(10U(10U&l0O(0U(s0p10h12v0s0b3TEE&l8c66pe66F&s0C)0U)s1p6vsb4T(0B&a41c3r41LëìïðçèÏÐ
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&a234.8Ho
&a242Hr
&a227.6Hm
&l8C&a3R&a1092.8HDepartment of the Treasury - Internal Revenue Service
(0U(s1p10vs1b4T&a4R&a1096.4HU.S. Individual Income Tax Return
&a6c5.3RLabel
(0U(s1p8vsb4T&a4R&a3782HIRS Use Only - Do not write or staple in this space.
&a9c6r9L&l4.8C(See
instructions
on page 12.)
&l8C&a9c8.2R&l4.8C(s1BUse the IRS
label.(sB
Otherwise,
please print
or type.
&l8C&a9c11.7R&l5.33C(s1BPresidential
Election Campaign(sB
(See page 12.)
&l8C(0U(s1p6vsb4T&a73c5RFor the year Jan. 1-Dec. 31, 1993, or other tax year beginning
&a5R&a3510.8H,1993, ending
&a5R&a4600.4H,19
&a5R&a4949.6HOMB No. 1545-0074
&a315c5.8r315LYour social security number
&a+1RSpouse's social security number
&l4C&a320c20.6r320LFor Privacy Act and Paperwork
Reduction Act Notice, see
instructions.
&l8C(0U(s1p8vsb4T&a51c12r51LDo you want $3 to go to this fund?&a2464H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
If a joint return, does your spouse want $3 to go to this fund?&a3369H  .  .  .  .  .  .  .
&a12R&a4144.4H(s1BYes(sB
&a4144.4H(s1BYes(sB
&a12R&a4594.4H(s1BNo(sB
&a4594.4H(s1BNo(sB
&a199.2c12R(s1BNote:(sB
(0U(s1p6vsb4T&a350c11.75r350L&l3.43CChecking "Yes"
will not change
your tax or re-
duce your refund.
&l8C(0U(s1p8vsb4T&a57c14r57LSingle
Married filing joint return (even if only one had income)
Married filing separate return.  Enter spouse's SSN above & full name here. (Bj(0U(s1p8vsb4T
Head of household (with qualifying person). (See page 13.) If the qualifying person is a child but not your
dependent, enter this child's name here. (Bj(0U(s1p8vsb4T
Qualifying widow(er) with dependent child (year spouse died (Bj(0U(s1p8vsb4T 19         ). (See page 13.)
(s1BYourself.(sB
&a+1R(s1BSpouse(sB&a1653H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
&a45c23r45L(s1BDependents: (sB
(s1B(1) (sBName (first, initial, and last name) 
&a31RIf your child didn't live with you but is claimed as your dependent under a pre-1985 agreement, check here  (Bj(0U(s1p8vsb4T
Total number of exemptions claimed&a2352H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
&a75c19.8r75L&l4.8CIf your parent (or someone else) can claim you as a dependent on his
or her tax return, (s1Bdo not (sBcheck box 6a.  But be sure to check the box on
line 33b on page 2 &a2488H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
&l3.43C&a54.13R&a2498H(s1B(2) (sB
&a2470.4HCk. if 
&a2464.4Hunder 
&a2472.8Hage 1 
&a54.13R&a4282.4H  (s1B(5) (sBNo. of 
&a4241.6H  months lived 
&a4241.6H  in your home 
&a4329.2H  in 1993 
&l4.8C&a38.67R&a2825.6H(s1B(3) (sBIf age 1 or older, 
&a2940.8Hdependent's 
&a2793.2Hsocial security number 
&a38.67R&a3666.8H(s1B(4) (sBDependent's 
&a3701.6Hrelationship to 
&a3863.6Hyou 
(0U(s1p6vsb4T&l8C&a330c20r330LNo. of boxes
&a20.5Rchecked on 6a
&a21Rand 6b
&a23RNo. of your
&a23.5Rchildren on 6c
&a24Rwho:
&a25R(B|(0U(s1p6vsb4T lived with you
&a26R(B|(0U(s1p6vsb4T didn't live with
&a26.4Ryou due to divorce
&a26.8Ror separation  (see
&a27.2Rpage 15)
&a28.5RDependents on 6c
&a29Rnot entered above
&a31RAdd numbers
&a31.5Rentered on
&a32Rlines above       (Bj(0U(s1p6vsb4T
(0U(s1p8vsb4T&a45c33r45LWages, salaries, tips, etc. Attach Form(s) W-2 &a2695H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
(s1BTaxable (sBinterest income (see page 16). Attach Schedule B if over $400&a3600H  .  .  .  .  .  .  .  .  .  .  .  .  .
(s1BTax-exempt (sB interest (see page 17). DON'T include on line 8a
Dividend income. Attach Schedule B if over $400&a2834H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Taxable refunds, credits, or offsets of state and local income taxes (see page 17) &a3947H  .  .  .  .  .  .  .  .
Alimony received&a1651H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Business income or (loss). Attach Schedule C or C-EZ &a3043H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Capital gain or (loss). Attach Schedule D&a2486H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Capital gain distributions not reported on line 13 (see page 17)&a3321H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Other gains or (losses). Attach Form 4797&a2556H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Total IRA distributions&a1852H  .  .  .  .  .
Total pensions and annuities&a2061H  .  .
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E&a4156H  .  .  .  .  .
Farm income or (loss). Attach Schedule F&a2556H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Unemployment compensation (see page 19)&a2625H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Social security benefits&a1852H  .  .  .  .  .
Other income. List type and amount - see page 20 &a2904H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
&a+1RAdd the amounts in the far right column for lines 7 through 22. This is your (s1Btotal income (sB&a4224H  .  .  .(Bj(0U(s1p8vsb4T
Your IRA deduction (see page 20) &a2311H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Spouse's IRA deduction (see page 20)&a2450H  .  .  .  .  .  .  .  .  .  .  .  .  .  .
One-half of self-employment tax (see page 21)&a2728H  .  .  .  .  .  .  .  .  .  .
Self-employed health insurance deduction (see page 22)&a3076H  .  .  .  .  .
Keogh retirement plan and self-employed SEP deduction &a3146H  .  .  .  .
Penalty on early withdrawal of savings&a2450H  .  .  .  .  .  .  .  .  .  .  .  .  .  .
Alimony paid. Recipient's SSN (Bj(0U(s1p8vsb4T
&a+1RAdd lines 24a through 29. These are your (s1Btotal adjustments (sB&a3249H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .(Bj(0U(s1p8vsb4T
&l4.36CSubtract line 30 from line 23. This is your (s1Badjusted gross income. (sBIf this amount is less than
$23,050 and a child lived with you, see page EIC-1 to find out if you can claim the "Earned
Income Credit" on line 56 &a1996H  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .(Bj(0U(s1p8vsb4T
&l8C&a139c43r139L(s1Bb (sBTaxable amount (see page 18)
(s1Bb (sBTaxable amount (see page 18)
&a+3R(s1Bb (sBTaxable amount (see page 19)
(0U(s1p10vs1b4T&a6c14.5r6LFiling Status
&a16R(0U(s1p8vsb4T(See page 12.)
&a+1R&l5.33CCheck only
one box.
&l8C(0U(s1p10vs1b4T&a20.5RExemptions
(0U(s1p8vsb4T&a+1R&l5.33C(See page 13.)
&a+5RIf more than six
dependents,
see page 14.
&l8C(0U(s1p10vs1b4T&a33.5RIncome
(0U(s1p8vsb4T&a+1R&l5.33C(s1BAttach
Copy B of your
Forms W-2,
W-2G, and
1099-R here.(sB
&a+2RIf you did not
get a W-2, see
page 10.
&a+2RIf you are
attaching a
check or money
order, put it on
top of any
Forms W-2,
W-2G, or
1099-R.
&l8C(0U(s1p10vs1b4T&a52.5RAdjustments
to Income
&a+1R(0U(s1p8vsb4T(See page 20.)
(0U(s1p10vs1b4T&a61RAdjusted
Gross Income
(0U(s1p8vs1b4T&l4.36C&a11.73R&a951.2HL
&a946.4HA
&a947.6HB
&a947.6HE
&a951.2HL

&a946.4HH
&a947.6HE
&a945.2HR
&a947.6HE
(0U(s1p8vsb4T&l8C&a9c63.8RD193 For Paperwork Reduction Act Notice, see instr. 
(0U(s1p6vsb4T&a145.92c63.8RCopyright (c) 1993 form software only CPSystems, Inc. (FOR DEMO USE ONLY)
(0U(s1p8vsb4T&a63.8R&a5058.8HForm (s1B1040 (sB(1993) 
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