Form 1040 (2004) Page 2. Summary: This is an example of Form 1040 (2004), page 2, with items included as described in the text. Additionally, these line items are completed:

Under “Tax and Credits’:
“37. Amount from line 36 (adjusted gross income)’ field contains 35,308
“39. Itemized deductions (from Schedule A) or your standard deduction (see left margin)’ field contains 13,573
“40. Subtract line 39 from line 37’ field contains 21,735
“41. If line 37 is $107,025 or less, multiply $3,100 by the total number of exemptions claimed on line 6d. If line 37 is over $107,025, see the worksheet on page 33’ field contains 9,300
“42. Taxable income. Subtract line 41 from line 40. If line 41 is more than line 40, enter 0’ field contains 12,435
“43. Tax (see page 33).’ field contains 1,243
“45. Add lines 43 and 44’ field contains 1,243
“51. Child tax credit (see page 37).’ field contains 1,000
“55. Add lines 46 through 54. These are your total credits’ field contains 1,000
“56. Subtract line 55 from line 45. If line 55 is more than line 45, enter 0’ field contains 243
Under “Other Taxes’:
“57. Self-employment tax. Attach Schedule SE’ field contains 6,266
“62. Add lines 56 through 61. This is your total tax’ field contains 6,509
Under “Payments’:
“63. Federal income tax withheld from Forms W-2 and 1099’ field contains 272
“64. 2004 estimated tax payments and amount applied from 2003 return’ field contains 8,400
“70. Add lines 63 through 69. These are your total payments’ field contains 8,672
Under “Refund’:
“71. If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid’ field contains 2,163
“73. Amount of line 71 you want applied to your 2005 estimated tax’ field contains 2,163
Under “Sign Here’:
“Your signature’ field contains John E. Michaels
“Date’ field contains 3/1/2005
“Your occupation’ field contains Minister
“Spouse's signature. If a joint return, both must sign.’ field contains Susan R. Michaels
“Date’ field contains 3/1/2005
“Spouse's occupation’ field contains Homemaker