Department of the Treasury—Internal Revenue Service Form

1040EZ
Name, Address, and SSN
See separate instructions.
Presidential Election Campaign (see page 9)
P R I N T C L E A R L Y

Income Tax Return for Single and Joint Filers With No Dependents (99)
Your first name and initial Last name

2010

OMB No. 1545-0074 Your social security number

Alexander M.
If a joint return, spouse’s first name and initial

Jones
Last name Apt. no.

4 0 5 6 4 8 0 9 8
Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions.

1330 W. Fargo
City, town or post office, state, and ZIP code. If you have a foreign address, see instructions.

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Make sure the SSN(s) above are correct.

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Chicago, Illinois 60626

Checking a box below will not change your tax or refund.

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Check here if you, or your spouse if a joint return, want $3 to go to this fund . 1 Wages, salaries, and tips. This should be shown in box 1 of your Form(s) W-2. Attach your Form(s) W-2. Taxable interest. If the total is over $1,500, you cannot use Form 1040EZ.

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You 1 2 3 4

Spouse
52,000
300

Income
Attach Form(s) W-2 here.
Enclose, but do not attach, any payment.
You may be entitled to a larger deduction if you file Form 1040A or 1040. See Before You Begin on page 4.

2 3 4 5

Unemployment compensation and Alaska Permanent Fund dividends (see page 11). Add lines 1, 2, and 3. This is your adjusted gross income. If someone can claim you (or your spouse if a joint return) as a dependent, check the applicable box(es) below and enter the amount from the worksheet on back. You Spouse If no one can claim you (or your spouse if a joint return), enter $9,350 if single; $18,700 if married filing jointly. See back for explanation. Subtract line 5 from line 4. If line 5 is larger than line 4, enter -0-. This is your