Form

Department of the Treasury - Internal Revenue Service

1040A
Your first name and initial

U.S. Individual Income Tax Return
Last name

(99)

2013

IRS Use Only - Do not write or staple in this space.
OMB No. 1545-0074 Your social security number

Robert
If a joint return, spouse's first name and initial

Greene
Last name

412-34-5670
Spouse's social security number

Vilma 1001 N.W. 93 Street

Greene
Apt. no.

412-34-5671
Make sure the SSN(s) above and on line 6c are correct. 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.

Home address (number and street). If you have a P.O. box, see instructions.

City, town or post office, state and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Miami, FL 33168
Foreign country name Foreign province/state/county Foreign postal code

X

You

X

Spouse

Filing status
Check only one box.

1 2 3 6a

X X X

Exemptions b If more than six dependents, see Instructions.

4 Single Head of household (with qualifying person). (See instr.) If the qualifying person is a child but not your dependent, Married filing jointly (even if only one had income) enter this child's name here. Married filing separately. Enter spouse's SSN above and 5 full name here. Qualifying widow(er) with dependent child (see instructions) Boxes Yourself. If someone can claim you as a dependent, do not check checked on box 6a. 2 6a and 6b Spouse No. of children

}

c Dependents:
(1) First name Last name

(2) Dependent's social security number

(3) Dependent's relationship to you

(4) X if child under age 17 qualifying for child tax credit (see instructions)

on 6c who: lived with you did not live with you due to divorce or separation