General Facts: Rodney and Alice Smith have three small children, ranging in age from 5 to 10. One child, the youngest is blind and needs special care. Rodney works as an accountant for a large CPA firm and has gross income of $68,000 (Federal withholding $7,500 State withholding $3,200). Alice is a lawyer with a national law firm and earns $56,000 (Federal withholding $5,100 State withholding $2,100). Group-term life insurance: Rodney's employer provides group-term life insurance at twice the employee's annual salary. Rodney is 40 years of age. (Use tables in textbook) Dividends: During 2022, Rodney and Alice receive the following dividends on their jointly held investments: Dividends from Mexico Inc. (Mexican Corp) $750 (Ordinary Dividend) Dividends from Widget Steel Corp $150 (Ordinary Dividend AND Qualifying Dividend) Interest Income: They received interest income from the following investments: Interest on State of Ohio highway bonds $840 (Tax exempt on federal & State of Ohio) Interest on deposits in savings and loans $400. Child Care Expenses: Rodney and Alice have childcare expenses for the youngest child paid to We Tote Tots (Federal Identification = 12-3456789) in the amount of $400 per month. Special needs educational expenses for the youngest child due to blindness are $1,500 (which is a medical deduction, not childcare). Itemized Deductions: Medical expenses for. Rodney for MD Rx S 610 Alice $1,000 Children $ 4,000 Rodney's father $ 300 Rodney's mother $ 600 Real estate property taxes: 32,200 Interest on Home Mortgage: 56,100 Contributions: Christian Church $650 Red Cross $150 Cancer Heart $100 Goodwill (Furniture) $150 value Fill in the from 1040 the tax return using the IRS fill-in forms found at www.irs.gov, including Form 1040 $1040 Filing Status Check only one bax. 2021 OMB No. 1545-0074 S Use Only-Do not write or staple in this space Single Married filing jointly Manied filing separately (MFS) 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 social security number Your first name and middle initial Department of the Treasury-Intermal Pev Servic U.S. Individual Income Tax Return Foreign country name If more than four dependents, I joint return, spouse's first name and middle initial 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. Attach Sch. Bif required. see instructions and check here Standard Deduction for- Single or Marriad Sing separataly $12.550 Last name 6a 7 Last name Last name 8 9 Marriad Sing 10 jointly or At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Someone can claim: Standard Deduction You as a dependent Your spouse as a dependent Spouse itemizes on a separate retum or you were a dual-status alien Age/Blindness You: Were born before January 2, 1957 Dependents (see instructions): Spouse: Are blind (2) Social security number (1) First name State Foreign province/state/county Wages, salaries, tips, etc. Attach Form(s) W-2 2a 3a 4a 5a 6a 2a Tax-exempt interest 3a Qualified dividends 4a IRA distributions 5a Pensions and annuities Social security benefits b Taxable amount. Capital gain or (oss). Attach Schedule D if required. If not required, check here Other income from Schedule 1, line 10- Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income Adjustments to income from Schedule 1, line 26 ZIP code b Taxable interest b Ordinary dividends b Taxable amount. b Taxable amount 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 13 Qualified business income deduction from Form 8995 or Form 8995-A Add lines 12c and 13 14 15 Taxable income. Subtract line 14 from line 11. If zero or less, enter-O- Qualifying widowed 125,100 Head of household $18.900 If you checked any box under Standard Deduction, instructions For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Apt. no. Foreign postal code your tax or refund. Spouse's social security number Was born before January 2, 1957 (3) Relationship to you 12a 12b Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a bax below will not change CM. No 11320 Is blind (4)r qualifies for (see instructions: Child tax credit Credit for other dependents 1 2b 3b 4b 5b 6b 07 8 9 10 11 You Spouse Yes No 12c 13 14 15 Form 1040 (201) Form 1040 (2021) If you have a qualifying child anach Sch. EIC. 18 17 18 19 20 21 22 23 24 25 Refund Direct deposit? See instructions Sign Here a b 0 d 26 27a 28858 31 32 33 Tax (see instructions). Check if any from Form(s): 1 Amount from Schedule 2, line 3 Add lines 16 and 17 Add lines 25a through 25c 2021 estimated tax payments and amount applied from 2020 return Eamed income credit (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 0 Prior year (2019) earned income 27a Refundable child tax credit or additional child tax credit from Schedule 8812 29 American opportunity credit from Form 8863, line 8. 30 Recovery rebate credit. See instructions 36 Amount 37 You Owe 38 Third Party Designee Add lines 19 and 20 Subtract line 21 from line 18. If zero or less, enter-0- 8814 Nonrefundable child tax credit or credit for other dependents from Schedule 8812 Amount from Schedule 3, line 8 Form(s) W-2 Form(s) 1099 Other forms (see instructions) 2 4972 3 Other taxes, including self-employment tax, from Schedule 2, line 21 Add lines 22 and 23. This is your total tax Federal income tax withheld from: 28 29 30 Amount from Schedule 3, line 15 31 Add lines 27a and 28 through 31. These are your total other payments and refundable credits Add lines 25d, 26, and 32. These are your total payments 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid 35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here b Routing number Type: Checking Savings d 25a 25b 250 Phone 27a 18 17 18 19 20 21 22 23 24 25d 26 Account number Amount of line 34 you want applied to your 2022 estimated tax 36 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions Estimated tax penalty (see instructions) 38 Do you want to allow another person to discuss this return with the IRS? See instructions Designe's name 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 jother than taxpayer) is based on all information of which preparer has any knowledge. Dato Your signature Your occupation If the IRS sent you an identity PIN, enter there 32 33 34 35a 37 Yes. Complete below. Personal identification number (PIN) K Protection tane inst Page 2 No