Form

Department of the Treasury - Internal Revenue Service

1040A

U.S. Individual Income Tax Return

Your first name and initial

(99)

2013

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

OMB No. 1545-0074

Last name

Your social security number

Treveris

Riveron Arteaga

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

472-51-7121

Last name

Spouse's social security number

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

Apt. no.

Make sure the SSN(s) above

and on line 6c are correct.

15511 Flight Way

Presidential Election Campaign

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

Apple Valley, MN 55124

Foreign country name

Foreign province/state/county

Foreign postal code

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.

You

Filing
status
Check only
one box.

1
2
3

6a

Exemptions
b

c Dependents:
If more than six
dependents,
see Instructions.

(1) First name

(2) Dependent's social

security number

(3) Dependent's
relationship to you

Last name

(4) X if child under

age 17 qualifying
for child tax credit
(see instructions)

Attach
Form(s) W-2
here. Also
attach
Form(s)
1099-R if tax
was withheld.

If you did not

get a W-2, see
instructions.

Adjusted
gross
income

Wages, salaries, tips, etc. Attach Form(s) W-2.

8a
b
9a
b
10
11a

Taxable interest. Attach Schedule B if required.

Tax-exempt interest. Do not include on line 8a.
Ordinary dividends. Attach Schedule B if required.
Qualified dividends (see instructions).
Capital gain distributions (see instructions).
IRA
11a
distributions.
12a Pensions and
12a
annuities.

lived with
you

(see instructions)

Dependents
on 6c not
entered above

Add numbers
on lines
above

19,838.

8a
8b
9a
9b
10
11b Taxable amount
(see instructions).
12b Taxable amount
(see instructions).

11b
12b

13 Unemployment compensation and Alaska Permanent Fund dividends.

14a Social security
14b Taxable amount
14a
(see instructions).
benefits.

14b

15

Add lines 7 through 14b (far right column). This is your total income.

15

20,993.

16
17
18

Educator expenses (see instructions).

IRA deduction (see instructions).
Student loan interest deduction (see instructions).

19
20

Tuition and fees. Attach Form 8917.

19
Add lines 16 through 19. These are your total adjustments.

20

0.

21

13

1,155.

16
17
18

Subtract line 20 from line 15. This is your adjusted gross income.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
UYA

on 6c who:

did not live

with you due
to divorce or
separation

d Total number of exemptions claimed.

Income

Spouse

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.
1
6a and 6b
Spouse
No. of children

21

20,993.
Form 1040A (2013)

Form 1040A (2013)

Tax, credits, 22 Enter the amount from line 21 (adjusted gross income).
and
23a Check
You were born before January 2, 1949,
payments
Spouse was born before January 2, 1949,
if:

Standard
Deduction
forPeople who
check any
box on line
23a or 23b or
who can be
claimed as a
dependent,
see
instructions.
All others:
Single or
Married filing
separately,
$6,100
Married filing
jointly or
Qualifying
widow(er),
$12,200
Head of
household,
$8,950

If you have a
qualifying
child, attach
Schedule EIC.

Refund
Direct Deposit?
See instructions
and fill in 43b,
43c, and 43d
or Form 8888.

472-51-7121 Page 2
22
20,993.

Treveris Riveron Arteaga

Blind

Total boxes

23a 0
checked
b If you are married filing separately and your spouse itemizes
deductions, check here
23b
24 Enter your standard deduction.
24
25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-.
25
26 Exemptions. Multiply $3,900 by the number on line 6d.
26
27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.
This is your taxable income.
27
28 Tax, including any alternative minimum tax (see instructions).
28
29 Credit for child and dependent care expenses. Attach
Form 2441.
29
30 Credit for the elderly or the disabled. Attach
Schedule R.
30
31 Education credits from Form 8863, line 19.
31
32 Retirement savings contributions credit. Attach Form 8880.
32
23.
33 Child tax credit. Attach Schedule 8812, if required.
33
34
34 Add lines 29 through 33. These are your total credits.
35 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. This is your
total tax.
35
36 Federal income tax withheld from Forms W-2 and 1099. 36
2,505.
37 2013 estimated tax payments and amount
applied from 2012 return.
37
38a Earned income credit (EIC).
NO38a
b Nontaxable combat pay election. 38b
39 Additional child tax credit. Attach Schedule 8812.
39
40
40 American opportunity credit from Form 8863, line 8.
41
41 Add lines 36, 37, 38a, 39, and 40. These are your total payments.
42 If line 41 is more than line 35, subtract line 35 from line 41.
42
This is the amount you overpaid.
43a Amount of line 42 you want refunded to you. If Form 8888 is attached, check here
43a
b Routing

c Type:

number

Blind

Checking

6,100.
14,893.
3,900.
10,993.
1,200.

23.
1,177.

2,505.
1,328.
1,328.

Savings

d Account
number

44
45

Amount
you owe
Third party
designee

Sign
here
Joint return?
See instructions.
Keep a copy
for your
records.

Paid
preparer
use only

46

Amount of line 42 you want applied to your

44
2014 estimated tax.
Amount you owe. Subtract line 41 from line 35. For details on how to pay, see
instructions.
Estimated tax penalty (see instructions).
46
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Designee's
name

Yes. Complete the following.

No

Personal identification
number (PIN)

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my
knowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration
of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.
Your signature
Date
Your occupation
Daytime phone number

unemployed
Spouse's signature. If a joint return, both must sign.

Print/type preparer's name

Date

Preparer's signature

(763)688-5981
If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)

Spouse's occupation

Date

Check

if

PTIN

self-employed
Firm's name
Firm's address

UYA

Phone
no.

45

Firm's EIN
Phone no.

Form 1040A (2013)

Form

8880

Credit for Qualified Retirement Savings Contributions

Attach to Form 1040, Form 1040A, or Form 1040NR.
Information about Form 8880 and its instructions is at www.irs.gov/form8880.

Department of the Treasury

Internal Revenue Service

Name(s) shown on return

OMB No. 1545-0074

2013

Attachment
Sequence No.

54

Your social security number

Treveris Riveron Arteaga

472-51-7121

You cannot take this credit if either of the following applies.

The amount on Form 1040, line 38; Form 1040A, line 22; or Form 1040NR, line 37 is more than $29,500 ($44,250 if head of
CAUTION
household; $59,000 if married filing jointly).
The person(s) who made the qualified contribution or elective deferral (a) was born after January 1, 1996, (b) is
claimed as a dependent on someone else's 2013 tax return, or (c) was a student (see instructions).
(a) You
(b) Your spouse
1 Traditional and Roth IRA contributions for 2013. Do not include rollover contributions 1
2 Elective deferrals to a 401(k) or other qualified employer plan, voluntary employee
2
232.
contributions, and 501(c)(18)(D) plan contributions for 2013 (see instructions) . .
3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
232.
4 Certain distributions received after 2010 and before the due date
(including extensions) of your 2013 tax return (see instructions). If
married filing jointly, include both spouses' amounts in both
4
columns. See instructions for an exception . . . . . . . . . . . . . . .
5 Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . .
5
232.
6
6 In each column, enter the smaller of line 5 or $2,000 . . . . . . . . .
232.
7
7 Add the amounts on line 6. If zero, stop; you cannot take this credit . . . . . . . . . . . . . . . . .
232.
8 Enter the amount from Form 1040, line 38*; Form 1040A, line 22; or
Form 1040NR, line 37 . . . . . . . . . . . . . . . . . . . . . . . . . .
8
20,993.
9 Enter the applicable decimal amount shown below:

If line 8 isOver-

--$17,750
$19,250
$26,625
$28,875
$29,500
$35,500
$38,500
$44,250
$59,000

But not
over-

$17,750
$19,250
$26,625
$28,875
$29,500
$35,500
$38,500
$44,250
$59,000
---

And your filing status isMarried

filing jointly

Head of
household
Enter on line 9-

.5
.5
.5
.5
.5
.5
.2
.1
.1
.0

.5
.5
.5
.2
.1
.1
.1
.1
.0
.0

Single, Married filing

separately, or
Qualifying widow(er)

.5
.2
.1
.1
.1
.0
.0
.0
.0
.0

Note: If line 9 is zero, stop; you cannot take this credit.

10 Multiply line 7 by line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11 Limitation based on tax liability. Enter the amount from the Credit Limit Worksheet in the
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Credit for qualified retirement savings contributions. Enter the smaller of line 10 or line 11
here and on Form 1040, line 50; Form 1040A, line 32; or Form 1040NR, line 47 . . . . . . . . . .

X . 10

10

23.

11

1,200.

12

23.

*See Pub. 590 for the amount to enter if you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico.
For Paperwork Reduction Act Notice, see your tax return instructions.
UYA

Form

8880 (2013)