Patty Banyan is a single taxpayer, age 27 (birthdate May 18, 1992) living at 543 Space Drive, Houston, TX 77099. Her Social Security number is 466-33-1234. For 2019, Patty has no dependents, and received a W-2, from her job at a local restaurant where she parks cars. These wages are Patty's only income for 2019.

Required:
Complete Form 1040 for Patty Banyan for the 2019 tax year. If there is an over-payment, she would like a refund.

• She wants to donate $3 to the Presidential Election Campaign Fund. The election to donate does not affect tax liability in any way.
• Patty has health care coverage for the full year.
• Enter all amounts as positive numbers.
• If an amount box requires no entry or the amount is zero, enter "0".
• If required, round amounts to the nearest dollar.

an Employee's social security number 466-33-1234

OMB No. 1545-0008

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b Employer identification number (EIN) 33-1235672			1 Wages, tips, other compensation 20,051.12		2 Federal income tax withheld 1,197.78
c Employer's name, address, and ZIP code Burger Box 1234 Mountain Road Houston, TX 77099			3 Social security wages 20,051.12		4 Social security tax withheld 1,243.17
			5 Medicare wages and tips 20,051.12		6 Medicare tax withheld 290.74
			7 Social security tips		8 Allocated tips
d Control number			9		10 Dependent care benefits
e Employee's first name and initial Last name Suff. Patty Banyan 543 Space Drive Houston, TX 77099			11 Nonqualified plans		12a See instructions for box 12
			13Statutory employee Retirement plan Third-party sick pay ◻ ◻ ◻		Code |
					12b
			14 Other		Code |
					12c
					Code |
					12d
					Code |
f Employee's address and ZIP code

15 State TX	Employer's state ID number	16 State wages, tips, etc.	17 State income tax	18 Local wages, tips, etc.	19 Local income tax		20 Locality name

Form W-2 Wage and Tax Statement Copy—To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service.

2019

Department of the Treasury—Internal Revenue Service