040
,
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I
(99)
1
DepartmentoftheTreasury-,alRevenueService
U.S.IndividualIncomeTaxReturn
IRSUseOnly-Donotwriteorstapleinthisspace.PFortheyearJan.1-Dec.31,2010,orothertaxyearbeginning,2010,ending
10MB
No.1545-0074
Name,
R
YourfirstnameandinitialLastnameYoursocialsecuritynumber
I
ddress,
N
MARK
B
DAYTON
nd
SSN
T
Ifajointreturn,spouse'sfirstnameandinitial
LastnameSpouse'ssocialsecuritynumber
C
Seeseparate
L
Homeaddress(numberandstreet).Ifyouhavea
P.O.
box,seeinstructions.Apt.no.
E
instructions.AMakesuretheSSN(s)above
R
1800IDSCENTER
......andonline6carecorrect.
L
City,townorpostoffice,state,andZIPcode.Ifyouhaveaforeignaddress,seeinstructions.YCheckingaboxbelowwillnotPresidential
MINNEAPOLISMN55402-4523
changeyourtaxorrefund.
A
a
ElectionCampaign~Checkhereifyou,oryourspouseiffilingjointly,want$3togotothisfund.•••••.•~Spouse
FilingStatus
1X
Single4Headofhousehold(withqualifyingperson).(Seeinstructions.)IfCheckonlyonebox.
2
3
Marriedfilingjointly(evenifonlyonehadincome),Marriedfilingseparately.Enterspouse'sSSNaboveandfullnamehere.~
5
thequalifyingpersonisachildbutnotyourdependent,enterthischild'snamehere.~Qualifyingwidow(er)withdependentchild
_1_
}Boxeschecked
Exemptions
6aYourself.Ifsomeonecanclaimyouasadependent,donotcheckbox6a••...•••••on6aand6bNo.ofchildren
b
Souse•.•••••..•••..•.•.•••..•••••••.•.•on6cwho:cDependents:
(2)
Dependent's
(3)
Dependent's(4)
J
ifchildunderage17•
livedwithyou
socialsecuritynumberrelationshipto
qualifyingforchildtaxcredit•
did
not
live
with
~(~1L)~F~i~~t~n~a~m~e~~L~a~st~n~a~m~e
-+
yLo~u~
-+
~(s~ee~p~ag~e-'5~1----
youduetodivorceorseparation(seeinstructions)Dependentson6cnotenteredabove
If
more
thanfour
dependents,see
instructionsand
check.....
0
here~
dTotalnumberofclaimed..•••.
Income
AttachForm(s)
W-2
here.AlsoattachForms
W-2G
and
1099-R
if
tax
waswithheld.Ifyoudidnotget
a
W-2,seepage20.Enclose,butdonotattach,anypayment.Also,pleaseuseForm
1040-V.
Adjusted
GrossIncome
7Wages,salaries,tips,etc.AttachForm(s)W-2•8aTaxableinterest.AttachScheduleBifrequired•
b
Tax-exemptinterest.Donotincludeonline8a•9aOrdinarydividends.AttachSchedule
8
ifrequired.bQualifieddividends101112131415
a
16
a
17Taxablerefunds,credits,oroffsetsofstateandlocalincometaxesAlimonyreceived..•.••.'..•••..•.....•.•.Businessincomeor(loss).AttachScheduleCorC-EZ••.•..•Capitalgainor(loss).AttachScheduleDifrequired.Ifnotrequired,checkhere~•
D'
Othergainsor(losses).AttachForm4797••..••••••••..•.•.••IRAdistributions
1
15a
II
bTaxableamount.•Pensionsandan~u;ti~S::::16a.
b
Taxableamount.•Rentalrealestate,royalties,partnerships,Scorporations,trusts,etc.AttachScheduleE
f---'c.:_+-------
-.::.':":O:..=..:c=_
18Farmincomeor(loss).AttachScheduleF•19Unemploymentcompensation••••2
°
aSocialsecuritybenefits••.•LI2=.0.::.c::a..JI
___Jj~
~a~a~l~~~o~n;Certainbusinessexpensesofreservists,performingartists,andfee-basisgovernmentofficials.AttachForm2106or2106-EZ25Healthsavingsaccountdeduction.AttachForm8889.26Movingexpenses.AttachForm3903••.•.•..27One-halfofself-employmenttax.AttachScheduleSE28Self-employedSEP,SIMPLE,andqualifiedplans.29Self-employedhealthinsurancededuction.30Penaltyonearlywithdrawalofsavings31aAlimonypaidbRecipient'sSSN~_32IRAdeduction•••.••.••.•33Studentloaninterestdeduction..•34Tuitionandfees.AttachForm8917.35Domesticproductionactivitiesdeduction.AttachForm890336Addlines23through31aand32through35..••••..••37Subtractline36fromline22.Thisisincome
fs<f
Disclosure,PrivacyAct,andPaperworkReductionActNotice,seeseparateinstructions.
RS
OA12105.000
Form1040(2010)
MARKBDAYTON
Taxand
38Amountfromline37(adjustedgrossincome).•••••.•••••••.•••••••
Credits
39aCheck
{EJ
YouwerebornbeforeJanuary2,1946,
EJ
Blind.}Totalboxesif:SpousewasbornbeforeJanuary2,1946,Blind.checked~bIfyourspouseitemizesonaseparatereturnoryouwereadual-statusalien,checkhere~40Itemizeddeductions(fromScheduleA)oryourstandarddeduction(seeinstructions)••••.41Subtractline40fromline38••••.•••••••••••••.••.•••.••42Exemptions.Multiply$3,650bythenumberonline6d•••••••.•..•••••Taxableincome.Subtractline42fromline41.Ifline42ismorethanline41,enter-0-Tax
(seeinstructions).Check
if
anytaxisfrom:
a
0
orm(s)8814
b
0
orm4972
Alternativeminimumtax(seeinstructions).AttachForm6251•Addlines44and45•.•••••••••••••••••••Foreigntaxcredit.AttachForm1116ifrequired••.•••••Creditforchildanddependentcareexpenses.AttachForm2441EducationcreditsfromForm8863,line23••••••••.Retirementsavingscontributionscredit.AttachForm8880•Childtaxcredit(seeinstructions)••••••.••Residentialenergycredits.AttachForm5695••.•.•••
OthercreditsfromFonn
aD3800bD8801cDAddlines47through53.Theseareyourtotalcredits54fromline46.than
Payments
61FederalincometaxwithheldfromFormsW-2and1099.622010estimatedtaxpaymentsandamountappliedfrom2009return63Makingworkpaycredit.AttachScheduleM•43444546474849505152535455
Other
56
Taxes
575859
If
youhaveaqualifyingchild,attachScheduleEIC.
Refund
Directdeposit?~Seeinstructions.
Self-employmenttax.AttachScheduleSE.•••••...•..••....••..••UnreportedsocialsecurityandMedicaretaxfromForm:aD4137b08919.•AdditionaltaxonIRAs,otherqualifiedretirementplans,etc.AttachForm5329ifrequired.aDForm(s)W-2,box9b
[Xl
Schedule
H
cDForm5405,line16•••64aEarnedincomecredit(EIG)••••••bNontaxablecombatpayelection••..
L
6_4_b--t
---l
65Additionalchildtaxcredit.AttachForm8812•66AmericanopportunitycreditfromForm8863,line14.67First-timehomebuyercreditfromForm5405,line10•68Amountpaidwithrequestforextensiontofile.•.69Excesssocialsecurityandtier1RRTAtaxwithheld•.70Creditforfederaltaxonfuels.AttachForm4136.••...••.••CreditsfromForm:
a
D
2439b
D
8839C
D
8801
dO
8885
6571.totalAmountoflineAmountyouowe.Subtractline72fromline60.FordetailsonhowtoEstimatedtaxpenalty(seeinstructions)•.•.••••.••.••.•
Amount
76
YouOwe
77
DoyouwanttoallowanotherpersontodiscussthisreturnwiththeIRS(seeinstructions)?
n
Here
Jointreturn?Seepage12.
iii...
Keepacopy~for
PaidPreparerUseOnly
Date
JSA
OA12205.000
Form
1040
(2010)
OMBNo.1545-0074
SCHEDULEA
(Form
1040)
ItemizedDeductions
~@10
DepartmentoftheInternalRevenue~AttachtoForm1040.~SeeInstructionsforScheduleA(Form1040).Attachment
No.07
Name(s)shownonForm
1040
N
YoursocialsecuritynumberCaution.Donotincludeexpensesreimbursedorpaidbyothers.Medicalanddentalexpenses(seeinstructions)EnteramountfromFonn1040,line38••••••
'--'=---L__
Multiplyline
2
by
7.5%(.075)•••.•.•....•.•
Subtractline
3
fromline
1.
Ifline
3
ismorethanline
1,
enter
Medical
1
and
2
DentalExpenses
3
4
5
TaxesYouPaid
6
7
8
9
Interest
10
YouPaid
11
Stateandlocal(checkonlyonebox):amlncometaxes,or}............b
D
GeneralsalestaxesRealestatetaxes(seeinstructions)•....••••••Newmotorvehicletaxesfromline11oftheworksheetonback(forcertainvehiclespurchasedin2009).Skipthislineifyoucheckedbox5b•••.•••••••••••••••Othertaxes.Listtypeandamount~
ST.Ml'__3_
5
6
Addlines
5
8..........•.......
HomemortgageinterestandpointsreportedtoyouonForm1098HomemortgageinterestnotreportedtoyouonForm1098.Ifpaidtothepersonfromwhomyouboughtthehome,seeinstructionsandshowthatperson'sname,identifying
no.,
andaddress~Note.Yourmortgageinterestdeductionmaybelimited(see
13
instructions).
12
PointsnotreportedtoyouonForm
1098.
Seeinstructionsforspecialrules•.••..•.••••••.••.•.•Mortgageinsurancepremiums(seeinstructions)••••••Investmentinterest.AttachForm4952ifrequired.(Seeinstructions.)'-'--'--''--~
4
15
GiftstoCharity
16
Giftsbycashorcheck.Ifyoumadeanygiftof
$250
ormore,seeinstructions...::;
BB..::;TATBMBNT.3.
f-'-=-+
__cSe...L.=l"'Sc_;O"-.=___
17
Otherthanbycashorcheck.Ifanygiftof
$250
ormore,seeinstructions.YoumustattachForm
8283
ifover
$500.
Ifyoumadeagiftandgotabenefitforit,seeinstructions.Carryoverfromprioryear.Addlines
1618
18
19
CasualtyandTheftLosses
20
AttachForm
4684.
JobExpenses
21
UnreimbursedemployeeandCertaineducation,etc.AttachForm
2106
or2106-EZifrequired.(SeeMiscellaneousDeductionsinstructions.)~_Taxpreparationfees•••••.•••••.•..•.••
2
23Otherexpenses-investment,safedepositbox,etc.Listtypeandamount~
s_t;E:_i3_'l'..8.TE_l'1E;_tJT_3_
Addlines
21
through
23
EnteramountfromFonn.•1040,line38••••••'-2"'--'-5-'-
-"-..:....="--'--'-=-"-"_~"y.'''.'.1
Multiplyline
25
by
2%(.02)
24
252627
Other
28
MiscellaneousDeductions
Total
29
ItemizedDeductions
30
Subtractline
26
fromline
24.
Ifline
26
ismorethanline
24,
Other-fromlistininstructions.Listtypeandamount~_Addtheamountsinthefarrightcolumnforlines4through
28.
Also,enterthisonForm
1040,
line
40.••••.••..•.....•..•......•.
Ifyouelecttoitemizedeductionseventhoughtheyarelessthanyourstandarddeduction,checkhere•.••••••••.•ForPaperworkReductionActNotice,seeForm
1040
instructions.ScheduleA(Form
1040)2010
JSA
OA14002.000
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