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1040 Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return 2010 (99) IRS Use Only—Do not write or staple in this space.

P For the year Jan. 1–Dec. 31, 2010, or other tax year beginning , 2010, ending , 20 OMB No. 1545-0074
Name, R
I
Your first name and initial Last name Your social security number
Address, N LESLIE G WASHINGTON 224 13 5578
T If a joint return, spouse’s first name and initial Last name Spouse’s social security number
and SSN
C
See separate L Apt. no.
Home address (number and street). If you have a P.O. box, see instructions. Make sure the SSN(s) above
E
instructions.
A 208 CURRY DR c and on line 6c are correct.
R
City, town or post office, state, and ZIP code. If you have a foreign address, see instructions. Checking a box below will not
L
Y WILLIAMSBURG, VA 23188 change your tax or refund.
Presidential
Election Campaign a Check here if you, or your spouse if filing jointly, want $3 to go to this fund . . . . . a You Spouse

Filing Status 1 X Single 4 Head of household (with qualifying person). (See instructions.) If
2 Married filing jointly (even if only one had income) the qualifying person is a child but not your dependent, enter this
Check only one 3 Married filing separately. Enter spouse’s SSN above child’s name here. a
box. and full name here. a 5 Qualifying widow(er) with dependent child

Exemptions 6a
b
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
} Boxes checked
on 6a and 6b
No. of children
c Dependents: (2) Dependent’s (3) Dependent’s (4)  if child under age 17 on 6c who:
qualifying for child tax credit • lived with you
(1) First name Last name social security number relationship to you
(see page 15) • did not live with
you due to divorce
or separation
If more than four (see instructions)
dependents, see Dependents on 6c
instructions and not entered above
check here a Add numbers on
d Total number of exemptions claimed . . . . . . . . . . . . . . . . . lines above a

Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7 5,837.

8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
Attach Form(s)
9a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
W-2 here. Also
attach Forms b Qualified dividends . . . . . . . . . . . 9b
W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10
1099-R if tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here a 13
If you did not 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14
get a W-2,
see page 20. 15a IRA distributions . 15a b Taxable amount . . . 15b
16a Pensions and annuities 16a b Taxable amount . . . 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
Enclose, but do 18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18
not attach, any
payment. Also, 19 Unemployment compensation . . . . . . . . . . . . . . . . . 19
please use 20a Social security benefits 20a b Taxable amount . . . 20b
Form 1040-V. 21 Other income. List type and amount 21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income a 22 5,837.
23 Educator expenses . . . . . . . . . . 23
Adjusted 24 Certain business expenses of reservists, performing artists, and
Gross fee-basis government officials. Attach Form 2106 or 2106-EZ 24
Income 25 Health savings account deduction. Attach Form 8889 . 25
26 Moving expenses. Attach Form 3903 . . . . . . 26
27 One-half of self-employment tax. Attach Schedule SE . 27
28 Self-employed SEP, SIMPLE, and qualified plans . . 28
29 Self-employed health insurance deduction . . . . 29
30 Penalty on early withdrawal of savings . . . . . . 30
31a Alimony paid b Recipient’s SSN a 31a
32 IRA deduction . . . . . . . . . . . . . 32
33 Student loan interest deduction . . . . . . . . 33
34 Tuition and fees. Attach Form 8917 . . . . . . . 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 31a and 32 through 35 . . . . . . . . . . . . . 36 0.
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . a 37 5,837.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2010)

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Form 1040 (2010) LESLIE G WASHINGTON 224-13-5578 Page 2

Tax and 38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38 5,837.

Credits
39a Check
if:
{ You were born before January 2, 1946,
Spouse was born before January 2, 1946,
Blind.
Blind.
} Total boxes
checked a 39a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here a
39b
40 Itemized deductions (from Schedule A) or your standard deduction (see instructions) . . 40 5,700.
41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41 137.
42 Exemptions. Multiply $3,650 by the number on line 6d . . . . . . . . . . . . 42 0.
43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43 137.
44 Tax (see instructions). Check if any tax is from: a Form(s) 8814 b Form 4972 . 44 14.
45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45
46 Add lines 44 and 45 . . . . . . . . . . . . . . . . . . . . . a 46 14.
47 Foreign tax credit. Attach Form 1116 if required . . . . 47
48 Credit for child and dependent care expenses. Attach Form 2441 48
49 Education credits from Form 8863, line 23 . . . . . 49
50 Retirement savings contributions credit. Attach Form 8880 50
51 Child tax credit (see instructions) . . . . . . . . 51
52 Residential energy credits. Attach Form 5695 . . . . 52
53 Other credits from Form: a 3800 b 8801 c 53
54 Add lines 47 through 53. These are your total credits . . . . . . . . . . . . 54 0.
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- . . . . . . a 55 14.
Other 56 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 56
57 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 57
Taxes 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 58
59 a Form(s) W-2, box 9 b Schedule H c Form 5405, line 16 . . . . 59
60 Add lines 55 through 59. This is your total tax . . . . . . . . . . . . . a 60 14.
Payments 61 Federal income tax withheld from Forms W-2 and 1099 . . 61 3,890.
62 2010 estimated tax payments and amount applied from 2009 return 62
63 Making work pay credit. Attach Schedule M . . . . . . . 63
If you have a 64a Earned income credit (EIC) . . . . . .NO. . . . 64a
qualifying
child, attach b Nontaxable combat pay election 64b
Schedule EIC. 65 Additional child tax credit. Attach Form 8812 . . . . . . 65
66 American opportunity credit from Form 8863, line 14 . . . 66
67 First-time homebuyer credit from Form 5405, line 10 . . . 67
68 Amount paid with request for extension to file . . . . . 68
69 Excess social security and tier 1 RRTA tax withheld. . . . 69
70 Credit for federal tax on fuels. Attach Form 4136 . . . . 70
71 Credits from Form: a 2439 b 8839 c 8801 d 8885 71
72 Add lines 61, 62, 63, 64a, and 65 through 71. These are your total payments . . . . a 72 3,890.
Refund 73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid 73 3,876.
74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here . a 74a 3,876.
Direct deposit?
a
b Routing number 0 6 1 0 0 0 1 0 4 a c Type: X Checking Savings
See a d Account number 1 0 0 0 1 3 1 3 0 0 2 3 5 8 2
instructions.
75 Amount of line 73 you want applied to your 2011 estimated tax a 75
Amount 76 Amount you owe. Subtract line 72 from line 60. For details on how to pay, see instructions ▶ 76 0.
You Owe 77 Estimated tax penalty (see instructions) . . . . . . . 77

Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. X No

Designee Designee’s Phone Personal identification

name a no. a number (PIN) a

Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here
Joint return? Your signature Date Your occupation Daytime phone number
F

See page 12.

Keep a copy SELF EMPOLYED 757-206-5444
for your Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation
records.
Print/Type preparer’s name Preparer’s signature Date PTIN
Paid Check if
SELF-PREPARED self-employed
Preparer
Firm’s name a Firm's EIN a
Use Only
Firm’s address a Phone no.
Form 1040 (2010)

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