l
A
B
If
a
JoInt
-anrrn,
spouse'Sfirst
rurne
nnd
initin!
,rmcflalleL.
Ohama
UseIheIRSL
I
abEl.H110
1'--I;.t-.'
Il"llJmberlJlld
~trRI;l[l,
1IYtJuhave
i:I
P.o.b-Olt
SEE
po:::.ge19.
Apt,
no,
QIh€:fI.,....
"S!!:,
E
I~""::.
pl9f.!S:a
prlnt~
CilY.
unvn
or
pO:J~
orfiCB',
stat~.
end
ZIP
coda.
Iryou
heve
afore]!)"
address,
sea
p.age19.
m
typ".\
Chicago,
IL
a06'1ti
Pr!olsidenli111"-Election
Campaign~
(:;~"pale19.1
~i'
Label
h~;
;
ueuons
';1-
~~~C'
1
:J.i
Fiji
ng
Status
C;-ll;:,:.:l
l
OJ,[.1'
:.p~
'bJ;~_
SPOu..S6
1
_1;,
seclalsocurttynumber
BarackH.
Lil::;ll1-"rrre
Obarna
1A
Important!
A
Youmustenter
yourSSN!s)above,
YouSpouse
I2JYes
DNo
[ZJYes
D~jo
Note.
Che~I,lng"Vas"willnat
ch.nge
yourtax
Of
reduceyourrefund.
Dovcu.
oryour
speuse
If
filingajoint
return.
want
n
o
go
to
Ihislund?
Sing!?Marriedfilingjoin!return
leven
ifo~lyon"hadincome)
5
MJJrriedHliny
SH;JtHilLe
reusn,Ent~r
5rOu~(f_:jS:O~Ii;;;
:ip.t::urily
no.atmvsandlullname
here.
I>-
Hea·<Jorhou,ehr>W
(wi!>"
'lualilyingper~on).ISeepnge19.)IfthequalifyingpersonIsa
child
but
notyourdependent,enter
thi3
child'snamehere.
r-_
Ouall!VInqwldowler)
will'
de
Jend~nl
childI'lear
5
ousadiedI>).(Seepa~e19.)
EJ(emptions
NG.01bn...
ch""kDdon
6,ond[;b
:f
moremen
srx
!'JCJ.H}(iG~ri'l.s,
;:'f~
f.h~~[!
10.
5a
121
Yoursult,IIyourparent(orsomeone
else)
canclaimyouasadependent
On
hisorhartax}
return.do
110t
checkbox6a.•....•..•...._
b~Spouse..•..,.",.......
c
Dependents:
I,)
Oep"~d"nl'''(a)i1,~,ruI"nl·'
1
4
)_"n
qu'i1iio!l
rel.llonshlp
to,hllll.,
<hild
"~
,.,11.':)_f_:_,f!'_:_.!_:_r...,.m._.:c.::-:-__
--'l;;;il_r.\_"_._m_B
+-_'O_,,_iill
s!cUfiiyrelrnliHY1JU
crldll_{~~
ime20}
!Vialia
A.
Obarnadaughter
0
o
No.or
your
chlldranonse
•..,D!
o
Ii".d..I!h
you
~didnolIiv~wilh
'YClU
d'letodivorce
or
separation
(s."p.oge
~O)
o
DCrefld~nt.s
an6c
[lolI.'!u\erm:iahov£!_
[2]
o
income
dT
AHnel,
FormsW·2andW·2Ghera.
AI~"..uachfurml.)
1O~9·F/
if
la}:.
i".Vn~
WiUlh~hJ.
Et'.,;-.t,,:r.$·~.
t"J.:l
do
nl":~
lUnd"
m~(
p:::yn"j~nt.pJSO~.
rlc.~:;"
~S,~
Form
104Q·V.
ILdd
uLlrnbl]o1'S
en'ef!~den
1&"
1"1
lfl
'H
20"
21
22
7W"ges.
salaries.
lips,etc.,Illtach
Form(s)
\111·2
Oa
T"",bln
Inlere'L
AttachScl19dul~B
IF
required
bTa:~-e"empl
intsrest.Do
not
includeonlineBa
9
Ordin~ry
dividend.:;.AltachScheduleBiFruqulred10Taaabla
refunds,credits.
Ofoff!<p.t5
orStilte
anrttm;,,1
income
tam,
[seapnge
221
11I\li"":,,,·/;;;cei'ied
12BU5tr'e;;stncornaDr11(55).""\tachScheduleC
orC-E~.
I
C
(.~pilnl
gain
nr
!i!)s~l.
AuacnS<:hllo;!uieD
Ii
raquiTerl
IFnetrequIrEd.Checkhere
I>
c..\~l-icr
gf:ins
r..~,.
Ut)S3CS}
ji.ttuc.hForlTl,;
197.,......
i••••_
1nl~.1P.Adi,':
jD~ticmj..
l..J.2.,~lr
II
bk;~111~
amount
(see
page
21)
!
~iJ[
Ji~r.;;":1i1":
~r..j
Jll::U'~~S
Usa,
13
i
055;
b
iL);o:ub!.;:
arnennl~see
pllge
lJ)
p'~ot~~d:l~~t,;,IlC!,
t::'Yf.lltU:5_
pn:'n~r5hp~;.:;
r:nrr.H'jiDtjCJns.'rusts,Ole.
Alt~r.J1
ScheduleE
f
nrrnincomeor
UD3S).
I\ttJch
Schedul"
F
Unemploymenl
ccmpensarton,
S"'~ia.1,"cmilyneneflts..
1_
20=a,,-,I
~_....JI·
b~a~~bl~1l~OU~lls~e
~,g~
25)
other
income.
List
typoand"mount(seepage251
Adjusted
Gross
income
?oJ
2Jl
StlJd~nl
IOiH'!;
il1t!:::f'~sldeduction
(Seepage27}.
25,·,jcdlol
"avlIlg~
accountdeduc\lun..''IlIm:hFarmii653
2[;
MI'HJI"g
nxpeuses.
l~n2lcll
Farm3903
27
On,,·
~;~Ir
JI
,alj·enlpiuymLmL
la:{
AI{~(:hSch~dul~
Sf
28
sen
·E-n~pl,:,r/Ed
hearth:nsuriJnce.de.jt..:Cliuli
I=':te
page
29:
2~S,'lr.'·mpl~·~ed:;E?SII·.1PLE."I'd(jlmliOedplan,
:;0('I(;I'I~il'l
en~arl:..wllhur~w~lafsavmqs
cla~"r,.r~y~o.rl~
I<~rlpl~nt'~~5tl",.'-_
n
Mdlin~'23through31a.
33Subtract
line]2iromline22This
IS
income
ForDlsclusure.p.rillacyAcl.andPaperworlcReductlnnI\ctNolie,,"seepage55.
CaL1')0.1132U8Farm
1040
12000)
 
SCHEDULESA&B
(form
1D40)
(ScheduleS
ison
back)
OMBNo.15'15·0074
Schedule!:lj~.~U:emizeIdeductions
I>
Attach
\0
Form
n~mei!iJ:;~o""m
'jn
form
1·JtlO
Barac!\H....
r,licilelleL.
Obama
lViedicRI
alld
DentaiZExpenses
3
·1
TaxesYou
Paid
,S~e
IJ'sye
f\'
2,)
Interest
YouPaid
[S~r,
rl~~.:!
P~-11
NQ'~.
r:
~r~(H":i:lr
I!,i,t~
",:5;;(.~
..,~~
;Jajuctibl~.
Giftsto
15
Charity
If
'J~:.
mi\"~
j.
1
n
(uiLa
d
nota
h.-:n1"-llt
h~;
1~
-:.io~!!;
rJi1lJr_'
.~·[I
jobE.~p~nse,20antiMost
ouier
Mis[ellanaousDeriuctiuns
21
IS••,
:<2.
Il.ly~
r1-:-<
('-If
".":.Xr.'!;;i.;2tjI-t,\
~j~~·_jut.
1I
t~rr:.)
Olher27
MiSGC
llaneous
Daductlcns
5Stateand",,~~Iincometaxes.
B
Realestats
taxes
(seepageA·2)
7Personalpropertytaxes.
8Othertaxes.Listtypeand
amount
i>-•••••._.•••••._••
9Ad
10Harnemortgage
intp.resl
and[JointsIP,ported
10
youor.Form109811
rlomemortgage
inte,e!il
not
reportedtoyou
O~
Farm
lOBe.
Ifpnid
to
thi;personiromwhomyoubought
tile
horne,secpageA·Jandshowthatperson'sname,IdenUf~lingno.•andaddress~,..
12PQI!1t~not
reponedto
"louonForm1098
:;<:E:
p~gre1\·3for~pecialrules.13lnvastrnentlntarast.Attach
Form
4952
if
required.
(Sse
page
A-3.).•.•.
1'1i'.dcl·1013.
Girts
by
cashorCheck,If
you
madeanygiftof$250
or
mom,
SI~8
page
A·~
Otherthan
by
cash
Dr
check.
Ifanygirtof$250ormore,seepaqe
.t\·4.
YoumustattachForm8283
i!
over
$500
Carryoverrromprioryear
Add
!lm15
117
Unreirnbursecemployesexpenses=jobtravel,uniondues.
joL.
education.etc.YoumustauachForm~106or
2105-EZ
iF
required.(SeepageA·5.)~.,..____..
ra;~
pry:p;;lalionieesOrI1"[r,xpenses-investment,safedepositbox,etc,listtypeanclamount~___..__.....•..........___..
23
2'1
25
2B
Addlines20through
n.
Ent~f
amO\!B\
lromForm1040.!tne
J,"'-"....._'-------'--.,",.....
-"'I
Muioply
linc
2,j
above
by
2%(.0Subtract
lirl
[rom
line
23.Ii
Total28
lternized
Deductions
I~O~:1.
O~~~rli;:d~:~i:~~:
~t~i~~:~
:~~rt~::~~:~~:3
a~~~e~;::;;t
:~J~~~tel'y)7
iorlines4through27.Also,
enter
thisamounton
Form
1040.
line36...
j»
o
Yes.YOU/deducl:on
may
beIImiled.Seepage1\-5
fOf
theamountto
enter,
ForPape'-':JorkReduclionActNolie,..seeForm1040instructions.2,350
9,38911,Sag
sc
heduleA
If
0
rm10(10)2000
 
Form10~O
0001
I>
b
I>-
II
Gil
TaJ(and
Credits
b
Standard
36
DeducLion
for
MO::it
People
Single:37
S'l,~(lO
38Headtil
household:
~6,450
39
Marned
fIling
40
jointlyor
41
Qualif»inglIiidow(er):
42
$1,15Q
Married
43
riling
'1,1
".palillely:45
S3.675
46
47
~8
49
50
51
Other
52
Taxes
53
54
5S
56
57,
PaymE!nts
58
L
59
II
'/ow
nO""a
6O..
1j"n1<fymg
.ctdld,tlut)-::h
b
Sthod"l~
EIC,
61
82
63
6465
34Amountfromline33(adjusted9wSSincome).3[iBCheckIf:
0
Vouwera65oraltJer,
0
Blind:
0
SpousewasG5orolder.Addthenumber
or
boxeschec.kedebove"ndenterthetntalhere..
If
you
are
married
filing
separatelyand
your
SPGUS~
Il~rni;:"s
deductions,
or
youWereadual-statusalien,
SaE
page31ano
~h"di
hore.
J>-
35b
Enter
yourItemizeddeductions
{ron"Sch"L.lulcAI,nij
26,
UI'
standard
deductlu
n3h<>wn
ontheleft,
But
seepage
31
tolindynur
standard
deduction
I{
youche,:ol,,,dany
boxon
line
358
or
35b
or
if
someone
can
ciOlin'youasadepende,,[
SubtractIIns36(romllne34Iiline3~Is~96,
100
orless,multiply
$2,800
by
the
tOl/JInumberoiexempucnscl~imsdonlineEd.Ifline34isover.S96,700,see
tile
worksheetonpage32fortheamounttoenter..
Taxableincome.
Subtraclline
38
fromline37.Iillne38ismoreIhanline37,enter
·0·
Tax15eepage32).
Chaok
if
an)'
laY.
isfroma
0
"ormI5]
88'1
'Ib
0
Form
,1972
Alternutiveminimumtax,AttachForm
5251
Addlines40and
4'1•
Foreigntaxcredit.AttachForm
1115
Ifr~qulredCredit
for
childand
dependent
caresxpenses.
AI"f'r.h
Form
2,1<1',
Credit
forthe
elderlyDrthedisabled.
Auach
5chlidul'"
R.
Educ.lion
credn;,
AttachForm
BBo3
Cllild
ta:i
cr",lit(~"epeg_
36)
Adoption
cr~~t./muchForrnB039.
other.Check
if
from"
0
orm3600b
0
F')rmfJ96c
0
Form8801
cI
0
Farm
{spi!cH'1J_Addlines43
through
49.ThaseareyeurtotalcreditsSublract
Im8SO
from
I
lin~
Refund
en
6711
Amount
YQUOwe
Sign
Here
JOint
return?
5~"
page
19,
I(eepacopy
foryour
records,
Paid
Preparer's
Use
Only
Ssll-emplcyrnenttax.AttachScheduleSE.SoclelsecurnyandMedicare
lax
ontipincomenotreportedtaemployer.AttachF
Orr"
413"/TaxanIRAs,otherretirementplans,and
MSAS.
AttachForm
5329
IfrequiredAdvanceearnedIncome
credit
payments
(rurn
Forrrus]
W·Z,
Household"rnploYln~nltaxes,Aua..:h3ch~ouleHAdd
llnes5156.
Thi~
I:;totaltax
FedsralincometaxwitllheldfromForms'N·2
2""l:l,,9
"2
OQ
0
estim
tJu~d
t3X
0i::lments:Uldamuun
l
,[J~~
Ii.-:=.:
IJ
cu
I
~:9S
'B
rL":i
urr,
Earned
Inconl€!
credit[EIC).
tlorlbr.abl~fr.,rn~dfm:ome.aUlo~nt
b-
l..-_
andc}'pe
1""_,..
Exccss5or.iBIsecurityandRRTA
til;'
wit.hheld
(S~~
P~~1i!
SOl
Additionalchildtax~recllt.AttachForm
BE,
2Amounlpaid
",IUI
request
for
extension
10
fil~Iseep~ge
50)Other
payments.
Checl(If~oma
0
arm
2·139
b
0
orm
It
136,andG1S'I,rlot,,,1
69
70
Underpenalties
or
perjury.I
nertare
I.hatI
hbVI2-
ena.mifieatl"'~sreturn;'!llda.l:comp~nyl[l95.ciu~dule:sandstmements,
i'Jmj
to
'.J1"2'
bestof
m~1
~wCJ'.;)im:J~~ndb~~eLtheYllr'i;!
UlJe:,
correct.
ond
complS'le.Oet::!ariUiol'1
at
preptarl11
~olhS!rthan
t.:U:PlJ}"f:HtlSI
basedon
a'i
j,nlormatloncr~\,Ihic;h
::re-parer
nas
nrly'kno'NI';:!1.!g~
M!I)'
thE'IRS.
dI5i:U50$
t~h
jELUm
','.'rth
til'.!
plf::pJr(·:
5Q"",.
I;,IO'I'J,
se,~.'"
;~;
P
Y.~_
0
I·J~
Daytimephonem]ftlb'ii'J
Attorney/prof.
.,
Spouse'scccuesucn
unlv,dean
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