Letter of AgreementIRS - Tax FormFirst-Name-and-InitialLastNameSocial Security #Spouse-First-NameSpouse-LastNameSocial Security #Apartment No.Home AddressAddress City State / Province / CountyAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Foreign CountryForeign Province / State / CountyForeign Postal CodeMarried Filling SeparatelyMarried filling separately. Enter spouse's SSN above and full name here.Head of House Hold with qualifying personhead of house hold with qualifying person. If the qualifying person is a child but not your dependent, enter the child's name.ExemptionsDependent Name 1Dependent 1 SS #Dependent 1 RelationshipDependent Name 2Dependent 2 SS #Dependent 2 RelationshipDependent Name 3Dependent 3 SS #Dependent 3 RelationshipDependent Name 4Dependent 4 SS #Dependent 4 RelationshipIncome7Wages, salaries, tips, etc. Attach Form(s) W-28aTaxable interest. Attach Schedule B if required8bTax-exempt interest. Do not include on line 8a9aOrdinary dividends. Attach Schedule B if required9bQualified dividends10Taxable refunds, credits, or offsets of state and local income taxes11Alimony received12Business income or (loss). Attach Schedule C or C-EZ13Capital gain or (loss). Attach Schedule D if required.14Other gains or (losses). Attach Form 479715aIRA distributions15bIRA distributions Taxable amount16aPensions and annuities16bPensions and annuities Taxable amount17Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E18Farm income or (loss). Attach Schedule F19Unemployment compensation20aSocial security benefits20bSocial security benefits Taxable Amount21Other income22Combine the amounts in the far right column for lines 7 through 21.Adjusted Gross Income23Educator expenses24Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ25Health savings account deduction. Attach Form 888926Moving expenses. Attach Form 390327Deductible part of self-employment tax. Attach Schedule SE28Self-employed SEP, SIMPLE, and qualified plans29Self-employed health insurance deduction30Penalty on early withdrawal of savings31aAlimony paid31bRecipient’s SSN32IRA deduction33Student loan interest deduction34Tuition and fees. Attach Form 891735Domestic production activities deduction. Attach Form 890336Add lines 23 through 3537Subtract line 36 from line 22. This is your adjusted gross incomeTax and Credits38Amount from line 37 (adjusted gross income)40Itemized deductions (from Schedule A) or your standard deduction41 Subtract line 40 from line 3842Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d.43Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-44Tax45Alternative minimum tax (see instructions). Attach Form 625146Excess advance premium tax credit repayment. Attach Form 896247Add lines 44, 45, and 4648Foreign tax credit. Attach Form 1116 if required49Credit for child and dependent care expenses. Attach Form 244150Education credits from Form 8863, line 1951Retirement savings contributions credit. Attach Form 888052Child tax credit. Attach Schedule 8812, if required53Residential energy credits. Attach Form 569554Other credits from Form55Add lines 48 through 54. These are your total credits56Subtract line 55 from line 47. If line 55 is more than line 47, enter -0-Other Taxes57Self-employment tax. Attach Schedule SE58Unreported social security and Medicare tax from Form59Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required60aHousehold employment taxes from Schedule H .60bFirst-time homebuyer credit repayment. Attach Form 5405 if required61Health care: individual responsibility62Taxes63Add lines 56 through 62. This is your total taxPayments64Federal income tax withheld from Forms W-2 and 1099652017 estimated tax payments and amount applied from 2016 return66aEarned income credit (EIC)66bNontaxable combat pay election67Additional child tax credit. Attach Schedule 881268American opportunity credit from Form 8863, line 869Net premium tax credit. Attach Form 896270Amount paid with request for extension to file71Excess social security and tier 1 RRTA tax withheld72Credit for federal tax on fuels. Attach Form 413673Credits from Form74Add lines 64, 65, 66a, and 67 through 73. These are your total paymentsRefund75If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid76aAmount of line 75 you want refunded to you. If Form 8888 is attached, check here76bRouting number76dAccount number77Amount of line 75 you want applied to your 2018 estimated taxAmout You Owe78Amount you owe. Subtract line 74 from line 63.79Estimated tax penaltyThird Party DesigneeDesignees-NameDesignees-PhoneDesignees-PINSign HereYour-SignatureYour SignatureYour-OccupationDaytime-Phone-NumberSpouses-SignatureIf a joint return both must signSpouses-OccupationIdentity-Protection-PINIf IRS sent you an ID PIN enter it here You Might Also Like Bill of Sale May 30, 2018 Tax Document June 14, 2018 Employee Contract June 7, 2018