1040 for a single taxpayer. 1040 PG 1 Schedule 1 Form 1040 Page 1. Form Department of the Treasury- Internal Revenue Service (99) 1040 U.S. Individual Income Tax Return 2021 OMB No. 1545-0074 Married filing Filing Status Single Married filing separately (MFS) jointly Check only one box. IRS Use Only-Do not write or staple in this space. Head of household (HOH) Qualifying widow(er) (QW) 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. Your first name and middle initial Last name Ken If joint return, spouse's first name and middle initial Last name Your social security number 111-22-3333 Spouse's social security number Home address (number and street). If you have a P.O. box, see instructions. City, town, or post office. If you have a foreign address, also complete spaces below. Foreign country name Foreign province/state/county State Foreign postal code Apt. no. ZIP code At any time during 2021, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency? 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 your tax or refund. You Spouse Yes No Standard Deduction Someone can claim: You as a dependent Your spouse as a dependent Age/Blindness Dependents You: (see instructions): Spouse itemizes on a separate return or you were a dual-status alien Were born before January 2, 1957 Are blind (2) Social security number Spouse: Was born before January 2, 1957 (3) Relationship to you Is blind (4) if qualifies for (see instructions): (1) First name Last name Child tax credit Credit for other dependents If more than four dependents, see instructions and check here 1 Wages, salaries, tips, etc. Attach Form(s) W-2 2a Tax-exempt interest Attach Sch. B if required. 3a Qualified dividends 4a IRA distributions 5a Pensions and annuities 6a Social security benefits 1 2a 0b Taxable interest. 2b 33,400 3a ob Ordinary dividends. 3b 4a Ob Taxable amount 4b 5a 28,400 b Taxable amount 5b 8a 28,400 b Taxable amount 8b 0 7 1,340 8 9 34,740 10 11 0 Standard Deduction for- Single or Married filing separately. $12,550 - Married filing jointly or Qualifying widow(er). $25,100 Head of household, $18,800 . If you checked any box under 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here 8 Other income from Schedule 1, line 10 9 Add lines 1,2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income 10 Adjustments to income from Schedule 1, line 26 11 Subtract line 10 from line 9. This is your adjusted gross income 12a Standard deduction or itemized deductions (from Schedule A) b Charitable contributions if you take the standard deduction (see instructions) c Add lines 12a and 12b Standard Deduction, 13 Qualified business income deduction from Form 8995 or Form 8995-A see instructions. 14 Add lines 12c and 13 15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. 12a 12b 0 12c 0 13 0 14 0 15 63,140 Cat. No. 113208 Form 1040 (2021) < Prev 2 of 2 Next Required Information [The following Information applies to the questions displayed below.] Ken is 63 years old and unmarried. He retired at age 55 when he sold his business, Understock.com. Though Ken is retired, he is still very active. Ken reported the following financial Information this year. Assume Ken files as a single taxpayer. a. Ken won $1,540 In an illegal game of poker (the game was played in Utah, where gambling is illegal). b. Ken sold 1,340 shares of stock for $32 a share. He inherited the stock two years ago. His tax basis (or Investment) in the stock was $31 per share. c. Ken received $28,400 from an annuity he purchased eight years ago. He purchased the annulty, to be paid annually for 20 years, for $238,560. d. Ken received $13,850 in disability benefits for the year. He purchased the disability Insurance policy last year. e. Ken decided to go back to school to learn about European history. He received a $840 cash scholarship to attend. He used $470 to pay for his books and tuition, and he applied the rest toward his new car payment. f. Ken's son, Mike, Instructed his employer to make half of his final paycheck of the year payable to Ken as a gift from Mike to Ken. Ken received the check on December 30 In the amount of $1,610. g. Ken received a $780 refund of the $3,940 in state Income taxes his employer withheld from his pay last year. Ken claimed $12,940 in itemized deductions last year (the standard deduction for a single filer was $12,550). h. Ken received $33,400 of Interest from corporate bonds and money market accounts. 2. Complete page 1 of Form 1040 through line 9 and Schedule 1 for Ken. Note: Input all the values as positive numbers. Enter any non-financial Information, (e.g. Names, Addresses, social security numbers) EXACTLY as they appear in any given Information or Problem Statement. Use 2022 tax rules regardless of year on tax form. Ken does not wish to contribute to the Presidential Election Campaign fund and did not have any virtual currency transactions or interests. Social security numbers: Ken: 111-22-3333 1040 for a single taxpayer. 1040 PG 1 Schedule 1