Medical and Dental Expense: |
| 1 | Medical and dental expense | |
Taxes You Paid: |
| 5 | State and local income tax | |
| 6 | Read Estate Taxes | |
| 7 | Personal Property Taxes | |
| 8 | Other Taxes | |
Interest You Paid: |
| 10 | Home mortgage interest and points from Form 1099 | |
| 11 | Home mortgage interest not on from Form 1099 | |
| 12 | Points not reported on Form 1099 | |
| 13 | Investment interest | |
Gifts to Charity: |
| 15 | Gifts by cash or check | |
| 16 | Gifts other than by cash or check | |
Casualty and Theft Losses: |
| 19 | Enter amount from Form 4684 | |
Job Expense and Miscellaneous Deductions: |
| 20 | Unreimbursed employee expenses | |
| 21 | Tax preparation fee | |
| 22 | Other expenses - Investment, safe deposit box | |
Other Miscellaneous Deductions: (not subject to the 2% limit) |
| 27 | Other expenses (see instructions) | |
Information required to calculate form: |
| | Adjusted Gross Income | |