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|00000000| 00 80 31 30 34 30 c5 da | 0d 2d 2d 2d 2d 2d 2d 0d |..1040..|.------.|
|00000010| d5 53 45 20 54 48 45 20 | 31 30 34 30 c5 da 20 46 |.SE THE |1040.. F|
|00000020| 4f 52 4d 20 4f 4e 4c 59 | 20 49 46 3a 0d 0d 20 20 |ORM ONLY| IF:..  |
|00000030| 31 2e 20 d9 4f 55 52 20 | 46 49 4c 49 4e 47 20 53 |1. .OUR |FILING S|
|00000040| 54 41 54 55 53 20 49 53 | 20 53 49 4e 47 4c 45 2e |TATUS IS| SINGLE.|
|00000050| 0d 0d 20 20 32 2e 20 d9 | 4f 55 20 44 4f 20 4e 4f |..  2. .|OU DO NO|
|00000060| 54 20 43 4c 41 49 4d 20 | 41 4e 59 20 44 45 50 45 |T CLAIM |ANY DEPE|
|00000070| 4e 44 45 4e 54 53 2e 0d | 0d 20 20 33 2e 20 d9 4f |NDENTS..|.  3. .O|
|00000080| 55 20 41 52 45 20 55 4e | 44 45 52 20 54 48 45 20 |U ARE UN|DER THE |
|00000090| 41 47 45 20 4f 46 20 36 | 35 20 41 4e 44 0d 20 20 |AGE OF 6|5 AND.  |
|000000a0| 20 20 20 4e 4f 54 20 42 | 4c 49 4e 44 2e 0d 0d 20 |   NOT B|LIND... |
|000000b0| 20 34 2e 20 d9 4f 55 52 | 20 54 41 58 41 42 4c 45 | 4. .OUR| TAXABLE|
|000000c0| 20 49 4e 43 4f 4d 45 20 | 28 4c 49 4e 45 20 35 29 | INCOME |(LINE 5)|
|000000d0| 20 49 53 0d 20 20 20 20 | 20 4c 45 53 53 20 54 48 | IS.    | LESS TH|
|000000e0| 41 4e 20 24 35 30 2c 30 | 30 30 2e 0d 0d 20 20 35 |AN $50,0|00...  5|
|000000f0| 2e 20 d9 4f 55 20 48 41 | 44 20 4f 4e 4c 59 20 57 |. .OU HA|D ONLY W|
|00000100| 41 47 45 53 2c 20 53 41 | 4c 41 52 49 45 53 20 41 |AGES, SA|LARIES A|
|00000110| 4e 44 0d 20 20 20 20 20 | 54 49 50 53 2e 0d 0d 20 |ND.     |TIPS... |
|00000120| 20 36 2e 20 d9 4f 55 52 | 20 54 41 58 41 42 4c 45 | 6. .OUR| TAXABLE|
|00000130| 20 49 4e 54 45 52 45 53 | 54 20 49 53 20 4c 45 53 | INTERES|T IS LES|
|00000140| 53 0d 20 20 20 20 20 54 | 48 41 4e 20 24 34 30 30 |S.     T|HAN $400|
|00000150| 2e 0d 0d 20 20 37 2e 20 | c9 46 20 59 4f 55 20 48 |...  7. |.F YOU H|
|00000160| 41 44 20 4d 4f 52 45 20 | 54 48 41 4e 20 4f 4e 45 |AD MORE |THAN ONE|
|00000170| 0d 20 20 20 20 20 45 4d | 50 4c 4f 59 45 52 20 41 |.     EM|PLOYER A|
|00000180| 4e 44 20 59 4f 55 52 20 | 54 4f 54 41 4c 20 57 41 |ND YOUR |TOTAL WA|
|00000190| 47 45 53 0d 20 20 20 20 | 20 41 52 45 20 4c 45 53 |GES.    | ARE LES|
|000001a0| 53 20 54 48 41 4e 20 24 | 35 35 2c 35 30 30 2e 0d |S THAN $|55,500..|
|000001b0| 0d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|000001c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000001d0| 2d 2d 2d 2d 2d 2d 2d 0d | 0d 31 3a 20 c5 4e 54 45 |-------.|.1: .NTE|
|000001e0| 52 20 59 4f 55 52 20 54 | 4f 54 41 4c 20 57 41 47 |R YOUR T|OTAL WAG|
|000001f0| 45 53 2c 20 53 41 4c 41 | 52 49 45 53 0d 41 4e 44 |ES, SALA|RIES.AND|
|00000200| 20 54 49 50 53 20 46 52 | 4f 4d 20 59 4f 55 52 20 | TIPS FR|OM YOUR |
|00000210| d7 2d 32 2e 0d 0d 32 3a | 20 c5 4e 54 45 52 20 59 |.-2...2:| .NTER Y|
|00000220| 4f 55 52 20 54 41 58 41 | 42 4c 45 20 49 4e 54 45 |OUR TAXA|BLE INTE|
|00000230| 52 45 53 54 20 49 4e 43 | 4f 4d 45 0d 4f 46 20 24 |REST INC|OME.OF $|
|00000240| 34 30 30 20 4f 52 20 4c | 45 53 53 2e 0d 0d 33 3a |400 OR L|ESS...3:|
|00000250| 20 d4 48 49 53 20 49 53 | 20 59 4f 55 52 20 41 44 | .HIS IS| YOUR AD|
|00000260| 4a 55 53 54 45 44 20 47 | 52 4f 53 53 0d 49 4e 43 |JUSTED G|ROSS.INC|
|00000270| 4f 4d 45 2e 0d 0d 34 3a | 20 d4 48 49 53 20 4c 49 |OME...4:| .HIS LI|
|00000280| 4e 45 20 57 49 4c 4c 20 | 54 4f 47 47 4c 45 20 42 |NE WILL |TOGGLE B|
|00000290| 45 54 57 45 45 4e 0d c4 | c5 d0 c5 ce c4 c5 ce d4 |ETWEEN..|........|
|000002a0| 2d d9 c5 d3 20 41 4e 44 | 20 c4 c5 d0 c5 ce c4 c5 |-... AND| .......|
|000002b0| ce d4 2d ce cf 2e 20 20 | c9 46 0d 59 4f 55 20 41 |..-...  |.F.YOU A|
|000002c0| 52 45 20 4e 4f 54 20 41 | 20 44 45 50 45 4e 44 45 |RE NOT A| DEPENDE|
|000002d0| 4e 54 20 54 48 45 4e 20 | 59 4f 55 52 0d 50 45 52 |NT THEN |YOUR.PER|
|000002e0| 53 4f 4e 41 4c 20 45 58 | 45 4d 50 54 49 4f 4e 20 |SONAL EX|EMPTION |
|000002f0| 57 49 4c 4c 20 42 45 20 | 24 35 39 30 30 2e 20 20 |WILL BE |$5900.  |
|00000300| c9 46 0d 59 4f 55 20 41 | 52 45 20 41 20 44 45 50 |.F.YOU A|RE A DEP|
|00000310| 45 4e 44 45 4e 54 2c 20 | 54 48 45 20 50 52 4f 47 |ENDENT, |THE PROG|
|00000320| 52 41 4d 20 57 49 4c 4c | 0d 43 41 4c 43 55 4c 41 |RAM WILL|.CALCULA|
|00000330| 54 45 20 59 4f 55 52 20 | 45 58 45 4d 50 54 49 4f |TE YOUR |EXEMPTIO|
|00000340| 4e 2e 0d 0d 35 3a 20 d4 | 48 49 53 20 49 53 20 59 |N...5: .|HIS IS Y|
|00000350| 4f 55 52 20 d4 c1 d8 c1 | c2 cc c5 20 c9 ce c3 cf |OUR ....|... ....|
|00000360| cd c5 2e 0d 0d 36 3a 20 | c5 4e 54 45 52 20 54 48 |.....6: |.NTER TH|
|00000370| 45 20 49 4e 43 4f 4d 45 | 20 54 41 58 20 59 4f 55 |E INCOME| TAX YOU|
|00000380| 20 48 41 56 45 0d 50 41 | 49 44 2e 0d 0d 37 3a 20 | HAVE.PA|ID...7: |
|00000390| d4 48 45 20 50 52 4f 47 | 52 41 4d 20 57 49 4c 4c |.HE PROG|RAM WILL|
|000003a0| 20 43 41 4c 43 55 4c 41 | 54 45 20 41 4e 0d 41 50 | CALCULA|TE AN.AP|
|000003b0| 50 52 4f 58 49 4d 41 54 | 45 20 56 41 4c 55 45 20 |PROXIMAT|E VALUE |
|000003c0| 46 4f 52 20 59 4f 55 52 | 20 49 4e 43 4f 4d 45 0d |FOR YOUR| INCOME.|
|000003d0| d4 c1 d8 2e 20 20 c6 4f | 52 20 41 4e 20 45 58 41 |....  .O|R AN EXA|
|000003e0| 43 54 20 46 49 47 55 52 | 45 2c 20 50 4c 45 41 53 |CT FIGUR|E, PLEAS|
|000003f0| 45 0d 52 45 46 45 52 20 | 54 4f 20 54 48 45 20 54 |E.REFER |TO THE T|
|00000400| 41 58 20 54 41 42 4c 45 | 53 2e 0d 0d 38 3a 20 d4 |AX TABLE|S...8: .|
|00000410| 48 49 53 20 49 53 20 59 | 4f 55 52 20 52 45 46 55 |HIS IS Y|OUR REFU|
|00000420| 4e 44 20 49 46 20 59 4f | 55 20 48 41 56 45 0d 50 |ND IF YO|U HAVE.P|
|00000430| 41 49 44 20 54 4f 4f 20 | 4d 55 43 48 20 54 41 58 |AID TOO |MUCH TAX|
|00000440| 2e 0d 0d 39 3a 20 d4 48 | 49 53 20 49 53 20 54 48 |...9: .H|IS IS TH|
|00000450| 45 20 41 4d 4f 55 4e 54 | 20 59 4f 55 20 4f 57 45 |E AMOUNT| YOU OWE|
|00000460| 20 49 46 20 59 4f 55 0d | 48 41 56 45 20 4e 4f 54 | IF YOU.|HAVE NOT|
|00000470| 20 50 41 49 44 20 45 4e | 4f 55 47 48 20 54 41 58 | PAID EN|OUGH TAX|
|00000480| 2e 0d                   |                         |..      |        |
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