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Form
8815
Department of the Treasury
Internal Revenue Service (99)
Exclusion of Interest From Series EE and I
U.S. Savings Bonds Issued After 1989
(For Filers With Qualified Higher Education Expenses)
a
a
Attach to Form 1040 or Form 1040A.
OMB No. 1545-0074
20
13
Attachment
Sequence No.
167
Name(s) shown on return
Your social security number
1
(a)
Name of person (you, your spouse, or your dependent) who
was enrolled at or attended an eligible educational institution
(b)
Name and address of eligible educational institution
If you need more space, attach a statement.
2
Enter the total qualified higher education expenses you paid in 2013 for the person(s) listed in
column (a) of line 1. See the instructions to find out which expenses qualify
........
2
3
Enter the total of any nontaxable educational benefits (such as nontaxable scholarship or
fellowship grants) received for 2013 for the person(s) listed in column (a) of line 1 (see instructions)
3
4
......
4
5
...................
5
6
Enter the interest included on line 5 (see instructions)
...............
6
7
If line 4 is equal to or more than line 5, enter “1.000.” If line 4 is less than line 5, divide line 4 by line
5. Enter the result as a decimal (rounded to at least three places)
...........
7
8
Multiply line 6 by line 7
.........................
8
9
Enter your modified adjusted gross income (see instructions)
....
9
Note:
If line 9 is $89,700 or more if single or head of household, or
$142,050 or more if married filing jointly or qualifying widow(er) with
10
Enter: $74,700 if single or head of household; $112,050 if married filing
jointly or qualifying widow(er) with dependent child
.......
10
11
Subtract line 10 from line 9. If zero or less, skip line 12, enter -0- on line
13, and go to line 14
.................
11
12
Divide line 11 by: $15,000 if single or head of household; $30,000 if married filing jointly or
qualifying widow(er) with dependent child. Enter the result as a decimal (rounded to at least three
places)
12
13
Multiply line 8 by line 12
.........................
13
14
Schedule B (Form 1040A or 1040), line 3
..................
a
14
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 10822S
Form
8815
(2013)
Information about Form 8815 and its instructions is at www.irs.gov/form8815.
Enter the total proceeds (principal and interest) from all series EE and I U.S. savings bonds issued
after 1989 that you cashed during 2013
dependent child, stop. You cannot take the exclusion.
Excludable savings bond interest. Subtract line 13 from line 8. Enter the result here and on
Subtract line 3 from line 2. If zero or less, stop You cannot take the exclusion
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