1040 U.S. Individual Income Tax Return 2019 Department of the Treasury-intamal Revenue Service 1991 OMB No. 1545-0074 IRS USA Oray-Doriot wit or staple in this space. Filing Status Single Maried filing Jointly Married ting separataty (MES Head of household (OH) Qualitying widower) (OM Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or GW box, enter the child's name it the qualifying person is one box a child but not your dependent Your first name and middle initial Last name Your social security number If joint retuen, spouse's first name and middle initial Last name Spouse's social security number Home address number and street. you have a P.O.box, see instructions. Apt. . Presidential Election Campaign Check here you, or your spouse it ring intly, want $3 to go to this tund City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your tax or refund You Spouse Foreign country name Foreign province/statcounty Foreign postal code If more than four dependents see instructions and here Standard Someone can claim You as a dependent Your spouse as a dependent Deduction Spouse itemizes on a separate return or you were a dual-status alion Age/Blindness You Were bom before January 2, 1966 Are bind Spouse: Was born before January 2, 1955 Is blind Dependents (see instructions): (2) Social security number (3) Relationship to you (4) / t qualities for see instructions (1) First name Last name Child tax credit Credit for other dependents 2b 3b 4b 4d Sb 6 1 Wages, salanes, tips, etc. Attach Fomis) W-2. 2a Tax-exempt interest 2a b Taxable interest. Attach Sch. Bit required 3a Qualified dividends 3a Standard b Ordinary dividends. Attach Sch. Bif required Deduction for 4a IRA distributions 4a b Taxable amount Single or Married C 40 | Pensions and annuities ing party d Taxable amount $12.200 5a Social secunty benefits b Taxable amount Mariefling 6 intly or Outlying Capital gain or loss. Attach Schedule D it required. If not required, check here widowie $24.400 7a Other income from Schedule 1. line 9 b Head of Add lines 1, 2, 3, 46, 4, 5, 6, and 7a. This is your total income household Ba Adjustments to income from Schedule 1, line 22 $18.350 If you checked b Subtractine Ba from line 7h. This is your adjusted gross income any box under Standard 9 Standard deduction or itemized deductions (from Schedule A) 9 Dediction 10 Qualified business income deduction. Attach Form 890s or Form 1995-A 10 de instructions. Add lines 9 and 10 b Taxable income. Subtract line 1 la from line 8b. If zero or less, enter-O- For Disclosure. Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cal No. 11320B 7b Ba Bb 11a 11b Form 1040 2019 Page 2 . 16 Form 1040 (2019 12a Tax (see inst.) Check it any from Forms 1 8814 2 4972 3 12a b Add Schedule 2. ine 3, and line 12a and enter the total 12b 13a Chid tax credit or credit for other dependents 13a b Add Schedule 3. Ine 7, and line 13a and enter the total 13b 14 Subtract line 13b from line 12b. If zero or less, enter-D- 14 15 Other tances, including self-employment tax, trom Schedule 2. ine 10 15 16 Add lines 14 and 15. This is your totaltak. 17 Federal income tax withheld from Forms W-2 and 1099 17 you have a 18 Other payments and refundable credits: quan ying tin, a Eamed Income credit (EIC) 18a attach Sch. EIC 18b . If you have b Additional child tax credit. Attach Schedule 8812 more 0 180 combat pay, American opportunity credit from Form 8862, line 8 instructions d Schedule 3, Ine 14 - . 180 e Add lines 18a through 18d. These are your total other payments and refundable credits 180 19 Add lines 17 and 18. These are your total payments 19 20 Refund 20 If line 19 is more than ine 16, subtract line 16 from line 19. This is the amount you overpald 21a Amount of time 20 you want refunded to you. If Form 8888 is attached, check here 21a Direct deposit? Routing number Type: Checking Savings Sestructions. Account number 22 Amount of line 20 you want applied to your 2020 estimated tax 22 Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions 23 You Owe 24 Estimated tax penalty (see instructions) 24 Third Party Do you want to allow another person fother than your paid preparer) to discuss this rebum with the IRS? See instructions. Yes. Complete below. Designee No Other than Designee's Phone Personal identification paid prepare name no. number (PIN) Sign Under perties of perjuy, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belie. they are true, correct, and complee Declaration of prepare fother than tapayer) is based on information of which preparer has any knowledge Here Your signature Date Your occupation If the IRS sent you an identity Protection PIN, enter it here Joint return? (see inst.) See instructions Spouse's signature. If a joint rotum, both must sign. Date Spouse's occupation If the RS sent your spouse an Keep a copy for Identity Protection PIN, enter it here your records (see inst.) Phone no. Email address Preparer's name Preparer's signature Date PTIN Check: Paid ard Party Designer Preparer Firm's name Phone no Self-employed Use Only Firm's address Firm's EN Go to www.irs.gow Form1040 for instructions and the latest intammation. For 1040 (2019 Download the Tax Form and enter the required values in the appropriate fields. 1040 U.S. Individual Income Tax Return 2019 Department of the Treasury-intamal Revenue Service 1991 OMB No. 1545-0074 IRS USA Oray-Doriot wit or staple in this space. Filing Status Single Maried filing Jointly Married ting separataty (MES Head of household (OH) Qualitying widower) (OM Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or GW box, enter the child's name it the qualifying person is one box a child but not your dependent Your first name and middle initial Last name Your social security number If joint retuen, spouse's first name and middle initial Last name Spouse's social security number Home address number and street. you have a P.O.box, see instructions. Apt. . Presidential Election Campaign Check here you, or your spouse it ring intly, want $3 to go to this tund City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your tax or refund You Spouse Foreign country name Foreign province/statcounty Foreign postal code If more than four dependents see instructions and here Standard Someone can claim You as a dependent Your spouse as a dependent Deduction Spouse itemizes on a separate return or you were a dual-status alion Age/Blindness You Were bom before January 2, 1966 Are bind Spouse: Was born before January 2, 1955 Is blind Dependents (see instructions): (2) Social security number (3) Relationship to you (4) / t qualities for see instructions (1) First name Last name Child tax credit Credit for other dependents 2b 3b 4b 4d Sb 6 1 Wages, salanes, tips, etc. Attach Fomis) W-2. 2a Tax-exempt interest 2a b Taxable interest. Attach Sch. Bit required 3a Qualified dividends 3a Standard b Ordinary dividends. Attach Sch. Bif required Deduction for 4a IRA distributions 4a b Taxable amount Single or Married C 40 | Pensions and annuities ing party d Taxable amount $12.200 5a Social secunty benefits b Taxable amount Mariefling 6 intly or Outlying Capital gain or loss. Attach Schedule D it required. If not required, check here widowie $24.400 7a Other income from Schedule 1. line 9 b Head of Add lines 1, 2, 3, 46, 4, 5, 6, and 7a. This is your total income household Ba Adjustments to income from Schedule 1, line 22 $18.350 If you checked b Subtractine Ba from line 7h. This is your adjusted gross income any box under Standard 9 Standard deduction or itemized deductions (from Schedule A) 9 Dediction 10 Qualified business income deduction. Attach Form 890s or Form 1995-A 10 de instructions. Add lines 9 and 10 b Taxable income. Subtract line 1 la from line 8b. If zero or less, enter-O- For Disclosure. Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cal No. 11320B 7b Ba Bb 11a 11b Form 1040 2019 Page 2 . 16 Form 1040 (2019 12a Tax (see inst.) Check it any from Forms 1 8814 2 4972 3 12a b Add Schedule 2. ine 3, and line 12a and enter the total 12b 13a Chid tax credit or credit for other dependents 13a b Add Schedule 3. Ine 7, and line 13a and enter the total 13b 14 Subtract line 13b from line 12b. If zero or less, enter-D- 14 15 Other tances, including self-employment tax, trom Schedule 2. ine 10 15 16 Add lines 14 and 15. This is your totaltak. 17 Federal income tax withheld from Forms W-2 and 1099 17 you have a 18 Other payments and refundable credits: quan ying tin, a Eamed Income credit (EIC) 18a attach Sch. EIC 18b . If you have b Additional child tax credit. Attach Schedule 8812 more 0 180 combat pay, American opportunity credit from Form 8862, line 8 instructions d Schedule 3, Ine 14 - . 180 e Add lines 18a through 18d. These are your total other payments and refundable credits 180 19 Add lines 17 and 18. These are your total payments 19 20 Refund 20 If line 19 is more than ine 16, subtract line 16 from line 19. This is the amount you overpald 21a Amount of time 20 you want refunded to you. If Form 8888 is attached, check here 21a Direct deposit? Routing number Type: Checking Savings Sestructions. Account number 22 Amount of line 20 you want applied to your 2020 estimated tax 22 Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions 23 You Owe 24 Estimated tax penalty (see instructions) 24 Third Party Do you want to allow another person fother than your paid preparer) to discuss this rebum with the IRS? See instructions. Yes. Complete below. Designee No Other than Designee's Phone Personal identification paid prepare name no. number (PIN) Sign Under perties of perjuy, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belie. they are true, correct, and complee Declaration of prepare fother than tapayer) is based on information of which preparer has any knowledge Here Your signature Date Your occupation If the IRS sent you an identity Protection PIN, enter it here Joint return? (see inst.) See instructions Spouse's signature. If a joint rotum, both must sign. Date Spouse's occupation If the RS sent your spouse an Keep a copy for Identity Protection PIN, enter it here your records (see inst.) Phone no. Email address Preparer's name Preparer's signature Date PTIN Check: Paid ard Party Designer Preparer Firm's name Phone no Self-employed Use Only Firm's address Firm's EN Go to www.irs.gow Form1040 for instructions and the latest intammation. For 1040 (2019 Download the Tax Form and enter the required values in the appropriate fields