Form 1040 U.S. Individual Income Tax Return 2019 Filing Status Check only one box. (99) Department of the TreasuryInternal Revenue Service Single Married filing jointly Married filing separately (MFS) OMB No. 1545-0074 IRS Use OnlyDo 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 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 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. 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 Apt. no. City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Foreign country name Foreign province/state/county Standard Deduction Someone can claim: Age/Blindness You: You as a dependent If more than four dependents, see instructions and here Your spouse as a dependent Spouse itemizes on a separate return or you were a dual-status alien Were born before January 2, 1955 (1) First name Spouse: Are blind Dependents (see instructions): Standard Deduction for Single or Married filing separately, $12,200 Married filing jointly or Qualifying widow(er), $24,400 Head of household, $18,350 If you checked any box under Standard Deduction, see instructions. Foreign postal code Was born before January 2, 1955 (2) Social security number (3) Relationship to you Is blind (4) if qualifies for (see instructions): Child tax credit Credit for other dependents Last name 1 Wages, salaries, tips, etc. Attach Form(s) W-2 . 2a Tax-exempt interest . . . . 2a b Taxable interest. Attach Sch. B if required 2b 3a Qualified dividends . . . . 3a b Ordinary dividends. Attach Sch. B if required 3b 4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b c Pensions and annuities . . . 4c d Taxable amount . . . . . . 4d 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b 6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . 7a Other income from Schedule 1, line 9 . . . . . . . . . 7a 7b b 8a b 9 10 11a b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6 Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . 8a Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . 8b Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 9 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10 Add lines 9 and 10 . . . . . . . . . . . . 11a . . . . . . . . . . . 11b . . . . . . . . . . . . . Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2019) Page 2 Form 1040 (2019) 12a b 13a b If you have a qualifying child, attach Sch. EIC. If you have nontaxable combat pay, see instructions. Refund Direct deposit? See instructions. Amount You Owe Third Party Designee Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 Add Schedule 2, line 3, and line 12a and enter the total Child tax credit or credit for other dependents . . . 12a . . . . . . . . . . . . . . . . . . . . . 12b 13a Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . 13b 14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 16 Add lines 14 and 15. This is your total tax . 17 Federal income tax withheld from Forms W-2 and 1099 18 Other payments and refundable credits: . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . . . . 17 a Earned income credit (EIC) . . . . . . . . . . . 18a b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b c American opportunity credit from Form 8863, line 8 . . . . . . . . 18c d Schedule 3, line 14 . . . . . . . . . . 18d e Add lines 18a through 18d. These are your total other payments and refundable credits . . . . . 18e 19 Add lines 17 and 18e. These are your total payments . . . . . . 19 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . b Routing number d Account number . . . . . . . . . . . . . . . . . . . . . c Type: . Checking 22 Amount of line 20 you want applied to your 2020 estimated tax . 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions 24 Estimated tax penalty (see instructions) . . . . . . . . . . . . . . . 20 21a Savings 22 . . . . . 23 24 Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes. Complete below. No (Other than paid preparer) Designee's name Sign Here 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 belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Paid Preparer Use Only Joint return? See instructions. Keep a copy for your records. Phone no. Personal identification number (PIN) Your signature Date Your occupation If the IRS sent you an Identity Protection PIN, enter it here (see inst.) Spouse's signature. If a joint return, both must sign. Date Spouse's occupation If the IRS sent your spouse an Identity Protection PIN, enter it here (see inst.) Phone no. Email address Preparer's name Preparer's signature Date PTIN Check if: 3rd Party Designee Firm's name Firm's address Self-employed Phone no. Go to www.irs.gov/Form1040 for instructions and the latest information. Firm's EIN Form 1040 (2019) SCHEDULE 1 (Form 1040 or 1040-SR) Department of the Treasury Internal Revenue Service OMB No. 1545-0074 Additional Income and Adjustments to Income Go 2019 Attach to Form 1040 or 1040-SR. to www.irs.gov/Form1040 for instructions and the latest information. Attachment Sequence No. 01 Your social security number Name(s) shown on Form 1040 or 1040-SR At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part I 1 2a b 3 4 5 6 7 8 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . Alimony received . . . . . . . . . . . . . . . . . . . . . . . . Date of original divorce or separation agreement (see instructions) Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . Unemployment compensation . . . . . . . . . . . . . . . . . . . . Other income. List type and amount . . . . . . . . 1 2a . . . . . . . . . . . . . . . . . . . . 3 4 5 6 7 9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a . . . . 8 9 Part II Yes No Additional Income . . . . Adjustments to Income 10 11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . . . 13 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . . 14 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . 15 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . 16 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . 17 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . 18a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Recipient's SSN . . . . . . . . . . . . . . . . . . . . . c Date of original divorce or separation agreement (see instructions) 19 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . 21 Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . 22 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040 or 1040-SR, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71479F 10 11 12 13 14 15 16 17 18a 19 20 21 22 Schedule 1 (Form 1040 or 1040-SR) 2019 SCHEDULE A (Form 1040 or 1040-SR) Department of the Treasury Internal Revenue Service (99) Itemized Deductions OMB No. 1545-0074 to www.irs.gov/ScheduleA for instructions and the latest information. Attach to Form 1040 or 1040-SR. Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 16. Taxes You Paid 1 2 3 4 5 Caution: Do not include expenses reimbursed or paid by others. Medical and dental expenses (see instructions) . . . . . . Enter amount from Form 1040 or 1040-SR, line 8b 2 Multiply line 2 by 7.5% (0.075) . . . . . . . . . . . . Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . State and local taxes. 1 . . . . a State and local income taxes or general sales taxes. You may include either income taxes or general sales taxes on line 5a, but not both. If you elect to include general sales taxes instead of income taxes, check this box . . . . . . . . . . . . . . . . . b State and local real estate taxes (see instructions) . . . . . . . c State and local personal property taxes . . . . . . . . . . d Add lines 5a through 5c . . . . . . . . . . . . . . . e Enter the smaller of line 5d or $10,000 ($5,000 if married filing separately) . . . . . . . . . . . . . . . . . . . 6 Other taxes. List type and amount 7 Add lines 5e and 6 Attachment Sequence No. 07 Your social security number Name(s) shown on Form 1040 or 1040-SR Medical and Dental Expenses 2019 Go . . . . . . . . . . . . . . . . . 3 . . . . . . 4 . . . . 7 . . . . 10 . . . . 14 5a 5b 5c 5d 5e 6 . . Interest You 8 Home mortgage interest and points. If you didn't use all of your home Paid mortgage loan(s) to buy, build, or improve your home, see Caution: Your mortgage interest deduction may be limited (see instructions). instructions and check this box . . . . . . . . . . . a Home mortgage interest and points reported to you on Form 1098. See instructions if limited . . . . . . . . . . . . . . . . 8a b Home mortgage interest not reported to you on Form 1098. See instructions if limited. If paid to the person from whom you bought the home, see instructions and show that person's name, identifying no., and address . . . . . . . . . . . . . . . . . . . 8b Gifts to Charity Caution: If you made a gift and got a benefit for it, see instructions. Casualty and Theft Losses c Points not reported to you on Form 1098. See instructions for special rules . . . . . . . . . . . . . . . . . . . . . d Mortgage insurance premiums (see instructions) . . . . . . . e Add lines 8a through 8d . . . . . . . . . . . . . . . 9 Investment interest. Attach Form 4952 if required. See instructions 10 Add lines 8e and 9 . . . . . . . . . . . . . . . . . 11 Gifts by cash or check. If you made any gift of $250 or more, see instructions . . . . . . . . . . . . . . . . . . . 12 Other than by cash or check. If you made any gift of $250 or more, see instructions. You must attach Form 8283 if over $500 . . . . 13 Carryover from prior year . . . . . . . . . . . . . . 14 Add lines 11 through 13 . . . . . . . . . . . . . . . . 8c 8d 8e 9 . . 11 12 13 . . 15 Casualty and theft loss(es) from a federally declared disaster (other than net qualified disaster losses). Attach Form 4684 and enter the amount from line 18 of that form. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Otherfrom list in instructions. List type and amount 15 Other Itemized Deductions 16 Total 17 Add the amounts in the far right column for lines 4 through 16. Also, enter this amount on Form 1040 or 1040-SR, line 9 . . . . . . . . . . . . . . . . . . . . 17 Itemized Deductions 18 If you elect to itemize deductions even though they are less than your standard deduction, check this box . . . . . . . . . . . . For Paperwork Reduction Act Notice, see the Instructions for Forms 1040 and 1040-SR. . . . . . . Cat. No. 17145C . . Schedule A (Form 1040 or 1040-SR) 2019 Individual Tax Return homework Instructions: complete the 2019 federal individual income tax return (Form 1040, Schedule 1 and Schedule A) for Bob and Melissa Grant. Stop after completing 1040 Line 12a for this homework. Submit and check you're a Bob and Melissa Grant are married and live in Lexington, Kentucky. The Grants have 17-year old twin daughters. The Grants would like to file a joint tax return for the year. The following information relates to the Grant's tax year: Bob's Social Security number is 987-45-1234 Melissa's Social Security number is 494-37-4893 Jane's Social Security number is 412-32-5690 Anna's Social Security number is 412-32-6940 The Grants' mailing address is 95 Hickory Road, Lexington, Kentucky 40502. Jane and Anna are tax dependents for federal tax purposes Bob Grant received the following during the year: Employer University of Kentucky Gross Wages $117,450 Federal Income Tax Withholding $22,000 State Income Tax Withholding $6,000 Federal Income Tax Withholding $2,450 State Income Tax Withholding $1,025 Melissa Grant received the following during the year: Employer Gross Wages Jensen Photography $20,500 All applicable and appropriate payroll taxes were withheld by Grants' respective employers. The Grants also received the following during the year: Interest Income from First Kentucky Bank Interest Income from City of Lexington, KY Bond Interest Income from U.S. Treasury Bond $580 $600 $825 Disability insurance payments received by Bob on account of injury 3,000 Bob's employer paid for the insurance policy issued by Aflac (NYSE AFL) as part of the tax-free fringe benefits Payment to Melissa as a result of a lawsuit for damages she sustained in a car accident: Reimbursement for her medical Expenses $14,500 Punitive Damages $10,000 1 Eight years ago, Melissa purchased an annuity contract for $80,000. This year, she received her first payment on the annuity. The payment amount was $16,000. The annuity started to pay on January 1 and she received a full first year's payment. It will pay her $16,000 per year for ten years beginning this year. In 2019, they also received $420 of Kentucky state income tax refund. They took itemized deduction in 2018 and the amount of their total itemized deduction in 2018 is $31,878. The total of their 2018 State and Local Taxes paid is $9,100. The Grants also placed $455 in the Kentucky Derby and won $3,225 from their tickets. The Grants paid or incurred the following expenses during the year: Dentist/Orthodontist (not paid by insurance) Medical visits (not paid by insurance) Prescriptions (not paid by insurance) Real property taxes on residence Mortgage interest on principal residence Contribution to First Baptist Church of Kentucky (Qualified Charity) Fee paid to Jones & Company, CPAs for tax preparation $ 23,000 625 380 1,800 8,560 7,000 200 In addition, Melissa paid $2,500 of interest on her student loan. During the year, the Grants' personal belongings were damaged by a federally declared disaster in September of the current year. All the items are considered damaged in one event. Item Purchase Date Decline in FMV Tax Basis of Item Laptop computer and Printer Rifle TV/Projector 2005 Honda Pilot 09/01/2013 3,000 3,000 Insurance Reimbursement Received 500 03/01/2010 03/01/2010 07/01/2011 12,000 5,000 4,000 12,500 13,000 6,500 500 1,000 500 The Grants do not want to contribute to the Presidential Election Campaign and do not have any virtual currency. 2