Department of the Treasury - Internal Revenue Service (99) 1040 U.S. Individual Income Tax Return 2021 OMB No 1545-0074 IRSI A Only-Do not write or staple in this space Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW) Check only 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 one box. . person is a child but not your dependent Your first name and middle initial Last name Your social security number If joint return, spouse's first name and middle initial , Last name Spouse's social security number Home address (number and street). If you have a P.O. box, see instructions. . Apt. no. Presidential Election Campaign Check here if you, or your City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change Foreign country name Foreign province/state/county / Foreign postal code your tax or refund. You Spouse At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes No 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 alien Age/Blindness You: Were born before January 2, 1957 Are blind Spouse: Was born before January 2, 1957 , Is blind Dependents (see instructions): (2) Social Security (3) Relationship (4) If qualifies for (see instructions): if If more (1 (1) First name Last name number to you Child tax credit Credit for other dependents than four dependents, see instructions and check here 1 Wages, salaries, tips, etc. Attach Form(s) W-2 1 Attach 2a Tax-exempt interest. 2a b Taxable interest 2b Sch. Bit 3a Qualified dividends 3b b Ordinary dividends . required. 4a IRA distributions . 4a b Taxable amount 4b 5a Pensions and annuities 5a b Taxable amount b 5b Standard 6a Social security benefits b Taxable amount b 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 .... 8 separately, $12,550 9 Add lines 1, 2b, 3, 4, 5b, 6b, 7, and 8. This is your total income 9 Married filing 10 Adjustments to income from Schedule 1, line 26 10 jointly or Qualifying 11 Subtract line 10 from line 9. This is your adjusted gross income 11 widow(er), 12a $25,100 12a Standard deduction or itemized deductions (from Schedule A) Head of b Charitable contributions if you take the standard deduction (see instructions) 12b household $18.800 c Add lines 12a and 12b. 12c 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 Deduction, see instructions 15 Taxable income. Subtract line 14 from line 11. If zero or less, enter-O- . 15 E| | | a | Form 1040 (2021) Page 2 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 16 17 Amount from Schedule 2, line 3 18 Add lines 16 and 17 .. 19 Nonrefundable child tax credit or credit for other dependents from Schedule 8812 20 Amount from Schedule 3, line 8 21 Add lines 19 and 20 22 Subtract line 21 from line 18. If zero or less, enter-O- 23 Other taxes, including self-employment tax, from Schedule 2 line 21 23 24 Add lines 22 and 23. This is your total tax 24 25 Federal income tax withheld from: a Form(s) W-2 25a b Form(s) 1099 25b c Other forms (see instructions) 25c d Add lines 25a through 25c 25d 26 26 If you have a 2021 estimated tax payments and amount applied from 2020 return qualifying child. 27a Earned income credit (EIC). 27a attach Sch. EIC. Check here if you were born after January 1, 1998, and before January 2, 2004, and you satisfy all the other requirements for taxpayers who are at least age 18, to claim the EIC. See instructions b Nontaxable combat pay election 27b c Prior year (2019) eamed income 27c 28 Refundable child tax credit or additional child tax credit from Schedule 8812 28 29 American opportunity credit from Form 8863, line 8. 29 30 Recovery rebate credit. See instructions 30 31 Amount from Schedule 3, line 15 31 32 Add lines 27 and 28 through 31. These are your total other payments and refundable credits 32 33 Add lines 25d, 26, and 32. These are your total payments 33 Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid 34 35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here 35a Direct deposit? > Routing number c Type: Checking Savings See instructions Account number 36 Amount of line 34 you want applied to your 2022 estimated tax.. 36 Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions 37 You Owe 38 Estimated tax penalty (see instructions) 38 Third Party Do you want to allow another person to discuss this return with the IRS? See Designee instructions Yes. Complete below. No Designee's Phone Personal identification name no. number (PIN) Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and Here belief, they are true, correct, and complete. Declaration of prepare (other than taxpayer) is based on all information of which preparer has any knowledge. 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 return, both must sign. Date Spouse's occupation if the IRS 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 PTIN Check if: Self-employed Preparer Firm's name Phone no. Use Only Firm's address Firm's EIN Date Paid Individual Tax Return Problem 3 Required: Use the following information to complete Rhonda Hill's 2019 federal income tax return. If any information is missing, use reasonable assumptions to fill in the gaps. The forms, schedules, and instructions can be found at the IRS website (www.irs.gov). The instructions can be helpful in completing the forms. Facts: 1. Rhonda Hill (unmarried) is employed as an office manager at the main office of Carter and Associates CPA firm. Rhonda lives in a home she purchased 20 years ago. Rhonda's older cousin Mabel Wright lives with Rhonda in the home. Mabel is retired and receives $2,400 of Social Security payments each year. Mabel is able to save this money because Rhonda provides all of Mabel's support. Rhonda also provided the following information: Rhonda does not want to contribute to the presidential election campaign. Rhonda lives at 1234 Blue Ridge Way, Tulsa, Oklahoma 74101. Rhonda's birthday is 12/18/1955 and her Social Security number is 335-67-8910. Mabel's birthday is 11/2/1946 and her Social Security number is 566-77-8899. Rhonda does not have any foreign bank accounts or trusts. Rhonda did not acquire, sell, or exchange virtual currency in 2019. 2. Rhonda received a Form W-2 from Carter and Associates (her employer) that contained the following information: Line 1 Wages. tips. other compensation Line 2 Federal income tax withheld Line 3 Social Security wages Line 4 Social Security tax withheld Line 5 Medicare wages and tips Line 6 Medicare tax withheld Line 16 State wages, tips, etc. Line 17 State income tax Carter and Associates address is 1234 CPA Way Tulsa, Oklahoma 74101; its FEIN is 91:0001002; and its State ID number is 123456678 $72,000 7,800 72,000 4,464 72,000 1,044 72,000 2,700 3. Rhonda received $250 in interest from Tulsa City bonds, $120 interest from IBM bonds, and $15 from her savings account at UCU Credit Union. She also received a $460 dividend from Huggies Company and $500 from Bicker Corporation. Both dividends are qualified dividends. 4. Rhonda sold 200 shares of DM stock for $18 a share on June 15, 2019. She purchased the stock on December 12, 2013, for $10 a share. She also sold 50 shares of RSA stock for $15 a share on October 2, 2019. She purchased the stock for $65 a share on February 2, 2019. Stock basis amounts have been reported to the IRS. 5. The following is a record of the medical expenses that Rhonda paid for herself during the year. The amounts reported are amounts she paid in excess of insurance reimbursements. Rhonda drove 210 miles for medical purposes in 2019. Insurance premiums Prescription medications Over-the-counter medications Doctor and dentist visits Eyeglasses Physical therapy $3,700 100 250 1,450 300 200 6. Rhonda paid $6,800 in mortgage interest during the year to UCU credit union (reported to her on Form 1098). She also paid $1,240 in real property taxes during the year. 7. Rhonda contributed $5,400 to Heavenly Church during the year. Heavenly Church's address is 1342 Religion Way, Tulsa, Oklahoma 74101. Department of the Treasury - Internal Revenue Service (99) 1040 U.S. Individual Income Tax Return 2021 OMB No 1545-0074 IRSI A Only-Do not write or staple in this space Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW) Check only 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 one box. . person is a child but not your dependent Your first name and middle initial Last name Your social security number If joint return, spouse's first name and middle initial , Last name Spouse's social security number Home address (number and street). If you have a P.O. box, see instructions. . Apt. no. Presidential Election Campaign Check here if you, or your City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change Foreign country name Foreign province/state/county / Foreign postal code your tax or refund. You Spouse At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes No 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 alien Age/Blindness You: Were born before January 2, 1957 Are blind Spouse: Was born before January 2, 1957 , Is blind Dependents (see instructions): (2) Social Security (3) Relationship (4) If qualifies for (see instructions): if If more (1 (1) First name Last name number to you Child tax credit Credit for other dependents than four dependents, see instructions and check here 1 Wages, salaries, tips, etc. Attach Form(s) W-2 1 Attach 2a Tax-exempt interest. 2a b Taxable interest 2b Sch. Bit 3a Qualified dividends 3b b Ordinary dividends . required. 4a IRA distributions . 4a b Taxable amount 4b 5a Pensions and annuities 5a b Taxable amount b 5b Standard 6a Social security benefits b Taxable amount b 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 .... 8 separately, $12,550 9 Add lines 1, 2b, 3, 4, 5b, 6b, 7, and 8. This is your total income 9 Married filing 10 Adjustments to income from Schedule 1, line 26 10 jointly or Qualifying 11 Subtract line 10 from line 9. This is your adjusted gross income 11 widow(er), 12a $25,100 12a Standard deduction or itemized deductions (from Schedule A) Head of b Charitable contributions if you take the standard deduction (see instructions) 12b household $18.800 c Add lines 12a and 12b. 12c 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 Deduction, see instructions 15 Taxable income. Subtract line 14 from line 11. If zero or less, enter-O- . 15 E| | | a | Form 1040 (2021) Page 2 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 16 17 Amount from Schedule 2, line 3 18 Add lines 16 and 17 .. 19 Nonrefundable child tax credit or credit for other dependents from Schedule 8812 20 Amount from Schedule 3, line 8 21 Add lines 19 and 20 22 Subtract line 21 from line 18. If zero or less, enter-O- 23 Other taxes, including self-employment tax, from Schedule 2 line 21 23 24 Add lines 22 and 23. This is your total tax 24 25 Federal income tax withheld from: a Form(s) W-2 25a b Form(s) 1099 25b c Other forms (see instructions) 25c d Add lines 25a through 25c 25d 26 26 If you have a 2021 estimated tax payments and amount applied from 2020 return qualifying child. 27a Earned income credit (EIC). 27a attach Sch. EIC. Check here if you were born after January 1, 1998, and before January 2, 2004, and you satisfy all the other requirements for taxpayers who are at least age 18, to claim the EIC. See instructions b Nontaxable combat pay election 27b c Prior year (2019) eamed income 27c 28 Refundable child tax credit or additional child tax credit from Schedule 8812 28 29 American opportunity credit from Form 8863, line 8. 29 30 Recovery rebate credit. See instructions 30 31 Amount from Schedule 3, line 15 31 32 Add lines 27 and 28 through 31. These are your total other payments and refundable credits 32 33 Add lines 25d, 26, and 32. These are your total payments 33 Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid 34 35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here 35a Direct deposit? > Routing number c Type: Checking Savings See instructions Account number 36 Amount of line 34 you want applied to your 2022 estimated tax.. 36 Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions 37 You Owe 38 Estimated tax penalty (see instructions) 38 Third Party Do you want to allow another person to discuss this return with the IRS? See Designee instructions Yes. Complete below. No Designee's Phone Personal identification name no. number (PIN) Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and Here belief, they are true, correct, and complete. Declaration of prepare (other than taxpayer) is based on all information of which preparer has any knowledge. 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 return, both must sign. Date Spouse's occupation if the IRS 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 PTIN Check if: Self-employed Preparer Firm's name Phone no. Use Only Firm's address Firm's EIN Date Paid Individual Tax Return Problem 3 Required: Use the following information to complete Rhonda Hill's 2019 federal income tax return. If any information is missing, use reasonable assumptions to fill in the gaps. The forms, schedules, and instructions can be found at the IRS website (www.irs.gov). The instructions can be helpful in completing the forms. Facts: 1. Rhonda Hill (unmarried) is employed as an office manager at the main office of Carter and Associates CPA firm. Rhonda lives in a home she purchased 20 years ago. Rhonda's older cousin Mabel Wright lives with Rhonda in the home. Mabel is retired and receives $2,400 of Social Security payments each year. Mabel is able to save this money because Rhonda provides all of Mabel's support. Rhonda also provided the following information: Rhonda does not want to contribute to the presidential election campaign. Rhonda lives at 1234 Blue Ridge Way, Tulsa, Oklahoma 74101. Rhonda's birthday is 12/18/1955 and her Social Security number is 335-67-8910. Mabel's birthday is 11/2/1946 and her Social Security number is 566-77-8899. Rhonda does not have any foreign bank accounts or trusts. Rhonda did not acquire, sell, or exchange virtual currency in 2019. 2. Rhonda received a Form W-2 from Carter and Associates (her employer) that contained the following information: Line 1 Wages. tips. other compensation Line 2 Federal income tax withheld Line 3 Social Security wages Line 4 Social Security tax withheld Line 5 Medicare wages and tips Line 6 Medicare tax withheld Line 16 State wages, tips, etc. Line 17 State income tax Carter and Associates address is 1234 CPA Way Tulsa, Oklahoma 74101; its FEIN is 91:0001002; and its State ID number is 123456678 $72,000 7,800 72,000 4,464 72,000 1,044 72,000 2,700 3. Rhonda received $250 in interest from Tulsa City bonds, $120 interest from IBM bonds, and $15 from her savings account at UCU Credit Union. She also received a $460 dividend from Huggies Company and $500 from Bicker Corporation. Both dividends are qualified dividends. 4. Rhonda sold 200 shares of DM stock for $18 a share on June 15, 2019. She purchased the stock on December 12, 2013, for $10 a share. She also sold 50 shares of RSA stock for $15 a share on October 2, 2019. She purchased the stock for $65 a share on February 2, 2019. Stock basis amounts have been reported to the IRS. 5. The following is a record of the medical expenses that Rhonda paid for herself during the year. The amounts reported are amounts she paid in excess of insurance reimbursements. Rhonda drove 210 miles for medical purposes in 2019. Insurance premiums Prescription medications Over-the-counter medications Doctor and dentist visits Eyeglasses Physical therapy $3,700 100 250 1,450 300 200 6. Rhonda paid $6,800 in mortgage interest during the year to UCU credit union (reported to her on Form 1098). She also paid $1,240 in real property taxes during the year. 7. Rhonda contributed $5,400 to Heavenly Church during the year. Heavenly Church's address is 1342 Religion Way, Tulsa, Oklahoma 74101