(Seeinstructionsonpage14.)
Use
theIRSlabel.Otherwise,pleaseprintor~e.
I~~~~~~~~~~~~IIIIIIIL~__
residential
L.
ElectionCampaign~Checkhereif
1Single
FilingStatus
2
00
MarriedfilingJointly(ovenifonly
one
hadIncome)3
D
Marriedfilingseparately.Enterspouse'sSSNaboveandlullnamehore.
5
Checkonlyonebox.
Boxescheol<.d
ono.and6b
No.or
children
on
6cwho:•IIvsdwithyou
•didnot
llve
withyoudUI
todivorce
01
separation(seepage16)
Exemptions
68
Yourself.
If
someonecanclaimyouasadependent,donotcheckbox6a..bOOS
ouae
(3)
Dependent'.relationshipto
you
oDependenta:
(1)
First
name
L",,\name
(2)
Dependent'.socialsecuritynumb.,
If
morethanfourdependents,seepage17and
D
Depondent.on
ee
notenteredabove
checkhere
~
,
:
Addnumb...
GJ
.Totalnumberofexemptionsclaimed...........
..
...
..
.
.
....
.........
..
.._
..........
.......
..
:~~
..
~
Income
7Wages,salaries,tips,etc.AttachForm(s)
W-2
..............................................................................
7
276463.
AttachForm(s)
8a
TaxableInterest.AttachSchedule
B
Ifrequired
8a
1
135.
W-2here.AlaobTax-exemptInterest.Donotincludeonline8a
:::::::::::::::::::::::::::::::::.(·sb..
f..······.·.....................
attachForme
9a
Ordinarydividends.AttachSchedule
B
Ifrequired................................
r....................................
a
W-2Gand
b
Qualifieddividends(seepage22).....................................:.............9b1099·R
if
tax10Taxablerefunds,credits,oroffsetsofstaleandlocalincometaxes.........
s.'r.:wr...~.......
S.'f.M'r....~....
10
o.
as
withheld.11Alimonyreceived................................................\,.....,.,"'..............................................:...........
11
If
youdidnot12BusinessIncomaor(loss).AttachScheduleCorC·EZ.....................................................................12geta
W-2,
13Capitalgainor(loss).AttachSchedule
0
Ifrequired.Ifnotrequired,checkhere.....................~
D
13
23.
seepage22.
'14
Othergainsor(losses).AttachForm4797
....................................................................................
1415.IRAdistributions
.
,
...................
1
'5a
I
31
l
995.1
bTaxableamount
.
..
,
..............
15bEnclose,butdo16.PensionsandannuitiesbTaxableamount16b
31826.
notattach,any
............
16a
..................
payment.Also,17.Rentalrealestate,royalties,partnerships,Scorporations,trusts,etc.AttachScheduleE
...................
,
....
17pleaseuse18FarmIncomeor(loss).AttachSChed~leF.........,..........................................................................18Form'040-V.19
UnomploymootcompensationInexce...of2.400purreclpont.
19
seepage27)...........................................................................................................................
208Socialsecuritybenefits
............
I
20a
I
27
l
923.1
b
T~ableamount(seepage27)20b
23
735.
21
OtherIncome.Listtypeandamount(seepage29)
1'·>'::,
2122AddtheamountsInthefarrlnhtcolumnforlines7throuoh21.ThisIsvourtotalIncome....
......
~
22
333182.
23
~~~atgr
~)(penses(seepage29).........,.........................................23
.',."
Adjusted
24
nuenoesexpensesofreservists,perfOffTlngwtlsts.and
r...
-besl.governmont
24
ffiolals.AttachFOffTl
2100012100·EZ...................................................
~j~
Gross
25Healthsavingsaccountdeduction.AttachForm8889
25
Income
......
,
.................
26Movingexpenses.AttachForm3903
...........
"
...............................
26
27One-haltofself-employment
tax.
AttachScheduleSE
........................
27
28
Self-employedSEP,SIMPLE,andqualifiedplans
..............................
28
29
Self-employedhealthInsurancededuction(seepage30).....................
29
30Penaltyonearlywithdrawalofsavings.............................................
30
~.
31.
Alimonypaid
b
Recipient'sSSN~
,
,
31a
I-··r
32IRAdeduction(seepage31).........................................................32
1:;<.'
33StudentloanInterestdeduction(seepage34)
.................................
3334Tuitionandfeesdeduction.AttachForm891734
','_"
..
,
..............................
35
Domesticproductionactivitiesdeduction.AttachForm
6903
...............
35
..
36
Addlines23through
31a
and32through35.................................................................................36
910001
37
Subtractline36fromline22ThisIsvouradlustedorollIncome
~
37
333,182.
0·20'09
...
.
.
,
...........
--
....
...
.
LHA
ForDisclosure,PrivacyAct,andPaperworkReductionActNotice,seepage
97.
Form
1040
(2009)
 
StanQwdDoductlonror-•Poopl.who
oh.ck
OIly
bOKonlin.
eg.,
39b,01
400
or
who
oanbo
claImedaaa
dependent.
•All
Olher.:
Slngl.01
MIIITled
nllng
oop8rl'e.taly,
$5.700
MlllTlod
filing
jointly
01
Qualifying
wldow("'~
$11,-400
Head
or
household,
$8,350
36Amountfromline37(adJustedgrossIncome)
I""""""'
~!!....f--~~..L.:!.'-="....,
398
Check
{[X]
Youwere
born
beforeJanuary
2,
1945,0Blind.}Totalboxes
If:
D
SpousewasbornbeforeJan'uary
2,
1945,
D
lind.ohecked...~
3ba'-;==H
b
Iryour.pou,",nomln.
on.
sepaI.I.,.lurn
Q(
youworo
a
dIIal·.taluu
.lIen,.•·.pogo36IIl1d
ohocll
her.~
8Gb
408
itemizeddeductions(fromScheduleA~oryourstandarddeduotlonIseeleftmargin).
b~1~:I:·~~·.~~~~~~.~t.,~~"J.~~o~or:(~:::~~~.M~~~.~~.~:.~:.~~.~.~.~I.~.I~~~:.~.~.~~;t40b
0
41Subtractline40afromline38.42Exemptions.Ifline38Is$125,100orlessandyoudid
not
providehousing
10
a
MldwasterndisplacedIndividual,multiply$3,650bythenumberonline6d.Otherwise,seepage37;..
48
TaxableIncome.Subtractline42fromline41."line421smoreIhanline41,enter
-0-..44
Tax.Chockif'anytaxIsfrom:
aD
Form(s)8'814
bD
For(l14972.
45
Alternallveminimumtax:AttachForm6251,.............
1-.:!lL..j~~~~
46
Addllnes
44
and
45~
1---2!4---'->!..L....",_,,_~
47Foreigntax
credlt,
AttachForm1116Ifrequired.
46
Creditforchildanddependent
care
expenses.AttachForm2441.49EducationcreditsfromForm8863,lino29.
60
RetirementsavingscontribUtionscredit.AttachForm8880..
51
Childlaxcredit(seepage42).52CreditsfromForm:
a
D
396b
0
839
0
0
695..
63
OthercreditsfromForm;aD3800
b
06801
0
D
L..!!.!!.......l-__,
54
Addlines47through
53.
Theseareyourlotaloredlts
j.-..!!!!..1I---=-=:--~-:::-
TaxesPayments
61
FederalIncometaxwllhhaldfromFormsW-2and1099..
62
2009estlrl}atedlaxpayments
and
amountappliedfrom
2008
return..
63
Makinoworkpayandgovernmenlrotiroecredits.AttachSchedule
M..
64aEarnedIncomeoredlt(EIC)...
b
Nontaxablecombatpayelection
~""-L....
-I
66Addlllonalchildtaxcrodlt.AttachForm8812.66RefundableeducationcreditfromForm8863,line16..67First-timenomebuyercredit.AttachForm5405
I-.l!~-------I
66Amountpaidwithrequestforextensiontofile(seepage72)
J.-!:~I------:-:=-=-I
69Excesssoolalsecurityandtlor1RRTAtaxwithheld(seepage
72lS'X'.M'l'
S.
1-.l!-'4-----=..=.....-=-j
CreditsfromForm:a02439b04136008801d08885
If
you
have
a
quallfyfng
child,
.Itach
Soh.dul.
EIC.
Refund
Self-omploymenttax.AttachScheduleSf
r=;r=;.
57UnreportedsocialsecurityandMedicaretaxfromForm;
8
L.J
4137b
L.J
8919.
68
AdditionaltaxonIRAs,olherqualifiedretirementplans,
etc,
AttachForm5329
If
required.
59
Addiilonaltaxes:
a
D
AEICpayments
b
00
Householdemploymenttaxes.AttachScheduleH..
 
SCHEDULEA(Form1040)
ItemizedDeductions
~AttachtoForm.1040.
~See
InstructionsforScheduleA(Form1040).
MedicalandDental
2
Expenses
3
TaxesYou
5
Paid
(SeepageA·2.)
6
7
8
Caution.
Do
notInclude
exoenses
reimbursed
or
paidbyothers.Medicalanddentalexpenses(SeepageA·1.).EnteramountfromForm1040,line38..Multiplyline2by7.5%(.075)
.._----r-;
IStateandlocal(checkonlyonebox):a
[X]
Incometaxes,or},
s,~as.'};'.A"r.~
l.P.
b
D
GeneralsalestaxesRealestatetaxes(SeepageA·5.).NewmotorvehicletaxesfromIIne,11oftheworksheetonpage2,SkipthislineIfyoucheckedbox5b,..Othertaxes,Usttypeandamount~_HomemortgageInterestandpointsreportedtoyouonForm1096
m;,t---=-:!!...L.=..;==--=-j
HomemortgageinterestnotreportedtoyouonForm1098.Ifpaidtothepersonfromwhomyouboughtthehome,seepageA·7andshowthatperson'sname,Identifyingno.,andaddress
~-------------------------------------
YouPaid
(SeepageA·e.)Note.Personal12interestIsnot13deductible.14
Giftsto
16
Charity
17Ilyoumade
a
gift
andgot
a
18enofitlor
It,
A·B.
CasualtyandTheftLosses
Job
Expenses21lindCertain.MiscellaneousDeductionsPointsnot
reportedto
youonForm1098.QualifiedmortgageInsurancepremiums(SeepageA·7.)..InvestmentInterest.AttachForm4952Ifrequired.(SeepageA·8.)..Giftsbycashorcheck
s.aa
S.T.f\T.2.~.WT.l.l.
r-=t---.o::..L=.!<..-=-j
Otherthanbycashorcheck.Ifanygiftof$250ormore,seepageA·8.YoumustattachForm8283'Ifover$500
1-'-'--t----~"-"--'-1
Carryoverfromprioryear.(Seepage
MO.)
Unrelmbursedemployee
expensea-
lobtravel,uniondues,jobeducation,etc.AttachForm2106or2106·EZIfrequired.(SeepageA·10.)
~-------------------------------------
22
Taxpreparationfees'..
23
Otherexpenses-Investment,safedepOSitbox,etc.Usttypeandamount
~-------------------------------------
24
Addlines21through23"""..""."..
25
EnteramountfromForm1040,line38"".Multiplyline25by2%(.02)."""..
I
OtherMiscellaneousDeductions
28
Other·fromlistonpageA·11•.Usttypeandamollnt
~------------~--------------------------~-------
-------------------------------------------~---
ItemizedDeductions
29IsForm1040,line38,over$166,600(over$83,400Ifmarrtedfilingseparately)?
o
No.YourdeductionIsnotlimited.AddtheamountsInthefarright,column}"
!'
forlines4through28.Also,enterthisamountonForm1040,line40a.
S.T.wr....
l.2~
[X]
Yes.Yourdeductionmaybelimited.SeepageA·11fortheamounttoenter.LHA
91V50111-04-0V
ForPaperwor1<ReductionActNotice,seeForm1040Instructions.ScheduleA(Form1(40)2009
4
L4100412745960547422009.03041BIDEN
JR•.
JOSEPHR547421
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