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1040
L A B E L H E R E

Form

Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return DEMARCO S
If a joint return, spouse’s first name and initial

2009

(99)

IRS Use Only—Do not write or staple in this space.

Label
(See instructions on page 14.)

For the year Jan. 1–Dec. 31, 2009, or other tax year beginning Last name Your first name and initial

, 2009, ending

, 20

OMB No. 1545-0074 Your social security number

TODD

PY
Apt. no. child’s name here.

Last name

269 90 7092
Spouse’s social security number

Use the IRS label. Otherwise, please print or type.

Home address (number and street). If you have a P.O. box, see page 14.

5053 EAST MICHIGAN STREET INDIANAPOLIS, IN
1 2 3 6a b c

You must enter your SSN(s) above.
Checking a box below will not change your tax or refund.
You Spouse

Presidential Election Campaign

46201

Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 14)

Filing Status
Check only one box.

X

Single Married filing jointly (even if only one had income)

Married filing separately. Enter spouse’s SSN above and full name here.

CO
4 5

City, town or post office, state, and ZIP code. If you have a foreign address, see page 14.

Head of household (with qualifying person). (See page 15.) If the qualifying person is a child but not your dependent, enter this

Qualifying widow(er) with dependent child (see page 16)

Exemptions

X

Yourself. If someone can claim you as a dependent, do not check box 6a .

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EW

Spouse . Dependents:
(1) First name

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Last name

(2) Dependent’s social security number

(3) Dependent’s (4)  if qualifying relationship to you child for child tax credit (see page 17)

Boxes checked on 6a and 6b No. of children on 6c who: ● lived with you
● did not...