$\backslash$begin$\{$tabular$\}\{|$l$|$l$|\}$

$\backslash$hline Description & Amount $\backslash \backslash$

$\backslash$hline Gross Income: & $\backslash \backslash$

$\backslash$hline Salary & $\backslash \backslash$

$\backslash$hline Alimony received & $\backslash \backslash$

$\backslash$hline Rental receipts & $\backslash \backslash$

$\backslash$hline Disability insurance payments & $\backslash \backslash$

$\backslash$hline Interest income from corporate bonds & $\backslash \backslash$

$\backslash$hline Interest income from municipal bonds & $\backslash \backslash$

$\backslash$hline $(1)$ Gross income & $\backslash \backslash$

$\backslash$hline Deductions for AGI: & $\backslash \backslash$

$\backslash$hline Expenses for rental property & $\backslash \backslash$

$\backslash$hline $(2)$ Total for AGI deductions & $\backslash \backslash$

$\backslash$hline $(3)$ AGI & $\backslash \backslash$

$\backslash$hline From AGI deductions: & $\backslash \backslash$

$\backslash$hline Medical expenses & $\backslash \backslash$

$\backslash$hline State income taxes & $\backslash \backslash$

$\backslash$hline Charitable contributions & $\backslash \backslash$

$\backslash$hline $(4)$ Total itemized deductions & $\backslash \backslash$

$\backslash$hline $(5)$ Standard deduction & $\backslash \backslash$

$\backslash$hline & $\backslash \backslash$

$\backslash$hline $(7)$ Taxable income & $\backslash \backslash$

$\backslash$hline $(8)$ Tax on taxable income & $\backslash \backslash$

$\backslash$hline $(9)$ Credits & $\backslash \backslash$

$\backslash$hline $(10)$ Tax prepayments & $\backslash \backslash$

$\backslash$hline & $\backslash \backslash$

$\backslash$hline

$\backslash$end$\{$tabular$\}$