Form 1040-SS - U.S. Self-Employment Tax Return Form (2014)

Form 1040-SS
Department of the Treasury
Internal Revenue Service
U.S. Self-Employment Tax Return (Including the Additional Child Tax
Credit for Bona Fide Residents of Puerto Rico)
U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, or Puerto Rico.
For the year Jan. 1–Dec. 31, 2014, or other tax year beginning
, 2014, and ending , 20
.
Information about Form 1040-SS and its separate instructions is at www.irs.gov/form1040ss.
OMB No. 1545-0090
2014
Please type or print
Your first name and initial Last name Your social security number
If a joint return, spouse’s first name and initial Last name Spouse’s social security number
Present home address (number, street, and apt. no., or rural route)
City, town or post office, commonwealth or territory, and ZIP code
Foreign country name Foreign province/state/county
Foreign postal code
Part I Total Tax and Credits
1 Filing status. Check the box for your filing status (see instructions).
Single
Married filing jointly
Married filing separately.
Enter spouse's social security no. above and full name here.
2 Qualifying children. Complete only if you are a bona fide resident of Puerto Rico and you are claiming the additional child
tax credit (see instructions).
(a) First name Last name
(b) Child’s
identifying number
(c) Child’s
relationship to you
3 Self-employment tax from Part V, line 12. . . . . . . . . . . . . . . . . . . 3
4 Household employment taxes (see instructions). Attach Schedule H (Form 1040) . . . . . 4
5 Additional Medicare Tax. Attach Form 8959. . . . . . . . . . . . . . . . . . 5
6 Total tax. Add lines 3 through 5 (see instructions). . . . . . . . . . . . . . . . 6
7 2014 estimated tax payments (see instructions) . . . . . . . 7
8 Excess social security tax withheld (see instructions). . . . . . 8
9 Additional child tax credit from Part II, line 3 . . . . . . . . 9
10 Reserved . . . . . . . . . . . . . . . . . . . . 10
11 Total payments and credits (see instructions) . . . . . . . . . . . . . . . . 11
12 If line 11 is more than line 6, subtract line 6 from line 11. This is the amount you overpaid . . 12
13 a Amount of line 12 you want refunded to you. If Form 8888 is attached, check here .
13a
b
Routing Number
c Type: Checking Savings
d
Account Number
14 Amount of line 12 you want applied to 2015 estimated tax . .
14
15
Amount you owe. If line 6 is more than line 11, subtract line 11 from line 6. For details on how
to pay, see instructions . . . . . . . . . . . . . . . . . . . . . . .
15
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete the following. No
Designee's
name
Phone
no.
Personal Identification
Number (PIN)
Sign
Here
Joint Return?
See instructions.
Keep a copy
for your
records.
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 the taxpayer) is based on all information of which the preparer has
any knowledge.
Your signature Date
Daytime phone number
If the IRS sent you an Identity Protection PIN, enter
it here (see inst.)
Spouse’s signature. If a joint return, both must sign.
Date
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer's signature Date
Check if
self-employed
PTIN
Firm’s name
Firm's address
Firm's EIN
Phone no.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
Cat. No. 17184B
Form 1040-SS (2014)
Page 1/4
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Form 1040-SS - U.S. Self-Employment Tax Return Form (2014) PDF

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