) 25

23

27

26

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

29

Self-employed health insurance deduction (see page 30)

27

30

29

Self-employed SEP, SIMPLE, and qualified plans

31

30

Penalty on early withdrawal of savings

32

31

Alimony paid b Recipient’s SSN 

Add lines 23 through 34a 35

32

Subtract line 35 from line 22. This is your adjusted gross income 

33

Adjusted

Gross

Income

36

If you did not

get a W-2,

see page 19. Form

Married filing separately. Enter spouse’s SSN above

and full name here. 

Cat. No. 11320B





Label

Form 1040 (2004)

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

Head of household (with qualifying person). (See page 17.) 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 24)

Moving expenses. Attach Form 3903

25

26

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 75.

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 18)

34a 34a

Student loan interest deduction (see page 28)

33

35

 

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 16.)

(99)

Tuition and fees deduction (see page 29)

36

4

5

Educator expenses (see page 26) 23

b Qualified dividends (see page 20) 9b

2004

24 Certain business expenses of reservists, performing artists, and

fee-basis government officials. Attach Form 2106 or 2106-EZ 24

28 Health savings account deduction. Attach Form 8889 28
Total for form

1040 ONLY

Married filing

jointly or

Qualifying

widow(er),

$9,700

Head of

household,

$7,150

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

Add lines 63, 64, 65a, and 66 through 69. These are your total payments 

Form 1040 (2004) Page 2

37 Amount from line 36 (adjusted gross income) 37

Check

if:

38a

Tax and

Credits

38a

Single or

Married filing

separately,

$4,850

b If your spouse itemizes on a separate return or you were a dual-status alien, see page 31 and check here  38b

39 39

40 Subtract line 39 from line 37 40

41

If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on

line 6d. If line 37 is over $107,025, see the worksheet on page 33

41

42 Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0- 42

43 43

48

52

Education credits. Attach Form 8863

47

Other credits. Check applicable box(es):

46

55

56

Add lines 46 through 54. These are your total credits

Subtract line 55 from line 45. If line 55 is more than line 45, enter -0- 

55

Self-employment tax. Attach Schedule SE

56

Other

Taxes

57

71

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

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59

58

60

Add lines 56 through 61. This is your total tax 

61 61

63 Federal income tax withheld from Forms W-2 and 1099 63

64 2004 estimated tax payments and amount applied from 2003 return 64 Payments

65a

Amount paid with request for extension to file (see page 54) 68

67

Excess social security and tier 1 RRTA tax withheld (see page 54) 66

68

70

69 Other payments from:

72a 72a

73 73

If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid

74 74

Amount of line 71 you want refunded to you 

Refund

75

Amount of line 71 you want applied to your 2005 estimated tax 

Estimated tax penalty (see page 55)

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.

75

You were born before January 2, 1940, Blind.

Spouse was born before January 2, 1940, Blind.

a Form 3800

b Form 8801 c Specify

a Form 2439 b Form 4136

59

Household employment taxes. Attach Schedule H

60

69

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 33). Check if any tax is from:

Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55 

b

Direct deposit?

See page 54

and fill in 72b,

72c, and 72d.

Routing number

Account number

c Checking Savings

a Form(s) 8814 Form 4972

b

d





70

53

Retirement savings contributions credit. Attach Form 8880

57

58

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

71



Child tax credit (see page 37)

Credits from:

51

Additional child tax credit. Attach Form 8812

66

67

Standard

Deduction

for—

Joint return?

See page 17.

Daytime phone number

( )

Earned income credit (EIC)

Credit for the elderly or the disabled. Attach Schedule R

44

45

Alternative minimum tax (see page 35). Attach Form 6251

Add lines 43 and 44 

Credit for child and dependent care expenses. Attach Form 2441

49

If you have a

qualifying

child, attach

Schedule EIC.

44

45

65a

Spouse’s occupation

( )

Form 1040 (2004)

● People who

checked any

box on line

38a or 38b or

who can be

claimed as a

dependent,

see page 31.

● All others:

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 56)? Third Party

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

54

Foreign tax credit. Attach Form 1116 if required

54

a Form 8396 b Form 8859

50

Adoption credit. Attach Form 8839

62 62

Type:

c Form 8885

Total boxes  checked 

50

48

52

47

46

53

51

49

b Nontaxable combat pay election  65b
Electronically

Filed Returns

Department of the Treasury—Internal Revenue Service

1040 U.S. Individual Income Tax Return

For the year Jan. 1–Dec. 31, 2004, or other tax year beginning , 2004, ending , 20 OMB No. 1545-0074

Your first name and initial Last name Your social security number

(See

instructions

on page 16.)

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 16. Apt. no.

City, town or post office, state, and ZIP code. If you have a foreign address, see page 16.

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 17)

6a Yourself. If someone can claim you as a dependent, do not check box 6a

Exemptions b Spouse

(4) if qualifying

child for child tax

credit (see page 18)

c Dependents: (2) Dependent’s

social security number

(3) Dependent’s

relationship to (1) First name Last name you

If more than four

dependents, see

page 18.

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 Form(s)

W-2 here. Also

attach Forms

W-2G and

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 20) 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.

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

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

15a IRA distributions 15a 15b b Taxable amount (see page 22)

16a Pensions and annuities 16a b Taxable amount (see page 22) 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 24) 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 26) 25

23

27

26

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

29

Self-employed health insurance deduction (see page 30)

27

30

29

Self-employed SEP, SIMPLE, and qualified plans

31

30

Penalty on early withdrawal of savings

32

31

Alimony paid b Recipient’s SSN 

Add lines 23 through 34a 35

32

Subtract line 35 from line 22. This is your adjusted gross income 

33

Adjusted

Gross

Income

36

If you did not

get a W-2,

see page 19. Form

Married filing separately. Enter spouse’s SSN above

and full name here. 

Cat. No. 11320B





Label

Form 1040 (2004)

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

Head of household (with qualifying person). (See page 17.) 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 24)

Moving expenses. Attach Form 3903

25

26

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 75.

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 18)

34a 34a

Student loan interest deduction (see page 28)

33

35

 

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 16.)

(99)

Tuition and fees deduction (see page 29)

36

4

5

Educator expenses (see page 26) 23

b Qualified dividends (see page 20) 9b

2004

24 Certain business expenses of reservists, performing artists, and

fee-basis government officials. Attach Form 2106 or 2106-EZ 24

28 Health savings account deduction. Attach Form 8889 28
Electronically

Filed Returns

Married filing

jointly or

Qualifying

widow(er),

$9,700

Head of

household,

$7,150

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

Add lines 63, 64, 65a, and 66 through 69. These are your total payments 

Form 1040 (2004) Page 2

37 Amount from line 36 (adjusted gross income) 37

Check

if:

38a

Tax and

Credits

38a

Single or

Married filing

separately,

$4,850

b If your spouse itemizes on a separate return or you were a dual-status alien, see page 31 and check here  38b

39 39

40 Subtract line 39 from line 37 40

41

If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on

line 6d. If line 37 is over $107,025, see the worksheet on page 33

41

42 Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter -0- 42

43 43

48

52

Education credits. Attach Form 8863

47

Other credits. Check applicable box(es):

46

55

56

Add lines 46 through 54. These are your total credits

Subtract line 55 from line 45. If line 55 is more than line 45, enter -0- 

55

Self-employment tax. Attach Schedule SE

56

Other

Taxes

57

71

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

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59

58

60

Add lines 56 through 61. This is your total tax 

61 61

63 Federal income tax withheld from Forms W-2 and 1099 63

64 2004 estimated tax payments and amount applied from 2003 return 64 Payments

65a

Amount paid with request for extension to file (see page 54) 68

67

Excess social security and tier 1 RRTA tax withheld (see page 54) 66

68

70

69 Other payments from:

72a 72a

73 73

If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid

74 74

Amount of line 71 you want refunded to you 

Refund

75

Amount of line 71 you want applied to your 2005 estimated tax 

Estimated tax penalty (see page 55)

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.

75

You were born before January 2, 1940, Blind.

Spouse was born before January 2, 1940, Blind.

a Form 3800

b Form 8801 c Specify

a Form 2439 b Form 4136

59

Household employment taxes. Attach Schedule H

60

69

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 33). Check if any tax is from:

Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55 

b

Direct deposit?

See page 54

and fill in 72b,

72c, and 72d.

Routing number

Account number

c Checking Savings

a Form(s) 8814 Form 4972

b

d





70

53

Retirement savings contributions credit. Attach Form 8880

57

58

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

71



Child tax credit (see page 37)

Credits from:

51

Additional child tax credit. Attach Form 8812

66

67

Standard

Deduction

for—

Joint return?

See page 17.

Daytime phone number

( )

Earned income credit (EIC)

Credit for the elderly or the disabled. Attach Schedule R

44

45

Alternative minimum tax (see page 35). Attach Form 6251

Add lines 43 and 44 

Credit for child and dependent care expenses. Attach Form 2441

49

If you have a

qualifying

child, attach

Schedule EIC.

44

45

65a

Spouse’s occupation

( )

Form 1040 (2004)

● People who

checked any

box on line

38a or 38b or

who can be

claimed as a

dependent,

see page 31.

● All others:

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see page 56)? Third Party

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

54

Foreign tax credit. Attach Form 1116 if required

54

a Form 8396 b Form 8859

50

Adoption credit. Attach Form 8839

62 62

Type:

c Form 8885

Total boxes  checked 

50

48

52

47

46

53

51

49

b Nontaxable combat pay election  65b
Head of household (with qualifying person). (See page 19.)

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

enter this child’s name here.  Married filing separately. Enter spouse’s SSN above and

full name here. 

Form Department of the Treasury—Internal Revenue Service

1040A 2004 U.S. Individual Income Tax Return

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 18.)

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 18. 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 18.

Filing

status

Boxes

checked on

6a and 6b

Yourself. If someone can claim you as a dependent, 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 21)

(2) Dependent’s social

security number

c ● lived with

you

● did not live

with you due

to divorce or

separation

(see page 21)

If more than six

dependents,

see page 20.

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 23).

11b

Enclose, but do

not attach, any

payment.

11a 11b

Taxable amount

(see page 24).

12a Pensions and 12b

annuities. 12a 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 13

14a Taxable amount

(see page 26).

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 26). 17

Student loan interest deduction (see page 29).

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 22.

Form 1040A (2004)

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)

10 Capital gain distributions (see page 23). 10

Presidential

Election Campaign

(See page 18.)  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 29). 19

1 Single

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

3

Qualifying widow(er) with dependent child (see page 19)

4

5

16 Educator expenses (see page 26). 16

b Qualified dividends (see page 23). 9b
If you have

a qualifying

child, attach

Schedule

EIC.

Single or

Married filing

separately,

$4,850

30

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

Total boxes

checked 

Check You were born before January 2, 1940, Blind

if:

23a

Spouse was born before January 2, 1940, Blind 23a

b

23b

If you are married filing separately and your spouse itemizes

deductions, see page 30 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 If line 22 is $107,025 or less, multiply $3,100 by the total number of

exemptions claimed on line 6d. If line 22 is over $107,025, see the

worksheet on page 32. 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 31). 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

39 Federal income tax withheld from Forms W-2 and 1099. 39

2004 estimated tax payments and amount

applied from 2003 return. 40

Add lines 39, 40, 41a, and 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

2005 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 51). 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 (2004)

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

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.

Routing

number

Account

number

Checking Savings  b

c

 d

Amount

you owe

Direct

deposit?

See page 50

and fill in

45b, 45c,

and 45d.



41a Earned income credit (EIC). 41a

Page 2

Form 1040A (2004)

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 18.

Daytime phone number

( )

Spouse’s occupation

( )

Head of

household,

$7,150

Married filing

jointly or

Qualifying

widow(er),

$9,700

Standard

Deduction

for—

● People who

checked any

box on line

23a or 23b or

who can be

claimed as a

dependent,

see page 31.

● 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

Retirement savings contributions credit. Attach

Form 8880.

Type:

Child tax credit (see page 36).

42

b Nontaxable combat pay election. 41b
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 2004 OMB No. 1545-0675

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

Presidential

Election

Campaign 

(page 11)

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

24–32 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 19. 

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

Income

Cat. No. 11329W



4 4

12

12

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

8a 8a

9 9

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

Unemployment compensation and Alaska Permanent Fund dividends

(see page 13).

3

3

Amount

you owe

b Routing number

Account number

c Type: Checking

Enter amount from

worksheet on back.

If single, enter $7,950.

If married filing jointly, enter $15,900.

See back for explanation.

Have it directly

deposited! See

page 18 and fill

in 11b, 11c,

and 11d.

d





Form 1040EZ (2004)

(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 19)? 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 11. 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 11.

Important! 



Label

(See page 11.)

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. 

b Nontaxable combat pay election. 8b
(99)

Schedule 1 Department of the Treasury—Internal Revenue Service

Interest and Ordinary Dividends

for Form 1040A Filers

(Form 1040A)

2004 

Name(s) shown on Form 1040A You

Part I

Interest

(See back

of schedule

and the

instructions

for Form

1040A,

line 8a.)

Note. If you received a Form 1099-INT, Form 1099-OID, or substitute statem

brokerage firm, enter the firm’s name and the total interest shown on t

1 List name of payer. If any interest is from a seller-financed mortgage

and the buyer used the property as a personal residence, see back of

schedule and list this interest first. Also, show that buyer’s social

security number and address. 

1

2 Add the amounts on line 1. 2

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

after 1989. Attach Form 8815.

3

3

Subtract line 3 from line 2. Enter the result here and on Form 1040A,

line 8a.

4

4

Part II

Ordinary

dividends

Note. If you received a Form 1099-DIV or substitute statement from a broker

enter the firm’s name and the ordinary dividends shown on that form.

(See back

of schedule

and the

instructions

for Form

1040A, 

line 9a.)

5 List name of payer. 

5

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

line 9a. 6

For Paperwork Reduction Act Notice, see Form 1040A instructions. Cat. No. 12075R Schedul
(99)

(d) Amount paid

(see instructions)

(c) Identifying

number (SSN or EIN)

(b) Address (number, street, apt. no., Part I city, state, and ZIP code)(a) Care provider’s

1 name

Persons or

organizations

who provided

the care

You must

complete this

part.

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

2 Part II

Credit for child

and dependent

care expenses

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.

3

3

4 4

5

5

6 6

7

Enter your earned income. See the instructions.

8

8

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.

9

9

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

amount on line 7.

Decimal

amount is

If line 7 is:

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 2003

expenses in 2004, see the instructions.

For Paperwork Reduction Act Notice, see Form 1040A instructions. Schedule 2 (Form 1040A) 2004

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

Cat. No. 10749I

Schedule 2 Department of the Treasury—Internal Revenue Service

Child and Dependent Care

Expenses for Form 1040A Filers (Form 1040A)

2004 OMB No. 1545-0085

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

Decimal

amount is

If line 7 is:

But not

Over over

Enter the amount from Form 1040A, line 22.

Enter the smallest of line 3, 4, or 5.

7

Did you receive

dependent care benefits? Yes

No 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. If you do, you

must use Form 1040. See Schedule H and its instructions for details.

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

the instructions.

(a) Qualifying person’s name (b) Qualifying person’s social

security number

(c) Qualified expenses

you incurred and paid

in 2004 for the person

listed in column (a) First Last

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

10 Enter the amount from Form 1040A, line 28.

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

or line 10 here and on Form 1040A, line 29.

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

10

11
Schedule 2 (Form 1040A) 2004

Enter the total amount of dependent care benefits you received

for 2004. This amount should be shown in box 10 of your Form(s)

W-2. Do not include amounts that were reported to you as wages

in box 1 of Form(s) W-2.

Part III 12

12

Enter the amount forfeited, if any. See the instructions.

Subtract line 13 from line 12.

13 13

14

Enter the total amount of qualified expenses

incurred in 2004 for the care of the qualifying

person(s).

14

15

Enter the smaller of line 14 or 15.

15

16

Enter your earned income. See the instructions.

16

17

Enter the amount shown below that applies to

you.

17

18

18

19

Excluded benefits. Enter here the smaller of the following:

● The amount from line 19 or

19

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

enter your spouse’s earned income on line 18).

20

Taxable benefits. Subtract line 20 from line 14. Also, include this

amount on Form 1040A, line 7. In the space to the left of line 7, enter

“DCB.”

20

Dependent

care benefits

21

21

Enter the smallest of line 16, 17, or 18.

22

23

24

25

To claim the child and dependent care

credit, complete lines 22–26 below.

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

Enter the amount from line 20.

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

the credit. Exception. If you paid 2003 expenses in 2004, see the

instructions for line 9.

Complete line 2 on the front of this schedule. 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.

22

23

24

25

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

on the front of this schedule and complete lines 4–11. 26

Page 2

Schedule 2 (Form 1040A) 2004

● 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.
Due to your continued disabled condition, you were unable to engage in any

substantial gainful activity in 2004, check this box 

(99)

Schedule 3 Department of the Treasury—Internal Revenue Service

Credit for the Elderly or the Disabled

for Form 1040A Filers (Form 1040A) 2004 OMB No. 1545-0085

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

You may be able to take this credit and reduce your tax if by the end of 2004:

or

In most cases, the IRS can figure the credit for you. See the instructions.

Part I If your filing status is:

1 You were 65 or older 1

Check the

box for your

filing status

and age You were under 65 and you retired on permanent

and total disability

2

2

3 Both spouses were 65 or older 3

4 Both spouses were under 65, but only one spouse

retired on permanent and total disability 4

5 Both spouses were under 65, and both retired on

permanent and total disability 5 Married filing

jointly 6 One spouse was 65 or older, and the other spouse

was under 65 and retired on permanent and total

disability 6

7 One spouse was 65 or older, and the other spouse

was under 65 and not retired on permanent and

total disability 7

8 You were 65 or older and you lived apart from

your spouse for all of 2004 8

Married filing

separately 9 You were under 65, you retired on permanent and

total disability, and you lived apart from your

spouse for all of 2004 9

If: 1 You filed a physician’s statement for this disability for 1983 or an earlier year,

or you filed or got a statement for tax years after 1983 and your physician signed

line B on the statement, and

Part II

Statement of

permanent

and total

disability

2

Complete this part

only if you checked

box 2, 4, 5, 6,

or 9 above.

For Paperwork Reduction Act Notice, see Form 1040A instructions. Schedule 3 (Form 1040A) 2004

● You were age 65 or older ● You were under age 65, you retired on permanent

and total disability, and you received taxable

disability income.

Single,

Head of household, or

Qualifying widow(er)

And by the end of 2004: Check only one box:

Cat. No. 12064K

Yes

No

Skip Part II and complete Part III on the back.

Complete Parts II and III.

Did you check

box 1, 3, 7, or

8?





● If you did not check this box, have your physician complete the statement on

page 4 of the instructions. You must keep the statement for your records.

● If you checked this box, you do not have to get another statement for 2004.

But you must also meet other tests. See the separate instructions for Schedule 3.

TIP
Schedule 3 (Form 1040A) 2004

10 If you checked (in Part I): Enter: Part III Box 1, 2, 4, or 7 $5,000

Figure your

credit

Box 3, 5, or 6 $7,500

10

11

● Box 6, add $5,000 to the taxable disability income of the spouse

who was under age 65. Enter the total.

11

If you completed line 11, enter the smaller of line 10 or line 11; all

others, enter the amount from line 10.

12

12

Enter the following pensions, annuities, or

disability income that you (and your spouse if

filing a joint return) received in 2004.

13

Nontaxable part of social security benefits

and

a

Nontaxable part of railroad retirement benefits

treated as social security (see the instructions). 13a

Nontaxable veterans’ pensions

and

b

13b

Add lines 13a and 13b. (Even though these

income items are not taxable, they must be

included here to figure your credit.) If you did not

receive any of the types of nontaxable income

listed on line 13a or 13b, enter -0- on line 13c.

c

13c

14 Enter the amount from Form 1040A, line 22. 14

15 If you checked (in Part I): Enter:

Box 1 or 2 $7,500

Box 3, 4, 5, 6, or 7 $10,000

Box 8 or 9 $5,000 15

Subtract line 15 from line 14. If zero or less,

enter -0-.

16

16

17 Enter one-half of line 16. 17

18 Add lines 13c and 17. 18

Subtract line 18 from line 12. If zero or less, stop; you cannot take

the credit. Otherwise, go to line 20.

19

19

20 Multiply line 19 by 15% (.15). 20

● Box 2, 4, or 9, enter your taxable disability income.

● Box 5, add your taxable disability income to your spouse’s taxable

disability income. Enter the total.

For more details on what to include on line 11, see

the instructions.

Did you check

box 2, 4, 5, 6,

or 9 in Part I?

You must complete line 11.

Enter the amount from line 10

on line 12 and go to line 13.

Yes

No 



Box 8 or 9 $3,750

Page 2

Schedule 3 (Form 1040A) 2004

Any other pension, annuity, or disability benefit

that is excluded from income under any other

provision of law (see the instructions).

If you checked (in Part I):

21

21

Credit for the elderly or the disabled. Enter the smaller of line 20

or line 21 here and on Form 1040A, line 30. 22

TIP

22

Enter the amount from Form 1040A, line 28, minus any amount on

Form 1040A, line 29.
SCHEDULES A&B O

Schedule A—Itemized Deductions

(Form 1040) (Schedule B is on back)

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

A

S

Name(s) shown on Form 1040 Your so

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

5

Taxes You 5 State and local (check only one box):

Paid

6 Real estate taxes (see page A-3) 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-4

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-4

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-6.) 

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 37

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 

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 37

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 39.

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 37, over $142,700 (over $71,350 if married filing separately)?

(99)

 See Instructions for Schedules A and B (Form 1040).

a Income taxes, or

b General sales taxes (see page A-2) 
Schedules A&B (Form 1040) 2004 OMB No. 1

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

Schedule B—Interest and Ordinary Dividends 

Part I

Interest

(See page B-1

and the

instructions for

Form 1040,

line 8a.)

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

(See page B-2

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 

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

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

Foreign

Accounts

and Trusts

At any time during 2004, did you have an interest in or a signature or other authority over a fin

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

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 2004, did you receive a distribution from, or were you the grantor of, or transfero

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 2004? If “No,” see page C-3 for limit on losses

If you started or acquired this business during 2004, 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) 2004

(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)

11 Contract labor (see page C-4)

2004
Schedule C (Form 1040) 2004 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 2004, 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) 2004
SCHEDULE C-EZ OMB No. 1545-0074

(Form 1040)

Net Profit 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 on back. Sequence No. 09A

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

Business address (including suite or room no.). Address not required if same as on Form 1040, page 1.

C

E

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

employee” box on that form was checked, see Statutory Employees in the instructions for

Schedule C, line 1, on page C-3 and check here  1

2 Total expenses (see instructions). If more than $5,000, you must use Schedule C 2

3

3 Net profit. Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on

Form 1040, line 12, and also on Schedule SE, line 2. (Statutory employees do not report this

amount on Schedule SE, line 2. Estates and trusts, enter on Form 1041, line 3.)

For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 14374D Schedule C-EZ (Form 1040) 2004

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

You May Use

Schedule C-EZ

Instead of

Schedule C

Only If You:

And You:

● Use the cash method of accounting.

● Had only one business as a sole

proprietor.

● Had business expenses of $5,000 or

less. ● Are not required to file Form 4562,

Depreciation and Amortization, for

this business. See the instructions

for Schedule C, line 13, on page

C-4 to find out if you must file.

● Do not deduct expenses for

business use of your home.

● Do not have prior year unallowed

passive activity losses from this

business.

 

Name of proprietor Social security number (SSN)

General Information

A Principal business or profession, including product or service B Enter code from pages C-7, 8, & 9



Figure Your Net Profit

Part I

Part II

● Did not have a net loss from your

business.

● Had no employees during the year.

1

● Did not have an inventory at any

time during the year.

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

8a Do you have evidence to support your deduction? Yes No

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

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

5 Of the total number of miles you drove your vehicle during 2004, enter the number of miles you used your vehicle for:

Business b Commuting c Other

4

Part III Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 2.

a

b

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

2004
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)

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

7

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

Carryover Worksheet on page D-6 of the instructions

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-1 of the instructions

14

15

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

Carryover Worksheet on page D-6 of the instructions ( )

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

Part III on the back 15

For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule D (Form 1040) 2004 Cat. No. 11338H

( )

44

Part I

Part II

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.)

(e) Cost or other basis

(see page D-6 of

the instructions)

(d) Sales price

(see page D-6 of

the instructions)

2004

7

(f) Gain or (loss)

Subtract (e) from (d)
Schedule D (Form 1040) 2004

Summary

Combine lines 7 and 15 and enter the result. If line 16 is a loss, skip lines 17 through 20, and

go to line 21. If a gain, enter the gain on Form 1040, line 13, and then go to line 17 below

16

16

18

Part III

Page2

18 Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet on page D-7 of the

instructions 



Are lines 18 and 19 both zero or blank?

19

Schedule D (Form 1040) 2004

21

Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet on

page D-8 of the instructions



20

21 If line 16 is a loss, enter here and on Form 1040, line 13, the smaller of:

19

● The loss on line 16 or

● ($3,000), or if married filing separately, ($1,500) 

Yes. Complete Form 1040 through line 42, and then complete the Qualified Dividends and

Capital Gain Tax Worksheet on page 34 of the Instructions for Form 1040. Do not complete

lines 21 and 22 below.

No. Complete Form 1040 through line 42, and then complete the Schedule D Tax Worksheet

on page D-9 of the instructions. Do not complete lines 21 and 22 below.

22 Do you have qualified dividends on Form 1040, line 9b?

Yes. Complete Form 1040 through line 42, and then complete the Qualified Dividends and

Capital Gain Tax Worksheet on page 34 of the Instructions for Form 1040.

No. Complete the rest of Form 1040.

( )

17 Are lines 15 and 16 both gains?

Yes. Go to line 18.

No. Skip lines 18 through 21, and go to line 22.

Note. When figuring which amount is smaller, treat both amounts as positive numbers.
SCHEDULE E O

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

Name(s) shown on return Your so

Income or Loss From Rental Real Estate and Royalties Note. If you are in the business of renting pe

Schedule C or C-EZ (see page E-3). Report farm rental income or loss from Form 4835 on page 2, line 40.

1 List the type and location of each rental real estate property:

A

B

C

2 

Properties 

(Add 

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 

Part I

Management fees

(99)

For each rental real estate property

listed on line 1, did you or your fam

use it during the tax year for person

purposes for more than the greater 

● 14 days or

● 10% of the total days rented at

fair rental value?

(See page E-3.)
Schedule E (Form 1040) 2004 Attachment Sequence No. 13 

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

Income or Loss From Partnerships and S Corporations Note. If you report a loss from a

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

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) 

(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

iden

33 (a) Name

A

B

Passive Income and Loss Nonpassive Income and 

(e) Deduction or loss

from Schedule K–1

(d) Passive income

from Schedule K–1

(f) O

S

(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)—Resid

(c) Excess inclusion from

Schedules Q, line 2c

(see page E-6)

(e

Sche

(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), box 14, code B; Schedule K-1 (Form 1120S),

box 17, code N; 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 

27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed

loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? 

If you answered “Yes,” see page E-6 before completing this section.

Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.


O

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

Department of the Treasury

Internal Revenue Service

Qualifying Child Information

For Paperwork Reduction Act Notice, see Form 1040A

or 1040 instructions.

Cat. No. 13339M Schedule EIC (Form 1

Before you begin: See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 65a a

65b, to make sure that (a) you can take the EIC and (b) you have a qualifying chi

Qualifying Child Information

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

for each qualifying child.

4

2

5

6

1 Child’s name

Child’s SSN

Child’s relationship to you

Number of months child lived with

you in the United States during 2004

months

Yes.

If the child was born before 1986—

Was the child permanently and totally

disabled during any part of 2004?

b

Yes.

First name Last name First name La

Name(s) shown on return Your so

(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 2 agree wit

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

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

Administration at 1-800-772-1213.

Child 1 Child 

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 42

of the Form 1040A instructions or page 44 of the

Form 1040 instructions unless the child was born and

died in 2004. If your child was born and died in 2004

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

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

No. 

Go to line 5. Go to line 5. Continue 

Yes. Yes. No. 

Continue Continue The child is not a

qualifying child.

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

2004 but less than 7 months, enter “7.”

● If the child was born or died in 2004 and your

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

or she was alive during 2004, enter “12.”

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

You may also be able to take the additional child tax credit if your child (a) was under age 17 at the end o

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

details, see the instructions for line 42 of Form 1040A or line 67 of Form 1040.

. . . . . . . . . .

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

to 10 years. See back of schedule for details.

(for example, son, daughter, grandchild,

niece, nephew, foster child, etc.)

Was the child under age 24 at the end

of 2004 and a student?

a

Child’s year of birth

If born after 1985, skip lines 4a

and 4b; go to line 5.

Year

If born after 1985

and 4b; go to line 

Year

3

CAUTION

TIP
SCHEDULE F OMB No. 1545-0074 Profit or Loss From Farming

(Form 1040)  Attach to Form 1040, Form 1041, Form 1065, or Form 1065-B.

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 14

Name of proprietor Social security number (SSN)

A Principal product. Describe in one or two words your principal crop or activity for the current tax year. B Enter code from Part IV

D Employer ID number (EIN), if any

C Accounting method: Accrual Cash

E Did you “materially participate” in the operation of this business during 2004? If “No,” see page F-2 for limit on passive losses. Yes No

Farm Income—Cash Method. Complete Parts I and II (Accrual method taxpayers complete Parts II and III, and line 11 of Part I.)

Do not include sales of livestock held for draft, breeding, sport, or dairy purposes; report these sales on Form 4797.

(1)

1 Sales of livestock and other items you bought for resale

(2)

2 Cost or other basis of livestock and other items reported on line 1

3 Subtract line 2 from line 1 3

4 Sales of livestock, produce, grains, and other products you raised 4

5a Total cooperative distributions (Form(s) 1099-PATR) 5a 5b 5b Taxable amount

6a Agricultural program payments (see page F-2) 6a 6b 6b Taxable amount

7 Commodity Credit Corporation (CCC) loans (see page F-3):

a CCC loans reported under election 7a

b CCC loans forfeited 7b 7c Taxable amount 7c

8 Crop insurance proceeds and certain disaster payments (see page F-3):

a Amount received in 2004 8a 8b 8b Taxable amount

c If election to defer to 2005 is attached, check here  8d Amount deferred from 2003 8d

9 Custom hire (machine work) income 9

10 Other income, including Federal and state gasoline or fuel tax credit or refund (see page F-3) 10

Gross income. Add amounts in the right column for lines 3 through 10. If accrual method taxpayer, enter the

amount from page 2, line 51 

11

11

Farm Expenses—Cash and Accrual Method. Do not include personal or living expenses such as taxes, insurance,

repairs, etc., on your home.

Labor hired (less employment credits)

12

24 24

Pension and profit-sharing

plans

Chemicals

12 25

Rent or lease (see page F-5):

Conservation expenses

(see page F-4)

13

26a

13

Vehicles, machinery, and equipment

a

26b

14

14

Custom hire (machine work) b Other (land, animals, etc.)

26

Repairs and maintenance

15

Depreciation and section 179

expense deduction not claimed

elsewhere (see page F-4)

27 27

Seeds and plants purchased 28

15

28

29 Storage and warehousing 29

Supplies purchased

16

Employee benefit programs other

than on line 25

30

16

30

17 Taxes 31

17

31

18 Utilities 32

Fertilizers and lime

18 32

19 Veterinary, breeding, and medicine

Freight and trucking

19 33

Other expenses (specify):

34a

20

Gasoline, fuel, and oil

20

a

34b

21 21

Insurance (other than health) b

23 Interest: c 34c

a Mortgage (paid to banks, etc.) 23a d 34d

b Other 23b e 34e

35 Total expenses. Add lines 12 through 34f  35

36 Net farm profit or (loss). Subtract line 35 from line 11. If a profit, enter on Form 1040, line 18, and also on

Schedule SE, line 1. If a loss, you must go on to line 37 (estates, trusts, and partnerships, see page F-6) 36

37a All investment is at risk. 37 If you have a loss, you must check the box that describes your investment in this activity (see page F-6).

37b Some investment is not at risk. ● If you checked 37a, enter the loss on Form 1040, line 18, and also on Schedule SE, line 1.

● If you checked 37b, you must attach Form 6198.

For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule F (Form 1040) 2004

 See Instructions for Schedule F (Form 1040).

Car and truck expenses (see

page F-4—also attach Form 4562)

Cat. No. 11346H

Feed purchased

22 22

f 34f

25

33

34

1

2



Part I

Part II



(99)

2004
Schedule F (Form 1040) 2004 Page 2

Farm Income—Accrual Method (see page F-6)

Do not include sales of livestock held for draft, breeding, sport, or dairy purposes; report these sales on Form

4797 and do not include this livestock on line 46 below.

38 Sales of livestock, produce, grains, and other products during the year 38

39a Total cooperative distributions (Form(s) 1099-PATR) 39a 39b Taxable amount 39b

40a Agricultural program payments 40a 40b 40b Taxable amount

Commodity Credit Corporation (CCC) loans:

a CCC loans reported under election 41a

b CCC loans forfeited 41b 41c Taxable amount 41c

Crop insurance proceeds

41

42

Custom hire (machine work) income

42

43

Other income, including Federal and state gasoline or fuel tax credit or refund

43

44

Add amounts in the right column for lines 38 through 44

44

Inventory of livestock, produce, grains, and other products at beginning of

the year

45

Cost of livestock, produce, grains, and other products purchased during

the year

46

46

47

Add lines 46 and 47

47

48

Inventory of livestock, produce, grains, and other products at end of year

48

Cost of livestock, produce, grains, and other products sold. Subtract line 49 from line 48* 50

49

51 Gross income. Subtract line 50 from line 45. Enter the result here and on page 1, line 11  51

*If you use the unit-livestock-price method or the farm-price method of valuing inventory and the amount on line 49 is larger than the amount on

line 48, subtract line 48 from line 49. Enter the result on line 50. Add lines 45 and 50. Enter the total on line 51.

Principal Agricultural Activity Codes

Select one of the following codes and enter the six-digit

number on page 1, line B.

50

45

49

Part IV

Part III

File Schedule C (Form 1040), Profit or Loss From

Business, or Schedule C-EZ (Form 1040), Net

Profit From Business, instead of Schedule F if:

● Your principal source of income is from providing

agricultural services such as soil preparation,

veterinary, farm labor, horticultural, or management

for a fee or on a contract basis or

● You are engaged in the business of breeding, raising, and

caring for dogs, cats, or other pet animals.

Crop Production

111100 Oilseed and grain farming

111210 Vegetable and melon farming

111300 Fruit and tree nut farming

111400 Greenhouse, nursery, and floriculture production

111900 Other crop farming

Animal Production

112111 Beef cattle ranching and farming

112112 Cattle feedlots

112120 Dairy cattle and milk production

112210 Hog and pig farming

112300 Poultry and egg production

112400 Sheep and goat farming

112510 Animal aquaculture

112900 Other animal production

Forestry and Logging

113000 Forestry and logging (including forest nurseries

and timber tracts)

These codes for the Principal Agricultural Activity classify farms

by the type of activity they are engaged in to facilitate the

administration of the Internal Revenue Code. These six-digit

codes are based on the North American Industry Classification

System (NAICS).

Schedule F (Form 1040) 2004

CAUTION
(Form 1040) Credit for the Elderly or the Disabled

Attachment

 Attach to Form 1040.  See Instructions for Schedule R (Form 1040). Sequence No. 16

Your social security number

You may be able to take this credit and reduce your tax if by the end of 2004:

● You were age 65 or older or

You filed a physician’s statement for this disability for 1983 or an earlier year, or you filed or got a

statement for tax years after 1983 and your physician signed line B on the statement, and

If:

Due to your continued disabled condition, you were unable to engage in any substantial gainful activity

in 2004, check this box 

● If you checked this box, you do not have to get another statement for 2004.

OMB No. 1545-0074 Schedule R

For Paperwork Reduction Act Notice, see Form 1040 instructions.

Department of the Treasury

Internal Revenue Service

Name(s) shown on Form 1040

But you must also meet other tests. See page R-1.

In most cases, the IRS can figure the credit for you. See page R-1.

Check the Box for Your Filing Status and Age

Statement of Permanent and Total Disability (Complete only if you checked box 2, 4, 5, 6, or 9 above.)

1

Schedule R (Form 1040) 2004

2

If your filing status is:

1 You were 65 or older 1

2 You were under 65 and you retired on permanent and total disability 2

3 Both spouses were 65 or older 3

4 Both spouses were under 65, but only one spouse retired on

permanent and total disability 4

5 Both spouses were under 65, and both retired on permanent and total

disability 5

Married filing

jointly

6 One spouse was 65 or older, and the other spouse was under 65 and

retired on permanent and total disability 6

7 One spouse was 65 or older, and the other spouse was under 65 and

not retired on permanent and total disability 7

8 You were 65 or older and you lived apart from your spouse for all of

Married filing 2004 8

separately

9 You were under 65, you retired on permanent and total disability, and

you lived apart from your spouse for all of 2004 9

Did you check

box 1, 3, 7,

or 8?

Single,

Head of household, or 

Qualifying widow(er)

And by the end of 2004: Check only one box:

Cat. No. 11359K

Part I

Part II

● You were under age 65, you retired on permanent and total disability, and

you received taxable disability income.

Yes Skip Part II and complete Part III on back.

No Complete Parts II and III.





● If you did not check this box, have your physician complete the statement on page R-4. You must

keep the statement for your records.

(99)

2004

TIP
Schedule R (Form 1040) 2004 Page 2

Figure Your Credit

Box 1, 2, 4, or 7 $5,000

10 Enter:

10

● Box 6, add $5,000 to the taxable disability income of the

spouse who was under age 65. Enter the total.

11

If you completed line 11, enter the smaller of line 10 or line 11; all others, enter the

amount from line 10

12

12

Enter the following pensions, annuities, or disability income that

you (and your spouse if filing a joint return) received in 2004.

13

a Nontaxable part of social security benefits and

13a Nontaxable part of railroad retirement benefits

treated as social security (see page R-3).

b Nontaxable veterans’ pensions and

13b Any other pension, annuity, or disability benefit that

is excluded from income under any other provision

of law (see page R-3).

Add lines 13a and 13b. (Even though these income items are

not taxable, they must be included here to figure your credit.)

If you did not receive any of the types of nontaxable income

listed on line 13a or 13b, enter -0- on line 13c

c

13c

14

Enter the amount from Form 1040,

line 37

14

15

15

Subtract line 15 from line 14. If zero or

less, enter -0-

16

16

17 Enter one-half of line 16 17

18 Add lines 13c and 17 18

Subtract line 18 from line 12. If zero or less, stop; you cannot take the credit. Otherwise,

go to line 20

19

19

24

20 Multiply line 19 by 15% (.15)

Did you check

box 2, 4, 5, 6,

or 9 in Part I?

Box 3, 5, or 6 $7,500

Box 8 or 9 $3,750

If you checked (in Part I):

Box 1 or 2 $7,500

Enter:

Box 3, 4, 5, 6, or 7 $10,000

Box 8 or 9 $5,000

If you checked (in Part I):

Part III







● Box 2, 4, or 9, enter your taxable disability income.

● Box 5, add your taxable disability income to your spouse’s

taxable disability income. Enter the total.

For more details on what to include on line 11, see page R-3.

11

If you checked (in Part I):



Yes You must complete line 11.

No Enter the amount from line 10

on line 12 and go to line 13.







Schedule R (Form 1040) 2004

21 Enter the amount from Form 1040, line 45

23 Subtract line 22 from line 21

Add the amounts from Form 1040, lines 46 and 47, and enter

the total

22

Credit for the elderly or the disabled. Enter the smaller of line 20 or line 23 here and

on Form 1040, line 48

24

22

21

20

23

TIP
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 57.

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), box 14, code A

1

1

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

box 14, code A (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) 2004

● 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 30

● $87,900 or less, multiply line 4 by 15.3% (.153). Enter the result here and on 

Form 1040, line 57.

● More than $87,900, multiply line 4 by 2.9% (.029). Then, add $10,899.60 to the

result. Enter the total here and on Form 1040, line 57.

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

Did You Receive Wages or Tips in 2004?

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 $87,900?

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)

2004
Schedule SE (Form 1040) 2004 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), box 14, code A. 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), box

14, code A (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, stop; you do not owe self-employment tax. Exception.

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

6

87,900 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 2004

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 $87,900 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 57

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 (a) your net nonfarm profits3 were less

than $1,733 and also less than 72.189% of your gross nonfarm income4 and (b) you had net earnings

from self-employment of at least $400 in 2 of the prior 3 years.

17

17

3 From Sch. C, line 31; Sch. C-EZ, line 3; Sch. K-1 (Form 1065), box 14, code A; and

Sch. K-1 (Form 1065-B), box 9.

1 From Sch. F, line 11, and Sch. K-1 (Form 1065),

box 14, code B.

4 From Sch. C, line 7; Sch. C-EZ, line 1; Sch. K-1 (Form 1065), box 14, code C; and Sch.

K-1 (Form 1065-B), box 9.

2 From Sch. F, line 36, and Sch. K-1 (Form 1065),

box 14, code A.

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

Farm Optional Method. You may use this method only if (a) your gross farm income1 was not more

than $2,400 or (b) your net farm profits2 were less than $1,733.

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.

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

50% (.5). Enter the result here and on Form 1040, line 30 13

13

Schedule SE (Form 1040) 2004

12
O

Employee Business Expenses Form 2106

 See separate instructions.

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Your name Occupation in which you incurred expenses Social s

Employee Business Expenses and Reimbursements

Column A C

Step 1 Enter Your Expenses M

Ent

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 

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 incurred while away from home on business by 70% (.70)

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. (Reservists, qualified performing artists, fee-basis state or

local government officials, 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 

Part I

(99)
Form 2106 (2004) 

Vehicle Expenses

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

are claiming vehicle expenses.) (a) Vehicle 1 

11 Enter the date the vehicle was placed in service 11 

12 Total miles the vehicle was driven during 2004 12 miles 

13 Business miles included on line 12 13 miles 

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

15 Average daily roundtrip commuting distance 15 miles 

16 Commuting miles included on line 12 16 miles 

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

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

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

21 If “Yes,” is the evidence written? 

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 

Section C.)

22 Multiply line 13 by 37.5¢ (.375) 22

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

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 (see instructions) 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 comp

for the vehicle.)

(a) Vehicle 1 (b) Vehic

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

/ /
OMB No. 1545-1441 2106-EZ Unreimbursed Employee Business Expenses Form

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Attachment

Sequence No. 54A

Your name Occupation in which you incurred expenses Social security number

1

Vehicle expense using the standard mileage rate. Complete Part II and multiply line 8a by 37.5¢

(.375)

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

4 Business expenses not included on lines 1 through 3. Do not include meals and entertainment 4

5

Meals and entertainment expenses: $ × 50% (.50) (Employees subject to

Department of Transportation (DOT) hours of service limits: Multiply meal expenses incurred

while away from home on business by 70% (.70) instead of 50%. For details, see instructions.)

5

Total expenses. Add lines 1 through 5. Enter here and on line 20 of Schedule A (Form 1040).

(Armed Forces reservists, fee-basis state or local government officials, qualified performing

artists, and individuals with disabilities: See the instructions for special rules on where to enter

this amount.)

6

6

Cat. No. 20604Q Form 2106-EZ (2004)

Part I

Part II

Figure Your Expenses

You May Use This Form Only if All of the Following Apply.

● You are an employee deducting ordinary and necessary expenses attributable to your job. An ordinary expense is one that is

common and accepted in your field of trade, business, or profession. A necessary expense is one that is helpful and

appropriate for your business. An expense does not have to be required to be considered necessary.

● If you are claiming vehicle expense, you are using the standard mileage rate for 2004.

● You do not get reimbursed by your employer for any expenses (amounts your employer included in box 1 of your Form W-2 are

not considered reimbursements).

Information on Your Vehicle. Complete this part only if you are claiming vehicle expense on line 1.

7

8

a

9

10

11a

b

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

Of the total number of miles you drove your vehicle during 2004, enter the number of miles you used your vehicle for:

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

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

Do you have evidence to support your deduction?

If “Yes,” is the evidence written?

Business

Yes No

b Commuting c Other

Yes No

Yes No

Yes No

(99)

For Paperwork Reduction Act Notice, see page 4.

Caution: You can use the standard mileage rate for 2004 only if: (a) you owned the vehicle and used the standard mileage rate for the first year

you placed the vehicle in service or (b) you leased the vehicle and used the standard mileage rate for the portion of the lease period after 1997.

2004
VOID CORRECTED

2

OMB No. 1545-0145

Notice to Shareholder of Undistributed

Long-Term Capital Gains

1a

1b

Copy A

1d

Attach to

Form 1120-RIC

or Form 1120-REIT

For Instructions

and Paperwork

Reduction Act

Notice, see back of

Copies A and D.

Form 2439 Department of the Treasury - Internal Revenue ServiceCat. No. 11858E

Form 2439

Name, address, and ZIP code of RIC or REIT

Identification number of RIC or REIT

Shareholder’s identifying number

Shareholder’s name, address, and ZIP code

Total undistributed long-term capital gains

Unrecaptured section 1250 gain

Tax paid by the RIC or REIT on the box 1a gains

Section 1202 gain

For calendar year 2004, or other tax year of the

regulated investment company (RIC) or the

real estate investment trust (REIT)

beginning , 2004, and

ending ,

(99)

20

1c Collectibles (28%) gain

2004
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 32

Enter your earned income. See instructions

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 37 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 2003 expenses in 2004, see

the instructions

9

For Paperwork Reduction Act Notice, see page 4 of the instructions. Form 2441 (2004)

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 61.

.

(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 2004 for the

person listed in column (a)

8

6

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

9

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

10

11

10

11

Enter the amount from Form 1040, line 45, minus any amount on Form 1040, line 46

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

here and on Form 1040, line 47

2004
Form 2441 (2004) Page 2

Dependent Care Benefits

Enter the total amount of dependent care benefits you received in 2004. Amounts you

received as an employee should be shown in box 10 of your Form(s) W-2. Do not include

amounts reported as wages in box 1 of Form(s) W-2. If you were self-employed or a partner,

include amounts you received under a dependent care assistance program from your sole

proprietorship or partnership

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

Subtract line 13 from line 12

Enter the total amount of qualified expenses incurred

in 2004 for the care of the qualifying person(s)

13

15

Enter the smaller of line 14 or 15 16

14

Enter your earned income. See instructions

15

17

Enter the amount shown below that applies

to you.

18

Enter the smallest of line 16, 17, or 18

16

19

Enter the amount from line 12 that you received from your sole proprietorship or

partnership. If you did not receive any such amounts, enter -0-

17

20

Taxable benefits. Subtract line 26 from line 21. If zero or less, enter -0-. Also, include

this amount on Form 1040, line 7. On the dotted line next to line 7, enter “DCB”

18

27

Part III

To claim the child and dependent care

credit, complete lines 28–32 below.

28

29

30

19

20

27

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

Subtract line 29 from line 28. If zero or less, stop. You cannot take the credit.

Exception. If you paid 2003 expenses in 2004, see the instructions for line 9

Enter the smaller of line 30 or 31. Also, enter this amount on line 3 on the front of this

form and complete lines 4–11

Add lines 23 and 26

32

29

30

32

13

14

12

12

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

line 29 above. Then, add the amounts in column (c) and enter the total here

31

31

Form 2441 (2004)

● 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.



21 Subtract line 20 from line 14

Enter $5,000 ($2,500 if married filing separately and you were required to enter your

spouse’s earned income on line 18)

22

Deductible benefits. Enter the smallest of line 19, 20, or 22. Also, include this amount

on the appropriate line(s) of your return (see the instructions)

23

24 Enter the smaller of line 19 or 22

25 Enter the amount from line 23

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

24

25

21

22

23

26
OMB No. 1545-0155 Investment Credit

Form 3468

Department of the Treasury  Attach to your tax return.

Internal Revenue Service

Attachment

Sequence No. 52

Name(s) shown on return Identifying number

Current Year Credit

1b

1

c

Energy credit. Enter the basis of energy property placed in

service during the tax year (see instructions)

2

2

4 4

5

Allowable Credit (See Who must file Form 3800 to find out if you complete Part II or file Form 3800.)

For Paperwork Reduction Act Notice, see page 4. Form 3468 (2004)

Part I

Part II

Rehabilitation credit (see instructions for requirements that must be met):

b Pre-1936 buildings × 10% (.10)

Certified historic structures × 20% (.20)

3

× 10% (.10)

Reforestation credit. Enter the amortizable basis of qualified

timber property acquired before 10/23/04 (see instructions) × 10% (.10)

Credit from cooperatives. Enter the unused investment credit from cooperatives

5 Current year credit. Add lines 1b through 4

1c

3

Cat. No. 12276E

Check this box if you are electing under section 47(d)(5) to take your qualified rehabilitation

expenditures into account for the tax year in which paid (or, for self-rehabilitated property, when

capitalized). See instructions. Note: This election applies to the current tax year and to all later

tax years. You may not revoke this election without IRS consent 

a

Enter the amount of qualified rehabilitation expenditures and multiply by the percentage shown:

e Rehabilitation credit from an electing large partnership (Schedule K-1 (Form 1065-B), box 9) 1e

6

f

Foreign tax credit 9a

Credits from Form 1040, lines 47 through 53 9b

9a

9d

c Possessions tax credit (Form 5735, line 17 or 27)

d Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 9a through 9e 9f

Net income tax. Subtract line 9f from line 8. If zero, skip lines 11 through 14 and enter -0- on line 15 10

7 Alternative minimum tax: Enter the alternative minimum tax (AMT) from the following line of the

appropriate form or schedule 7

10

Tentative minimum tax (see instructions)

11

13

12 Enter 25% (.25) of the excess, if any, of line 11 over $25,000 (see instructions)

Subtract line 14 from line 10. If zero or less, enter -0-

14 14

Credit allowed for the current year. Enter the smaller of line 5 or line 15 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 15 is smaller than line 5, see instructions. 16

b

9c

6 Regular tax before credits:

8 Add lines 6 and 7 8

11

Enter the greater of line 12 or line 13

12

13

e

Net regular tax. Subtract line 9f from line 6. If zero or less, enter -0-

15 15

16

(99)

Enter the assigned NPS project number or the pass-through entity’s

employer identification number (see instructions)

Enter the date that the NPS approved the Request for Certification of

Completed Work (see instructions)

Enter the date on which the 24- or

60-month measuring period begins

Enter the adjusted basis of the building as of the beginning date above

(or the first day of your holding period, if later)

Enter the amount of the qualified rehabilitation expenditures incurred,

or treated as incurred, during the period on line 1d(1) above

$

$

(1)

(2)

(1)

(2)

(3)

d

/ /

/ /

$

$

and ends

$

$

/ /

9e

2004

● Individuals. Enter the amount from Form 1040, line 43

● Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A, Part

I, line 1; or the applicable line of your return

● Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines

1a and 1b, or the amount from the applicable line of your return

● Individuals: Form 6251, line 35

● Corporations: Form 4626, line 14

● Estates and trusts: Form 1041, Schedule I, line 56 O

General Business Credit

Form 3800

Department of the Treasury

Internal Revenue Service  Attach to your tax return. 

 See instructions on pages 3 and 4.

Name(s) shown on return Identifying 

Current Year Credit

1a

2

3 3

4 4

5 5

6

8

7

Passive activity credits included on line 2 (see instructions)

Subtract line 3 from line 2

Passive activity credits allowed for 2004 (see instructions)

Carryforward of general business credit to 2004. See instructions for the schedule to attach

Carryback of general business credit from 2005 (see instructions)

Current year credit. Add lines 4 through 7

Allowable Credit

For Paperwork Reduction Act Notice, see page 2. 

Part II

Part I

2

b

d

e

f

g

6

Cat. No. 12392F

Current year credit. Add lines 1a through 1t

q

h

i

j

k

l

1h

1i

1j

1k

1p

1a

1b

1d

1e

1f

1g

Current year investment credit (Form 3468)

Current year work opportunity credit (Form 5884)

Current year credit for alcohol used as fuel (Form 6478)

Current year credit for increasing research activities (Form 6765)

Current year low-income housing credit (Form 8586)

Current year disabled access credit (Form 8826)

Current year enhanced oil recovery credit (Form 8830)

Current year renewable electricity production credit (Form 8835, Section A only)

Current year Indian employment credit (Form 8845)

Current year credit for employer social security and Medicare taxes paid on certain employee tips (Form 8846)

Current year credit for contributions to selected community development corporations (Form 8847)

Current year trans-Alaska pipeline liability fund credit (see instructions)

1q

p

Current year orphan drug credit (Form 8820) 1l

c Current year welfare-to-work credit (Form 8861) 1c

8

7

1r r

Current year general credits from an electing large partnership (Schedule K-1 (Form 1065-B))

Credit allowed for the current year. Enter the smaller of line 8 or line 18 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 19 is smaller than line 8, see instructions.

Individuals, estates, and trusts: See instructions if claiming the research credit. C corporations:

See Schedule A if claiming any regular investment credit carryforward and the line 19 instructions

if there has been an ownership change, acquisition, or reorganization

19

19

9

f

Foreign tax credit 12a

Credits from Form 1040, lines 47 through 53

12a

c Possessions tax credit (Form 5735, line 17 or 27) 12c

d Credit for fuel from a nonconventional source 12d

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 12a through 12e 12f

10

Net income tax. Subtract line 12f from line 11. If zero, skip lines 14 through 17 and enter -0- on line 18

10 Alternative minimum tax (see instructions)

Tentative minimum tax (see instructions)

14

11

Enter 25% (.25) of the excess, if any, of line 14 over $25,000 (see instructions)

13

Subtract line 17 from line 13. If zero or less, enter -0-

17

16

b 12b

Regular tax before credits (see instructions)

Add lines 9 and 10

Enter the greater of line 15 or line 16

15

16

e 12e

14 Net regular tax. Subtract line 12f from line 9. If zero or less, enter -0-

18

9

15

17

18

11

13

(99)

m Current year new markets credit (Form 8874) 1m

n Current year credit for small employer pension plan startup costs (Form 8881) 1n

o Current year credit for employer-provided child care facilities and services (Form 8882) 1o

t

s

Current year biodiesel fuels credit (Form 8864)

Current year low sulfur diesel fuel production credit (Form 8896)

1t

1s
OMB No. 1545-0162 Credit for Federal Tax Paid on Fuels

Form 4136

Department of the Treasury

Internal Revenue Service

Attachment

 Attach this form to your income tax return. Sequence No. 23

Name (as shown on your income tax return) Taxpayer identification number

Cat. No. 12625R Form 4136 (2004)

2 Nontaxable Use of Aviation Gasoline

375

10% gasohol

7.7% gasohol

5.7% gasohol

Nontaxable Use of Gasoline and Gasohol

(b)

Rate

(c)

Gallons

(d)

Amount of credit

Off-highway business use of gasoline $

1

(e)

CRN

362

3 Nontaxable Use of Undyed Diesel Fuel

Use of gasoline on a farm for farming purposes

e

d

f

a

b

c Other nontaxable use of gasoline

 See the Instructions on page 3.

(a) Type

of use

Claimant certifies that the diesel fuel did not contain visible evidence of dye.

Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and

check here 

For Paperwork Reduction Act Notice, see the instructions.

(b)

Rate

(c)

Gallons

(d)

Amount of credit

Use in commercial aviation (other than foreign trade) $

(e)

CRN

354

Other nontaxable use

a

b

(a) Type

of use

Claimant has the name and address of the person(s) who sold the diesel fuel to the claimant and the date(s) of the purchase(s) and if

exported, the required proof of export.

Caution: Claims cannot be made on line 3 for diesel fuel used

on a farm for farming purposes. Only registered ultimate

vendors may make those claims (see line 6).

(b)

Rate

(c)

Gallons

(d)

Amount of credit

$

(e)

CRN

(a) Type

of use

Nontaxable use

Use in certain intercity and local buses

a

b

c

Use in trains

350

353

$

4

$

$

$





360 

.184

.184

.184

.184

.132

.14396

.15436

.15

.194

.194

.244

.244

.20

.17

359

376

324

Nontaxable Use of Undyed Kerosene

Claimant certifies that the kerosene did not contain visible evidence of dye.

Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed explanation and check

here 

Claimant has the name and address of the person(s) who sold the kerosene to the claimant and the date(s) of the purchase(s) and if

exported, the required proof of export.

Caution: Claims cannot be made on line 4 for kerosene used

on a farm for farming purposes or for kerosene sold from a

blocked pump. Only registered ultimate vendors may make

those claims (see line 7).

(b)

Rate

(c)

Gallons

(d)

Amount of credit

$

(e)

CRN

(a) Type

of use

Nontaxable use

$ 346 .244

.244

Caution: ● You cannot claim any amounts on Form 4136 that you claimed on Form 8849 or Schedule C (Form 720).

● Sales by gasoline wholesale distributors cannot be claimed on Form 4136. Instead, use Schedule 4 (Form 8849)

or Schedule C, line 11 (Form 720) to make these claims.

2004
$

Form 4136 (2004) Page 2

10

10 Total income tax credit claimed. Add lines 1 through 9, column (d). Enter here and on

Form 1040, line 69 (also check box b on line 69); Form 1120, line 32g; Form 1120-A, line

28g; Form 1120S, line 23c; Form 1041, line 24g; or the proper line of other returns. 

6 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Claimant certifies that the diesel fuel did not contain visible evidence of dye.

Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and check here 

Claimant sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the

buyer to take the claim; and obtained the required certificate from the buyer and has no reason to believe any information in the

certificate is false. See the instructions for additional information to be submitted.

UV Registration No. 

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use on a farm for farming purposes 360

Use by a state or local government

a

b

$

$

7 Sales by Registered Ultimate Vendors of Undyed Kerosene

Claimant certifies that the kerosene did not contain visible evidence of dye.

Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed explanation and check here 

Claimant sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the buyer

to take the claim; and obtained the required certificate (for lines 7a and 7b) from the buyer and has no reason to believe any information

in the certificate is false, or has the Regulations section 48.6427-10(e)(4) statement, if required, for line 7c. See the instructions for

additional information to be submitted.

UV Registration No. 

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use on a farm for farming purposes

346

Use by a state or local government

a

b

$

$

c Sales from a blocked pump

8 Nontaxable Use of Liquefied Petroleum Gas (LPG) in Certain Buses

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use in certain intercity and local buses

352

Use in qualified local buses or school buses

a

b

$

$

9 Gasohol Blending

Claimant bought gasoline taxed at the full rate and blended it with alcohol to make gasohol. The gasohol was sold or used in

claimant’s trade or business. For each batch of gasohol, claimant has the required information relating to the purchase of the

gasoline and alcohol used to make the gasohol and to support the amount claimed.

(a)

Rate (b)

Gasoline

(d)

Amount of credit

(col. (a)  col. (b))

(e)

CRN

10% gasohol

357

7.7% gasohol

a

b

$

$

c 5.7% gasohol

(c)

Alcohol

Gallons of





UP Registration No. 

.244

.244

.244

.244

.244

.062

.136

.03734

.02804

.02031

Form 4136 (2004)

Nontaxable Use of Aviation Fuel

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use in commercial aviation (other than foreign trade)

Other nontaxable use 369

a

b

$

$ .175

.219

.044

5

355

377

361

356

363

c Other nontaxable uses
OMB No. 1545-0172 Depreciation and Amortization

Form 4562 (Including Information on Listed Property)

Department of the Treasury

Internal Revenue Service

Attachment

 See separate instructions. Sequence No. 67

Name(s) shown on return Business or activity to which this form relates Identifying number

Election To Expense Certain Property Under Section 179

Note: If you have any listed property, complete Part V before you complete Part I.

1 Maximum amount. See page 2 of the instructions for a higher limit for certain businesses 1 $102,000

2 Total cost of section 179 property placed in service (see page 3 of the instructions) 2

3 Threshold cost of section 179 property before reduction in limitation 3 $410,000

4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- 4

Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing

separately, see page 3 of the instructions

5

5

(a) Description of property (b) Cost (business use only) (c) Elected cost

6

7 Listed property. Enter the amount from line 29 7

8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 8

9 Tentative deduction. Enter the smaller of line 5 or line 8 9

10 Carryover of disallowed deduction from line 13 of your 2003 Form 4562 10

11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11

12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 12

13 Carryover of disallowed deduction to 2005. Add lines 9 and 10, less line 12  13

Note: Do not use Part II or Part III below for listed property. Instead, use Part V.

MACRS Depreciation (Do not include listed property.) (See page 5 of the instructions.)

(b) Month and

year placed in

service

(c) Basis for depreciation

(business/investment use

only—see instructions)

(d) Recovery

period (a) (e) Convention (f) Method (g) Depreciation deduction

Section B—Assets Placed in Service During 2004 Tax Year Using the General Depreciation System

19a 3-year property

b 5-year property

c 7-year property

d 10-year property

e 15-year property

f 20-year property

Residential rental 27.5 yrs. MM S/L

property

h

27.5 yrs. MM S/L

Nonresidential real MM S/L

property

i

MM S/L

Section C—Assets Placed in Service During 2004 Tax Year Using the Alternative Depreciation System

20a Class life S/L

b 12-year 12 yrs. S/L

c 40-year 40 yrs. MM S/L

Special Depreciation Allowance and Other Depreciation (Do not include listed property.)

17 MACRS deductions for assets placed in service in tax years beginning before 2004 17

15 Property subject to section 168(f)(1) election (see page 4 of the instructions) 15

16 Other depreciation (including ACRS) (see page 4 of the instructions) 16

Summary (see page 8 of the instructions)

21 Listed property. Enter amount from line 28 21

Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21.

Enter here and on the appropriate lines of your return. Partnerships and S corporations—see instr.

22

22

23 For assets shown above and placed in service during the current year,

enter the portion of the basis attributable to section 263A costs 23

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 12906N Form 4562 (2004)

Part IV

Part I

Part II

Part III

 Attach to your tax return.

39 yrs.

Section A

18 If you are electing under section 168(i)(4) to group any assets placed in service during the tax year

into one or more general asset accounts, check here 

Classification of property

g 25-year property 25 yrs. S/L

Special depreciation allowance for qualified property (other than listed property) placed in service

during the tax year (see page 3 of the instructions)

14

14

2004
Form 4562 (2004) Page 2

Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and

property used for entertainment, recreation, or amusement.)

Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only

24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable.

Section A—Depreciation and Other Information (Caution: See page 9 of the instructions for limits for passenger automobiles.)

24a Do you have evidence to support the business/investment use claimed? Yes No 24b If “Yes,” is the evidence written? Yes No

(i)

Elected

section 179

cost

(h)

Depreciation

deduction

(g)

Method/

Convention

(f)

Recovery

period

(e)

Basis for depreciation

(business/investment

use only)

(d)

Cost or other

basis

(c)

Business/

investment

use

percentage

(b)

Date placed in

service

(a)

Type of property (list

vehicles first)

26 Property used more than 50% in a qualified business use (see page 8 of the instructions):

%

%

%

27 Property used 50% or less in a qualified business use (see page 8 of the instructions):

% S/L –

% S/L –

% S/L –

28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 28

29 Add amounts in column (i), line 26. Enter here and on line 7, page 1 29

Section B—Information on Use of Vehicles

(f)

Vehicle 6

(e)

Vehicle 5

(d)

Vehicle 4

(c)

Vehicle 3

(b)

Vehicle 2

(a)

Vehicle 1

Total business/investment miles driven

during the year (do not include commuting

miles—See page 2 of the instructions)

30

31 Total commuting miles driven during the year

Total other personal (noncommuting)

miles driven

32

Total miles driven during the year.

Add lines 30 through 32

33

Was the vehicle available for personal Yes No Yes No Yes No Yes No Yes No Yes No

use during off-duty hours?

34

Was the vehicle used primarily by a

more than 5% owner or related person?

35

Is another vehicle available for personal

use?

36

Section C—Questions for Employers Who Provide Vehicles for Use by Their Employees

Yes No Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,

by your employees?

37

Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees?

See page 10 of the instructions for vehicles used by corporate officers, directors, or 1% or more owners

38

39 Do you treat all use of vehicles by employees as personal use?

Do you provide more than five vehicles to your employees, obtain information from your employees about

the use of the vehicles, and retain the information received?

40

41 Do you meet the requirements concerning qualified automobile demonstration use? (See page 10 of the instructions.)

Note: If your answer to 37, 38, 39, 40, or 41 is “Yes,” do not complete Section B for the covered vehicles.

Amortization

(e)

Amortization

period or

percentage

(b)

Date amortization

begins

(c)

Amortizable

amount

(d)

Code

section

(f)

Amortization for

this year

(a)

Description of costs

42 Amortization of costs that begins during your 2004 tax year (see page 11 of the instructions):

43 Amortization of costs that began before your 2004 tax year 43

44 Total. Add amounts in column (f). See page 12 of the instructions for where to report 44

Complete this section for vehicles used by a sole proprietor, partner, or other “more than 5% owner,” or related person.

If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.

Part VI

Part V

Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are

not more than 5% owners or related persons (see page 10 of the instructions).

Form 4562 (2004)

Special depreciation allowance for qualified listed property placed in service during the tax

year and used more than 50% in a qualified business use (see page 8 of the instructions)

25

25
Casualties and Thefts

Form 4684  See separate instructions.

 Attach to your tax return. Department of the Treasury

Internal Revenue Service

 Use a separate Form 4684 for each casualty or theft. 

Name(s) shown on tax return Identifyi

SECTION A—Personal Use Property (Use this section to report casualties and thefts of property no

or business or for income-producing purposes.)

1 Description of properties (show type, location, and date acquired for each property). Use a separate line for each prop

from the same casualty or theft.

Property A

Property B

Property C

Property D

Properties

A B C

Cost or other basis of each property 2 2

Insurance or other reimbursement (whether or not

you filed a claim) (see instructions)

3

3

Note: If line 2 is more than line 3, skip line 4.

Gain from casualty or theft. If line 3 is more than

line 2, enter the difference here and skip lines 5

through 9 for that column. See instructions if line 3

includes insurance or other reimbursement you did

not claim, or you received payment for your loss in

a later tax year

4

4

5 5 Fair market value before casualty or theft

6 Fair market value after casualty or theft 6

7 Subtract line 6 from line 5 7

8 Enter the smaller of line 2 or line 7 8

9

Subtract line 3 from line 8. If zero or less,

enter -0-

9

10 Casualty or theft loss. Add the amounts on line 9 in columns A through D 10

11 Enter the smaller of line 10 or $100 11

12 Subtract line 11 from line 10 12

Caution: Use only one Form 4684 for lines 13 through 18.

13 Add the amounts on line 12 of all Forms 4684 13

14 Add the amounts on line 4 of all Forms 4684 14

15

15

16 If line 14 is less than line 13, enter the difference 16

17 Enter 10% of your adjusted gross income from Form 1040, line 37. Estates and trusts, see instructions 17

Subtract line 17 from line 16. If zero or less, enter -0-. Also enter the result on Schedule A (Form 1040), line 19.

Estates and trusts, enter the result on the “Other deductions” line of your tax return

18

18

For Paperwork Reduction Act Notice, see page 4 of the instructions. 

● If line 14 is more than line 13, enter the difference here and on Schedule D. Do not

complete the rest of this section (see instructions).

● If line 14 is less than line 13, enter -0- here and go to line 16.

● If line 14 is equal to line 13, enter -0- here. Do not complete the rest of this section.

Cat. No. 12997O

Form 4684 (2004) 

Name(s) shown on tax return. Do not enter name and identifying number if shown on other side. Identifyi

SECTION B—Business and Income-Producing Property

Casualty or Theft Gain or Loss (Use a separate Part l for each casualty or theft.)

19 Description of properties (show type, location, and date acquired for each property). Use a separate line for each prope

aged from the same casualty or theft.

Property A

Property B

Property C

Property D

Properties

A B C 

20 Cost or adjusted basis of each property 20

Insurance or other reimbursement (whether or not

you filed a claim). See the instructions for line 3

21

21

Note: If line 20 is more than line 21, skip line 22

Gain from casualty or theft. If line 21 is more than line

20, enter the difference here and on line 29 or line 34,

column (c), except as provided in the instructions for

line 33. Also, skip lines 23 through 27 for that column.

See the instructions for line 4 if line 21 includes

insurance or other reimbursement you did not claim, or

you received payment for your loss in a later tax year

22

22

Fair market value before casualty or theft 23 23

24 Fair market value after casualty or theft 24

25 Subtract line 24 from line 23 25

26 Enter the smaller of line 20 or line 25 26

Note: If the property was totally destroyed by

casualty or lost from theft, enter on line 26

the amount from line 20.

27 Subtract line 21 from line 26. If zero or less, enter -0- 27

28 Casualty or theft loss. Add the amounts on line 27. Enter the total here and on line 29 or line 34 (see instructions) 28

Summary of Gains and Losses (from separate Parts l) (b) Losses from casualties or thefts 

(i) Trade, business,

rental or royalty

property

(ii) Incomeproducing and

employee property

(a) Identify casualty or theft

Casualty or Theft of Property Held One Year or Less

29

30 Totals. Add the amounts on line 29 30

31 Combine line 30, columns (b)(i) and (c). Enter the net gain or (loss) here and on Form 4797, line 14. If Form 4797

is not otherwise required, see instructions 31

32 Enter the amount from line 30, column (b)(ii) here. Individuals, enter the amount from income-producing property

on Schedule A (Form 1040), line 27, and enter the amount from property used as an employee on Schedule A

(Form 1040), line 22. Estates and trusts, partnerships, and S corporations, see instructions 32

Casualty or Theft of Property Held More Than One Year

33 Casualty or theft gains from Form 4797, line 32 33

34

35 35 Total losses. Add amounts on line 34, columns (b)(i) and (b)(ii)

36 Total gains. Add lines 33 and 34, column (c) 36

37 Add amounts on line 35, columns (b)(i) and (b)(ii) 37

Note: Partnerships, enter the amount from line 38a, 38b, or line 39 on Form 1065, Schedule K, line 11.

S corporations, enter the amount from line 38a or 38b on Form 1120S, Schedule K, line 10.

38 If the loss on line 37 is more than the gain on line 36:

a Combine line 35, column (b)(i) and line 36, and enter the net gain or (loss) here. Partnerships (except electing

large partnerships) and S corporations, see the note below. All others, enter this amount on Form 4797,

line 14. If Form 4797 is not otherwise required, see instructions 38a

b Enter the amount from line 35, column (b)(ii) here. Individuals, enter the amount from income-producing property on

Schedule A (Form 1040), line 27, and enter the amount from property used as an employee on Schedule A (Form 1040),

line 22. Estates and trusts, enter on the “Other deductions” line of your tax return. Partnerships (except electing large

partnerships) and S corporations, see the note below. Electing large partnerships, enter on Form 1065-B, Part II, line 11 38b

If the loss on line 37 is less than or equal to the gain on line 36, combine lines 36 and 37 and enter here. Partnerships

(except electing large partnerships), see the note below. All others, enter this amount on Form 4797, line 3

39

39

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )

( )( )

Part I

Part II

Printed on recycled paper 

Attachment Sequence No. 26
Sales of Business Property

(Also Involuntary Conversions and Recapture Amounts

Under Sections 179 and 280F(b)(2)) Department of the Treasury 

Internal Revenue Service

Attachment 

Attach to your tax return. Sequence No. 27

Name(s) shown on return Identifying number

Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From Other

Than Casualty or Theft—Most Property Held More Than 1 Year (see instructions)

Enter the gross proceeds from sales or exchanges reported to you for 2004 on Form(s) 1099-B or 1099-S (or substitute

statement) that you are including on line 2, 10, or 20 (see instructions)

1

1

(f) Cost or other

basis, plus

improvements and

expense of sale

(e) Depreciation

allowed or

allowable since

acquisition

(g) Gain or (loss)

Subtract (f) from the

sum of (d) and (e)

(c) Date sold

(mo., day, yr.)

(b) Date acquired

(mo., day, yr.)

(a) Description

of property

(d) Gross

sales price

2

3 Gain, if any, from Form 4684, line 39

4 Section 1231 gain from installment sales from Form 6252, line 26 or 37

Gain, if any, from line 32, from other than casualty or theft

5

Combine lines 2 through 6. Enter the gain or (loss) here and on the appropriate line as follows:

6

7

Partnerships (except electing large partnerships) and S corporations. Report the gain or (loss) following the instructions

for Form 1065, Schedule K, line 10, or Form 1120S, Schedule K, line 9. Skip lines 8, 9, 11, and 12 below.

All others. If line 7 is zero or a loss, enter the amount from line 7 on line 11 below and skip lines 8 and 9. If line

7 is a gain and you did not have any prior year section 1231 losses, or they were recaptured in an earlier year,

enter the gain from line 7 as a long-term capital gain on Schedule D and skip lines 8, 9, 11, and 12 below.

8 Nonrecaptured net section 1231 losses from prior years (see instructions)

9 Subtract line 8 from line 7. If zero or less, enter -0-. If line 9 is zero, enter the gain from line 7 on line 12 below. If

line 9 is more than zero, enter the amount from line 8 on line 12 below and enter the gain from line 9 as a long-term

capital gain on Schedule D (see instructions)

Ordinary Gains and Losses

Ordinary gains and losses not included on lines 11 through 16 (include property held 1 year or less):

Loss, if any, from line 7

10

Gain, if any, from line 7 or amount from line 8, if applicable

11

Gain, if any, from line 31

12

Net gain or (loss) from Form 4684, lines 31 and 38a

13

Ordinary gain from installment sales from Form 6252, line 25 or 36

14

15

Combine lines 10 through 16

16

b

If the loss on line 11 includes a loss from Form 4684, line 35, column (b)(ii), enter that part of the loss here. Enter

the part of the loss from income-producing property on Schedule A (Form 1040), line 27, and the part of the loss

from property used as an employee on Schedule A (Form 1040), line 22. Identify as from “Form 4797, line 18a.”

See instructions

Redetermine the gain or (loss) on line 17 excluding the loss, if any, on line 18a. Enter here and on Form 1040,

line 14

For Paperwork Reduction Act Notice, see page 8 of the instructions. Cat. No. 13086I Form 4797 (2004)

Part I

Part II

OMB No. 1545-0184

Section 1231 gain or (loss) from like-kind exchanges from Form 8824

Ordinary gain or (loss) from like-kind exchanges from Form 8824

17

3

4

5

6

7

8

11

12

13

14

15

16

17

18a

18b

(99)

9

( )

Form 4797 2004

a

For all except individual returns, enter the amount from line 17 on the appropriate line of your return and skip lines

a and b below. For individual returns, complete lines a and b below:

18

See separate instructions.
Form 4797 (2004) Page 2

Gain From Disposition of Property Under Sections 1245, 1250, 1252, 1254, and 1255

(c) Date sold

(mo., day, yr.)

(b) Date acquired

(mo., day, yr.) (a) Description of section 1245, 1250, 1252, 1254, or 1255 property:

A

B

C

D

These columns relate to the properties on lines 19A through 19D.  Property A Property B Property C Property D

Gross sales price (Note: See line 1 before completing.)

Cost or other basis plus expense of sale

19

Depreciation (or depletion) allowed or allowable

20

Adjusted basis. Subtract line 22 from line 21

21

Total gain. Subtract line 23 from line 20

22

If section 1245 property:

23

a Depreciation allowed or allowable from line 22

b Enter the smaller of line 24 or 25a

If section 1250 property: If straight line depreciation was used, enter

-0- on line 26g, except for a corporation subject to section 291.

24

a Additional depreciation after 1975 (see instructions)

Applicable percentage multiplied by the smaller of line 24

or line 26a (see instructions)

b

Subtract line 26a from line 24. If residential rental property

or line 24 is not more than line 26a, skip lines 26d and 26e

c

d Additional depreciation after 1969 and before 1976

e Enter the smaller of line 26c or 26d

f Section 291 amount (corporations only)

g Add lines 26b, 26e, and 26f

25

If section 1252 property: Skip this section if you did not

dispose of farmland or if this form is being completed for a

partnership (other than an electing large partnership).

a Soil, water, and land clearing expenses

b Line 27a multiplied by applicable percentage (see instructions)

c Enter the smaller of line 24 or 27b

If section 1254 property:

26

Intangible drilling and development costs, expenditures for

development of mines and other natural deposits, and

mining exploration costs (see instructions)

a

b Enter the smaller of line 24 or 28a

If section 1255 property:

27

Applicable percentage of payments excluded from income

under section 126 (see instructions)

a

b Enter the smaller of line 24 or 29a (see instructions)

Summary of Part III Gains. Complete property columns A through D through line 29b before going to line 30.

Total gains for all properties. Add property columns A through D, line 24

28

Add property columns A through D, lines 25b, 26g, 27c, 28b, and 29b. Enter here and on line 13

29

Subtract line 31 from line 30. Enter the portion from casualty or theft on Form 4684, line 33. Enter the portion

from other than casualty or theft on Form 4797, line 6

30

31

32

33

Recapture Amounts Under Sections 179 and 280F(b)(2) When Business Use Drops to 50% or Less

(see instructions)

(b) Section 

280F(b)(2)

(a) Section

179

Section 179 expense deduction or depreciation allowable in prior years

34 Recomputed depreciation. See instructions

35 Recapture amount. Subtract line 34 from line 33. See the instructions for where to report

Part IV

Part III

20

21

22

23

24

25a

26a

27a

28a

29a

26b

26c

26d

26e

26f

26g

27b

27c

28b

29b

25b

30

31

32

33

34

35

Form 4797 (2004)
OMB No. 1545-0187 Farm Rental Income and Expenses Form 4835 (Crop and Livestock Shares (Not Cash) Received by Landowner (or Sub-Lessor))

(Income not subject to self-employment tax) Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040. Sequence No. 37

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

Employer ID number (EIN), if any

A Did you actively participate in the operation of this farm during 2004 (see instructions)? Yes No

Gross Farm Rental Income—Based on Production. Include amounts converted to cash or the equivalent.

1 Income from production of livestock, produce, grains, and other crops 1

2a Cooperative distributions (Form(s) 1099-PATR) 2a 2b 2b Taxable amount

3a Agricultural program payments (see instructions) 3a 3b 3b Taxable amount

4 Commodity Credit Corporation (CCC) loans (see instructions):

a CCC loans reported under election 4a

b CCC loans forfeited 4b 4c Taxable amount 4c

5 Crop insurance proceeds and certain disaster payments (see instructions):

a Amount received in 2004 5a 5b Taxable amount 5b

c If election to defer to 2005 is attached, check here  5d Amount deferred from 2003 5d

6 Other income, including Federal and state gasoline or fuel tax credit or refund (see instructions) 6

Gross farm rental income. Add amounts in the right column for lines 1 through 6. Enter the

total here and on Schedule E (Form 1040), line 42 

7

7

Expenses—Farm Rental Property. Do not include personal or living expenses.

8

8

Vehicles, machinery, and

equipment (see instructions)

20

9

20

9 Chemicals

22 Rent or lease:

Conservation expenses (see

instructions)

10

10

a

11

22b

Custom hire (machine work)

b Other (land, animals, etc.)

11 23 Repairs and maintenance

12 Depreciation and section

179 expense deduction

not claimed elsewhere

23

Seeds and plants

purchased

24

25 Storage and warehousing 25

26

12

26 Supplies purchased

27 Taxes 27 Employee benefit programs

other than on line 21 (see

Schedule F instructions)

13

13 28 Utilities 28

29

14 Veterinary, breeding, and

medicine

14 Feed purchased 29

15 Fertilizers and lime 15

16 Other expenses (specify):

30a

16 Freight and trucking

a

17

30b

17 Gasoline, fuel, and oil

b

18

30c

18 Insurance (other than health)

c

30d

19 Interest:

d

30e

a Mortgage (paid to banks, etc.)

e

b Other 19b

Labor hired (less employment

credits) (see Schedule F

instructions)

31 Total expenses. Add lines 8 through 30g  31

Net farm rental income or (loss). Subtract line 31 from line 7. If the result is income, enter it

here and on Schedule E, line 40. If the result is a loss, you must go on to line 33

32

32

33a All investment is at risk. If line 32 is a loss, you must check the box that describes your investment in this activity (see

instructions)

33 33b Some investment is not at risk.

You may need to complete Form 8582 to determine your deductible loss, regardless of which

box you check (see instructions). However, if you checked box 33b, you must complete Form

6198 before going to Form 8582. In either case, enter the deductible loss here and on

Schedule E, line 40 33c

For Paperwork Reduction Act Notice, see instructions on back. Form 4835 (2004)

Part I

Part II

Car and truck expenses (see

Schedule F instructions). Also

attach Form 4562 

19a

30

22a

Cat. No. 13117W

f

g

30f

30g

21

21

24

2004

 See instructions on back.

Pension and profit-sharing

plans

(99)
OMB No. 1545-0191

Form 4952 Investment Interest Expense Deduction

 Attach to your tax return. Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 51

Name(s) shown on return Identifying number

1 Investment interest expense paid or accrued in 2004 (see instructions) 1

2 Disallowed investment interest expense from 2003 Form 4952, line 7 2

3 Total investment interest expense. Add lines 1 and 2 3

4a

Gross income from property held for investment (excluding any net

gain from the disposition of property held for investment)

4a

5 Investment expenses (see instructions) 5

6 Net investment income. Subtract line 5 from line 4h. If zero or less, enter -0- 6

Cat. No. 13177Y Form 4952 (2004)

General Instructions

Section references are to the Internal

Revenue Code unless otherwise noted.

Total Investment Interest Expense

Net Investment Income

Investment Interest Expense Deduction

b Qualified dividends included on line 4a

c Subtract line 4b from line 4a

d Net gain from the disposition of property held for investment

e Enter the smaller of line 4d or your net capital gain from the disposition

of property held for investment (see instructions)

f Subtract line 4e from line 4d

Disallowed investment interest expense to be carried forward to 2005. Subtract line 6 from

line 3. If zero or less, enter -0-

7

8 Investment interest expense deduction. Enter the smaller of line 3 or 6. See instructions

4f

4b

4c

7

8

Part III

Part I

Part II

Purpose of Form

Use Form 4952 to figure the amount of

investment interest expense you can deduct

for 2004 and the amount you can carry

forward to future years. Your investment

interest expense deduction is limited to your

net investment income.

For more information, see Pub. 550,

Investment Income and Expenses.

Who Must File

If you are an individual, estate, or a trust, you

must file Form 4952 to claim a deduction for

your investment interest expense.

● You have no other deductible investment

expenses.

● Your investment interest expense is not

more than your investment income from

interest and ordinary dividends minus any

qualified dividends.

Allocation of Interest

Expense

If you paid or accrued interest on a loan and

used the loan proceeds for more than one

purpose, you may have to allocate the

interest. This is necessary because different

Specific Instructions

Part I—Total Investment

Interest Expense

Enter the investment interest expense paid or

accrued during the tax year, regardless of

when you incurred the indebtedness.

Investment interest expense is interest paid or

accrued on a loan or part of a loan that is

allocable to property held for investment (as

defined on this page).

Include investment interest expense

reported to you on Schedule K-1 from a

partnership or an S corporation. Include

amortization of bond premium on taxable

bonds purchased after October 22, 1986, but

before January 1, 1988, unless you elected to

offset amortizable bond premium against the

interest payments on the bond. A taxable

bond is a bond on which the interest is

includible in gross income.

Line 1

For Paperwork Reduction Act Notice, see back of form.

● You have no disallowed investment interest

expense from 2003.

Exception. You do not have to file Form 4952

if all of the following apply.

g Enter the amount from lines 4b and 4e that you elect to include in investment income (see

instructions)

h Investment income. Add lines 4c, 4f, and 4g 4h

4g

4d

4e

Property held for investment. Property held

for investment includes property that

produces income, not derived in the ordinary

course of a trade or business, from interest,

dividends, annuities, or royalties. It also

includes property that produces gain or loss,

not derived in the ordinary course of a trade

or business, from the disposition of property

that produces these types of income or is

held for investment. However, it does not

include an interest in a passive activity.

Investment interest expense does not

include any of the following:

● Home mortgage interest.

● Interest expense that is properly allocable

to a passive activity. Generally, a passive

activity is any business activity in which you

do not materially participate and any rental

activity. See the Instructions for Form 8582,

Passive Activity Loss Limitations, for details.

● Any interest expense that is capitalized,

such as construction interest subject to

section 263A.

● Interest expense related to tax-exempt

interest income under section 265.

● Interest expense, disallowed under section

264, on indebtedness with respect to life

insurance, endowment, or annuity contracts

issued after June 8, 1997, even if the

proceeds were used to purchase any

property held for investment.

Exception. A working interest in an oil or

gas property that you held directly or through

an entity that did not limit your liability is

property held for investment, but only if you

did not materially participate in the activity.

2004

(99)

rules apply to investment interest, personal

interest, trade or business interest, home

mortgage interest, and passive activity

interest. See Pub. 535, Business Expenses.

Part II—Net Investment

Income

Gross income from property held for

investment includes income, unless derived in

the ordinary course of a trade or business,

from interest, ordinary dividends (except

Alaska Permanent Fund dividends), annuities,

and royalties.

Line 4a
Cat. No. 13187U

OMB No. 1545-0193

Form 4972 Tax on Lump-Sum Distributions

(From Qualified Plans of Participants Born Before January 2, 1936)

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040 or Form 1041. Sequence No. 28

Name of recipient of distribution Identifying number

Complete this part to see if you can use Form 4972

Yes No

1

1

2

Was this a distribution of a plan participant’s entire balance (excluding deductible voluntary employee

contributions and certain forfeited amounts) from all of an employer’s qualified plans of one kind (pension,

profit-sharing, or stock bonus)? If “No,” do not use this form

2

3

4

3 Was this distribution paid to you as a beneficiary of a plan participant who was born before 

January 2, 1936?

5a

5a Did you use Form 4972 after 1986 for a previous distribution from your own plan? If “Yes,” do not use this

form for a 2004 distribution from your own plan

Complete this part to choose the 20% capital gain election (see instructions)

Capital gain part from Form 1099-R, box 3 6

Multiply line 6 by 20% (.20)  7

Complete this part to choose the 10-year tax option (see instructions)

Ordinary income from Form 1099-R, box 2a minus box 3. If you did not complete Part II, enter

the taxable amount from Form 1099-R, box 2a 8

9

10

11

12

14

15

16

17

18

22

For Paperwork Reduction Act Notice, see instructions. Form 4972 (2004)

Did you roll over any part of the distribution? If “Yes,” do not use this form

Death benefit exclusion for a beneficiary of a plan participant who died before August 21, 1996

Total taxable amount. Subtract line 9 from line 8

Current actuarial value of annuity from Form 1099-R, box 8. If none, enter -0-

Part III

Part I

Part II

6

7

8

9

10

11

12

14

15

16

17

18

22

19

20

21

13

19

20

21

If you also choose to use Part III, go to line 8. Otherwise, include the amount from line 7 in the

total on Form 1040, line 43, or Form 1041, Schedule G, line 1b, whichever applies.

13

If you are receiving this distribution as a beneficiary of a plan participant who died, did you use Form 4972

for a previous distribution received for that participant after 1986? If “Yes,” do not use the form for this

distribution 5b

Adjusted total taxable amount. Add lines 10 and 11. If this amount is $70,000 or more, skip

lines 13 through 16, enter this amount on line 17, and go to line 18

Divide line 11 by line 12 and enter the result as a decimal (rounded

to at least three places)

Multiply line 16 by the decimal on line 20

Subtract line 21 from line 11

Multiply line 12 by 50% (.50), but do not enter more than $10,000

Subtract $20,000 from line 12. If line 12 is

$20,000 or less, enter -0-

Multiply line 14 by 20% (.20)

Minimum distribution allowance. Subtract line 15 from line 13

Subtract line 16 from line 12

Federal estate tax attributable to lump-sum distribution

Subtract line 18 from line 17. If line 11 is zero, skip lines 20 through 22 and go to line 23

.

If you answered “No” to both questions 3 and 4, do not use this form.

4 Were you (a) a plan participant who received this distribution, (b) born before January 2, 1936, and (c) a

participant in the plan for at least 5 years before the year of the distribution?

b

Multiply line 19 by 10% (.10) 23

Tax on amount on line 23. Use the Tax Rate Schedule in the instructions 24

25

Multiply line 24 by ten (10). If line 11 is zero, skip lines 26 through 28, enter this amount on line

29, and go to line 30

Multiply line 22 by 10% (.10) 26

27

Tax on amount on line 26. Use the Tax Rate Schedule in the

instructions

Multiply line 27 by ten (10) 28

Subtract line 28 from line 25. Multiple recipients, see instructions  29

23

24

25

26

27

28

29

30

30

Tax on lump-sum distribution. Add lines 7 and 29. Also include this amount in the total on

Form 1040, line 43, or Form 1041, Schedule G, line 1b, whichever applies 

2004

(99)
Additional Taxes on Qualified Plans OMB No. 1545-0203 5329 (Including IRAs) and Other Tax-Favored Accounts Form

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 29

 Attach to Form 1040.

Name of individual subject to additional tax. If married filing jointly, see instructions. Your social security number

Home address (number and street), or P.O. box if mail is not delivered to your home

City, town or post office, state, and ZIP code If this is an amended

return, check here 

Enter your excess contributions from line 16 of your 2003 Form 5329 (see instructions). If zero,

go to line 15

13

14 14

If your traditional IRA contributions for 2004 are less than your

maximum allowable contribution, see instructions. Otherwise, enter -0-

15

2004 traditional IRA distributions included in income (see instructions)

15

2004 distributions of prior year excess contributions (see instructions)

Add lines 10, 11, and 12

Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter -0-

Excess contributions for 2004 (see instructions)

Additional Tax on Early Distributions

Complete this part if you took a taxable distribution, before you reached age 591⁄2 , from a qualified retirement plan (including

an IRA) or modified endowment contract (unless you are reporting this tax directly on Form 1040—see above). You may also

have to complete this part to indicate that you qualify for an exception to the additional tax on early distributions or for certain

Roth IRA distributions (see instructions).

1 Early distributions included in income. For Roth IRA distributions, see instructions 1

Early distributions included on line 1 that are not subject to the additional tax (see instructions).

Enter the appropriate exception number from the instructions: 

2

2

3 Amount subject to additional tax. Subtract line 2 from line 1 3

4 Additional tax. Enter 10% (.10) of line 3. Include this amount on Form 1040, line 59 4

For Paperwork Reduction Act Notice, see page 5 of the instructions. Cat. No. 13329Q Form 5329 (2004)

Apt. no.

Part I

Part II

If you only owe the additional 10% tax on early distributions, you may be able to report this tax directly

on Form 1040, line 59, without filing Form 5329. See the instructions for Form 1040, line 59.

Fill in Your Address Only

If You Are Filing This

Form by Itself and Not

With Your Tax Return



Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have

to include 25% of that amount on line 4 instead of 10% (see instructions).

5 5

6

7

8

6

7

8

Additional Tax on Certain Distributions From Education Accounts

Distributions included in income from Coverdell ESAs and QTPs

9

10

Distributions included on line 5 that are not subject to the additional tax (see instructions)

11

Amount subject to additional tax. Subtract line 6 from line 5

12

Additional tax. Enter 10% (.10) of line 7. Include this amount on Form 1040, line 59

9

10

11

12

Part III Additional Tax on Excess Contributions to Traditional IRAs

Complete this part if you contributed more to your traditional IRAs for 2004 than is allowable or you had an amount

on line 17 of your 2003 Form 5329.

Total excess contributions. Add lines 14 and 15 16

Additional tax. Enter 6% (.06) of the smaller of line 16 or the value of your traditional IRAs on December

31, 2004 (including 2004 contributions made in 2005). Include this amount on Form 1040, line 59 17

16

17

Complete this part if you included an amount in income, on Form 1040, line 21, from a Coverdell education savings

account (ESA) or a qualified tuition program (QTP).

 See separate instructions.

13

(99)

2004

Part IV Additional Tax on Excess Contributions to Roth IRAs

Enter your excess contributions from line 24 of your 2003 Form 5329 (see instructions). If zero, go to line 23

If your Roth IRA contributions for 2004 are less than your maximum

allowable contribution, see instructions. Otherwise, enter -0-

18 18

19

Complete this part if you contributed more to your Roth IRAs for 2004 than is allowable or you had an amount on line

25 of your 2003 Form 5329.

20 2004 distributions from your Roth IRAs (see instructions)

21 Add lines 19 and 20

22 Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter -0-

23 Excess contributions for 2004 (see instructions)

24 Total excess contributions. Add lines 22 and 23

Additional tax. Enter 6% (.06) of the smaller of line 24 or the value of your Roth IRAs on December 31,

2004 (including 2004 contributions made in 2005). Include this amount on Form 1040, line 59

25

21

22

23

24

25

19

20
Form 5329 (2004) Page 2

Additional Tax on Excess Accumulation in Qualified Retirement Plans (Including IRAs)

Minimum required distribution for 2004 (see instructions) 44

Amount actually distributed to you in 2004 45

Subtract line 45 from line 44. If zero or less, enter -0- 46

Additional tax. Enter 50% (.50) of line 46. Include this amount on Form 1040, line 59 47

Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge

and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature Date

Date Preparer’s SSN or PTIN Preparer’s

signature

Check if selfemployed

Firm’s name (or yours

if self-employed),

address, and ZIP code

EIN

Phone no.

 





Signature. Complete only if you are filing this form by itself and not with your tax return.

Please

Sign

Here

Paid

Preparer’s

Use Only

Additional Tax on Excess Contributions to Archer MSAs

Enter the excess contributions from line 40 of your 2003 Form 5329 (see instructions). If zero,

go to line 39

Additional tax. Enter 6% (.06) of the smaller of line 40 or the value of your Archer MSAs on

December 31, 2004 (including 2004 contributions made in 2005). Include this amount on Form

1040, line 59

38

47

34

39

26

27

Part VI

Part V

34

35

Additional Tax on Excess Contributions to Coverdell ESAs

Enter the excess contributions from line 32 of your 2003 Form 5329 (see instructions). If zero,

go to line 31

If the contributions to your Coverdell ESAs for 2004 were less than the

maximum allowable contribution, see instructions. Otherwise, enter -0-

36

37

26

35

39

40

41

44

45

46

36

37

38

If the contributions to your Archer MSAs for 2004 are less than the

maximum allowable contribution, see instructions. Otherwise, enter -0-

2004 distributions from your Archer MSAs from Form 8853, line 10

Add lines 35 and 36

Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter -0-

Excess contributions for 2004 (see instructions)

Total excess contributions. Add lines 38 and 39

Complete this part if you or your employer contributed more to your Archer MSAs for 2004 than is allowable or you

had an amount on line 41 of your 2003 Form 5329.

Complete this part if you did not receive the minimum required distribution from your qualified retirement plan.

Complete this part if the contributions to your Coverdell ESAs for 2004 were more than is allowable or you had an

amount on line 33 of your 2003 Form 5329.

28 2004 distributions from your Coverdell ESAs (see instructions)

29 Add lines 27 and 28 29

30 Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter -0- 30

27

28

31 Excess contributions for 2004 (see instructions) 31

32 Total excess contributions. Add lines 30 and 31 32

33 Additional tax. Enter 6% (.06) of the smaller of line 32 or the value of your Coverdell ESAs on

December 31, 2004 (including 2004 contributions made in 2005). Include this amount on Form

1040, line 59 33

40

41

Form 5329 (2004)

( )

Additional Tax on Excess Contributions to Health Savings Accounts (HSAs)

Complete this part if contributions to your HSAs were more than is allowable.

Part VII

42 Excess contributions for 2004 (see instructions) 42

43

Additional tax. Enter 6% (.06) of the smaller of line 42 or the value of your HSAs on December 31, 2004

(including 2004 contributions made in 2005). Include this amount on Form 1040, line 59

43

Part VIII
OMB No. 1545-0219

Form 5884 Work Opportunity Credit

Department of the Treasury

Internal Revenue Service  Attach to your tax return. Attachment

Sequence No. 77

Name(s) shown on return Identifying number

Current Year Credit (Members of a controlled group, see instructions.)

1 Enter the total qualified first-year wages paid or incurred during the tax year, and multiply by

the percentage shown, for services of employees who are certified as members of a targeted

group and:

1a

2 Add lines 1a and 1b. You must subtract this amount from your deduction for salaries and wages 2

If you are a— Then enter the total of the current year credits from—

Schedule K-1 (Form 1120S), box 13, code G, H, or J

Schedule K-1 (Form 1065), box 15, code G, H, or J

Schedule K-1 (Form 1041), line 14

Written statement from cooperative

a Shareholder

b Partner

c Beneficiary

d Patron

Work

opportunity

credits from

pass-through

entities:

3

3

Current year credit. Add lines 2 and 3. (S corporations, partnerships, estates, trusts,

cooperatives, regulated investment companies, and real estate investment trusts, see

instructions.)

4

4

Allowable Credit (See Who must file Form 3800 to find out if you complete Part II or file Form 3800.)

Form 5884 (2004)

Part I

Part II



Cat. No. 13570D

Worked for you at least 120 hours but fewer than 400 hours $  25% (.25)

Worked for you at least 400 hours $  40% (.40)

a

b 1b

For Paperwork Reduction Act Notice, see page 3.

● Individuals. Enter the amount from Form 1040, line 43

5

Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A,

Part I, line 1; or the applicable line of your return

●

●

8a 8a

b Credits from Form 1040, lines 47 through 53 8b

Foreign tax credit

Possessions tax credit (Form 5735, line 17 or 27)

Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 8a through 8e 8f

Net income tax. Subtract line 8f from line 7. If zero, skip lines 10 through 13 and enter -0- on line 14 9

6 Alternative minimum tax:

● Individuals. Enter the amount from Form 6251, line 35

● Corporations. Enter the amount from Form 4626, line 14 6

● Estates and trusts. Enter the amount from Form 1041, Schedule I, line 56

9

Tentative minimum tax (see instructions)

10 10

Enter 25% (.25) of the excess, if any, of line 10 over $25,000 (see instructions)

12

Subtract line 13 from line 9. If zero or less, enter -0-

13 13

Credit allowed for the current year. Enter the smaller of line 4 or line 14 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 14 is smaller than line 4, see instructions 15



5 Regular tax before credits:

7 Add lines 5 and 6 7

11

Enter the greater of line 11 or line 12

11

12

c

d

e

8c

8d

Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a

and 1b, or the amount from the applicable line of your return

Net regular tax. Subtract line 8f from line 5. If zero or less, enter -0-

14 14



15

8e

f

2004
OMB No. 1545-0227

Form 6251 Alternative Minimum Tax—Individuals

 See separate instructions.

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040 or Form 1040NR. Sequence No. 32

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

17

Alternative Minimum Taxable Income (See instructions for how to complete each line.)

1 If filing Schedule A (Form 1040), enter the amount from Form 1040, line 40, and go to line 2. Otherwise,

enter the amount from Form 1040, line 37, and go to line 7. (If less than zero, enter as a negative amount.)

2

3

Medical and dental. Enter the smaller of Schedule A (Form 1040), line 4, or 21⁄2% of Form 1040, line 37

4

Miscellaneous deductions from Schedule A (Form 1040), line 26

Taxes from Schedule A (Form 1040), line 9

5

6 If Form 1040, line 37, is over $142,700 (over $71,350 if married filing separately), enter the amount from line

9 of the Itemized Deductions Worksheet on page B-1 of the Instructions for Schedules A & B (Form 1040)

7

8

12

18

13

14

19

20

21

29

30

31

32

Exemption. (If this form is for a child under age 14, see page 6 of the instructions.)

33

Subtract line 29 from line 28. If zero or less, enter -0- here and on lines 33 and 35 and stop here

● If you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends

on Form 1040, line 9b; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (as refigured

for the AMT, if necessary), complete Part III on the back and enter the amount from line 55 here.

Alternative minimum tax foreign tax credit (see page 7 of the instructions)

Tentative minimum tax. Subtract line 32 from line 31

Tax from Form 1040, line 43 (minus any tax from Form 4972 and any foreign tax credit from Form 1040,

line 46). If you used Schedule J to figure your tax, the amounts for lines 43 and 46 of Form 1040 must

be refigured without using Schedule J (see page 8 of the instructions)

For Paperwork Reduction Act Notice, see page 8 of the instructions. Cat. No. 13600G Form 6251 (2004)

Enter the home mortgage interest adjustment, if any, from line 6 of the worksheet on page 2 of the instructions

1

2

3

4

5

6

7

8

9

10

11

12

13

30

29

31

32

33

34

( )

IF your filing status is . . .

AND line 28 is

not over . . .

THEN enter on

line 29 . . .

Single or head of household $112,500 $40,250

9

10

11

34

Alternative Minimum Tax

Alternative minimum tax. Subtract line 34 from line 33. If zero or less, enter -0-. Enter here and on Form

1040, line 44

Part I

Part II

16

Married filing jointly or qualifying widow(er) 150,000 58,000

Married filing separately 75,000 29,000

If line 28 is over the amount shown above for your filing status, see page 6 of the instructions.

15

35

35



(99)

Tax refund from Form 1040, line 10 or line 21 ( )

Investment interest expense (difference between regular tax and AMT) 

Depletion (difference between regular tax and AMT)

Net operating loss deduction from Form 1040, line 21. Enter as a positive amount

Interest from specified private activity bonds exempt from the regular tax

Qualified small business stock (7% of gain excluded under section 1202)

Exercise of incentive stock options (excess of AMT income over regular tax income)

Estates and trusts (amount from Schedule K-1 (Form 1041), line 9)

Electing large partnerships (amount from Schedule K-1 (Form 1065-B), box 6) 

Disposition of property (difference between AMT and regular tax gain or loss)

Depreciation on assets placed in service after 1986 (difference between regular tax and AMT)

Passive activities (difference between AMT and regular tax income or loss)

Loss limitations (difference between AMT and regular tax income or loss) 

Circulation costs (difference between regular tax and AMT)

Long-term contracts (difference between AMT and regular tax income)

22 Mining costs (difference between regular tax and AMT)

23 Research and experimental costs (difference between regular tax and AMT) 

24 Income from certain installment sales before January 1, 1987

25 Intangible drilling costs preference

26 Other adjustments, including income-based related adjustments

27 Alternative tax net operating loss deduction

28 Alternative minimum taxable income. Combine lines 1 through 27. (If married filing separately and line

28 is more than $191,000, see page 6 of the instructions.)

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

( )

( )

● All others: If line 30 is $175,000 or less ($87,500 or less if married filing separately), multiply line 30 by 26% (.26).

Otherwise, multiply line 30 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the result. 

2004
36 Enter the amount from Form 6251, line 30 36

Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax

Worksheet in the instructions for Form 1040, line 43, or the amount from line

13 of the Schedule D Tax Worksheet on page D-9 of the instructions for

Schedule D (Form 1040), whichever applies (as refigured for the AMT, if

necessary) (see page 8 of the instructions)

Enter the amount from Schedule D (Form 1040), line 19 (as refigured for the

AMT, if necessary) (see page 8 of the instructions)

If you did not complete a Schedule D Tax Worksheet for the regular tax or

the AMT, enter the amount from line 37. Otherwise, add lines 37 and 38, and

enter the smaller of that result or the amount from line 10 of the Schedule

D Tax Worksheet (as refigured for the AMT, if necessary)

Subtract line 40 from line 36

If line 41 is $175,000 or less ($87,500 or less if married filing separately), multiply line 41 by 26% (.26).

Otherwise, multiply line 41 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the

result 

Enter the smaller of line 45 or line 46

Add lines 42, 48, 50, and 52

If line 36 is $175,000 or less ($87,500 or less if married filing separately), multiply line 36 by 26% (.26).

Otherwise, multiply line 36 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the

result

Enter the smaller of line 53 or line 54 here and on line 31

37

38

39

40

41

42

43

46

48

54

55

39

40

41

42

47

37

38

Form 6251 (2004) Page 2

Tax Computation Using Maximum Capital Gains Rates

Enter the smaller of line 36 or line 39

Multiply line 49 by 15% (.15) 

Form 6251 (2004)

Part III

49

50

51

Multiply line 47 by 5% (.05) 

52

Enter the smaller of line 36 or line 37

47

46

50

48

Subtract line 47 from line 46

Subtract line 46 from line 40

Multiply line 51 by 25% (.25) 

53

49

If line 38 is zero or blank, skip lines 51 and 52 and go to line 53. Otherwise, go to line 51.

51

52

53

54

55

44



Enter:

● $58,100 if married filing jointly or qualifying widow(er),

● $29,050 if single or married filing separately, or

● $38,900 if head of household.

45 45

44

43

Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax

Worksheet in the instructions for Form 1040, line 43, or the amount from line

14 of the Schedule D Tax Worksheet on page D-9 of the instructions for

Schedule D (Form 1040), whichever applies (as figured for the regular tax). If

you did not complete either worksheet for the regular tax, enter -0-

Subtract line 44 from line 43. If zero or less, enter -0-
OMB No. 1545-0228 Installment Sale Income

Form 6252  Attach to your tax return.

Department of the Treasury

Internal Revenue Service

 Use a separate form for each sale or other disposition of

property on the installment method.

Attachment

Sequence No. 79

Name(s) shown on return Identifying number

Description of property 

Date acquired (month, day, year)  / / Date sold (month, day, year) 

Was the property sold to a related party (see instructions) after May 14, 1980? If “No,” skip line 4 Yes No

Was the property you sold to a related party a marketable security? If “Yes,” complete Part III. If “No,”

complete Part III for the year of sale and the 2 years after the year of sale Yes No

Gross Profit and Contract Price. Complete this part for the year of sale only.

1

Selling price including mortgages and other debts. Do not include interest whether stated or unstated

Mortgages, debts, and other liabilities the buyer assumed or took

the property subject to (see instructions)

2a

3

Subtract line 6 from line 5

4

Cost or other basis of property sold

5 5

Depreciation allowed or allowable

6

6

Adjusted basis. Subtract line 9 from line 8

7 7

Commissions and other expenses of sale

8 8

Income recapture from Form 4797, Part III (see instructions)

9 9

Add lines 10, 11, and 12

10 10

Subtract line 13 from line 5. If zero or less, do not complete the rest of this form (see instructions)

11

If the property described on line 1 above was your main home, enter the amount of your excluded

gain (see instructions). Otherwise, enter -0-

11

12

Gross profit. Subtract line 15 from line 14

12

13

Subtract line 13 from line 6. If zero or less, enter -0-

13

Contract price. Add line 7 and line 17

14 14

Installment Sale Income. Complete this part for the year of sale and any year you receive a payment or

have certain debts you must treat as a payment on installment obligations.

15

Gross profit percentage. Divide line 16 by line 18. For years after the year of sale, see instructions

15

16

If this is the year of sale, enter the amount from line 17. Otherwise, enter -0-

16

17

Payments received during year (see instructions). Do not include interest, whether stated or unstated

17

18

Add lines 20 and 21

18

Payments received in prior years (see instructions). Do not include

interest, whether stated or unstated

19 19

20

Installment sale income. Multiply line 22 by line 19

20

21

Enter the part of line 24 that is ordinary income under the recapture rules (see instructions)

21

Subtract line 25 from line 24. Enter here and on Schedule D or Form 4797 (see instructions)

22 22

Related Party Installment Sale Income. Do not complete if you received the final payment this tax year.

Name, address, and taxpayer identifying number of related party

Did the related party resell or dispose of the property (“second disposition”) during this tax year?

If the answer to question 28 is “Yes,” complete lines 30 through 37 below unless one of the following conditions is

met. Check the box that applies.

The second disposition was more than 2 years after the first disposition (other than dispositions

of marketable securities). If this box is checked, enter the date of disposition (month, day, year)  / /

The first disposition was a sale or exchange of stock to the issuing corporation.

The second disposition was an involuntary conversion and the threat of conversion occurred after the first disposition.

The second disposition occurred after the death of the original seller or buyer.

It can be established to the satisfaction of the Internal Revenue Service that tax avoidance was not a principal purpose

for either of the dispositions. If this box is checked, attach an explanation (see instructions).

23

Selling price of property sold by related party (see instructions)

23

24 24

Enter contract price from line 18 for year of first sale

25 25

Enter the smaller of line 30 or line 31

26 26

Total payments received by the end of your 2004 tax year (see instructions)

27

Subtract line 33 from line 32. If zero or less, enter -0-

28

Multiply line 34 by the gross profit percentage on line 19 for year of first sale

29

Enter the part of line 35 that is ordinary income under the recapture rules (see instructions)

30

Subtract line 36 from line 35. Enter here and on Schedule D or Form 4797 (see instructions)

30

For Paperwork Reduction Act Notice, see page 4. Form 6252 (2004)

Part II

Part I

Part III

Yes No

Cat. No. 13601R

b

a

b

c

d

e

31

32

33

34

35

36

37

31

32

33

34

35

36

37

/ /

2004
OMB No. 1545-0644 Gains and Losses From Section 1256

Contracts and Straddles Form 6781

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 82  Attach to your tax return.

Name(s) shown on tax return Identifying number

A Mixed straddle election

B Straddle-by-straddle identification election

C Mixed straddle account election

D Net section 1256 contracts loss election

Section 1256 Contracts Marked to Market

(a) Identification of account (b) (Loss)

1

2 Add the amounts on line 1 in columns (b) and (c)

4

5

Form 1099-B adjustments. See instructions and attach schedule

Combine lines 3 and 4

If you have a net section 1256 contracts loss and you checked box D above, enter the amount of that loss

to be carried back, as a positive number

6

7 Combine lines 5 and 6

Short-term capital gain or (loss). Multiply line 7 by 40% (.40). Enter here and include on the appropriate line

of Schedule D (see instructions)

8

Long-term capital gain or (loss). Multiply line 7 by 60% (.60). Enter here and include on the appropriate line

of Schedule D (see instructions)

9

Gains and Losses From Straddles. Attach a separate schedule listing each straddle and its components.

Section A—Losses From Straddles

(h) Recognized

loss. If column (f)

is more than (g),

enter difference.

Otherwise, enter

-0-

(f) Loss.

If column (e)

is more than

(d), enter

difference.

Otherwise,

enter -0-

(e) Cost or

other basis

plus

expense of

sale

(g)

Unrecognized

gain on

offsetting

positions

(c) Date 

closed out

or sold

(b) Date 

entered

into or

acquired

(d) Gross

sales price (a) Description of property

10

( )

11a Enter the short-term portion of losses from line 10, column (h), here and include on the appropriate line of

Schedule D (see instructions)

( )

Enter the long-term portion of losses from line 10, column (h), here and include on the appropriate line of

Schedule D (see instructions)

b

Section B—Gains From Straddles

(f) Gain. If column

(d) is more than (e),

enter difference.

Otherwise, enter -0-

12

Enter the short-term portion of gains from line 12, column (f), here and include on the appropriate line of

Schedule D (see instructions)

13a

b Enter the long-term portion of gains from line 12, column (f), here and include on the appropriate line of

Schedule D (see instructions)

Unrecognized Gains From Positions Held on Last Day of Tax Year. Memo Entry Only (see instructions)

(e) Unrecognized gain. 

If column (c) is more 

than (d), enter difference.

Otherwise, enter -0-

(d) Cost or other basis 

as adjusted

(c) Fair market value on last

business day of tax year

14

Form 6781 (2004)

Part I

Part II

Part III

(e) Cost or other

basis plus expense of

sale

(c) Date 

closed out

or sold

(b) Date 

entered

into or

acquired

(d) Gross

sales price (a) Description of property

(a) Description of property (b) Date 

acquired

Cat. No. 13715G

Check all applicable boxes (see instructions).

(c) Gain

Note: If line 5 shows a net gain, skip line 6 and enter the gain on line 7. Partnerships and S corporations, see

instructions.

For Paperwork Reduction Act Notice, see page 4.

13a

11a

11b

13b

3

4

5

6

7

8

9

2004

3 Net gain or (loss). Combine line 2, columns (b) and (c)

2 ( )
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
Mortgage Interest Credit O

Form 8396 (For Holders of Qualified Mortgage Credit Certificates Issued by

State or Local Governmental Units or Agencies) Department of the Treasury 

Internal Revenue Service

A

 Attach to Form 1040. S

Name(s) shown on Form 1040 Your socia

Enter the address of your main home to which the qualified mortgage certificate relates if it is different from the address shown on Form 1040

Current Year Mortgage Interest Credit

Interest paid on the certified indebtedness amount. If someone else (other than your spouse

if filing jointly) also held an interest in the home, enter only your share of the interest paid

1

1

2 

Enter the certificate credit rate shown on your mortgage credit certificate. Do not enter the

interest rate on your home mortgage

2

If line 2 is 20% or less, multiply line 1 by line 2. If line 2 is more than 20%, or you refinanced

your mortgage and received a reissued certificate, see the instructions for the amount to enter.

3

3

4 Enter any 2001 credit carryforward from line 18 of your 2003 Form 8396 4

5 Enter any 2002 credit carryforward from line 16 of your 2003 Form 8396 5

6 Enter any 2003 credit carryforward from line 19 of your 2003 Form 8396 6

7 Add lines 3 through 6 7

8 Enter the amount from Form 1040, line 45 8

9 Enter the total of the amounts from Form 1040, lines 46 through 51 9

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

11

11

12

Current year mortgage interest credit. Enter the smaller of line 7 or line 10. Also include

this amount in the total on Form 1040, line 53, and check box a on that line

12

Mortgage Interest Credit Carryforward to 2005. (Complete only if line 11 is less than li

13 13

Add lines 3 and 4

14 14

Enter the amount from line 7

15

Enter the larger of line 11 or line 12

15

16 16

Subtract line 14 from line 13

17

2003 credit carryforward to 2005. Enter the smaller of line 6 or line 15

17

18 18

Subtract line 16 from line 15

19

2002 credit carryforward to 2005. Enter the smaller of line 5 or line 17

19 2004 credit carryforward to 2005. Subtract line 11 from line 3. If zero or less, enter -0-

Part I

Part II

For Paperwork Reduction Act Notice, see back of form. Cat. No. 62502X 

You must reduce your deduction for home mortgage interest on Schedule A (Form 1040)

by the amount on line 3.

 See instructions on back.
Caution: See the instructions for Worksheets 1, 2, and 3 on pages 7 and 8 before completing Part 

Rental Real Estate Activities With Active Participation (For the definition of active participation

see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.)

Combine lines 3a, 3b, and 3c

Combine lines 1d, 2c, and 3d. If the result is net income or zero, all losses are allowed, including

any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete Form 8582.

Report the losses on the forms and schedules normally used

Note: Enter all numbers in Part II as positive amounts. See page 8 for an example.

Subtract line 7 from line 6

10

Combine lines 1a, 1b, and 1c

Part I

Part II

Part III

O

Passive Activity Loss Limitations Form 8582

 See separate instructions. Department of the Treasury

Internal Revenue Service  Attach to Form 1040 or Form 1041.

A

S

Name(s) shown on return Iden

2004 Passive Activity Loss

1a

Activities with net income (enter the amount from Worksheet 1,

column (a))

1a

1b

Activities with net loss (enter the amount from Worksheet 1,

column (b))

b

1c

Prior years unallowed losses (enter the amount from Worksheet

1, column (c))

c

d 1d

All Other Passive Activities

3a

Activities with net income (enter the amount from Worksheet 3,

column (a))

3a

3b

Activities with net loss (enter the amount from Worksheet 3,

column (b))

b

3c

c

d

Prior years unallowed losses (enter the amount from Worksheet 3,

column (c))

4

4

Special Allowance for Rental Real Estate With Active Participation

5 Enter the smaller of the loss on line 1d or the loss on line 4 5

6 Enter $150,000. If married filing separately, see page 8 6

7 Enter modified adjusted gross income, but not less than zero (see page 8) 7

Note: If line 7 is greater than or equal to line 6, skip lines 8 and

9, enter -0- on line 10. Otherwise, go to line 8.

8 8

9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. If married filing separately, see page 8 9

Enter the smaller of line 5 or line 9 10

Special Allowance for Commercial Revitalization Deductions From Rental Real Esta

12

11

Add the income, if any, on lines 1a and 3a and enter the total

Total losses allowed from all passive activities for 2004. Add lines 10, 14, and 15. See

pages 10 and 11 of the instructions to find out how to report the losses on your tax return

For Paperwork Reduction Act Notice, see page 12 of the instructions. 

3d

Cat. No. 63704F

( )

( )

( )

( )

If line 4 is a loss and: ● Line 1d is a loss, go to Part II. 

(99)

Add lines 2a and 2b

2a Commercial revitalization deductions from Worksheet 2, column (a) 2a

2b

Prior year unallowed commercial revitalization deductions from

Worksheet 2, column (b)

b

c 2c

( )

( )

Commercial Revitalization Deductions From Rental Real Estate Activities

Caution: If your filing status is married filing separately and you lived with your spouse at any time during the yea

Part II or Part III. Instead, go to line 15.

If line 2c is a loss, go to Part III. Otherwise, go to line 15.

Note: Enter all numbers in Part III as positive amounts. See the example for Part II on page 8.

Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions

Enter the loss from line 4

Reduce line 12 by the amount on line 10

Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13

Part IV Total Losses Allowed

13

14

15

16

11

12

13

14

15

16

( 

● Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III. 

● Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III a
Cat. No. 63987I

OMB No. 1545-0984

Form 8586 Low-Income Housing Credit

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to your tax return. Sequence No. 36b

Name(s) shown on return Identifying number

Current Year Credit

1 Number of Forms 8609 attached 

2 Eligible basis of buildings (total from attached Schedules A (Form 8609), line 1) 2

3a Qualified basis of low-income buildings (total from attached Schedules A (Form 8609), line 3) 3a

b Has there been a decrease in the qualified basis of any buildings since the close of the preceding

(i) (ii) (iii) (iv)

4 Current year credit from attached Schedules A (Form 8609) (see instructions) 4

If you are a— Then enter the total of the current year credits from—

a Shareholder Schedule K-1 (Form 1120S), box 13, codes A and B

5 Low-income housing credits from pass-through entities (if more than one entity, see instructions):

5

6 Add lines 4 and 5. See instructions to find out if you complete lines 7 through 18 or file Form 3800 6

Allowable Credit

Form 8586 (2004)

Part I

EIN of pass-through entity

–

7 Current year credit or passive activity credit (see instructions) 7

tax year?

buildings that had a decreased basis. If you need more space, attach a schedule.

Yes No If “Yes,” enter the building identification numbers (BINs) of the

Part II

For Paperwork Reduction Act Notice, see back of form.

b Partner

c Beneficiary

Schedule K-1 (Form 1065), box 15, codes A and B, or

Schedule K-1 (Form 1065-B), box 8

Schedule K-1 (Form 1041), line 14

● Individuals. Enter the amount from Form 1040, line 43

8

Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A,

Part I, line 1; or the applicable line of your return

●

●

11a 11a

b Credits from Form 1040, lines 47 through 53 11b

Foreign tax credit

Possessions tax credit (Form 5735, line 17 or 27)

Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 11a through 11e 11f

12 Net income tax. Subtract line 11f from line 10. If zero, skip lines 13 through 16 and enter -0- on line 17 12

9 Alternative minimum tax:

● Individuals. Enter the amount from Form 6251, line 35

● Corporations. Enter the amount from Form 4626, line 14 9

● Estates and trusts. Enter the amount from Form 1041, Schedule I, line 56

15 Tentative minimum tax (see instructions):

15

13

Enter 25% (.25) of the excess, if any, of line 13 over $25,000 (see instructions)

16

Subtract line 16 from line 12. If zero or less, enter -0-

16

17

Credit allowed for the current year. Enter the smaller of line 7 or line 17 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 17 is smaller than line 7, see instructions 18



8 Regular tax before credits:

10 Add lines 8 and 9 10

14

Enter the greater of line 14 or line 15

c

d

e

11c

11d

Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a

and 1b, or the amount from the applicable line of your return

Net regular tax. Subtract line 11f from line 8. If zero or less, enter -0-

18

17



(99)

11e

f

13

14

 See instructions on back.

● Individuals. Enter the amount from Form 6251, line 33

● Corporations. Enter the amount from Form 4626, line 12

● Estates and trusts. Enter the amount from Form 1041,

Schedule I, line 54

2004

OMB No. 1545-1007

Form 8606 Nondeductible IRAs

 See separate instructions.

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040, Form 1040A, or Form 1040NR. Sequence No. 48

Name. If married, file a separate form for each spouse required to file Form 8606. See page 5 of the instructions. Your social security number

Home address (number and street, or P.O. box if mail is not delivered to your home) Apt. no. Fill in Your Address Only

if You Are Filing This

Form by Itself and Not

With Your Tax Return

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

1

1 Enter your nondeductible contributions to traditional IRAs for 2004, including those made for

2004 from January 1, 2005, through April 15, 2005 (see page 5 of the instructions)

2 Enter your total basis in traditional IRAs (see page 5 of the instructions) 2

3 Add lines 1 and 2

4

3

Enter those contributions included on line 1 that were made from January 1, 2005, through April

15, 2005

5

4

Subtract line 4 from line 3 5

6 Enter the value of all your traditional, SEP, and SIMPLE IRAs as of

December 31, 2004, plus any outstanding rollovers (see page 6 of

the instructions)

8

7

Enter the net amount you converted from traditional, SEP, and SIMPLE

IRAs to Roth IRAs in 2004. Do not include amounts converted that

you later recharacterized (see page 6 of the instructions). Also enter

this amount on line 16

9 9

10

Add lines 6, 7, and 8

10

 .

11

Divide line 5 by line 9. Enter the result as a decimal rounded to at

least 3 places. If the result is 1.000 or more, enter “1.000”

11 Multiply line 8 by line 10. This is the nontaxable portion of the amount

you converted to Roth IRAs. Also enter this amount on line 17

12

12

13

Multiply line 7 by line 10. This is the nontaxable portion of your

distributions that you did not convert to a Roth IRA

13

14

15

Subtract line 13 from line 3. This is your total basis in traditional IRAs for 2004 and earlier

years

Cat. No. 63966F Form 8606 (2004)



In 2004, did you take a

distribution from traditional,

SEP, or SIMPLE IRAs or

make a Roth IRA conversion?

No

Yes

Enter the amount from line 3 on

line 14. Do not complete the rest

of Part I.

Go to line 4.

Taxable amount. Subtract line 12 from line 7. Also include this amount on Form 1040, line 15b;

Form 1040A, line 11b; or Form 1040NR, line 16b





6

For Paperwork Reduction Act Notice, see page 8 of the instructions.

Part I Nondeductible Contributions to Traditional IRAs and Distributions From Traditional, SEP, and SIMPLE IRAs

Complete this part only if:

● You made nondeductible contributions to a traditional IRA for 2004,

● You took distributions from a traditional, SEP, or SIMPLE IRA in 2004 (other than a rollover, conversion,

recharacterization, or return of certain contributions) and you made nondeductible contributions to a traditional IRA

in 2004 or an earlier year, or

● You converted part, but not all, of your traditional, SEP, and SIMPLE IRAs to Roth IRAs in 2004 (excluding any portion

you recharacterized) and you made nondeductible contributions to a traditional IRA in 2004 or an earlier year.

Enter your distributions from traditional, SEP, and SIMPLE IRAs in

2004. Do not include rollovers, conversions to a Roth IRA, certain

returned contributions, or recharacterizations of traditional IRA

contributions (see page 6 of the instructions)

7

Add lines 11 and 12. This is the nontaxable portion of all your distributions

14

8

15

Note: You may be subject to an additional 10% tax on the amount on line 15 if you were under

age 591⁄2 at the time of the distribution (see page 7 of the instructions).

2004

(99)
Form 8606 (2004) Page 2

Under penalties of perjury, I declare that I have examined this form, including accompanying attachments, and to the best of my

knowledge and belief, it is true, correct, and complete. Sign Here Only if You

Are Filing This Form

by Itself and Not With

Your Tax Return  Your signature  Date

Part III

Complete this part if you converted part or all of your traditional, SEP, and SIMPLE IRAs to a Roth IRA in 2004 (excluding

any portion you recharacterized).

17

18

If you completed Part I, enter the amount from line 11. Otherwise, enter your basis in the amount

on line 16 (see page 7 of the instructions)

16

19 Enter your total nonqualified distributions from Roth IRAs in 2004 including any qualified first-time

homebuyer distributions (see page 7 of the instructions)

20 Qualified first-time homebuyer expenses (see page 7 of the instructions). Do not enter more

than $10,000

21 Subtract line 20 from line 19. If zero or less, enter -0- and skip lines 22 through 25

22 Enter your basis in Roth IRA contributions (see page 7 of the instructions)

19

Taxable amount. Subtract line 17 from line 16. Also include this amount on Form 1040,

line 15b; Form 1040A, line 11b; or Form 1040NR, line 16b

Form 8606 (2004)

Caution: If your modified adjusted gross income is over $100,000 or you are married filing separately and you lived with

your spouse at any time in 2004, you cannot convert any amount from traditional, SEP, or SIMPLE IRAs to Roth IRAs

for 2004. If you erroneously made a conversion, you must recharacterize (correct) it (see page 7 of the instructions).

Part II

16 If you completed Part I, enter the amount from line 8. Otherwise, enter the net amount you

converted from traditional, SEP, and SIMPLE IRAs to Roth IRAs in 2004. Do not include amounts

you later recharacterized back to traditional, SEP, or SIMPLE IRAs in 2004 or 2005 (see page 7

of the instructions)

17

18

Distributions From Roth IRAs

Complete this part only if you took a distribution from a Roth IRA in 2004 (other than a rollover, recharacterization, or

return of certain contributions—see page 7 of the instructions).

25 Taxable amount. Subtract line 24 from line 23. If zero or less, enter -0-. Also include this amount

on Form 1040, line 15b; Form 1040A, line 11b; or Form 1040NR, line 16b

20

21

25

2004 Conversions From Traditional, SEP, or SIMPLE IRAs to Roth IRAs

22

24 Enter your basis in Roth IRA conversions (see page 8 of the instructions)

23 Subtract line 22 from line 21. If zero or less, enter -0- and skip lines 24 and 25. If more than

zero, you may be subject to an additional tax (see page 8 of the instructions)

24

23
SCHEDULE A

(Form 8609)

OMB No. 1545-0988 Annual Statement

 Attach to Form 8609 and file with owner’s Federal income tax return.

(Rev. November 2003) Attachment Department of the Treasury

Internal Revenue Service

For Paperwork Reduction Act Notice, see instructions for Form 8609.

A Building owner’s name B Identifying number 

C Building identification number  

1 Eligible basis of building 1

2 .

2 Low-income portion (smaller of unit fraction or floor-space fraction) (if first year of the credit

period, see instructions)

3 Qualified basis of low-income building. Multiply line 1 by line 2 (see instructions for exceptions) 3

4 Part-year adjustment for disposition or acquisition during the tax year 4

5 Credit percentage 5 .

6 Multiply line 3 or line 4 by the percentage on line 5 6

7 Additions to qualified basis, if any 7

8 8

9 9 .

10 Multiply line 7 or line 8 by the percentage on line 9 10

11 Section 42(f)(3)(B) modification 11

12 Add lines 10 and 11 12

13 Credit for building before line 14 reduction. Subtract line 12 from line 6 13

14 Disallowed credit due to Federal grants (see instructions) 14

15

15 Credit allowed for building for tax year. Subtract line 14 from line 13, but do not enter more than

the amount shown on Form 8609, Part I, line 1b

16 Taxpayer’s proportionate share of credit for the year (see instructions) 16

17

18

17 Adjustments for deferred first-year credit (see instructions)

Taxpayer’s credit. Combine lines 16 and 17. Enter here and in Part I of Form 8586

General Instructions

Specific Instructions

Item B. If you are an individual, enter your

social security number. All others, enter your

employer identification number.

Item C. Enter the building identification

number (BIN) from Part I, item E, of

Form 8609.

Purpose of Schedule

Schedule A (Form 8609) must be filed by

the building owner each year of the

15-year compliance period.

Sequence No. 36a

Credit percentage. Enter one-third of the percentage on line 5

Cat No. 10614Q

18

Section references are to the Internal

Revenue Code unless otherwise noted.

Note: Some of the line numbers on the

November 2003, December 1988, and

March 1991 revisions of Form 8609 differ

from other revisions. In these cases, the

line references are shown in parentheses in

these instructions.

Schedule A (Form 8609) (Rev. 11-2003)

Line 1. Generally, the eligible basis of a

building for its entire 15-year compliance

period is the amount of eligible basis

entered on Form 8609, line 7b (Part II, line

1b, on the 1988 and 1991 revisions); line 7

on the 2003 revision.

Basis increases for buildings in certain

high-cost areas. In order to increase the

allocated credit for buildings in certain

high-cost areas, the housing credit agency

may increase the eligible basis of buildings

located in these areas (after adjustments, if

any, for Federal subsidies and grants). The

agency may make this increase under the

high-cost-area provisions of section

42(d)(5)(C).

For a building receiving separate

allocations for the existing building and for

rehabilitation expenditures, file a separate

Schedule A for each credit claimed.

Recapture of Credit

If the qualified basis of the building has

decreased from the qualified basis at the

close of the previous tax year, you may

have to recapture parts of the credits

allowed in previous years. See Form 8611,

Recapture of Low-Income Housing Credit.

If the agency used an earlier revision of

Form 8609 that did not have line 3b in Part

I to issue a 1990 credit allocation to which

the high-cost-area provisions were applied,

it should have notified you of the Part I

percentage increase in a separate

statement. Based on this statement,

The agency shows the increased

percentage of the eligible basis in Part I,

line 3b, of Form 8609. The eligible basis

entered on Form 8609 should reflect the

percentage increase.

Part-year adjustment for disposition or acquisition during the tax year

If the owner is a partnership, S corporation,

estate, or trust (pass-through entity), the

entity will complete and attach Form 8609

and Schedule A to its tax return. If you are a

partner, shareholder, or beneficiary in the

pass-through entity that owns the building,

file only Form 8586, Low-Income Housing

Credit, to claim the credit using the

information that the entity furnishes you on

Schedule K-1.

Do you have in your records the original Form 8609 issued by the housing credit agency (or a copy thereof) for the above

building? Yes No. If “No,” see instructions.

D

Did the above building qualify as a part of a qualified low-income housing project and meet the requirements of section 42

as of the end of your tax year? Yes No. If “No,” see instructions and stop here.

Was there a decrease in the qualified basis of the above building for this tax year? Yes No. If “Yes,” see

instructions. If “No” and the entire credit has been claimed in prior tax years, stop here.

E

F

Item D. You must have an original, signed

Form 8609 (or copy thereof) issued by a

housing credit agency assigning a BIN for

the building in order to claim the credit,

even if no allocation is required (in the

case of a building financed with

tax-exempt bonds). If filing electronically,

you must check “Yes” to certify that you

have the required Form 8609 in your

records. If filing on paper and attaching a

copy of the required Form 8609, please

also answer “Yes.”

Item E. If “No,” stop here and see Form

8611 to find out if you have to recapture

part of the credit allowed in prior years.

Item F. If “Yes,” see the instructions for

line 2 to figure the reduced qualified basis.

Also, see Form 8611 to find out if you have

If “No” and the entire credit has been

claimed in prior tax years (generally this

can occur after the 11th year for which the

credit has been claimed for the building),

do not complete lines 1 through 18.

to recapture part of the credit allowed in

prior years.

Note: Any building owner claiming credit

without receiving a Part I of Form 8609

that is completed, signed, and dated by an

authorized official of the housing credit

agency may have all credits disallowed.
O

Tax for Children Under Age 14

With Investment Income of More Than $1,600 Form 8615

Department of the Treasury

Internal Revenue Service

 Attach only to the child’s Form 1040, Form 1040A, or Form 1040NR.

Child’s name shown on return Child’s socia

Parent’s name (first, initial, and last). Caution: See instructions before completing. Parent’s 

Parent’s filing status (check one):

Child’s Net Investment Income

1 Enter the child’s investment income (see instructions) 1

If the child did not itemize deductions on Schedule A (Form 1040 or Form 1040NR), enter $1,600.

Otherwise, see instructions

2

2

Subtract line 2 from line 1. If zero or less, stop; do not complete the rest of this form but do

attach it to the child’s return

3

3

4

Enter the child’s taxable income from Form 1040, line 42; Form 1040A, line 27; or Form 1040NR,

line 39

4

Enter the smaller of line 3 or line 4. If zero, stop; do not complete the rest of this form but do

attach it to the child’s return

5

5

Tentative Tax Based on the Tax Rate of the Parent

Enter the parent’s taxable income from Form 1040, line 42; Form 1040A, line 27; Form 1040EZ,

line 6; TeleFile Tax Record, line K(1); Form 1040NR, line 39; or Form 1040NR-EZ, line 14. If zero

or less, enter -0-

6

6

Enter the total, if any, from Forms 8615, line 5, of all other children of the parent named

above. Do not include the amount from line 5 above

7

7

8 8 Add lines 5, 6, and 7 (see instructions). 

9

Enter the tax on the amount on line 8 based on the parent’s filing status above (see instructions).

If the Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or

Schedule J (Form 1040) is used to figure the tax, check here 

9

10 Enter the parent’s tax from Form 1040, line 43; Form 1040A, line 28, minus any alternative minimum

tax; Form 1040EZ, line 10; TeleFile Tax Record, line K(2); Form 1040NR, line 40; or Form 1040NR-EZ,

line 15. Do not include any tax from Form 4972 or 8814. If the Qualified Dividends and Capital Gain

Tax Worksheet, Schedule D Tax Worksheet, or Schedule J (Form 1040) was used to figure the tax,

check here  10

Subtract line 10 from line 9 and enter the result. If line 7 is blank, also enter this amount on line

13 and go to Part III

11

11

12a Add lines 5 and 7 12a

b Divide line 5 by line 12a. Enter the result as a decimal (rounded to at least three places) 12b 

13 Multiply line 11 by line 12b 13

Child’s Tax—If lines 4 and 5 above are the same, enter -0- on line 15 and go to line 16.

14 Subtract line 5 from line 4 14

15

15 Enter the tax on the amount on line 14 based on the child’s filing status (see instructions). If the

Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or

Schedule J (Form 1040) is used to figure the tax, check here 

16 Add lines 13 and 15 16

17

17 Enter the tax on the amount on line 4 based on the child’s filing status (see instructions). If the

Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or

Schedule J (Form 1040) is used to figure the tax, check here 

18 Enter the larger of line 16 or line 17 here and on the child’s Form 1040, line 43; Form 1040A,

line 28; or Form 1040NR, line 40 18

For Paperwork Reduction Act Notice, see the instructions. 

A B

C

Single

Cat. No. 64113U

Part III

Part I

Part II

(99)  See separate instructions.

Before you begin: If the child, the parent, or any of the parent’s other children under age 14 must use the 

Worksheet or has income from farming or fishing, see Pub. 929, Tax Rules for Children a

explains how to figure the child’s tax using the Schedule D Tax Worksheet or Schedule 

Married filing jointly Married filing separately Head of household Q
OMB No. 1545-1073

Form 8801

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to Form 1040, 1040NR, or 1041. Sequence No. 74

Name(s) shown on return Identifying number

Net Minimum Tax on Exclusion Items

1 Combine lines 1, 6, and 10 of your 2003 Form 6251. Estates and trusts, see instructions 1

2 Enter adjustments and preferences treated as exclusion items (see instructions) 2

3 ( ) 3 Minimum tax credit net operating loss deduction (see instructions)

Combine lines 1, 2, and 3. If zero or less, enter -0- here and on line 15 and go to Part II. If more

than $191,000 and you were married filing separately for 2003, see instructions

4

4

5

Enter: $58,000 if married filing jointly or qualifying widow(er) for 2003; $40,250 if single or head

of household for 2003; or $29,000 if married filing separately for 2003. Estates and trusts, enter

$22,500

5

6

Enter: $150,000 if married filing jointly or qualifying widow(er) for 2003; $112,500 if single or head

of household for 2003; or $75,000 if married filing separately for 2003. Estates and trusts, enter

$75,000

6

7 Subtract line 6 from line 4. If zero or less, enter -0- here and on line 8 and go to line 9 7

8 Multiply line 7 by 25% (.25) 8

9

9 Subtract line 8 from line 5. If zero or less, enter -0-. If this form is for a child under age 14, see

instructions

10

Subtract line 9 from line 4. If zero or less, enter -0- here and on line 15 and go to Part II. Form

1040NR filers, see instructions

10

11

11 ● If for 2003 you reported capital gain distributions directly on Form 1040, line 13a; you reported

qualified dividends on Form 1040, line 9b (Form 1041, line 2b(2)); or you had a gain on both lines

16 and 17a of Schedule D (Form 1040) (lines 15a and 16a, column (2), of Schedule D (Form 1041)),

complete Part III of Form 8801 and enter the amount from line 58 here.

Minimum tax foreign tax credit on exclusion items (see instructions) 12

13

14

Tentative minimum tax on exclusion items. Subtract line 12 from line 11

14

15

Enter the amount from your 2003 Form 6251, line 34, or 2003 Form 1041, Schedule I, line 55

15 Net minimum tax on exclusion items. Subtract line 14 from line 13. If zero or less, enter -0-

16 16

Minimum Tax Credit and Carryforward to 2005

Enter the amount from your 2003 Form 6251, line 35, or 2003 Form 1041, Schedule I, line 56

17 17

18

Enter the amount from line 15 above

18

19

Subtract line 17 from line 16. If less than zero, enter as a negative amount

19

20

2003 minimum tax credit carryforward. Enter the amount from your 2003 Form 8801, line 26

20 Enter the total of your 2003 unallowed nonconventional source fuel credit and 2003 unallowed

qualified electric vehicle credit (see instructions)

21 21

22

Combine lines 18, 19, and 20. If zero or less, stop here and see instructions

22

23

Enter your 2004 regular income tax liability minus allowable credits (see instructions)

23

24 24

Enter the amount from your 2004 Form 6251, line 33, or 2004 Form 1041, Schedule I, line 54

25

Subtract line 23 from line 22. If zero or less, enter -0-

25

26

Minimum tax credit. Enter the smaller of line 21 or line 24. Also enter this amount on your 2004

Form 1040, line 54; Form 1040NR, line 49; or Form 1041, Schedule G, line 2d

26

Minimum tax credit carryforward to 2005. Subtract line 25 from line 21. Keep a record of this

amount because you may use it in future years

Cat. No. 10002S

Part II

Part I

Credit for Prior Year Minimum Tax—

Individuals, Estates, and Trusts

For Paperwork Reduction Act Notice, see page 4. Form 8801 (2004)

(99)

 See instructions on pages 3 and 4.

● All others: If line 10 is $175,000 or less ($87,500 or less if married filing separately for

2003), multiply line 10 by 26% (.26). Otherwise, multiply line 10 by 28% (.28) and subtract

$3,500 ($1,750 if married filing separately for 2003) from the result.

12

13



2004
Tax Computation Using Maximum Capital Gains Rates

27 Enter the amount from Form 8801, line 10 27

28

Enter the amount from line 26 of your 2003 Schedule D (Form 1040) (line 23 of the

2003 Schedule D (Form 1041)) or line 13 of your 2003 Schedule D Tax Worksheet*

28

29

Enter the amount from line 19 of your 2003 Schedule D (Form 1040),

or line 15d, column (2), of the 2003 Schedule D (Form 1041)

29

30

If you did not complete the 2003 Schedule D Tax Worksheet, enter the amount from

line 28. Otherwise, add lines 28 and 29, and enter the smaller of that result or the

amount from line 10 of your 2003 Schedule D Tax Worksheet

30

31

32

Enter the smaller of line 27 or line 30

32

33

Subtract line 31 from line 27

33

34

If line 32 is $175,000 or less ($87,500 or less if married filing separately for 2003), multiply line 32 by 26% (.26).

Otherwise, multiply line 32 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately for 2003) from the

result 

34

Enter:

● $56,800 if married filing jointly or qualifying widow(er) for 2003,

● $28,400 if single or married filing separately for 2003,

● $38,050 if head of household for 2003, or

● $1,900 for an estate or trust

37 Enter the smaller of line 27 or line 28 37

40

38

Form 8801 (2004) Page 2

Part III

41

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

your 2003 Schedule D (Form 1040), line 35

(2003 Schedule D (Form 1041), line 32)

42

Enter the smaller of line 38 or line 39. If line 38 is zero, go to line 48

Multiply line 40 by 5% (.05) 

Subtract line 40 from line 38. If zero or less, enter -0- and go to line 48

48

Subtract line 37 from line 31

49

Multiply line 54 by 25% (.25) 

Add lines 33, 41, 45, 47, 51, 53, and 55

39

42

46

53

51

Caution: If you did not complete Part IV of the 2003 Schedule D (Form 1040) (or Part V of the 2003 Schedule

D (Form 1041)) or the 2003 Schedule D Tax Worksheet, see the instructions before completing this part.

If line 29 is zero or blank, skip lines 54 and 55 and go to line 56. Otherwise, go to line 54.

Form 8801 (2004)

Enter the smaller of line 36 or line 37

45 Multiply line 44 by 8% (.08)  45

46 Subtract line 44 from line 42

47 Multiply line 46 by 10% (.10)  47

44

* The 2003 Schedule D Tax Worksheet is on page D-11 of the 2003 Instructions for Schedule D (Form 1040) (page 37 of the 2003 Instructions for Form 1041).

38

50

If line 27 is $175,000 or less ($87,500 or less if married filing separately), multiply line 27 by 26%

(.26). Otherwise, multiply line 27 by 28% (.28) and subtract $3,500 ($1,750 if married filing

separately) from the result

Enter the smaller of line 56 or line 57 here and on line 11 58

31

43

41

If you did not complete the 2003 Schedule D Tax Worksheet, enter the amount from

your 2003 Schedule D (Form 1040), line 43 (or 2003 Schedule D (Form 1041), line 40)

(or if that line is blank, the amount from your 2003 Schedule D (Form 1040), line 31 (or

2003 Schedule D (Form 1041), line 28)). Otherwise, enter the amount from line 32 of

the Schedule D Tax Worksheet* (or if that line is blank, the amount from line 20 of that

worksheet).

Enter the smaller of line 42 or line 43

Subtract line 40 from line 39

44

Subtract line 38 from line 37

Enter the smaller of line 48 or line 49

Multiply line 50 by 15% (.15) 

Subtract line 50 from line 49

Multiply line 52 by 20% (.20) 

39

40

43

48

49

50

52

55

54

56

57

51

52

53

54

55

56

58

57

35 Enter the amount from line 27 of your 2003 Schedule D (Form 1040) (line 24 of the

2003 Schedule D (Form 1041)) or line 14 of the 2003 Schedule D Tax Worksheet*,

whichever applies. If you did not complete either Part IV of the 2003 Schedule D

(Form 1040) (or Part V of the 2003 Schedule D (Form 1041)) or the 2003 Schedule

D Tax Worksheet, enter -0- 35

36 Subtract line 35 from line 34. If zero or less, enter -0- 36
Additional Child Tax Credit Form 8812

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

Internal Revenue Service

Name(s) shown on return Your social 

For Paperwork Reduction Act Notice, see back of form. 

Cat. No. 10644E

3

2

4a

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

30 and 58, plus any uncollected social security and

Medicare or tier 1 RRTA taxes included on line 62.

Enter -0-.

Enter the total of the amounts from Form 1040, lines

65a and 66.

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

41a, 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 1 of your Child Tax Credit Worksheet on page 38 of the Form 1040 instructions

or page 37 of the Form 1040A instructions. If you used Pub. 972, enter the amount from line 8 of the

worksheet on page 4 of the publication

Enter the amount from Form 1040, line 51, 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 t

Form 1

Form 1





8812

1040

1040A

. . . . . . . . . .

3

Enter your total earned income. See the instructions on back

5 Is the amount on line 4a more than $10,750?

No.

Yes. Subtract $10,750 from the amount on line 4a. Enter the result

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

4a

5

Multiply the amount on line 5 by 15% (.15) 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.

(99)

b Nontaxable combat pay included on line 4a 4b
OMB No. 1545-1128 Parents’ Election To Report

Child’s Interest and Dividends Form 8814

 See instructions on back. Department of the Treasury

Internal Revenue Service

Attachment

 Attach to parents’ Form 1040 or Form 1040NR. Sequence No. 40

Name(s) shown on your return Your social security number

Child’s name (first, initial, and last) Child’s social security number

If more than one Form 8814 is attached, check here 

Child’s Interest and Dividends To Report on Your Return

Enter your child’s taxable interest. If this amount is different from the amounts shown on the

child’s Forms 1099-INT and 1099-OID, see the instructions

1a

1a

b Enter your child’s tax-exempt interest. Do not include this

amount on line 1a 1b

2 Enter your child’s ordinary dividends, including any Alaska Permanent Fund dividends. If your

child received any ordinary dividends as a nominee, see the instructions

Enter your child’s capital gain distributions. If your child received any capital gain distributions

as a nominee, see the instructions

Add lines 1a, 2, and 3. If the total is $1,600 or less, skip lines 5 and 6 and go to line 7. If the

total is $8,000 or more, do not file this form. Your child must file his or her own return to report

the income

3

1,600 00

4

Base amount

4

5

Subtract line 5 from line 4. See the instructions for where to report this amount. Go to line 7

below  6

Tax on the First $1,600 of Child’s Interest and Dividends

Amount not taxed 800 00

9

7 7

Subtract line 7 from line 4. If the result is zero or less, enter -0-

No. Enter $80 here and see the Note below.

Tax. Is the amount on line 8 less than $800?

8 8

Yes. Multiply line 8 by 10% (.10). Enter the result here and see the Note below.

Note: If you checked the box on line C above, see the instructions. Otherwise, include the amount from line 9 in the tax you enter

on Form 1040, line 43, or Form 1040NR, line 40. Be sure to check box a on Form 1040, line 43, or Form 1040NR, line 40.

For Paperwork Reduction Act Notice, see page 3. Cat. No. 10750J Form 8814 (2004)



A B

C

3

6

2

5

Part I

Part II

9

Caution: The Federal income tax on your child’s income, including qualified dividends and capital gain distributions, may be less

if you file a separate tax return for the child instead of making this election. This is because you cannot take certain tax benefits

that your child could take on his or her own return. For details, see Tax benefits you may not take on page 2.

2004
Exclusion of Interest From Series EE and I 

U.S. Savings Bonds Issued After 1989 Form 8815

(For Filers With Qualified Higher Education Expenses)

 Attach to Form 1040 or Form 1040A.

Department of the Treasury

Internal Revenue Service 

Name(s) shown on return Your soc

(a)

Name of person (you, your spouse, or your dependent) who

was enrolled at or attended an eligible educational institution

1 (b)

Name and address of eligible educational ins

If you need more space, attach a statement.

Enter the total qualified higher education expenses you paid in 2004 for the person(s) listed in

column (a) of line 1. See the instructions to find out which expenses qualify

2

2

Enter the total of any nontaxable educational benefits (such as nontaxable scholarship or

fellowship grants) received for 2004 for the person(s) listed in column (a) of line 1 (see instructions)

3

3

4 Subtract line 3 from line 2. If zero or less, stop. You cannot take the exclusion 4

5 Enter the total proceeds (principal and interest) from all series EE and I U.S. savings bonds

issued after 1989 that you cashed during 2004 5

6 Enter the interest included on line 5 (see instructions) 6

If line 4 is equal to or more than line 5, enter “1.000.” If line 4 is less than line 5, divide line 4

by line 5. Enter the result as a decimal (rounded to at least three places)

7

7 

8 Multiply line 6 by line 7 8

9 Enter your modified adjusted gross income (see instructions) 9

Note: If line 9 is $74,850 or more if single or head of household, or

$119,750 or more if married filing jointly or qualifying widow(er), stop.

You cannot take the exclusion.

10

Enter: $59,850 if single or head of household; $89,750 if married filing

jointly or qualifying widow(er)

10

Subtract line 10 from line 9. If zero or less, skip line 12, enter -0- on

line 13, and go to line 14

11

11

Divide line 11 by: $15,000 if single or head of household; $30,000 if married filing jointly or

qualifying widow(er). Enter the result as a decimal (rounded to at least three places)

12

12 

13 Multiply line 8 by line 12 13

14 Excludable savings bond interest. Subtract line 13 from line 8. Enter the result here and on

Schedule B (Form 1040), line 3, or Schedule 1 (Form 1040A), line 3, whichever applies  14

Cat. No. 10822S 

Purpose of Form

1. You cashed qualified U.S. savings bonds in 2004 that were

issued after 1989.

2. You paid qualified higher education expenses in 2004 for

yourself, your spouse, or your dependents.

3. Your filing status is any status except married filing separately.

4. Your modified AGI (adjusted gross income) is less than: $74,850

if single or head of household; $119,750 if married filing jointly or

qualifying widow(er). See the instructions for line 9 to figure your

modified AGI.

U.S. Savings Bonds That Qualify for E

Who May Take the Exclusion

If you cashed series EE or I U.S. savings bonds in 2004 that were

issued after 1989, you may be able to exclude from your income

part or all of the interest on those bonds. Use this form to figure the

amount of any interest you may exclude.

You may take the exclusion if all four of the following apply.

To qualify for the exclusion, the bonds must be s

savings bonds issued after 1989 in your name, o

they may be issued in your name and your spous

must have been age 24 or older before the bond

bond bought by a parent and issued in the name 

under age 24 does not qualify for the exclusion b

child.

Section references are to the Internal Revenue Code.

General Instructions

For Paperwork Reduction Act Notice, see back of form.

Recordkeeping Requirements

● A written record of each post-1989 series EE o

cash. Your record must include the serial numbe

value, and total redemption proceeds (principal a

bond. You may use Form 8818, Optional Form T

Redemption of Series EE and I U.S. Savings Bon

1989.

● Bills, receipts, canceled checks, or other docu

paid qualified higher education expenses in 2004

Keep the following records to verify interest you 

(99)
Like-Kind Exchanges

Form 8824

(and section 1043 conflict-of-interest sales)

Department of the Treasury

Internal Revenue Service  Attach to your tax return. 

Name(s) shown on tax return Identifying 

Information on the Like-Kind Exchange

1 Description of like-kind property given up 

2 Description of like-kind property received 

3 Date like-kind property given up was originally acquired (month, day, year) 3 

4 Date you actually transferred your property to other party (month, day, year) 4 

5 

Date like-kind property you received was identified by written notice to another party (see

instructions for 45-day written notice requirement) (month, day, year)

5

6 Date you actually received the like-kind property from other party (month, day, year) (see instructions) 6 

7 Was the exchange of the property given up or received made with a related party, either directly or indirect

(such as through an intermediary) (see instructions)? If “Yes,” complete Part II. If “No,” go to Part III

8 Name of related party Related pa

Address (no., street, and apt., room, or suite no., city or town, state, and ZIP code)

Relationship to you

During this tax year (and before the date that is 2 years after the last transfer of property that was part of th

exchange), did the related party directly or indirectly (such as through an intermediary) sell or dispose of an

part of the like-kind property received from you in the exchange?

9

During this tax year (and before the date that is 2 years after the last transfer of property that was part of th

exchange), did you sell or dispose of any part of the like-kind property you received?

10

If both lines 9 and 10 are “No” and this is the year of the exchange, go to Part III. If both lines 9 and 10 are “No” 

year of the exchange, stop here. If either line 9 or line 10 is “Yes,” complete Part III and report on this year’s tax 

gain or (loss) from line 24 unless one of the exceptions on line 11 applies.

11 If one of the exceptions below applies to the disposition, check the applicable box:

The disposition was after the death of either of the related parties.

The disposition was an involuntary conversion, and the threat of conversion occurred after the exchan

You can establish to the satisfaction of the IRS that neither the exchange nor the disposition had tax 

principal purpose. If this box is checked, attach an explanation (see instructions).

Caution: If you transferred and received (a) more than one group of like-kind properties or (b) cash or other (not 

see Reporting of multi-asset exchanges in the instructions.

Note: Complete lines 12 through 14 only if you gave up property that was not like-kind. Otherwise, go to 

12 Fair market value (FMV) of other property given up 12

13 Adjusted basis of other property given up 13

Gain or (loss) recognized on other property given up. Subtract line 13 from line 12. Report the

gain or (loss) in the same manner as if the exchange had been a sale

14

14

15 Cash received, FMV of other property received, plus net liabilities assumed by other party, reduced

(but not below zero) by any exchange expenses you incurred (see instructions) 15

16 FMV of like-kind property you received 16

17 Add lines 15 and 16 17

Adjusted basis of like-kind property you gave up, net amounts paid to other party, plus any

exchange expenses not used on line 15 (see instructions)

18

18

19 Realized gain or (loss). Subtract line 18 from line 17 19

20 Enter the smaller of line 15 or line 19, but not less than zero 20

21 Ordinary income under recapture rules. Enter here and on Form 4797, line 16 (see instructions) 21

Basis of like-kind property received. Subtract line 15 from the sum of lines 18 and 23

22

22

For Paperwork Reduction Act Notice, see page 4. Cat. No. 12311A 

Part I

Realized Gain or (Loss), Recognized Gain, and Basis of Like-Kind Property Received

Note: If the property described on line 1 or line 2 is real or personal property located outside the United States, in

23

24 Deferred gain or (loss). Subtract line 23 from line 19. If a related party exchange, see instructions

Subtract line 21 from line 20. If zero or less, enter -0-. If more than zero, enter here and on Schedule

D or Form 4797, unless the installment method applies (see instructions)

Recognized gain. Add lines 21 and 22

25

23

24

25

a

b

c

Part III

Part II Related Party Exchange Information
OMB No. 1545-1444

Form 8844 Empowerment Zone and Renewal

Community Employment Credit

Department of the Treasury

Internal Revenue Service  Attach to your tax return. Attachment

Sequence No. 99

Name(s) shown on return Identifying number

Current Year Credit

1 Enter the total qualified wages paid or incurred during calendar year 2004 only (see instructions)

2 2

If you are a— Then enter the total of the current year credits from—

Schedule K-1 (Form 1120S), box 13, code G, H, or M

Schedule K-1 (Form 1065), box 15, code G, H, or M

Schedule K-1 (Form 1041), line 14

Written statement from cooperative

a Shareholder

b Partner

c Beneficiary

d Patron

5

5

6 6

7

9

Part I



Cat. No. 16145S

3

4

3

4

Add lines 1a and 1b. You must subtract this amount from your deduction for salaries and wages

Form 8844

credits from

pass-through

entities:

Add lines 2 and 3

Empowerment zone and renewal community employment credit included on line 4 from passive

activities (see instructions)

Subtract line 5 from line 4

Passive activity credit allowed for 2004 (see instructions)

Carryback of empowerment zone and renewal community employment credit from 2005 (see instructions)

Current year credit. Add lines 6 through 9. (S corporations, partnerships, estates, trusts, and

cooperatives, see instructions.)

10

10

9

7

For Paperwork Reduction Act Notice, see page 4. Form 8844 (2004)

8 Carryforward of empowerment zone and renewal community employment credit to 2004 8

Part II Allowable Credit

● Individuals. Enter the amount from Form 1040, line 43

11 Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A,

Part I, line 1; or the applicable line of your return

●

●

14a 14a

b Credits from Form 1040, lines 47 through 53 14b

14d

Foreign tax credit

d

e 14e

Possessions tax credit (Form 5735, line 17 or 27)

f

Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 14a through 14e 14f

Net income tax. Subtract line 14f from line 13. If zero, skip lines 16 through 22 and enter -0- on line 23 15

Alternative minimum tax:

12

Tentative minimum tax (see instructions)

16

11

Enter 25% (.25) of the excess, if any, of line 16 over $25,000 (see instructions)

13

20

c 14c

Regular tax before credits:

13

12

Enter the greater of line 18 or line 19

18

19

Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a and

1b, or the amount from the applicable line of your return

Net regular tax. Subtract line 14f from line 11. If zero or less, enter -0-

15



16

Multiply line 17 by 75% (.75)

17

18

19

20

17

a Qualified empowerment zone wages

b Qualified renewal community wages

1a

1b

$ X 20% (.20)

$ X 15% (.15)

Subtract line 20 from line 15. If zero or less, enter -0-

24

21

General business credit (see instructions)

Subtract line 22 from line 21

21

22

23

24

22

23

Credit allowed for the current year. Enter the smaller of line 10 or line 23 here and on Form 1040, line 54; Form

1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule G, line 2c; or the applicable line of your

return. If line 23 is smaller than line 10, see instructions

Add lines 11 and 12

Individuals. Enter the amount from Form 6251, line 35

Corporations. Enter the amount from Form 4626, line 14

Estates and trusts. Enter the amount from Form 1041, Schedule I, line 56

●

●

● 

2004
OMB No. 1545-1561 Archer MSAs and

Long-Term Care Insurance Contracts Form 8853

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Name(s) shown on Form 1040

Cat. No. 24091H Form 8853 (2004)

Archer MSA contributions you made for 2004, including those made from January 1, 2005, through

April 15, 2005, that were for 2004. Do not include rollovers (see page 4 of the instructions)

Archer MSA Distributions

8a Total distributions you and your spouse received in 2004 from all Archer MSAs (see page 4 of

the instructions)

Unreimbursed qualified medical expenses (see page 4 of the instructions)

c

11a

Taxable Archer MSA distributions. Subtract line 9 from line 8c. If zero or less, enter -0-. Also

include this amount in the total on Form 1040, line 21. On the dotted line next to line 21, enter

“MSA” and the amount 10

Limitation from the worksheet on page 3 of the instructions

Compensation (see page 3 of the instructions) from the employer maintaining the high deductible

health plan. (If self-employed, enter your earned income from the trade or business under which

the high deductible health plan was established.) 

Archer MSA deduction. Enter the smallest of line 4, 5, or 6. Also include this amount in the

total on Form 1040, line 35. On the dotted line next to line 35, enter “MSA” and the amount

6

7

5

7

8a

8b

Attachment

Sequence No. 39

Caution: If line 4 is more than line 7, you may have to pay an additional tax (see page 4 of the instructions).

b

Section A. Archer MSAs. If you have only a Medicare Advantage MSA, skip Section A and complete Section B.

For Paperwork Reduction Act Notice, see page 8 of the instructions.

4

5

6

 See separate instructions.

If any of the distributions included on line 10 meet any of the Exceptions to the Additional

15% Tax (see page 4 of the instructions), check here 

Additional 15% tax (see page 4 of the instructions). Enter 15% (.15) of the distributions included

on line 10 that are subject to the additional 15% tax. Also include this amount in the total on

Form 1040, line 62. On the dotted line next to line 62, enter “MSA” and the amount

4

If you are filing jointly and both you and your spouse have high deductible health plans with self-only

coverage, complete a separate Part II for each spouse (see page 2 of the instructions).

Archer MSA Contributions and Deductions. See page 2 of the instructions before completing this part.

Distributions included on line 8a that you rolled over to another Archer MSA or a health savings account.

Also include any excess contributions (and the earnings on those excess contributions) included on

line 8a that were withdrawn by the due date of your return (see page 4 of the instructions)

Subtract line 8b from line 8a 8c

9 9

10

b

11b

Social security number of MSA

account holder. If both spouses

have MSAs, see page 1 of the instructions 

3 Total employer contributions to your Archer MSA(s) for 2004

Section B. Medicare Advantage MSA Distributions. If you are filing jointly and both you and your spouse received

distributions in 2004 from a Medicare Advantage MSA, complete a separate Section B for each spouse

(see page 5 of the instructions).

Total distributions you received in 2004 from all Medicare Advantage MSAs (see page 5 of the

instructions)

Unreimbursed qualified medical expenses (see page 5 of the instructions)

Taxable Medicare Advantage MSA distributions. Subtract line 13 from line 12. If zero or less,

enter -0-. Also include this amount in the total on Form 1040, line 21. On the dotted line next

to line 21, enter “Med MSA” and the amount

Additional 50% tax (see page 5 of the instructions). Also include this amount in the total on

Form 1040, line 62. On the dotted line next to line 62, enter “Med MSA” and the amount

If any of the distributions included on line 14 meet any of the Exceptions to the Additional

50% Tax (see page 5 of the instructions), check here 

12

13

14

15a

b

12

13

14

15b

3

2004

(99)

Part I

1a Did you or your employer make contributions to your Archer MSA for 2004?

b

c

2a

b

c

If “Yes,” were you uninsured when the MSA was established (see page 2 of the instructions)?

If line 1a is “Yes,” indicate coverage under high deductible health plan: Self-Only or Family

If “Yes,” was your spouse uninsured when the MSA was established (see page 2 of the instructions)?

If line 2a is “Yes,” indicate coverage under high deductible health plan: Self-Only or Family

If married, did your spouse or spouse’s employer make contributions to your spouse’s Archer MSA for 2004?

1a

1b

2a

2b

Part II

Part III

Yes No

General Information. See page 2 of the instructions.
23

19

21

28

Section C. Long-Term Care (LTC) Insurance Contracts. See Filing Requirements for Section C on page 6 of

the instructions before completing this section.

16a Name of insured 

In 2004, did anyone other than you receive payments on a per diem or other periodic basis under a qualified

LTC insurance contract covering the insured or receive accelerated death benefits under a life insurance

policy covering the insured?

Was the insured a terminally ill individual? Yes No

17

Gross LTC payments received on a per diem or other periodic basis. Enter the total of the amounts

from box 1 of all Forms 1099-LTC you received with respect to the insured on which the “Per

diem” box in box 3 is checked

18

Accelerated death benefits received on a per diem or other periodic basis. Do not include any

amounts you received because the insured was terminally ill (see page 7 of the instructions)

19

Add lines 20 and 21

Note: If you checked “Yes” on line 17 above, see Multiple Payees

on page 7 of the instructions before completing lines 23 through 27.

20

Multiply $230 by the number of days in the LTC period

21

Costs incurred for qualified LTC services provided for the insured

during the LTC period (see page 7 of the instructions)

22

Enter the larger of line 23 or line 24

23

Reimbursements for qualified LTC services provided for the insured

during the LTC period

24

Per diem limitation. Subtract line 26 from line 25

Taxable payments. Subtract line 27 from line 22. If zero or less, enter -0-. Also include this

amount in the total on Form 1040, line 21. On the dotted line next to line 21, enter “LTC” and

the amount

Form 8853 (2004) Page 2

Yes No

22

24

26

Name of policyholder (as shown on Form 1040)

Note: If “Yes” and the only payments you received in 2004 were accelerated death benefits that were paid

to you because the insured was terminally ill, skip lines 19 through 27 and enter -0- on line 28.

b Social security number of insured 

25

Enter the part of the amount on line 19 that is from qualified LTC insurance contracts 20

Caution: If you received any reimbursements from LTC contracts

issued before August 1, 1996, see page 7 of the instructions.

Social security number

of policyholder 

27

Attachment Sequence No. 39

Caution: Do not use lines 20 through 28 to figure the taxable amount of benefits paid under an

LTC insurance contract that is not a qualified LTC insurance contract. Instead, if the benefits

are not excludable from your income (for example, if the benefits are not paid for personal injuries

or sickness through accident or health insurance), report the amount not excludable as income

on Form 1040, line 21.

25

26

27

28

Form 8853 (2004)

If more than one Section C is attached, check here 
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 (2004)

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

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: $105,000 if married filing jointly; $52,000 if single, head of

household, or qualifying widow(er)

Enter the amount from Form 1040, line 37*, 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 45, or Form 1040A, line 28 

18

Subtract line 16 from line 15. If zero or less, stop; you cannot take any education

credits 

Education credits. Enter the smaller of line 14 or line 17 here and on Form 1040,

line 49, or Form 1040A, line 31 

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

* If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter.

 Attach to Form 1040 or Form 1040A.

Last name

First name

Caution: You cannot take both an education credit and the tuition and fees deduction (Form 1040, line 27, or Form 1040A, 

line 19) for the same student in the same year.

2004

17

18

16

17

Enter the total, if any, of your credits from Form 1040, lines 46 through 48, or Form

1040A, lines 29 and 30

(99)
OMB No. 1545-1805

8880 Credit for Qualified Retirement Savings Contributions Form

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 129

 Attach to Form 1040 or Form 1040A. 

Name(s) shown on return Your social security number

For Paperwork Reduction Act Notice, see back of form. Form 8880 (2004)

Cat. No. 33394D

● The amount on Form 1040, line 37, or Form 1040A, line 22, is more than $25,000 ($37,500 if head of household;

$50,000 if married filing jointly).

You cannot take this credit if either of the following applies.

4

1

Traditional and Roth IRA contributions for 2004. Do not include rollover

contributions

1

3

2

5

6

7

8

9

10

11

12

13

14

Elective deferrals to a 401(k) or other qualified employer plan, voluntary

employee contributions, and 501(c)(18)(D) plan contributions for 2004

(see instructions) 

2

3 Add lines 1 and 2

Certain distributions received after 2001 and before the due date

(including extensions) of your 2004 tax return (see instructions). If

married filing jointly, include both spouses’ amounts in both columns.

See instructions for an exception 

4

5 Subtract line 4 from line 3. If zero or less, enter -0-

6 In each column, enter the smaller of line 5 or $2,000 

8 Enter the amount from Form 1040, line 37*, or Form 1040A, line 22

9 Enter the applicable decimal amount shown below:

Note: If line 9 is zero, stop; you cannot take this credit.

10 Multiply line 7 by line 9 

11 Enter the amount from Form 1040, line 45, or Form 1040A, line 28

Enter the total of your credits from Form 1040, lines 46 through 49, or

Form 1040A, lines 29 through 31

12

13 Subtract line 12 from line 11. If zero, stop; you cannot take this credit 

Credit for qualified retirement savings contributions. Enter the smaller of line 10 or line

13 here and on Form 1040, line 50, or Form 1040A, line 32

14

(a) You (b) Your spouse

● The person(s) who made the qualified contribution or elective deferral (a) was born after January 1, 1987, (b) is

claimed as a dependent on someone else’s 2004 tax return, or (c) was a student (see instructions).

7 Add the amounts on line 6. If zero, stop; you cannot take this credit 

*See Pub. 590 for the amount to enter if you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico.

If line 8 is— 

Enter on line 9—

Single, Married filing 

separately, or 

Qualifying widow(er)

Over— But not 

over—

Married 

filing jointly

Head of 

household

---

$15,000

$16,250

$22,500

$24,375

$25,000

$30,000

$32,500

$37,500

$50,000

$15,000

$16,250

$22,500

$24,375

$25,000

$30,000

$32,500

$37,500

$50,000

---

.5

.5

.5

.5

.5

.5

.2

.1

.1

.0

.5

.5

.5

.2

.1

.1

.1

.1

.0

.0

.5

.2

.1

.1

.1

.0

.0

.0

.0

.0

X .

And your filing status is—

 See instructions on back.

2004

CAUTION
O

Form 8884 New York Liberty Zone

Department of the Treasury

Internal Revenue Service  Attach to your tax return. 

Name(s) shown on return Identifying n

Current Year Credit (Members of a controlled group, see instructions.)

1 Enter the total qualified wages paid or incurred during the tax year to New York (NY) Liberty

Zone business employees for work performed during calendar year 2002 or 2003 who have:

1a

2 Add lines 1a and 1b. You must subtract this amount from your deduction for salaries and wages 2

If you are a— Then enter the NY Liberty Zone business employee credits from—

Schedule K-1 (Form 1120S), box 13, code G, H, or N

Schedule K-1 (Form 1065), box 15, code G, H, or N

Schedule K-1 (Form 1041), line 14

Written statement from cooperative

a Shareholder

b Partner

c Beneficiary

d Patron

NY Liberty Zone

business

employee credits

from pass-through

entities:

3

3

4 Add lines 2 and 3 4

Allowable Credit

Part I

Part II



Cat. No. 33946Z

Worked for you at least 120 hours but fewer than 400 hours $  25% (.25) =

Worked for you at least 400 hours $  40% (.40) =

a

b 1b

For Paperwork Reduction Act Notice, see page 4.

● Individuals. Enter the amount from Form 1040, line 43

11

Corporations. Enter the amount from Form 1120, Schedule J, line 3; Form 1120-A,

Part I, line 1; or the applicable line of your return

●

●

14a 14a

b Credits from Form 1040, lines 47 through 53 14b

Foreign tax credit

Possessions tax credit (Form 5735, line 17 or 27)

Credit for fuel from a nonconventional source

Qualified electric vehicle credit (Form 8834, line 20)

Add lines 14a through 14e 14f

Net income tax. Subtract line 14f from line 13. If zero, skip lines 16 through 19 and enter -0- on line 20 15

11

Alternative minimum tax:

● Individuals. Enter the amount from Form 6251, line 35

● Corporations. Enter the amount from Form 4626, line 14 12

● Estates and trusts. Enter the amount from Form 1041, Schedule I, line 56

Enter 25% (.25) of the excess, if any, of line 16 over $25,000 (see instructions)

16

Credit allowed for the current year. Enter the smaller of line 10 or line 20 here and on Form

1040, line 54; Form 1120, Schedule J, line 6d; Form 1120-A, Part I, line 2; Form 1041, Schedule

G, line 2c; or the applicable line of your return. If line 20 is smaller than line 10, see instructions 21



10

Regular tax before credits:

12

Add lines 11 and 12 13

15

16

17

c

d

e

14c

14d

Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a

and 1b, or the amount from the applicable line of your return

Net regular tax. Subtract line 14f from line 11. If zero or less, enter -0-



20

14e

f

Business Employee Credit

NY Liberty Zone business employee credit included on line 4 from passive activities (see

instructions)

5

6 Subtract line 5 from line 4 6

7 NY Liberty Zone business employee passive activity credit allowed for 2004 (see instructions) 7

8

Carryback of NY Liberty Zone business employee credit from 2005 (see instructions)

8

9

Current year credit. Add lines 6 through 9. (S corporations, partnerships, estates, trusts,

cooperatives, regulated investment companies, and real estate investment trusts, see instructions.)

9

10

Subtract line 17 from line 15. If zero or less, enter -0-

17

General business credit (see instructions)

18 18

19

Subtract line 19 from line 18. If zero or less, enter -0-

19

20

Carryforward of NY Liberty Zone business employee credit to 2004

13

5

21
Form 8885 Health Coverage Tax Credit

Department of the Treasury

Internal Revenue Service

 Attach to Form 1040 or Form 1040NR.

Name of recipient (if both spouses are recipients, complete a separate form for each spouse) Recipient’s so

Cat. No. 34641D

Complete This Part To See if You Are Eligible To Take This Credit

1

Part I

Part II

Check the boxes below for each month in 2004 that all of the following statements were true on the first da

February March

Health Coverage Tax Credit

2 Amount paid for qualified health insurance coverage for all months checked on line 1 (see

instructions on page 4). Include advance payments, if any, from Form 1099-H, box 1

3 Enter the total amount of any (a) Archer MSA and health savings account distributions used

to pay amounts included on line 2 and (b) National Emergency Grants you received for health

insurance in 2004

4 Subtract line 3 from line 2. If zero or less, stop; you cannot take the credit

7 Health coverage tax credit. Subtract line 6 from line 5. If zero or less, enter -0-. Also include

on Form 1040, line 69, or Form 1040NR, line 63, and check box c on that line

For Paperwork Reduction Act Notice, see page 4.

Before you begin: See Definitions and Special Rules that begin on page 2.

5 Multiply line 4 by 65% (.65) and enter the result

6 Advance payments, if any, from Form 1099-H, box 1

January May June April

July November December August September October

Do not complete this form if you can be claimed as a dependent on someone else’s 2004 tax retu

● You were an eligible trade adjustment assistance (TAA) recipient, alternative TAA recipient, or Pension 

Corporation (PBGC) pension recipient.

● You were covered by a qualified health insurance plan for which you paid the premiums.

● You were not covered by, or eligible for coverage under, any employer-sponsored health insurance plan 

on page 3).

● You were not enrolled in Medicaid or State Children’s Health Insurance Program (SCHIP).

● You were not enrolled in the Federal Employees Health Benefits Program or eligible to receive benefit

military health system (TRICARE).

● You were not imprisoned under Federal, state, or local authority.

2

3

5

4

7

6

● You were not entitled to Medicare Part A or enrolled in Medicare Part B.

Note. You must attach invoices and proof of payment for any amounts

included on line 2 for which you did not receive an advance payment (see

instructions on page 4).

CAUTION
OMB No. 1545-1911

Form 8889 Health Savings Accounts (HSAs)

Department of the Treasury

Internal Revenue Service  Attach to Form 1040.

Name(s) shown on Form 1040

Cat. No. 37621P Form 8889 (2004)

HSA contributions you made for 2004 (or those made on your behalf), including those made

from January 1, 2005, through April 15, 2005, that were for 2004. Do not include employer

contributions or rollovers (see page 2 of the instructions)

HSA Distributions. If you are filing jointly and both you and your spouse each have separate HSAs,

complete a separate Part II for each spouse.

12a Total distributions you received in 2004 from all HSAs (see page 5 of the instructions)

Unreimbursed qualified medical expenses (see page 5 of the instructions)

c

15a

Taxable HSA distributions. Subtract line 13 from line 12c. If zero or less, enter -0-. Also, include

this amount in the total on Form 1040, line 21. On the dotted line next to line 21, enter “HSA”

and the amount 14

Add lines 6 and 7

Subtract line 9 from line 8. If zero or less, enter -0- 

HSA deduction. Enter the smaller of line 2 or line 10 here and on Form 1040, line 28

6

7

8

11

12a

12b

Attachment

Sequence No. 138

b

For Paperwork Reduction Act Notice, see page 5 of the instructions.

4

5

10

 See separate instructions.

If any of the distributions included on line 14 meet any of the Exceptions to the Additional

10% Tax (see page 5 of the instructions), check here 

Additional 10% tax (see page 5 of the instructions). Enter 10% (.10) of the distributions included

on line 14 that are subject to the additional 10% tax. Also include this amount in the total on

Form 1040, line 62. On the dotted line next to line 62, enter “HSA” and the amount

HSA Contributions and Deduction. See page 2 of the instructions before completing this part. If you are

filing jointly and both you and your spouse each have separate HSAs, complete a separate Part I for each

spouse (see page 2 of the instructions).

Distributions included on line 12a that you rolled over to another HSA. Also include any excess

contributions (and the earnings on those excess contributions) included on line 12a that were

withdrawn by the due date of your return (see page 5 of the instructions)

Subtract line 12b from line 12a 12c

13 13

14

b

15b

Social security number of HSA

beneficiary. If both spouses have

HSAs, see page 2 of the instructions 

3

Part I

1

2

3

Part II

6

2004

If you were age 55 or older at the end of 2004, married, and you or your spouse had family

coverage under a high-deductible health plan at any time during 2004, enter the additional

contribution amount from the worksheet on page 4 of the instructions 7

Caution: If line 2 is more than line 11, you may have to pay an additional tax (see page 4 of the

instructions).

Before you begin: Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required.

Check the box to indicate your coverage under a high-deductible

health plan during 2004 (see page 2 of the instructions)  Self-only Family

If you were under age 55 at the end of 2004, and on the first day of every month during 2004, you

were an eligible individual with the same annual deductible and coverage, enter the smaller of:

● Your annual deductible (see page 3 of the instructions), or

● $2,600 ($5,150 for family coverage).

All others, enter the limit from the worksheet on page 3 of the instructions

Enter the amount you and your employer contributed to your Archer MSAs for 2004 from Form

8853, lines 3 and 4. If you or your spouse had family coverage under a high-deductible health

plan at any time during 2004, also include any amount contributed to your spouse’s Archer MSAs

Subtract line 4 from line 3. If zero or less, enter -0-

If you and your spouse each have separate HSAs and had family coverage under a

high-deductible health plan at any time during 2004, see the instructions on page 4 for the amount

to enter. All others, enter the amount from line 5

2

5

4

Employer contributions made to your HSAs for 2004

8

9

10

11

9