Form
1040
Name,
Address,
and SSN
Department of the Treasury
' Internal Revenue Service
U.S. Individual Income Tax Return
For the year Jan 1 - Dec 31, 2010, or other tax year beginning
Your first name
MI
Martha
If a joint return, spouse’s first name
See separate
instructions.
2010
(99)
IRS Use Only ' Do not write or staple in this space.
, 2010, ending
, 20
S
Wade
MI
Last name
871-41-1234
Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions.
City, town or post office. If you have a foreign address, see instructions.
Riverbank
A
State
ZIP code
CA
95367
J
Checking a box below will not
change your tax or refund.
Check here if you, or your spouse if filing jointly, want $3 to go to this fund?
Filing Status
1
2
Check only
one box.
3
Exemptions
6a
b
Single
4
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse’s SSN above & full
name here
5
X
X
You
Spouse
Head of household (with qualifying person). (See
instructions.) If the qualifying person is a child
but not your dependent, enter this child’s
name here
Qualifying widow(er) with dependent child
X
Yourself. If someone can claim you as a dependent, do not check box 6a
Spouse
(2) Dependent’s
(3) Dependent’s
c Dependents:
social security
relationship
number
to you
(1) First name
Last name
Myrna P Wade
If more than four
dependents, see
instructions and
check here
Make sure the SSN(s)
above and on line 6c
are correct.
Apartment no.
158 Central Ave
Presidential
Election
Campaign
OMB No. 1545-0074
Your social security number
Last name
839-15-1011 Daughter
b
(4) if
child under
age 17
qualifying for
child tax cr
(see instrs)
X
Boxes checked
on 6a and 6b
1
No. of children
on 6c who:
? lived
with you
1
?
did not
live with you
due to divorce
or separation
(see instrs)
Dependents
on 6c not
entered above
Add numbers
on lines
d Total number of exemptions claimed
above
2
7 Wages, salaries, tips, etc. Attach Form(s) W-2
7
Income
8 a Taxable interest. Attach Schedule B if required
8a
b Tax-exempt interest. Do not include on line 8a
8b
9 a Ordinary dividends. Attach Schedule B if required
9a
Attach Form(s)
W-2 here. Also
b Qualified dividends
9b
attach Forms
10 Taxable refunds, credits, or offsets of state and local income taxes
10
W-2G and 1099-R
11 Alimony received
11
if tax was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ
12
19,352.
If you did not
13 Capital gain or (loss). Att Sch D if reqd. If not reqd, ck here
13
get a W-2,
see instructions.
14 Other gains or (losses). Attach Form 4797
14
15 a IRA distributions
15 a
b Taxable amount
15 b
16 a Pensions and annuities
16 a
b Taxable amount
16 b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
17
18 Farm income or (loss). Attach Schedule F
18
Enclose, but do
not attach, any
19 Unemployment compensation
19
payment. Also,
20
a
Social
security
benefits
20
a
b
Taxable
amount
20 b
please use
Form 1040-V.
21 Other income
21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income
22
19,352.
23 Educator expenses
23
Adjusted
24 Certain business expenses of reservists, performing artists, and fee-basis
government officials. Attach Form 2106 or 2106-EZ
24
Gross
Income
25 Health savings account deduction. Attach Form 8889
25
26 Moving expenses. Attach Form 3903
26
27 One-half of self-employment tax. Attach Schedule SE
27
1,367.
28 Self-employed SEP, SIMPLE, and qualified plans
28
29 Self-employed health insurance deduction
29
30 Penalty on early withdrawal of savings
30
31 a Alimony paid b Recipient’s SSN
31 a
32 IRA deduction
32
33 Student loan interest deduction
33
34 Tuition and fees. Attach Form 8917
34
35 Domestic production activities deduction. Attach Form 8903
35
36 Add lines 23 - 31a and 32 - 35
36
1,367.
37 Subtract line 36 from line 22. This is your adjusted gross income
37
17,985.
FDIA0112 12/22/10
Form 1040 (2010)
BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Martha S Wade
Form 1040 (2010)
Tax and
Credits
Other
Taxes
Payments
If you have a
qualifying
child, attach
Schedule EIC.
Refund
Direct deposit?
See instructions.
Amount
You Owe
Third Party
Designee
Sign
Here
Joint return?
See instructions.
Keep a copy
for your records.
Page 2
38
17,985.
Blind.
Blind.
Total boxes
checked
39 a
b If your spouse itemizes on a separate return, or you were a dual-status alien, check here
39 b
Itemized deductions (from Schedule A) or your standard deduction (see instructions)
40
41
42
43
Subtract line 40 from line 38
Exemptions. Multiply $3,650 by the number on line 6d
40
41
42
8,400.
9,585.
7,300.
If line 42 is more than line 41, enter -0-
43
2,285.
44
Tax (see instrs). Check if any tax is from:
44
45
46
229.
54 Add lines 47 through 53. These are your total credits
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -056 Self-employment tax. Attach Schedule SE
57 Unreported social security and Medicare tax from Form: a
4137 b
8919
58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required
59 a
Form(s) W-2, box 9
b
Schedule H
c
Form 5405, line 16
60 Add lines 55-59. This is your total tax
61 Federal income tax withheld from Forms W-2 and 1099
61
62 2010 estimated tax payments and amount applied from 2009 return
62
63 Making work pay credit. Attach Schedule M
63
400.
64 a Earned income credit (EIC)
64 a
2,806.
b Nontaxable combat pay election
64 b
65 Additional child tax credit. Attach Form 8812
65
771.
66 American opportunity credit from Form 8863, line 14
66
67 First-time homebuyer credit from Form 5405, line 10
67
68 Amount paid with request for extension to file
68
69 Excess social security and tier 1 RRTA tax withheld
69
70 Credit for federal tax on fuels. Attach Form 4136
70
71 Credits from Form: a
2439 b
8839 c
8801 d
8885 71
54
55
56
57
58
59
60
229.
0.
2,734.
72 Add lns 61-63, 64a, & 65-71. These are your total pmts
73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid
74 a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here
G b Routing number
XXXXXXXXX
G c Type:
Checking
G d Account number
XXXXXXXXXXXXXXXXX
75 Amount of line 73 you want applied to your 2011 estimated tax
75
76 Amount you owe. Subtract line 72 from line 60. For details on how to pay see instructions
77 Estimated tax penalty (see instructions)
77
72
73
74 a
3,977.
1,243.
1,243.
Taxable income. Subtract line 42 from line 41.
45
46
47
48
49
50
51
52
a
Form(s) 8814
b
Form 4972
Alternative minimum tax (see instructions). Attach Form 6251
Add lines 44 and 45
Foreign tax credit. Attach Form 1116 if required
47
Credit for child and dependent care expenses. Attach Form 2441
48
Education credits from Form 8863, line 23
49
Retirement savings contributions credit. Attach Form 8880
50
Child tax credit (see instructions)
51
Residential energy credits. Attach Form 5695
52
53
Other crs from Form: a
3800 b
8801 c
Designee’s
name
229.
229.
53
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Phone
no.
G
2,734.
Savings
76
X
Yes. Complete below.
Personal identification
number (PIN)
G
No
G
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.
Your signature
A
A
Date
Spouse’s signature. If a joint return, both must sign.
Print/Type preparer’s name
Paid
Preparer’s
Use Only
871-41-1234
38 Amount from line 37 (adjusted gross income)
39 a Check
You were born before January 2, 1946,
if:
Spouse was born before January 2, 1946,
Date
Preparer’s signature
Your occupation
Daytime phone number
Attorney
(209) 555-1401
Spouse’s occupation
Date
Check
if
PTIN
self-employed
Firm’s name
G
Firm’s address
G
Self-Prepared
Firm’s EIN G
Phone no.
Form 1040 (2010)
FDIA0112
12/22/10
Earned Income Worksheet
2010
G Keep for your records
Name(s) Shown on Return
Social Security Number
Martha S Wade
871-41-1234
Part I ' Earned Income Credit Wks Computation
If filing Schedule SE:
Net self-employment income
Optional Method and Church Employee income
Add lines 1a and 1b
One-half of self-employment tax
Subtract line 1d from line 1c
2
If not required to file Schedule SE:
a Net farm profit or (loss)
b Net nonfarm profit or (loss)
c Add lines 2a and 2b
3
If filing Schedule C or C-EZ as a statutory
employee, enter the amount from line 1
of that Schedule C or C-EZ
4
Add lines 1e, 2c and 3. To EIC Wks, line 5
Taxpayer
Spouse
Total
1
a
b
c
d
e
19,352.
19,352.
19,352.
1,367.
17,985.
19,352.
1,367.
17,985.
17,985.
17,985.
Part II ' Form 2441, Standard Deduction Worksheet and Schedule L Computations
Net self-employment earnings (line 4 above)
Wages, salaries, and tips less distributions
from nonqualified or section 457 plans, etc
7
Taxable employer-provided adoption benefits
8
Add lines 5 through 7. To Form 2441, lines 19
and 20
9 a Taxable dependent care benefits
b Nontaxable combat pay
10
Add lines 8, 9a and 9b . To Form 2441, lines 4
and 5
11
Scholarship or fellowship income not on W-2
12
SE exempt earnings less nontaxable income
13
Distributions from nonqualified/Sec. 457 plans
14
Add lines 8, 9a and 11 through 13. To Standard
Deduction Worksheet or Schedule L, line 3
5
6
17,985.
17,985.
17,985.
17,985.
17,985.
17,985.
17,985.
17,985.
17,985.
17,985.
17,985.
17,985.
Part III ' IRA Deduction Worksheet Computation
15
16
17
18
19
20
21
22
Net self-employment income or (loss)
Wages, salaries, tips, etc
Net self-employment loss
Alimony received
Nontaxable combat pay
Foreign earned income exclusion
Keogh, SEP or SIMPLE deduction
Combine lines 15 through 21. To IRA Wks, ln 2
Part IV ' Form 8812 and Schedule M Earned Income Computations
23
24
25
26
27
Self-employed, church and statutory employees
Wages, salaries, tips, etc
Nontaxable combat pay
Foreign earned income exclusion
Combine lines 23 through 26. To Form
8812, line 4a and Schedule M, line 1a
17,985.
17,985.
17,985.
17,985.
Form 1040
Line 51
Child Tax Credit Worksheet
2010
G Keep for your records.
Name as Shown on Return
Social Security Number
Martha S Wade
Before you begin:
871-41-1234
Caution!
Part 1
b Figure the amount of any credits you are claiming on Form 5695, Part I; Form 8834, Part I; Form 8910; Form
8936; or Schedule R.
? To be a qualifying child for the child tax credit, the child must be under age 17 at the end of 2010 and meet the other
requirements listed below.
Number of qualifying children:
2
Enter the amount from Form 1040, line 38; Form 1040A,
line 22; or Form 1040NR, line 37
1040 Filers. Enter the total of any '
? Exclusion of income from Puerto Rico, and
3
4
5
6
7
8
Part 2
1 x 1,000. Enter the result
1
9
10
11
12
13
2
Are you claiming any of the following credits?
? Mortgage interest credit, Form 8396.
? Residential energy efficient property credit, Form 5695, Part II.
? District of Columbia first-time homebuyer credit, Form 8859.
X No. Enter the amount from line 10.
Yes. Complete the Line 11 Worksheet to figure the amount to enter here.
Subtract line 11 from line 9. Enter the result
Is the amount on line 8 of this worksheet more than the amount on line 12?
No. Enter the amount from line 8.
This is your child tax credit
X Yes. Enter the amount from line 12. See the
TIP below.
TIP: You may be able to take the additional child tax credit on Form 1040, line 65;
Form 1040A, line 42; or Form 1040NR, line 62, only if you answered ’Yes’ on line 13.
? First, complete your Form 1040 through line 64a (also complete line 69), Form 1040A
through line 41a, or Form 1040NR through line 61 (also complete line 64).
? Then, use Form 8812 to figure any additional child tax credit.
12/28/10
1,000.
7
0.
8
9
1,000.
229.
11
0.
12
229.
13
229.
17,985.
? Amounts from Form 2555, lines 45 and 50;
3
0.
Form 2555-EZ, line 18; and Form 4563, line 15.
1040A and 1040NR Filers. Enter -0-.
Add lines 2 and 3. Enter the total
4
17,985.
Enter the amount shown below for your filing status.
? Married filing jointly ' $110,000
? Single, head of household, or qualifying
5
75,000.
widow(er) ' $75,000
? Married filing separately ' $55,000
Is the amount on line 4 more than the amount on line 5?
X No. Leave line 6 blank. Enter -0- on line 7.
Yes. Subtract line 5 from line 4
6
If the result is not a multiple of $1,000, increase it to the
next multiple of $1,000. For example, increase $425 to
$1,000, increase $1,025 to $2,000, etc.
Multiply the amount on line 6 by 5% (.05). Enter the result
Is the amount on line 1 more than the amount on line 7?
You cannot take the child tax credit on Form 1040, line 51; Form 1040A, line
No.
33; or Form 1040NR, line 48. You also cannot take the additional child tax
credit on Form 1040, line 65; Form 1040A, line 42; or Form 1040NR, line 62.
Complete the rest of your Form 1040, 1040A, or Form 1040NR.
Yes.
Subtract
line 7 from line 1. Enter the result. Go to Part 2
X
Enter the amount from Form 1040, line 46, Form 1040A, line 28, or Form 1040NR, line 44
Add the following amounts from '
Form 1040
or
Form 1040A or
Form 1040NR
Line 47
--Line 45
Line 48
Line 29
Line 46
+
Line 49
Line 31
--+
Line 50
Line 32
Line 47
+
Form 5695, line 11
+
Form 8834, line 22
+
Form 8910, line 21
+
Form 8936, line 14
+
Schedule R, line 22
+
Enter the total
10
0.
FDIA2212
1
Enter this amount on
Form 1040, line 51;
Form 1040A, line 33;
or Form 1040NR,
line 48.
Profit or Loss From Business
SCHEDULE C
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0074
(Sole Proprietorship)
(Form 1040)
2010
G Partnerships, joint ventures, etc, generally must file Form 1065 or 1065-B.
(99) GAttach to Form 1040, 1040NR, or 1041. GSee Instructions for Schedule C (Form 1040).
Attachment
Sequence No.
Name of proprietor
Social security number (SSN)
Martha S Wade
871-41-1234
A
B
Principal business or profession, including product or service (see instructions)
Attorney
Enter code from instructions
G 541990
C
Business name. If no separate business name, leave blank.
E
Business address (including suite or room no.)
X
D
Employer ID number (EIN), if any
G 158
Central Ave
Riverbank, CA 95367
City, town or post office, state, and ZIP code
F
Accounting method:
G
H
Did you ’materially participate’ in the operation of this business during 2010? If ’No,’ see instructions for limit on losses
If you started or acquired this business during 2010, check here
Part I
1
2
3
4
5
09
(1)
Cash
(2)
Accrual
Other (specify) G
(3)
X
Yes
No
Income
Gross receipts or sales. Caution. See instructions and check the box if:
? This income was reported to you on Form W-2 and the ’Statutory employee’ box on that form was
checked, or
? You are a member of a qualified joint venture reporting only rental real estate income not subject
to self-employment tax. Also see instructions for limit on losses
Returns and allowances
Subtract line 2 from line 1
Cost of goods sold (from line 42 on page 2)
Gross profit. Subtract line 4 from line 3
Other income, including federal and state gasoline or fuel tax credit or refund
(see instructions)
7 Gross income. Add lines 5 and 6
Part II
Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising
8
1,369. 18 Office expense
19 Pension and profit-sharing plans
9 Car and truck expenses
(see instructions)
9
20 Rent or lease (see instructions):
10 Commissions and fees
10
a Vehicles, machinery, and equipment
b Other business property
11 Contract labor
(see instructions)
11
21 Repairs and maintenance
12 Depletion
12
22 Supplies (not included in Part III)
13 Depreciation and section
23 Taxes and licenses
179 expense deduction
24 Travel, meals, and entertainment:
(not included in Part III)
(see instructions)
13
a Travel
1
2
3
4
5
24,395.
24,395.
24,395.
6
14
15
16
Employee benefit programs
(other than on line 19)
Insurance (other than health)
Interest:
a Mortgage (paid to banks, etc)
b Other
17 Legal & professional services
28
29
30
31
14
15
16 a
16 b
17
2,500.
450.
165.
b Deductible meals and entertainment
(see instructions)
25 Utilities
26 Wages (less employment credits)
27
Other expenses (from line 48 on
page 2)
Total expenses before expenses for business use of home. Add lines 8 through 27
Tentative profit or (loss). Subtract line 28 from line 7
Expenses for business use of your home. Attach Form 8829
Net profit or (loss). Subtract line 30 from line 29.
? If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2 or on Form
1040NR, line 13 (if you checked the box on line 1, see instructions). Estates and
trusts, enter on Form 1041, line 3.
? If a loss, you must go to line 32.
32
6
7
18
19
20 a
20 b
21
22
23
24,395.
384.
175.
24 a
24 b
25
26
27
28
29
30
5,043.
19,352.
31
19,352.
If you have a loss, check the box that describes your investment in this activity (see instructions).
? If you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form
1040NR, line 13 (if you checked the box on line 1, see the line 31 instructions). Estates and trusts, enter
on Form 1041, line 3.
? If you checked 32b, you must attach Form 6198. Your loss may be limited.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIZ0112
12/27/10
All investment is
at risk.
Some investment
32 b
is not at risk.
Schedule C (Form 1040) 2010
32 a
Martha S Wade
Cost of Goods Sold (see instructions)
871-41-1234
Schedule C (Form 1040) 2010
Part III
33
Method(s) used to value closing inventory:
34
Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If ’Yes,’ attach explanation
a
Cost
b
Lower of cost or market
c
Other (attach explanation)
Inventory at beginning of year. If different from last year’s closing inventory,
attach explanation
35
36
Purchases less cost of items withdrawn for personal use
36
37
Cost of labor. Do not include any amounts paid to yourself
37
38
Materials and supplies
38
39
Other costs
39
40
Add lines 35 through 39
40
41
Inventory at end of year
41
42
Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4
42
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 to find out if you must file Form 4562.
35
Page 2
Yes
No
Part IV
43
44
When did you place your vehicle in service for business purposes? (month, day, year)
.
G
Of the total number of miles you drove your vehicle during 2010, enter the number of miles you used your vehicle for:
a Business
b Commuting (see instructions)
c Other
45
Was your vehicle available for personal use during off-duty hours?
Yes
No
46
Do you (or your spouse) have another vehicle available for personal use?
Yes
No
Yes
No
Yes
No
47 a Do you have evidence to support your deduction?
b If ’Yes,’ is the evidence written?
Other Expenses. List below business expenses not included on lines 8-26 or line 30.
Part V
48
Total other expenses. Enter here and on page 1, line 27
48
Schedule C (Form 1040) 2010
FDIZ0112
12/27/10
SCHEDULE EIC
Earned Income Credit
(Form 1040A or 1040)
Qualifying Child Information
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0074
2010
Complete and attach to Form 1040A or 1040
only if you have a qualifying child.
(99)
Attachment
Sequence No.
Name(s) shown on return
Martha S Wade
Before you begin:
43
Your social security number
871-41-1234
? See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and
64b, to make sure that (a) you can take the EIC and (b) you have a qualifying child.
? Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social
security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or
SSN on the child’s social security card is not correct, call the Social Security Administration at 1-800-772-1213.
CAUTION!
? If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the
instructions for details.
? It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.
Qualifying Child Information
1
2
3
Child 1
Child’s name
First name
If you have more than three qualifying
children, you only have to list three to get
the maximum credit
Myrna
Child’s SSN
The child must have an SSN as defined in the
instructions for Form 1040A, lines 41a and
41b, or Form 1040, lines 64a and 64b, unless
the child was born and died in 2010. If your
child was born and died in 2010 and did not
have an SSN, enter ’Died’ on this line and
attach a copy of the child’s birth certificate,
death certificate, or hospital medical records.
Child’s year of birth
4 a Was the child under age 24 at the end of
2010, a student, and younger than you (or
your spouse, if filing jointly)?
b Was the child permanently and totally
disabled during any part of 2010?
Last name
Last name
First name
Last name
839-15-1011
2001
Year
Year
Year
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
Yes.
Go to line 5.
Yes.
Go to line 5.
Yes.
Go to line 5.
No.
Continue.
Yes.
No.
The child
is not a
qualifying child.
Yes.
Continue.
No.
Continue.
No.
The child
is not a
qualifying child.
Yes.
Continue.
No.
Continue.
No.
The child
is not a
qualifying child.
Child’s relationship to you
(for example, son, daughter, grandchild,
niece, nephew, foster child, etc)
6
First name
Child 3
P Wade
Continue.
5
Child 2
Daughter
Number of months child lived with you in the
United States during 2010
? If the child lived with you for more than
half of 2010 but less than 7 months,
enter ’7’.
? If the child was born or died in 2010 and
your home was the child’s home for the
entire time he or she was alive during
2010, enter ’12’
12
months
Do not enter more than
12 months.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA7401
11/04/10
months
Do not enter more than
12 months.
months
Do not enter more than
12 months.
Schedule EIC (Form 1040A or 1040) 2010
Form 1040
Line 64
Earned Income Credit Worksheet
2010
G Keep for your records
Name(s) Shown on Return
Social Security Number
Martha S Wade
871-41-1234
QuickZoom to Schedule EIC
QuickZoom to Information Worksheet to enter qualifying children information
QuickZoom to Wages, Salaries, & Tips Worksheet to enter earned and non-earned income
QuickZoom to page 2 of this worksheet, if credit is not calculated on line 7
1
2
a
b
c
3
4a
b
c
5
6
7
Enter the amount from Form 1040 or 1040A, line 7, or Form 1040EZ, line 1,
less amounts considered not earned for EIC purposes
Adjustments to line 1 amount:
Income reported as wages and as self-employment income
Other income entered as wages that is not considered earned income
Distributions from section 457 and other nonqualified plans reported on W-2
Subtract lines 2a, 2b and 2c from line 1
Taxpayer’s nontaxable combat pay election for EIC
4a
Spouse’s nontaxable combat pay election for EIC
b
Total nontaxable combat pay election
If you were self-employed or used Schedule C or Schedule C-EZ
as a statutory employee, enter the amount from the
Earned Income Worksheet, line 4
Earned income. Add lines 3, 4c, and 5
Enter the credit, from the EIC Table, for the amount on line 6. Be sure to use
the correct column for filing status and number of children
1
2a
b
c
3
4c
5
6
17,985.
17,985.
7
2,806.
8
17,985.
9
2,806.
10
2,806.
If line 7 is zero, stop. You cannot take the credit.
Enter "No" on the dotted line next to Form 1040, line 64a.
8
9
Enter your AGI from Form 1040, line 38
If you have:
? No qualifying children, is the amount on line 8 less than $7,500
($12,500 if married filing jointly)?
? 1 or more qualifying children, is the amount on line 8 less than $16,450
($21,500 if married filing jointly)?
Yes. Go to line 10 now.
No. Enter the credit, from the EIC Table, for the amount on line 8. Be
sure to use the correct column for filing status and number of children
Earned income credit.
? If ’Yes’ on line 9, enter the amount from line 7
? If ’No’ on line 9, enter the smaller of line 7 or line 9
X
10
Enter line 10 amount on Form 1040, line 64a, Form 1040A, line 41a, or Form 1040EZ, line 9a.
SCHEDULE M
OMB No. 1545-0074
Making Work Pay Credit
(Form 1040A or 1040)
Department of the Treasury
Internal Revenue Service
(99)
G Attach to Form 1040A or 1040.
2010
G See separate instructions.
Attachment
Sequence No.
Name(s) shown on return
Your social security number
Martha S Wade
871-41-1234
166
Caution:
To take the making work pay credit, you must include your social security number (if filing a joint return, the number of either you or
your spouse) on your tax return. A social security number does not include an identification number issued by the IRS. Only the
Social Security Administration issues social security numbers.
Caution:
You cannot take the making work pay credit if you can be claimed as someone else’s dependent or if you are a nonresident alien.
Important: Check the ’No’ box on line 1a and see the instructions if:
(a) You have a net loss from a business,
(b) You received a taxable scholarship or fellowship grant not reported on a Form W-2,
(c) Your wages include pay for work performed while an inmate in a penal institution,
(d) You received a pension or annuity from a nonqualified deferred compensation plan or a nongovernmental
section 457 plan, or
(e) You are filing Form 2555 or 2555-EZ.
1 a Do you (and your spouse if filing jointly) have 2010 wages of more than $6,451 ($12,903 if married filing jointly)?
Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly) on line 4 and go to line 5.
X No. Enter your earned income (see instructions)
1a
b Nontaxable combat pay included on line 1a
(see instructions)
2 Multiply line 1a by 6.2% (.062)
17,985.
1b
2
1,115.
3
400.
3
Enter $400 ($800 if married filing jointly)
4
Enter the smaller of line 2 or line 3 (unless you checked ’Yes’ on line 1a)
5
Enter the amount from Form 1040, line 38*, or Form 1040A, line 22
5
17,985.
6
Enter $75,000 ($150,000 if married filing jointly)
6
75,000.
7
Is the amount on line 5 more than the amount on line 6?
X No. Skip line 8. Enter the amount from line 4 on line 9 below.
Yes. Subtract line 6 from line 5
7
4
400.
8
Multiply line 7 by 2% (.02)
8
9
Subtract line 8 from line 4. If zero or less, enter -0-
9
400.
10
0.
11
400.
10
Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2010? You may have
received this payment in 2010 if you did not receive an economic recovery payment in 2009 but you received
social security benefits, supplemental security income, railroad retirement benefits, or veterans disability
compensation or pension benefits in November 2008, December 2008, or January 2009 (see instructions).
X
No. Enter -0- on line 10 and go to line 11.
Yes. Enter the total of the payments you (and your spouse, if filing jointly) received in 2010.
Do not enter more than $250 ($500 if married filing jointly)
11
Making work pay credit. Subtract line 10 from line 9. If zero or less, enter -0-. Enter the result here and on
Form 1040, line 63; or Form 1040A, line 40
*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
Schedule M (Form 1040A or 1040) 2010
FDIA8501
09/20/10
SCHEDULE SE
OMB No. 1545-0074
Self-Employment Tax
(Form 1040)
Department of the Treasury
Internal Revenue Service
2010
(99) G Attach to Form 1040 or Form 1040NR. G See Instructions for Schedule SE (Form 1040).
Name of person with self-employment income (as shown on Form 1040)
Social security number of person
with self-employment income G
Martha S Wade
Attachment
Sequence No.
17
871-41-1234
Before you begin: To determine if you must file Schedule SE, see the instructions.
May I Use Short Schedule SE or Must I Use Long Schedule SE?
Note. Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE, in the instructions.
Did you receive wages or tips in 2010?
No
I
Are you a minister, member of a religious order, or
Yes
I
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?
I
Yes
Was the total of your wages and tips subject to social
security or railroad retirement (tier 1) tax plus your net
earnings from self-employment more than $106,800?
G
No
I
Are you using one of the optional methods to figure your
net earnings (see instructions)?
G
No
I
Yes
Did you receive tips subject to social security or Medicare
tax that you did not report to your employer?
G
No
Yes
G
No
I
Did you receive church employee income (see instructions) reported on Form W-2 of $108.28 or more?
Yes
I
Yes
No Did you report any wages on Form 8919, Uncollected
Social Security and Medicare Tax on Wages?
G H
Yes
G
No
I
You may use Short Schedule SE below
G
You must use Long Schedule SE on page 2
I
Section A ' Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE.
1 a Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1065),
box 14, code A
1a
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 6b, or listed on Schedule K-1 (Form 1065), box 20,
code Y
2
3
4
1b
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, code J1. Ministers and members
of religious orders, see instrs for types of income to report on this line. See instrs for other income
to report
2
19,352.
Combine lines 1a, 1b, and 2. Subtract from that total the amount on Form 1040, line 29, or Form 1040NR,
line 29, and enter the result (see instructions)
3
19,352.
Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do not file this
schedule unless you have an amount on line 1b
4
17,872.
5
2,734.
Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions.
5
Self-employment tax. If the amount on line 4 is:
? $106,800 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 56,
or Form 1040NR, line 54.
? More than $106,800, multiply line 4 by 2.9% (.029). Then, add $13,243.20 to the result. Enter the
total here and on Form 1040, line 56, or Form 1040NR, line 54.
Deduction for one-half of self-employment tax. Multiply line 5 by 50% (.50).
Enter the result here and on Form 1040, line 27 or Form 1040NR, line 27
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
6
FDIA1101
12/29/10
6
1,367.
Schedule SE (Form 1040) 2010
Form
8812
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0074
Additional Child Tax Credit
(99)
2010
Complete and attach to Form 1040, Form 1040A, or Form 1040NR.
Name(s) shown on return
47
Your social security number
Martha S Wade
Part I
All Filers
1
Attachment
Sequence No.
871-41-1234
Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040, line 51).
1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040A, line 33).
1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040NR, line 48).
1040 filers:
1
1,000.
2
3
229.
771.
6
2,248.
If you used Pub 972, enter the amount from line 8 of the worksheet on page 4 of the publication.
2
3
Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 48
Subtract line 2 from line 1. If zero, stop; you cannot take this credit
4 a Earned income (see instructions)
b Nontaxable combat pay (see instructions)
5
6
4a
17,985.
4b
Is the amount on line 4a more than $3,000?
No. Leave line 5 blank and enter -0- on line 6.
X Yes. Subtract $3,000 from the amount on line 4a. Enter the result
14,985.
5
Multiply the amount on line 5 by 15% (.15) and enter the result
Next. Do you have three or more qualifying children?
X 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. 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.
Part II
Certain Filers Who Have Three or More Qualifying Children
7
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
8
1040 filers:
9
10
Enter the total of the amounts from Form 1040,
lines 27 and 57, plus any taxes that you identified using
code ’UT’ and entered on the dotted line next to line 60.
1040A filers: Enter -0-.
1040NR filers: Enter the total of the amounts from Form 1040NR, lines 27
and 55, plus any taxes that you identified using code ’UT’
and entered on the dotted line next to line 59.
Add lines 7 and 8
Enter the total of the amounts from Form 1040, lines
64a and 69.
1040A filers: 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 44
(see instructions).
1040NR filers: Enter the amount from Form 1040NR, line 64.
7
8
9
1040 filers:
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
12
Next, enter the smaller of line 3 or line 12 on line 13.
Part III
13
Additional Child Tax Credit
This is your additional child tax credit
13
771.
Enter this amount on
Form 1040, line 65,
Form 1040A, line 42, or
Form 1040NR, line 62.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA3001
07/08/10
Form 8812 (2010)
Martha S Wade
871-41-1234
SMART WORKSHEET FOR: Form 1040: Individual Tax Return
Tax Smart Worksheet
A
1
2
3
4
5
6
7
B
C
D
E
F
G
Tax
Check if from:
Tax table
Tax Computation Worksheet (see instructions)
Schedule D Tax Worksheet
Qualified Dividends and Capital Gain Tax Worksheet
Schedule J
Form 8615
Foreign Earned Income Tax Worksheet
Additional tax from Form 8814
Additional tax from Form 4972
Tax from additional Form(s) 4972
Recapture tax from Form 8863
IRC Section 197(f)(9)(B)(ii) election for an additional tax
Tax. Add lines A through F. Enter the result here and on line 44
SMART WORKSHEET FOR: Schedule C (Attorney): Profit or Loss from Business
Address Information Smart Worksheet
If you do not use your home address as your business address, complete the following:
Business street address 158 Central Ave
City, State and Zip Code (do not enter State and Zip Code if foreign address)
Riverbank
Or, foreign country information:
KEEP FOR YOUR RECORDS
CA
95367
229.
X
229.
Martha S Wade
871-41-1234
SMART WORKSHEET FOR: Schedule C (Attorney): Profit or Loss from Business
Domestic Production Activities Smart Worksheet
? Amounts have been gathered from the Schedule C as a starting point for the Domestic
Production Activities deduction calculation. Make adjustments as necessary, taking care not to
duplicate amounts on lines B, C and D. Be sure the amount on line E is also included on
line(s) B, C and D, as appropriate.
? If you qualify for the deduction, complete the Domestic Production column and the Oil-Related
Production column (if applicable). For the small business simplified overall method, enter
gross receipts. For the simplified deduction method, enter gross receipts and cost of goods sold.
For the Section 861 method, enter all amounts.
Total
A
B
C
D
E
Gross receipts
Cost of goods sold
Directly allocable deductions,
expenses, or losses
Indirectly allocable deductions,
expenses, or losses
W-2 wages (adjust for wages
from COGS, if necessary)
Domestic
Production
Oil-Related
Production
24,395.
5,043.
QuickZoom to Form 8903, Domestic Production Activities Deduction
SMART WORKSHEET FOR: Schedule C (Attorney): Profit or Loss from Business
Activity Summary Smart Worksheet
Supporting information provided by program. NO ENTRIES ARE NEEDED.
Regular Tax
A
B
C
D
E
F
G
H
I
J
K
L
M
N
Ownership
At risk status
Passive status
Schedule C
Tentative profit (loss)
Other preferences and adjustments
At risk disallowed loss
Passive carryover loss
Passive disallowed loss
Net profit (loss) allowed
Related Dispositions
Tentative profit (loss)
At risk disallowed loss
Passive carryover loss
Passive disallowed loss
Net profit (loss) allowed
KEEP FOR YOUR RECORDS
Alternative
Minimum Tax
Taxpayer
All
Nonpassive
19,352.
19,352.
19,352.
19,352.
Martha S Wade
871-41-1234
SMART WORKSHEET FOR: Earned Income Credit Worksheet
Nontaxable Combat Pay Election Smart Worksheet
QuickZoom to enter nontaxable combat pay on Form W-2
A Taxpayer:
1 Taxpayer, nontaxable combat pay
2 Election for earned income credit (EIC):
Elect taxpayer’s nontaxable combat pay as earned income for EIC?
3 Election for dependent care benefits (DCB):
Elect taxpayer’s nontaxable combat pay as earned income for DCB?
4 Election for child and dependent care credit:
Elect taxpayer’s nontaxable combat pay as earned income
for child and dependent care credit?
B Spouse:
1 Spouse, nontaxable combat pay
2 Election for earned income credit (EIC):
Elect spouse’s nontaxable combat pay as earned income for EIC?
3 Election for dependent care benefits (DCB):
Elect spouse’s nontaxable combat pay as earned income for DCB?
4 Election for child and dependent care credit:
Elect spouse’s nontaxable combat pay as earned income
for child and dependent care credit?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
C You may compare the tax benefit of electing or not electing by checking a box on line A or
line B and reviewing the overpayment or amount due below:
Overpayment
1,243.
Amount due
SMART WORKSHEET FOR: Earned Income Credit Worksheet
Investment Income Smart Worksheet
A
B
C
D
E
1
2
3
4
5
6
F
G
H
Taxable and tax exempt interest
Dividend income
Capital gain net income
Royalty and rental of personal property net income
Passive activity net income:
Rental real estate net income or loss
Farm rental net income or loss
Partnerships and S corporations net income or loss
Estates and trusts net income or loss
Total of lines 1 through 4
Total passive activity net income, line 5 if greater than zero
Interest and dividends from Forms 8814
Adjustments
Total investment income, add lines A through G
Is line H, total investment income over $3,100?
X No. You may take the credit.
Yes. Stop. You cannot take the credit.
KEEP FOR YOUR RECORDS
0.
Martha S Wade
871-41-1234
SMART WORKSHEET FOR: Schedule M: Making Work Pay
Schedule M, Line 10 Smart Worksheet
A
Economic recovery payment received in 2010?
KEEP FOR YOUR RECORDS
TAXPAYER
Yes X No
SPOUSE
Yes
No
For Privacy Notice, get form FTB 1131.
California Resident
Income Tax Return
CAIA3912
12/27/10
FORM
2010
540 C1 Side 1
APE
ATTACH FEDERAL RETURN
P
871-41-1234
MARTHA
WADE **
S WADE
10
PBA
541990
AC
A
R
RP
158 CENTRAL AVE
RIVERBANK
01
06
09
10
12
14
16
17
18
31
34
41
42
43
44
45
46
61
62
63
64
71
4
0
0
1
0
0
0
17985
7400
133
0
0
0
0
0
0
0
0
0
0
0
0
CA
95367
72
73
74
75
76
77
78
91
92
93
94
95
400
401
402
403
404
405
406
407
02-26-1975
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
408
410
413
415
416
417
418
110
111
112
113
115
116
117
0
0
0
0
0
0
0
0
0
0
0
0
0
0
APE
FS
3800
3803
SCHG1
5870A
5805 5805F
DESIGNEE
TPID
FN
0
0
0
0
0
0
0
0
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct, and complete.
Spouse’s/RDP’s signature
Your signature
(if a joint return, both must sign)
Sign
Here
Daytime phone number (optional)
It is unlawful
to forge a
spouse’s/
RDP’s
signature.
SELF PREPARED
Joint return?
(See
instructions.)
(209) 555-1401
Date
Your email address (optional). Enter only one.
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
Firm’s name (or yours, if self-employed)
Firm’s address
@Paid Preparer’s PTIN/SSN
@FEIN
Do you want to allow another person to discuss this return with us (see instructions)?
@
Print Third Party Designee’s Name
Telephone Number
051
3101106
Yes
X
No
Your Name:
MARTHA S WADE
Filing Status
3
4
Your SSN or ITIN:
871-41-1234
Single
Married/RDP filing jointly. (see instructions)
1
2
Married/RDP filing separately. Enter spouse’s/RDP’s SSN or ITIN above and full name here
X
Head of household (with qualifying person). (see instructions)
Qualifying widow(er) with dependent child. Enter year spouse/RDP died
5
If your California filing status is different from your federal filing status, check the box here
6 If someone can claim you (or your spouse/RDP) as a dependent, check the box here (see instructions)
Exemptions
7
Personal: If you checked 1, 3, or 4 above, enter 1 in the box. If you checked 2 or 5, enter 2 in the box.
If you checked the box on line 6, see the instructions
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1; if both are visually impaired, enter 2
9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1; if both are 65 or older, enter 2
@
10 Dependents: Enter name and relationship. Do not include yourself or your spouse/RDP.
MYRNA P WADE - DAUGHTER
11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32
Taxable Income 12 State wages from your Form(s) W-2, box 16
@
13
15
@ 16
@ 17
@ 18
19
> 31
>
@
@
77 Enter the amount from form FTB 3506, Part III, line 8
@ 77
78 Child and Dependent Care Expenses Credit from form FTB 3506, Part III, line 12
79 Add line 71, line 72, line 73, line 74, and line 78. These are your total payments
(see instructions)
Overpaid tax. If line 79 is more than line 64, subtract line 64 from line 79
Amount of line 91 you want applied to your 2011 estimated tax
Overpaid tax available this year. Subtract line 92 from line 91
Tax due. If line 79 is less than line 64, subtract line 79 from line 64
Side 2 Form 540 C1 2010
051
3102106
32
33
34
35
17,985.
17,985.
7,400.
10,585.
133.
198.
0.
0.
@ 45
@ 46
74 Excess SDI (or VPDI) withheld (see instructions)
Child and Dependent Care Expenses Credit (see instructions). Attach form FTB 3506.
75 Qualifying person’s social security number
@ 75
76 Qualifying person’s social security number
@ 76
95 Use Tax. This is not a total line (see instructions)
17,985.
@ 42
Add line 48, line 61, line 62, and line 63. This is your total tax
California income tax withheld (see instructions)
2010 CA estimated tax and other payments (see instructions)
Real estate and other withholding (see instructions)
Use Tax
99.
198.
G 43
G 44
Alternative minimum tax. Attach Schedule P (540)
Mental Health Services Tax (see instructions)
Overpaid Tax/
Tax Due
$
$
@ 14
Subtract line 47 from line 35. If less than zero, enter -0-
91
92
93
94
x $99 =
99.
41
(see instructions)
Payments
1
$
$
$
@ 12
63 Other taxes and credit recapture
64
71
72
73
x $99 =
x $99 =
x $99 =
9
11
Subtract line 14 from line 13. If less than zero, enter the result in parentheses (see instructions)
California adjustments ' additions. Enter the amount from Schedule CA (540), line 37, column C
California adjusted gross income. Combine line 15 and line 16
Enter the larger of your CA standard deduction OR your CA itemized deductions
Subtract line 18 from line 17. This is your taxable income. If less than zero, enter -0Tax. Check box if from: X Tax Table
Tax Rate Schedule
FTB 3800
FTB 3803
Exemption credits. Enter the amount from line 11. If your federal AGI is more than $162,186 (see instrs)
Subtract line 32 from line 31. If less than zero, enter -0Tax. (see instructions) Check box if from:
Schedule G-1
Form FTB 5870A
Add line 33 and line 34
New jobs credit, amount generated (see instructions)
New jobs credit, amount claimed (see instructions)
Credit
Code
amount
Credit
Code
amount
To claim more than two credits (see instructions)
Nonrefundable renter’s credit (see instructions)
Add line 42 through line 46. These are your total credits
6
Whole dollars only
1
7
8
Total dependent
exemptions
@ 10
13 Enter federal adjusted gross income from Form 1040, line 37; Form 1040A, line 21; Form 1040EZ, line 4
14 California adjustments ' subtractions. Enter the amount from Schedule CA (540), line 37, column B
15
16
17
18
19
Tax
31
32
33
34
35
Special Credits 41
42
43
44
45
46
47
48
Other Taxes
61
62
@
@
@
47
48
61
62
@
@
@
@
@
@
63
64
71
72
73
@
78
0.
0.
0.
74
79
@
@
91
92
93
94
95
CAIA3912
12/27/10
Your Name:
MARTHA S WADE
Contributions
Your SSN or ITIN:
871-41-1234
Code
400
401
@
@
@
@
@
@
@
@
@
@
@
@
@
@
@
California Seniors Special Fund (see instructions)
Alzheimer’s Disease/Related Disorders Fund
California Fund for Senior Citizens
Rare and Endangered Species Preservation Program
State Children’s Trust Fund for the Prevention of Child Abuse
California Breast Cancer Research Fund
California Firefighters’ Memorial Fund
Emergency Food For Families Fund
California Peace Officer Memorial Foundation Fund
California Sea Otter Fund
California Cancer Research Fund
Arts Council Fund
California Police Activities League (CALPAL) Fund
California Veterans Homes Fund
Safely Surrendered Baby Fund
110
Amount
You Owe
111
Interest and
Penalties
112
113
114
Refund and
Direct Deposit
115
402
403
404
405
406
407
408
410
413
415
416
417
418
Add code 400 through code 418. This is your total contribution
@
110
AMOUNT YOU OWE. Add line 94, line 95, and line 110 (see instructions). Mail to:
FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0009
Pay online ' Go to ftb.ca.gov and search for web pay
Interest, late return penalties, and late payment penalties
@
111
112
113
114
Underpayment of estimated tax. Check box:
FTB 5805 attached
FTB 5805F attached
@
Total amount due (see instructions). Enclose, but do not staple, any payment
REFUND OR NO AMOUNT DUE. Subtract line 95 and line 110 from line 93 (see instructions). Mail to:
FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0009
@
Amount
115
0.
Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip (see instructions).
Have you verified the routing and account numbers? Use whole dollars only.
All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:
Checking
Savings
@ Routing number
@ Type
@ Account number
@ 116 Direct deposit amount
The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:
Checking
Savings
@ Routing number
@ Type
@ Account number
@ 117 Direct deposit amount
CAIA3912
12/27/10
051
3103106
Form 540 C1 2010 Side 3
TAXABLE YEAR
2010
SCHEDULE
California Adjustments ' Residents
CA (540)
Important: Attach this schedule behind Form 540, Side 3 as a supporting California schedule.
Name(s) as shown on return
SSN or ITIN
MARTHA S WADE
Part I Income Adjustment Schedule
A
Section A ' Income
7
8
Wages, salaries, tips, etc. See instructions before making an
entry in column B or C
Taxable interest (b)
Ordinary dividends. See instructions
11
12
Alimony received
Business income or (loss)
11
12
13
14
Capital gain or (loss). See instructions
Other gains or (losses)
13
14
15
16
IRA distributions. See instructions
18
19
20
21
Farm income or (loss)
Unemployment compensation
Social security benefits
Other income.
(b)
B
Subtractions
See instructions
C
Additions
See instructions
9a
10
Taxable refunds, credits, offsets of state and local income taxes
(a)
19,352.
15 b
16 b
Pensions and annuities. See instructions
(a)
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc
22
(taxable amounts from
your federal return)
871-41-1234
7
8a
9
10
a California lottery winnings
b Disaster loss carryover from FTB 3805V
c Federal NOL (Form 1040, line 21)
d NOL carryover from FTB 3805V
Federal Amounts
17
18
19
20 b
(a)
a
b
c
d
e
f
e NOL from FTB 3805D, 3805Z,
3806, 3807, or 3809
21
f Other (describe):
Total. Combine line 7 through line 21 in column A. Add line 7
through line 21f in column B and column C. Go to Section B
22
Section B ' Adjustments to Income
23 Educator expenses. CAUTION: See instructions
a
b
c
d
e
f
19,352.
23
Certain business expenses of reservists, performing artists,
and fee-basis government officials
25 Health savings account deduction
26 Moving expenses
27 One-half of self-employment tax
28 Self-employed SEP, SIMPLE, and qualified plans
29 Self-employed health insurance deduction
30 Penalty on early withdrawal of savings
31 a Alimony paid.
24
24
25
26
27
28
29
30
1,367.
b Recipient’s:
SSN
32
33
34
35
36
37
Last name
IRA deduction
Student loan interest deduction
Tuition and fees. CAUTION: See instructions
Domestic production activities deduction
31 a
32
33
34
35
Add line 23 through line 31a and line 32 through line 35 in columns A, B, and C.
See instrs
36
1,367.
Total. Subtract line 36 from line 22 in columns A, B, and C.
See instructions
37
17,985.
For Privacy Notice, get form FTB 1131.
051
7731104
CAIA4012
12/16/10
Schedule CA (540) 2010 Side 1
MARTHA S WADE
Part II Adjustments to Federal Itemized Deductions
871-41-1234
Federal itemized deductions. Add the amounts on federal Schedule A (Form 1040), lines 4, 9, 15, 19, 20,
27, and 28
38
8,240.
Enter total of federal Schedule A (Form 1040), line 5 (State Disability Insurance, and state and local
income tax), line 7 (new motor vehicle tax), and line 8 (foreign income taxes only). See instructions
39
840.
40
Subtract line 39 from line 38
40
7,400.
41
Other adjustments including California lottery losses. See instructions.
Specify
41
42
Combine line 40 and line 41
42
7,400.
43
Is your federal AGI (Form 540, line 13) more than the amount shown below for your filing status?
Single or married/RDP filing separately
$162,186
No. Transfer the amount on line 42 to line 43.
Yes. Complete the Itemized Deductions Worksheet in the instructions for Schedule CA (540), line 43
43
7,400.
Enter the larger of the amount on line 43 or your standard deduction listed below
Single or married/RDP filing separately
$3,670
Married/RDP filing jointly, head of household, or qualifying widow(er)
$7,340
Transfer the amount on line 44 to Form 540, line 18
44
7,400.
38
39
Head of household
Married/RDP filing jointly or qualifying widow(er)
44
Side 2 Schedule CA (540) 2010
051
$243,283
$324,376
7732104
CAIA4012
12/16/10