Form 1040 U.S. Individual Income Tax Return 2005, Pages 1 and 2. Written above title “Dual-Status RETURN”. Summary: This is an example of Form 1040 (2005), pages 1 and 2 with items included as described in the text. Additionally, these line items are completed:

Page 1:

Under “Income”:

“7. Wages, salaries, tips, etc. Attach Form(s) W-2” field contains 28,300

“8a. Taxable interest. Attach Schedule B if required” field contains 395

“9a. Ordinary dividends. Attach Schedule B if required” field contains 120

“22. Add the amounts in the far right column for lines 7 through 21. This is your total income” field contains 28,815

Under “Adjusted Gross Income”:

“26. Moving expenses. Attach Form 3903” field contains 8,300

“36. Add lines 23 through 31a and 32 through 35” field contains 8,300

“37. Subtract line 36 from line 22. This is your adjusted gross income” field contains 20,515

Page 2:

Under “Tax and Credits”:

“38. Amount from line 37 (adjusted gross income)” field contains 20,515

“39b. If you are married filing separately and your spouse itemizes deductions, or you were a dual-status alien, see page 35 and check here” field contains box with check mark

“40. Itemized deductions (from Schedule A) or your standard deduction (see left margin)” field contains 922

“41. Subtract line 40 from line 38” field contains 19,593

“42. If line 38 is over $109,475, or you provided housing to a person displaced by Hurricane Katrina, see page 37. Otherwise multiply $3,200 by the total number of exemptions claimed on line 6d.” field contains 3,200

“43. Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter 0” field contains 16,393

“43. Tax (see page 37). Check if any tax is from a (checkbox) Form(s) 8814 b (checkbox) Form 4972” field contains 2,091

“46. Add lines 44 and 45” field contains 2,091

“57. Subtract line 56 from line 46. If line 56 is more than line 46, enter 0” field contains 2,091

Under “Other Taxes”:

“62. Add lines 57 through 62. This is your total tax. Total from 1040NR $36” field contains 2,127

Under “Payments”:

“64. Federal income tax withheld from Forms W-2 and 1099 (Line 62 includes $36 from Form 1040NR.)” field contains 2,736

“71. Add lines 64, 65, 66a, and 67 through 70. These are your total payments” field contains 2,736

Under “Refund”:

“72. If line 71 is more than line 63, subtract line 63 from line 71. This is the amount you overpaid” field contains 609

“73a. Amount of 72 you want refunded to you” field contains 609

Under “Sign Here”:

“Your signature” field contains Sam R. Brown

“Date” field contains 3-16-2006

“Your occupation” field contains R&D Specialist