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|00000000| 00 80 d0 41 52 54 20 c9 | d6 2e 20 c5 41 52 4e 45 |...ART .|.. .ARNE|
|00000010| 44 20 c9 4e 43 4f 4d 45 | 20 c3 52 45 44 49 54 0d |D .NCOME| .REDIT.|
|00000020| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000030| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0d 34 |--------|-----..4|
|00000040| 3a 20 c5 4e 54 45 52 20 | 54 48 45 20 41 4d 4f 55 |: .NTER |THE AMOU|
|00000050| 4e 54 20 46 52 4f 4d 20 | 4c 49 4e 45 20 37 2c 0d |NT FROM |LINE 7,.|
|00000060| 46 4f 52 4d 20 31 30 34 | 30 2e 0d 0d 35 3a 20 c5 |FORM 104|0...5: .|
|00000070| 4e 54 45 52 20 41 4e 59 | 20 4e 4f 4e 54 41 58 41 |NTER ANY| NONTAXA|
|00000080| 42 4c 45 20 45 41 52 4e | 45 44 0d 49 4e 43 4f 4d |BLE EARN|ED.INCOM|
|00000090| 45 2e 0d 0d 36 3a 20 c9 | 46 20 59 4f 55 20 57 45 |E...6: .|F YOU WE|
|000000a0| 52 45 20 53 45 4c 46 2d | 45 4d 50 4c 4f 59 45 44 |RE SELF-|EMPLOYED|
|000000b0| 20 4f 52 0d 52 45 50 4f | 52 54 45 44 20 49 4e 43 | OR.REPO|RTED INC|
|000000c0| 4f 4d 45 20 41 4e 44 20 | 45 58 50 45 4e 53 45 53 |OME AND |EXPENSES|
|000000d0| 20 4f 4e 0d d3 43 48 45 | 44 55 4c 45 20 c3 20 41 | ON..CHE|DULE . A|
|000000e0| 53 20 41 20 53 54 41 54 | 55 54 4f 52 59 20 45 4d |S A STAT|UTORY EM|
|000000f0| 50 4c 4f 59 45 45 2c 0d | 45 4e 54 45 52 20 54 48 |PLOYEE,.|ENTER TH|
|00000100| 45 20 41 4d 4f 55 4e 54 | 20 46 52 4f 4d 20 54 48 |E AMOUNT| FROM TH|
|00000110| 45 20 57 4f 52 4b 53 48 | 45 45 54 0d 4f 4e 20 50 |E WORKSH|EET.ON P|
|00000120| 41 47 45 20 34 36 20 4f | 46 20 54 48 45 20 c9 d2 |AGE 46 O|F THE ..|
|00000130| d3 20 49 4e 53 54 52 55 | 43 54 49 4f 4e 53 2e 0d |. INSTRU|CTIONS..|
|00000140| 0d 37 3a 20 d4 48 49 53 | 20 49 53 20 59 4f 55 52 |.7: .HIS| IS YOUR|
|00000150| 20 54 4f 54 41 4c 20 45 | 41 52 4e 45 44 20 49 4e | TOTAL E|ARNED IN|
|00000160| 43 4f 4d 45 2e 0d c9 46 | 20 49 54 20 45 58 43 45 |COME...F| IT EXCE|
|00000170| 45 44 53 20 24 32 31 2c | 35 30 30 2c 20 44 4f 20 |EDS $21,|500, DO |
|00000180| 4e 4f 54 0d 43 4f 4e 54 | 49 4e 55 45 20 57 49 54 |NOT.CONT|INUE WIT|
|00000190| 48 20 54 48 45 20 46 4f | 52 4d 2e 20 20 d9 4f 55 |H THE FO|RM.  .OU|
|000001a0| 20 4d 41 59 20 4e 4f 54 | 0d 43 4c 41 49 4d 20 41 | MAY NOT|.CLAIM A|
|000001b0| 4e 20 c5 c9 c3 20 43 52 | 45 44 49 54 2e 0d 0d 38 |N ... CR|EDIT...8|
|000001c0| 3a 20 c5 4e 54 45 52 20 | 59 4f 55 52 20 41 44 4a |: .NTER |YOUR ADJ|
|000001d0| 55 53 54 45 44 20 47 52 | 4f 53 53 20 49 4e 43 4f |USTED GR|OSS INCO|
|000001e0| 4d 45 2c 0d 4c 49 4e 45 | 20 33 32 20 4f 46 20 54 |ME,.LINE| 32 OF T|
|000001f0| 48 45 20 31 30 34 30 2e | 0d                      |HE 1040.|.       |
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