ADJUSTMENTS OT INCOME: Link to page 1 2 3 4 Home Page
IRA or KEOGH Payments $_______________________
Self Emp. Health Insurance $_______________________
Alimony Paid. $_______________________
Recipient’s SS #_______________________ Other Ajustments $_______________________ *************************************************************** CREDITS: Child Care Expense (See required $_______________________
information on last page)
Other Credits $_______________________
***************************************************************
ITEMIZED DEDUCTIONS:
Prescription Drugs, Doctors, Dentist
Hospitals and Medical Insurance (7.5%) $_______________________
Medical Travel & Lodging $_______________________
Hearing Aids, Eyeglasses, etc. $_______________________
Real Estate Taxes (Home) $_______________________
Personal Property tax $_______________________
Interest expense for home mortgage $_______________________
Was the home interest paid to an individual? Yes____No____
Did you borrow against your home after 8/16/86? Yes____No____
Investment Interest expense $_______________________
Charitable Contributions Cash & Checks $_______________________
Contribution other then cash, If over
$500.00 need to show date contributed,
who too, value, and description in the
notes section on the last page. $_______________________
Casualty or theft losses $_______________________
Moving Expenses $_______________________