Form Department of the Treasury - Internal Revenue Service

1040A U.S. Individual Income Tax Return 2007 IRS Use Only - Do not write or staple in this space.
Your first name and initial Last name OMB No. 1545-0074
Label Your social security number
(See instructions.) L
A Angie L Clark 002-74-8853
B
E If a joint return, spouse's first name and initial Last name Spouse's social security number
Use the L
IRS label. H Home address (number and street). If you have a P.O. box, see instructions. Apt. no. You must enter
Otherwise, E
please print R 74 Penacook Path your SSN(s) above.
E
or type. City, town or post office, state, and ZIP code. If you have a foreign address, see instructions. Checking a box below will not
Sunapee, NH 03782 change your tax or refund.
Presidential
Election Campaign Check here if you, or your spouse if filing a jointly, want $3 to go to this fund (see instructions) You Spouse

Filing
1 Single 4 X Head of household (with qualifying person). (See instructions.)
2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent,
status 3 Married filing separately. Enter spouse's SSN above and enter this child's name here.
Check only
one box. full name here. 5 Qualifying widow(er) with dependent child (see instructions)
6a X Yourself. If someone can claim you as a dependent, do not check Boxes
Exemptions
b Spouse
box 6a. checked on
6a and 6b
No. of children
1 } on 6c who:
(4) Check if
c Dependents: (2) Dependent's (3) Dependent's lived with
qualifying child
social security number
relationship to
for child tax you 3
you
(1) First name Last name credit (see instr.)
did not live
If more than six
Nicholas Clark 006-90-3432 Son with you due
to divorce or
dependents, Brady Bunnell 001-90-6140 Son X separation
see Instructions. (see instructions)
Corbyn Bunnell 003-94-3446 Son X 0
Dependents
on 6c not
entered above 0
Add numbers
on lines
d Total number of exemptions claimed. above 4
Income
Attach
7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7 50,848.
Form(s) W-2
here. Also 8a Taxable interest. Attach Schedule 1 if required. 8a 184.
attach b Tax-exempt interest. Do not include on line 8a. 8b
Form(s) 9a Ordinary dividends. Attach Schedule 1 if required. 9a
1099-R if tax b 9b
Qualified dividends (see instructions).
was withheld.
10 Capital gain distributions (see instructions). 10
11a IRA 11b Taxable amount
If you did not distributions. 11a 11b
get a W-2, see
(see instructions).
instructions. 12a Pensions and 12b Taxable amount
annuities. 12a (see instructions). 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 13

Enclose, but do 14a Social security 14b Taxable amount
not attach, any
payment. benefits. 14a (see instructions). 14b

15 Add lines 7 through 14b (far right column). This is your total income. 15 51,032.
Adjusted
16 Educator expenses (see instructions). 16
gross
17 IRA deduction (see instructions). 17
income
18 Student loan interest deduction (see instructions). 18 1,134.
19 Tuition and fees deduction. Attach Form 8917. 19
20 Add lines 16 through 19. These are your total adjustments. 20 1,134.
21 Subtract line 20 from line 15. This is your adjusted gross income. 21 49,898.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040A (2007)
UYA
Form 1040A (2007) Angie L Clark 002-74-8853 Page 2
Tax, 22 Enter the amount from line 21 (adjusted gross income). 22 49,898.
credits, 23a Check
and if:
You were born before January 2, 1943,
{
Spouse was born before January 2, 1943,
Blind
Blind
} Total boxes
checked 23a 0
payments b If you are married filing separately and your spouse itemizes
Standard deductions, see instructions and check here 23b
Deduction
for - 24 Enter your standard deduction (see left margin). 24 7,850.
People who 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25 42,048.
checked any
box on line
26 If line 22 is $117,300 or less, multiply $3,400 by the total number of exemptions
23a or 23b or claimed on line 6d. If line 22 is over $117,300, see the worksheet in instructions. 26 13,600.
who can be
claimed as a 27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
dependent,
See inst.
This is your taxable income. 27 28,448.
All others:
28 Tax, including any alternative minimum tax (see instructions). 28 3,704.
29 Credit for child and dependent care expenses.
Single or
Married filing Attach Schedule 2. 29
separately, 30 Credit for the elderly or the disabled. Attach
$5,350
Schedule 3. 30
Married filing
jointly or 31 Education credits. Attach Form 8863. 31
Qualifying 32 Child tax credit (see instructions). Attach
widow(er),
$10,700 Form 8901 if required. 32 2,000.
Head of 33 Retirement savings contributions credit. Attach
household, Form 8880. 33
$7,850
34 Add lines 29 through 33. These are your total credits. 34 2,000.
35 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. 35 1,704.
36 Advance earned income credit payments from Form(s) W-2, box 9. 36
37 Add lines 35 and 36. This is your total tax. 37 1,704.
38 Federal income tax withheld from Forms W-2 and 1099. 38 5,465.
39 2007 estimated tax payments and amount
applied from 2006 return. 39
If you have a
qualifying
40a Earned income credit (EIC). NO 40a
child, attach b Nontaxable combat pay election. 40b
Schedule EIC.
41 Additional child tax credit. Attach Form 8812. 41
42 Add lines 38, 39, 40a, and 41.These are your total payments. 42 5,465.
Refund 43 If line 42 is more than line 37, subtract line 37 from line 42.
This is the amount you overpaid. 43 3,761.
Direct Deposit? 44a Amount of line 43 you want refunded to you. If Form 8888 is attached, check here 44a 3,761.
See instructions
and fill in 44b, b Routing
44c, and 44d, or number 211489083 c Type: X Checking Savings
Form 8888.
d Account
number 08025182
45 Amount of line 43 you want applied to your
2008 estimated tax. 45
Amount 46 Amount you owe. Subtract line 42 from line 37. For details on how
you owe to pay, see instructions. 46
47 Estimated tax penalty (see instructions). 47
Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No
Third party
Designee's Phone Personal identification
designee name no. number (PIN)
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my
Sign knowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration
here of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.
Joint Return? Your signature Date Your occupation Daytime phone number
(see instructions).
Radiologic Tech 603-526-5070
Keep a copy
Spouse's signature. If a joint return, both must sign. Date Spouse's occupation
for your
records.

Preparer's Date Preparer's SSN or PTIN

Paid signature
Check if
self-employed
preparer's EIN
Firm's name (or
use only yours if self-employed), Phone no.
address, and ZIP code

UYA Form 1040A (2007)