Form D-40 EZ Individual Income Tax Forms and Instructions for Single and Joint Filers with No Dependents and All Other Filers

Interest and Ordinary Divi dends from (Use this calculation to determine which is better for you to claim) Line 15 *120400210002* 1040EZ 2012 D 40EZ a Tax from D 40EZ Line 6 a assets of more than $10 DC Low Income Credit or DC Earned Income Tax Credit b Low income credit b c Enter the lesser of Line a or Line b c Calculation LIC/EITC Take only one of these credits tract Line 17 (results) from children as defined on page 8 of the General Instructions claimed on 1040 1040A Compare Line c to Line f D 40EZ Income Tax Return l d Federal Earned Income Credit d Direct Deposit Refer to page 8 of General Instructions District of Columbia e DC Earned Income Tax Credit rate e x 40 employer s name; you did not have a personal finan cial interest in the account; and the corporation s chief financial officer has given you written notice that the corporation has filed a cur rent report that includes the account eral Instructions f DC Earned Income Tax Credit Multiply f Filing status for Single and Joint Filers Foreign accounts If you own more than 50% of the stock in any corpora tion that owns one or more foreign bank accounts; or if any time during 2012 you had an interest in or signature or other authority over a financial account in a foreign country (such as a bank account securities account or other financial account) unless: General Instructions Government of the http://www irs gov If Line c amount is greater than or equal to Line f enter it on D 40EZ Line 7 If Line f amount is greater than line c enter it on D 40EZ Line 13 If you are reducing your interest income on a bond by the amount of the amortized bond premium; If you are reporting original issue discount (OID) in an amount less than the amount shown on the IRS Form 1099 OID; If you had a foreign account or you received a distribution from or were a grantor of or transferor to a foreign trust If you have accrued interest from a bond; If you have any interest received from a seller financed mortgage and the buyer used the property as a personal residence; If you received interest or ordinary dividends as a nominee; or Include contributions Answer the IAT question; refer to page 8 of the Gen Income Tax Return Instructions Instructions for the D 40EZ Instructions regarding standard deduction and personal exemptions is an amended return Refer to page 8 of General Instructions Line 1 Total wages salaries tips unemployment compensation etc Enter amount from 1040 1040A 1040EZ 1040NR or 1040NR EZ Line 10 Refer to Payment options on page 4 of the General Instructions Line 10 Tax and/or contributions Add Lines 8 9a 9b 9c and 9d (if ap Line 11 Total DC income tax withheld Refer to instructions on page 6 of Line 12 Tax paid with extension of time to file or with original return if this Line 13 DC Earned Income Tax Credit Refer to page 7 of General Instructions Line 13a Number of Qualified EITC Children Enter the number of qualified Line 14 Total tax payments and credits Add lines 11 13 Line 15 Refund If Line 14 is the larger subtract Line 10 from Line 14 Line 16 Amount Owed If Line 10 is the larger subtract Line 14 from Line 17 Penalty and interest Enter any underestimated penalty and interest Line 19 Total refund Sub Line 2 Taxable interest and ordinary dividends If more than $1 500 file the Form D 40 Line 3 DC Adjusted Gross Income Add Lines 1 and 2 Line 4 Standard deduction plus exemption Refer to page 7 of the General Line 4a RESERVED Line 5 DC taxable income Line 3 minus Line 4 If Line 4 is equal to or more Line 6 Tax Refer to the instructions on page 8 of General Instructions Line 7 DC Low Income Credit Refer to instructions on page 7 of General Line 7a Number of exemptions claimed on federal return Enter the number Line 8 Net Tax Subtract Line 7 from Line 6 If Line 7 is equal to or more Line 9d RESERVED Line d by Line e (round to the nearest dollar) Lines 9a 9b and 9c Refer to instructions on page 8 of General Instructions million and 500 or more of federal exemptions on this form other than your signature with No Dependents l owed in the appropriate boxes Refer to page 4 of the General Instructions Line 18 Total amount due Add lines 16 and 17 Personal information (SSN name address telephone number) plicable) PTIN Refer to page 9 of General Instructions Refer to instructions on page 8 of General Instructions Refer to page 5 of the General Instructions to prepare personal information Refer to page 6 of the General Instructions regarding filing status and fill in the appropriate filing status Report any income shown in Box 1a of the Forms 1099 DIV or substitute statements You may refer to the General Instructions for Schedule B Revised 06/12 shareholders of record; Signature Refer to page 9 of General Instructions STAPLE W 2s AND ANY OTHER WITHHOLDING STATEMENTS HERE STAPLE OTHER DOCUMENTS IN UPPER LEFT IN BACK Taxable interest should be shown on your Forms 1099 INT 1099 OID or substitute statements Include interest from series EE HH and I US sav ings bonds Do not report any tax exempt interest from box 8 or 9 of Form 1099 INT Report on Line 2: than Line 3 make no entry If more than $100 000 file the Form D 40 than Line 6 make no entry the account was in your The accounts were with a US military banking facility operated by a US financial institution; The combined value of the accounts was $10 000 or less during the whole year; Third Party Designee Refer to page 9 of General Instruc tions This is a FILL IN format Please do not handwrite any data You were an officer or employee of a commercial bank that is supervised by the Comptroller of the Federal Reserve System or the Federal Deposit Insurance Corporation; the account was in your employer s name; and you did not have a personal financial interest in the account; You were an officer or employee of a domestic corporation with securi ties listed on a national securities exchange or with