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Form 8815 Exclusion of Interest From Series E.E. and I. U.S. Savings Bonds Issued After 1989 2005. Summary: This is an example of Form 8815 (2005) as pertains to the description in the text. The line items completed are:

Name(s) shown on return” field contains Mark & Joan Washington
Your social security number” field contains 000-00-4567
1a. Name of person (you, your spouse, or your dependent) who was enrolled at or attended an eligible educational institution” field contains Anna Washington
1b. Name and address of eligible educational institution” field contains
Jamestown University
Normal, Virginia 20100
2. Enter the total qualified higher education expenses you paid in 2005 for the person(s) listed in column (a) of line 1. See the instructions to find out which expenses qualify” field contains 7,650
3. Enter the total of any nontaxable educational benefits (such as nontaxable scholarship or fellowship grants) received for 2005 for the person(s) listed in column (a) of line 1 (see instructions)” field contains 0
4. Subtract line 3 from line 2. If zero or less, stop. You cannot take the exclusion” field contains 7,650
5. Enter the total proceeds (principal and interest) from all series E.E. and I. U.S. savings bonds issued after 1989 that you cashed during 2005” field contains 9,000
6. Enter the interest included on line 5 (see instructions)” field contains 3,000
7. If line 4 is equal to or more than line 5, enter 1.000. If line 4 is less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to at least three places)” field contains .850
8. Multiply line 6 by line 7” field contains 2550
9. Enter your modified adjusted gross income (see instructions)” field contains 108,500
10. Enter: $61,200 if single or head of household; $91,850 if married filing jointly or qualifying widow(er)” field contains91,850
11. Subtract line 10 from line 9. If zero or less, skip line 12, enter 0 on line 13, and go to line 14” field contains 16,650
12. Divide line 11 by: $15,000 if single or head of household; $30,000 if married filing jointly or qualifying widow(er). Enter the result as a decimal (rounded to at least three places)” field contains .555
13. Multiply line 8 by line 12” field contains 1,415
14. Excludable savings bond interest. Subtract line 13 from line 8. Enter the result here and on Schedule B (Form 1040), line 3, or Schedule 1 (Form 1040A), line 3, whichever applies” field contains 1,135