Prepare 1040EZ and W-4 Forms

Form 1040EZ Department of the Treasury—Internal Revenue Service Income Tax Return for Single and Joint Filers With No Dependents (99) 2016 OMB No. 1545-0074 Your first name and initial Last name Your social security number If a joint return, spouse’s first name and initial Last name Spouse’s social security number ▲ Make sure the SSN(s) above are correct. Home address (number and street). If you have a P.O. box, see instruct\ ions. Apt. no. City, town or post office, state, and ZIP code. If you have a foreign ad\ dress, also complete spaces below (see instructions).

Foreign country name Foreign province/state/county Foreign postal code Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund. You Spouse Income Attach Form(s) W-2 here.

Enclose, but do not attach, any payment. 1 Wages, salaries, and tips. This should be shown in box 1 of your Form(s\ ) W-2. Attach your Form(s) W-2.

1 2 Taxable interest. If the total is over $1,500, you cannot use Form 1040E\ Z. 2 3 Unemployment compensation and Alaska Permanent Fund dividends (see inst\ ructions). 3 4 Add lines 1, 2, and 3. This is your adjusted gross income. 4 5 If someone can claim you (or your spouse if a joint return) as a depen\ dent, check the applicable box(es) below and enter the amount from the worksheet o\ n back. You Spouse If no one can claim you (or your spouse if a joint return), enter $10,\ 350 if single; $20,700 if married filing jointly. See back for explanation. 5 6 Subtract line 5 from line 4. If line 5 is larger than line 4, enter -0-.\ This is your taxable income. ▶ 6 Payments, Credits, and Tax 7 Federal income tax withheld from Form(s) W-2 and 1099. 7 8a Earned income credit (EIC) (see instructions) 8a b Nontaxable combat pay election. 8b 9 Add lines 7 and 8a. These are your total payments and credits. ▶ 9 10 Tax. Use the amount on line 6 above to find your tax in the tax table in the instructions. Then, enter the tax from the table on this line.

10 11 Health care: individual responsibility (see instructions) Full\ -year coverage 11 12 Add lines 10 and 11. This is your total tax. 12 Refund Have it directly deposited! See instructions and fill in 13b, 13c, and 13d, or Form 8888. 13a If line 9 is larger than line 12, subtract line 12 from line 9. This is \ your refund. If Form 8888 is attached, check here ▶ 13a ▶ b Routing number ▶ c Type: Checking Savings ▶ d Account number Amount You Owe 14 If line 12 is larger than line 9, subtract line 9 from line 12. This is \ the amount you owe. For details on how to pay, see instructions. ▶ 14 Third Party Designee Do you want to allow another person to discuss this return with the IRS \ (see instructions)? Yes. Complete below. No Designee’s name ▶ Phone no. ▶ Personal identification number (PIN) ▶ Sign Here Joint return? See instructions.

Keep a copy for your records. Under penalties of perjury, I declare that I have examined this return and, to the best of my knowledge and belief, it is true, correct, and accurately lists all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge. ▲ Your signature Date Your occupation Daytime phone number Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection PIN, enter it here (see inst.) Paid Preparer Use Only Print/Type preparer’s name Preparer’s signature Date Check if self-employed PTIN Firm’s name ▶ Firm’s address ▶ Firm’s EIN ▶ Phone no. For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see ins\ tructions. Cat. No. 11329W Form 1040EZ (2016) Form 1040EZ (2016) Page 2 Use this form if • Your filing status is single or married filing jointly. If you are \ not sure about your filing status, see instructions.

• You (and your spouse if married filing jointly) were under age 65\ and not blind at the end of 2016. If you were born on January 1, 1952, you are considered to be age 65 at the end of 2016.

• You do not claim any dependents. For information on dependents, see\ Pub. 501.

• Your taxable income (line 6) is less than $100,000.

• You do not claim any adjustments to income. For information on adju\ stments to income, use the Tax Topics listed under Adjustments to Income at www.irs.gov/taxtopics (see instructions).

• The only tax credit you can claim is the earned income credit (EIC\ ). The credit may give you a refund even if you do not owe any tax. You do not need a qualifying child to claim the EIC. For inform\ ation on credits, use the Tax Topics listed under Tax Credits at www.irs.gov/taxtopics (see instructions). If you received a Form 1098-T or paid higher educ\ ation expenses, you may be eligible for a tax credit or deduction that you must claim on Form 10\ 40A or Form 1040. For more information on tax benefits for education, see Pub. 970.

Caution: If you can claim the premium tax credit or you received any advance pay\ ment of the premium tax credit in 2016, you must use Form 1040A or Form 1040.

• You had only wages, salaries, tips, taxable scholarship or fellowsh\ ip grants, unemployment compensation, or Alaska Permanent Fund dividends, and your taxable interest was not over $1,500.\ But if you earned tips, including allocated tips, that are not included in box 5 and box 7 of your Form W-2, you may not be abl\ e to use Form 1040EZ (see instructions). If you are planning to use Form 1040EZ for a child who received Alaska Permanent Fu\ nd dividends, see instructions. Filling in your return If you received a scholarship or fellowship grant or tax-exempt interest\ income, such as on municipal bonds, see the instructions before filling in the form. Also, see the instructions if y\ ou received a Form 1099-INT showing federal income tax withheld or if federal income tax was withheld from your unemployment co\ mpensation or Alaska Permanent Fund dividends. For tips on how to avoid common mistakes, see instructions. Remember, you must report all wages, salaries, and tips even if you do n\ ot get a Form W-2 from your employer. You must also report all your taxable interest, including interest from banks, savings\ and loans, credit unions, etc., even if you do not get a Form 1099-INT. Worksheet for Line 5 — Dependents Who Checked One or Both Boxes (keep a copy for your records)Use this worksheet to figure the amount to enter on line 5 if someone ca\ n claim you (or your spouse if married filing jointly) as a dependent, even if that person chooses not to do s\ o. To find out if someone can claim you as a dependent, see Pub. 501. A. Amount, if any, from line 1 on front ...... + 350.00 Enter total ▶ A . B. Minimum standard deduction .....................B . 1,050 C. Enter the larger of line A or line B here ..................C . D. Maximum standard deduction. If single, enter $6,300; if married filing jointly, enter $12,600 .D .

E. Enter the smaller of line C or line D here. This is your standard deduction ........E .

F. Exemption amount.

• If single, enter -0-.

• If married filing jointly and ——both you and your spouse can be claimed as dependents, enter -0-.

—only one of you can be claimed as a dependent, enter $4,050. } F . G. Add lines E and F. Enter the total here and on line 5 on the front ..........G .

If you did not check any boxes on line 5, enter on line 5 the amount shown below that applies to you.

• Single, enter $10,350. This is the total of your standard deduction\ ($6,300) and your exemption ($4,050).

• Married filing jointly, enter $20,700. This is the total of your st\ andard deduction ($12,600), your exemption ($4,050), and your spouse's exemption ($4,050). Mailing Return Mail your return by April 18, 2017. Mail it to the address shown on the last page of the instructions. www.irs.gov/form1040ez Form 1040EZ (2016)