_________________________________|__________|_______-____-____________
Name(s) shown on Form 1040 Zip Code SS# Number
1. Enter the amount of taxes you paid (not including SS & Medicare) $______
2. Enter the Portion of your tax dollars that you wish to direct to each Activity. The Portion for any Activity must be within the Budget Range for that Activity. Check to be sure that the sum of all of the Portions equals 100%. The President's recommendations are shown in parenthesis. (Please note : this form and its numbers are for the sake of example only)
Activity Budget Range Portion
Amount Charity
Agriculture, Food Stamps 2.1 ( 3.0) 4.2% ______% ____________| __________ Environment 3.0 ( 4.0) 5.0% ______% ____________| __________ Welfare 9.5 (16.0) 19.8% ______% ____________| __________ Health 9.2 (17.5) 18.5% ______% ____________| __________ Military 21.6 (23.0) 34.5% ______% ____________| ____xxxxxx Parks/Interior 1.0 ( 1.5) 2.0% ______% ____________| __________ General Service 5.0 ( 7.5) 10.0% ______% ____________| ____xxxxxx Transportation 4.0 ( 5.5) 6.0% ______% ____________| __________ National Debt 16.6 (18.0) 20.0% ______% ____________| ____xxxxxx Education 3.0 ( 4.0) 5.0% ______% ____________| __________
Total 75.0 (100.0) 125.0% ______% ____________| __________
3. Multiply the Portion for each Activity by the amount on line 1 and enter the result in the Amount column above. This is the amount of your tax dollars that will be directed to that Activity. Example : If you owe $1000 in taxes and enter 18% for National Debt then (.18 x $1000) or $180 goes to pay the National Debt.
4. You may enter how much of any particular activity you would like to be able to directly contribute to toward a charity/private sector provider for that activity up the the amount you set for that Activity. (xxxxx means not available) Ideally, you might be able to attach a check for an accredited charity up to the percent of your taxes that go to that Activity and have that total amount deducted from your tax bill.
________________ Place ________________ Stamp ________________ Here
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TDB Forms available on WWW
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