$1040 Department of the Treasury-Internal Revenue Service (99) U.S. Individual Income Tax Return 2021 OMB No. 1545-0074 IRS Use Only-Do not write or staple in this space. Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW) Filing Status If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child's name if the qualifying person is a child but not your dependent Check only one box. Your first name and middle initial JOHN If joint return, spouse's first name and middle initial St. Last name DoBy Last name Home address (number and street). If you have a P.O. box, see instructions. 1245 WEST 5TH City, town, or post office. If you have a foreign address, also complete spaces below. COALINGA Foreign country name Apt. no. State: ZIP code CA Foreign province/state/county Your social security number 554 78 4556 Spouse's social security number Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change Foreign postal code your tax or refund. - You At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Standard Your spouse as a dependent Deduction Spouse itemizes on a separate return or you were a dual-status alien Someone can claim: You as a dependent Age/Blindness You: Were born before January 2, 1957 Dependents (see instructions): Are blind Spouse: (2) Social security number Was born before January 2, 1957 (3) Relationship to you Spouse Yes No Is blind (4) if qualifies for (see instructions): Child tax credit Credit for other dependents If more than four dependents, see instructions and check (1) First name DAVID Last name DOBY 444 557777 SON here 1 Wages, salaries, tips, etc. Attach Form(s) W-2 1 124,566 Attach 2a Tax-exempt interest 2a b Taxable interest 2b 245 Sch. B if Qualified dividends 3a 1344 b Ordinary dividends 3b 156 required. 4a IRA distributions 4a b Taxable amount 4b 5a Pensions and annuities 5a b Taxable amount 5b Standard 6a Social security benefits 6a b Taxable amount. 6b Deduction for- 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here 7 Single or Married filing 8 Other income from Schedule 1, line 10 8 35,000 separately, 9 $12,550 Married filing 10 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income Adjustments to income from Schedule 1, line 26 9 161 311 10 jointly or Qualifying widow(er), $25,100 Head of 11 Subtract line 10 from line 9. This is your adjusted gross income 11 161,311 12a Standard deduction or itemized deductions (from Schedule A) 12a 18,800 b household, C Charitable contributions if you take the standard deduction (see instructions) Add lines 12a and 12b 12b 12c $18,800 18,800 If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A 13 any box under Standard 14 Add lines 12c and 13 14 18,800 Deduction, 15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . 15 see instructions 142,511 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 113208 Form 1040 (2021)