| INCOME: |
| Wages,
including salary, tips, bonuses |
$
___________________ |
|
| Taxable
interest |
___________________ |
|
| Tax-exempt
interest |
___________________ |
|
| Qualified
dividends |
___________________ |
|
| Taxable
refunds, credits, or offsets of state and local income taxes |
___________________ |
|
| Alimony
received |
___________________ |
|
| Business
income or (loss) |
___________________ |
|
| Capital
gain or (loss) |
___________________ |
|
| Other gains
or (losses) |
___________________ |
|
| IRA distributions |
___________________ |
|
| Pensions
and annuities |
___________________ |
|
| Rental
real estate, royalties, partnerships, S corporations, trusts |
___________________ |
|
| Farm income
or (loss) |
___________________ |
|
| Unemployment
compensation |
___________________ |
|
| Social
security benefits |
___________________ |
|
| Other income |
___________________ |
|
Total Income |
|
$ ___________________ |
ADJUSTMENTS: |
| Educator
expenses |
$
___________________ |
|
| Certain
business expenses of reservists, performing artists, and fee-basis
government officials |
___________________ |
|
| Health
savings account deduction |
___________________ |
|
| Moving
expenses |
___________________ |
|
| One-half
of self-employment tax |
___________________ |
|
| Self-employed
SEP, SIMPLE, and qualified plans |
___________________ |
|
| Self-employed
health insurance deduction |
___________________ |
|
| Penalty
on early withdrawal of savings |
___________________ |
|
| Alimony
paid |
___________________ |
|
| IRA deduction |
___________________ |
|
| Student
loan interest deduction |
___________________ |
|
| Tuition
and fees deduction |
___________________ |
|
| Domestic
production activities deduction |
___________________ |
|
| Other income |
___________________ |
|
Total Adjustments |
|
$ <___________________> |
ADJUSTED GROSS INCOME (AGI)
(Total income minus total adjustments) |
|
$
___________________
|