Form 1040A Vow first name and rubel Last name OMB No. 1545-0074 Your social security number If a mint return. spouse's first name and initial Last name Spouse's social security number Home address (number and skeet). If you have a P.O. box. see instructions. Apt no- Make are the SSN(s) above a and on line 6c we correct. City. town or post office. state. and LP code. If you have a foreign address. also complete spaces below (see instruct's:en). Presidential Election Campaign Check here d you. or your sparse II filin baeobng a t want 33 to go to bas MI notNohs fund gpinny. t rge y2uf tax Of wend. D you El Spouse Feign country name Foreign province/state/county Fang' postal code Filing status Check only one box. Department of the Treasury—Internal Revenue Service U.S. Individual Income Tax Return (99) 2017 IRS Use Only—Do not write or staple in this space. Exemptions If may than six dependents, see mstructions. 1 K Single 4 K Head of household (with qualifying person). (see Indrucbons.) 2 O Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, 3 O Married filing separately. Enter spouse's SSN above and enter this child's name here. lo full name here. lio 5 O Qualifying widow(er) (see instructions) 6a U Yourself. If someone can claim you as a dependent, do not check box 6a. b O Spouse c Dependents: (1) First name Last name 121 Dependent's social security number (3) Dependent's relationship to you (4)1 if chid wider age 17 qualifying for chid tax credit (see nstructions) I ■ d Total number of exemptions claimed. Boxes checked on 6a and 6b No. of children on 6c who: • kved with you • did not live with you due to divorce or separation (see instructions) Dependents on 6c not entered above Add numbers ri on lines above e Income Attach Form(s) W-2 here. Also attach Form(s) 1099-R if tax was withheld. If you did not get a W