Form 1040EZ
Department of the Treasury - Internal Revenue Service
Income Tax Return for Single and Joint Filers With No Dependents 2017
OMB No. 1545-0074
Your first name and initial Alex Last name Montgomery
Your social security number(xxx-xx-xxxx) 412345670
Home address (number and street). if you have a P.O. box, see instructions. 3344 Bayview Drive
City, town, or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Richmond Hill, GA 31324
Presidential Election Campaign
Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund. You
Income
1 Wages, salaries, and tips.
4 Add lines 1, 2, and 3. This is your adjusted gross income. 4 0
6 Subtract line 5 from line 4. If line 5 is larger than line 4, enter -0-. This is your taxable income. 6 0
7 Federal income tax withheld from Form(s) W-2 and 1099. 7
9 Add lines 7 and 8a. These are your total payments and credits. 9 0
Refund
13a If line 9 is larger than line 12, subtract line 12 from line 9. This is your refund. 13a 0
Amount You Owe
14 If line 12 is larger than line 9, subtract line 9 from line 12. This is the amount you owe. 14 0
Sign Here
Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct, and accurately lists all amounts and sources of income I recieved during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040EZ (2017)
