Leo (32) is filing as a single taxpayer. He changed jobs during the year, and when he left his first job, he decided to take a distribution of funds from his 401(k). He used the funds to make a down payment on a new car. The taxable amount of this distribution, reported in box 2a of Form 1099-R, was $14,500. There was a code 1 in box 7 of the Form 1099-R.
Leo was also the beneficiary of one of his great-grandmother's traditional IRAs. She passed away during the year, and Leo took a $2,000 distribution from the IRA. He used the money to pay down his credit card debt. As far as he knows, all of his great-grandmother's contributions to the account were deductible. This distribution was reported to him on a Form 1099-R with a code 4 in box 7.
Leo's only other income during the year was $40,000 in wages. He will claim the standard deduction.
Complete Schedule 2 (Form 1040), Additional Taxes, for Leo. You may also need to complete Form 5329, Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts. Then, enter the correct amounts on page 1 of Leo's Form 1040.
SCHEDULE 2 (Form 1040 or 1040-SR) Additional Taxes Department of the Treasury Attach to Form 1040 or 1040-SR. Internal Revenue Service Go to www.irs.gov/Form 1040 for instructions and the latest information. Name(s) shown on Form 1040 or 1040-SR OMB No. 1545-0074 2019 Attachment Sequence No. 02 Your social security number 4 Part I Tax 1 Alternative minimum tax. Attach Form 6251 1 2 Excess advance premium tax credit repayment. Attach Form 8962. 2 3 Add lines 1 and 2. Enter here and include on Form 1040 or 1040-SR, line 12b Part II Other Taxes 4 Self-employment tax. Attach Schedule SE. 5 Unreported social security and Medicare tax from Form: a 4137 b 8919 5 6 Additional tax on IRAs, other qualified retirement plans, and other tax-favored accounts. Attach Form 5329 if required . . 6 7a Household employment taxes. Attach Schedule H 7a b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required 7b 8 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 8 9 Section 965 net tax liability installment from Form 965-A 9 10 Add lines 4 through 8. These are your total other taxes. Enter here and on Form 1040 or 1040-SR, line 15. For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71478U Schedule 2 (Form 1040 or 1040-SR) 2019 00 10 5329 Additional Taxes on Qualified Plans Form (Including IRAs) and Other Tax-Favored Accounts (Rev. January 2020 Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. intamal Revenue Service Go to www.irs.gov/Forms329 for instructions and the latest information Name of individual subject to additional tax. It married fing jointly, see instructions. OMENO 1545-6074 2019 Attachment Sequence Ne 29 Your social security number Home address number and street), or P.O. box Imail is not delivered to your home Apt.no Fill in Your Address Only if You Are Filing This Form by itself and Not With Your Tax Return City, town or post office, state, and ZIP code. If you have a foreign address, also complete the spaces below. See instructions If this is an amended retum, check here Foreign postal code Foreign country name Foreign province/statcounty if you only owe the additional 10% tax on early distributions, you may be able to report this tax directly on Schedule 2 Form 1040 or 1040-SA), line 6, or Form 1040-NR line 57, without filing Form 5329. See the instructions for Schedule 2 (Form 1040 or 1040-SA), line 6 or for Form 1040-NA, line 57 Part 1 Additional Tax on Early Distributions. Complete this part of you took a taxable distribution (other than a qualified disaster distribution) before you reached age 59% from a qualified retirement plan including an IRA) or modified endowment contract (unless you are reporting this tax directly on Form 1040,1040-SR, or 1040-NR-see above). You also may have to complete this part to indicate that you quality for an exception to the additional tax on earty distributions or for certain Roth IRA distributions. See instructions. 1 Early distributions included in income. For Roth IRA distributions, see instructions. 2 Early distributions included on line 1 that are not subject to the additional tax (see instructions) Enter the appropriate exception number from the instructions: 2 3 Amount subject to additional tax. Subtract line 2 from line 1 3 4 Additional tax. Enter 10% (0.10) of line 3. Include this amount on Schedule 2 (Form 1040 or 1040-SR), line 6, or Form 1040-NR, line 57 Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have to include 25% of that amount on line 4 instead of 10%. See instructions. Part II Additional Tax on Certain Distributions From Education Accounts and ABLE Accounts. Complete this part if you included an amount in income, on Schedule 1 (Form 1040 or 1040-SR), line 8. or Form 1040-NR, line 21, from a Coverdell education savings account (ESA), a qualified tuition program (OTP) or an ABLE account. 5 Distributions included in income from a Coverdell ESA, a QTP. or an ABLE account 5 6 Distributions included on line 5 that are not subject to the additional tax (see instructions 6 7 Amount subject to additional tax. Subtract line 6 from line 5 7 8 Additional tax. Enter 10% (0.10) of line 7. Include this amount on Schedule 2 Form 1040 or 1040- SR), line 6, or Form 1040-NR, line 57 Part III Additional Tax on Excess Contributions to Traditional IRAs. Complete this part if you contributed more to your traditional IRAs for 2019 than is allowable or you had an amount on line 17 of your 2018 Form 5329. 9 Enter your excess contributions from line 16 of your 2018 Form 5329. See instructions. If zero, go to line 15 9 10 If your traditional IRA contributions for 2019 are less than your maximum allowable contribution, see instructions. Otherwise, enter-O-. 10 11 2019 traditional IRA distributions included in income (see instructions) 11 12 2019 distributions of prior year excess contributions (see instructions) 12 13 Add lines 10, 11, and 12 13 Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter --- 14 15 Excess contributions for 2019 (see instructions) 15 16 Total excess contributions. Add lines 14 and 15 16 17 Additional tax. Enter 6% 0.06) of the smaller of line 16 or the value of your traditional IRAs on December 31, 2019 including 2019 contributions made in 2020). Include this amount on Schedule 2 Form 1040 or 1040-SR, line 6, ar Form 1040-NR, line 57 17 Part IV Additional Tax on Excess Contributions to Roth IRAs. Complete this part if you contributed more to your Roth IRAs for 2019 than is allowable or you had an amount on line 25 of your 2018 Form 5329. 18 Enter your excess contributions from line 24 of your 2018 Form 5329. See instructions. It zero, go to line 23 18 19 If your Roth IRA contributions for 2019 are less than your maximum allowable contribution, see instructions. Otherwise, enter-O- 19 20 2019 distributions from your Roth IRAS (see instructions) 20 21 Add lines 19 and 20 21 22 Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter-O-. 22 23 Excess contributions for 2019 (see instructions) 23 24 Total excess contributions. Add lines 22 and 23 24 25 Additional tax. Enter 6% (0.06) of the smaller of line 24 or the value of your Roth IRAs on December 31, 2019 including 2019 contributions made in 2020). Include this amount on Schedule 2 (Fam 1040 or 1040-SR), line 6. or Form 1040-NR, line 57 25 For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions Cat No. 133290 Form 5329 2019 Page 2 Form 5329 (2019) Part V Additional Tax on Excess Contributions to Coverdell ESAs. Complete this part if the contributions to your Coverdell ESAs for 2019 were more than is allowable or you had an amount on line 33 of your 2018 Form 5329. 26 Enter the excess contributions from line 32 of your 2018 Form 5329. See instructions. If zero, go to line 31 26 27 If the contributions to your Coverdell ESAs for 2019 were less than the maximum allowable contribution, see instructions. Otherwise, enter-O- 27 28 2019 distributions from your Coverdell ESAS (see instructions) 28 29 Add ines 27 and 28 29 30 Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter-O- 30 31 Excess contributions for 2019 (see instructions) 31 32 Total excess contributions. Add lines 30 and 31 32 33 Additional tax. Enter 6% (0.06) of the smaller of line 32 or the value of your Coverdel ESAs on December 31, 2019 (including 2019 contributions made in 2020). Include this amount on Schedule 2 (Form 1040 or 1040-SR), line 6. or Form 1040-NR, line 57 33 Part VI Additional Tax on Excess Contributions to Archer MSAs. Complete this part if you or your employer contributed more to your Archer MSAs for 2019 than is allowable or you had an amount on line 41 of your 2018 Form 5329 34 Enter the excess contributions from line 40 of your 2018 Form 5329. See instructions. If zero, go to line 39 34 35 If the contributions to your Archer MSAs for 2019 are less than the maximum allowable contribution, see instructions. Otherwise, enter-O-. 35 36 2019 distributions from your Archer MSAS from Form 8853, line 8 36 37 Add lines 35 and 36 37 38 Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter-O- 38 39 Excess contributions for 2019 (see instructions) 39 40 Total excess contributions. Add lines 38 and 39 40 41 Additional tax. Enter 6% (0.06) of the smaller of line 40 or the value of your Archer MSAs on December 31, 2019 (including 2019 contributions made in 2020). Include this amount on Schedule 2 (Form 1040 or 1040-SA), line 6, or Form 1040-NR, line 57 41 Part Vil Additional Tax on Excess Contributions to Health Savings Accounts (HSAs). Complete this part if you, someone on your behalf, or your employer contributed more to your HSAs for 2019 than is allowable or you had an amount on line 49 of your 2018 Form 5329 42 Enter the excess contributions from line 48 of your 2018 Form 5329. If zero, go to line 47 42 43 If the contributions to your HSAs for 2019 are less than the maximum allowable contribution, see instructions. Otherwise, enter-O-. 2019 distributions from your HSAs from Form 8889, line 16 44 45 Add lines 43 and 44 45 46 Prior year excess contributions. Subtract line 45 from line 42. If zero or less, enter-O- 46 47 Excess contributions for 2019 (see instructions) 47 48 Total excess contributions. Add lines 46 and 47 48 49 Additional tax. Enter 6% (0.06) of the smaller of line 48 or the value of your HSAS on December 31, 2019 including 2019 contributions made in 2020). Include this amount on Schedule 2 Form 1040 or 1040-SA), line 6. ar Form 1040-NR line 57 49 Part VIII Additional Tax on Excess Contributions to an ABLE Account. Complete this partit contributions to your ABLE account for 2019 were more than is allowable. 50 Excess contributions for 2019 (see instructions). 50 51 Additional tax. Enter 6% (0.06) of the smaller of line 50 or the value of your ABLE account on December 31, 2019. Include this amount on Schedule 2 (Form 1040 or 1040-SR), line 6, or Form 1040-NR, line 57 51 Part IX Additional Tax on Excess Accumulation in Qualified Retirement Plans (Including IRAs). Complete this part if you did not receive the minimum required distribution from your qualified retirement plan. 52 Minimum required distribution for 2019 (see instructions) 52 53 Amount actually distributed to you in 2019. 53 54 Subtract line 53 from line 52. If zero or less, enter-O- 54 55 Additional tax. Enter 50% (0.50) of line 54. Include this amount on Schedule 2 Form 1040 or 1040-SR), line 6, or Form 1040-NR, line 57 55 Sign Here Only If You tof Are Filing This Form beliat it is true, comect, and complete Declaration of prepare other than taxpayer is based on all information of which preparer has any knowledge by itself and Not With Your Tax Return Your signature Paid Print/Type preparer's name Preparar's signature Check OPTIN Preparer se employed Use Only Firm's name Firm's EIN Firm's address Form 5329 2019 Phone 2019) Department of the Treasury - Internal Revenue Service 1040 (99) U.S. Individual Income Tax Return OMB No 1545-0074 RS Use Onty- Do not write ar staple in this space Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH Qualifying widower) (OW) 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 if 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 retum, 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 spouse if filing jointly, want $3 to go to this fund. 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/state/county 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 alien Age/Blindness Your Were bom before January 2, 1955 Are blind Spouse: Was bom before January 2, 1955 Is blind Dependents (see instructions): (2) Social security number (3) Relationship to you 4 qualifies for see instructions (1) First name Last name Child tax credit Credit for other dependents 1 2b 3b 4b 4c 4d 5b 6 7a 1 Wages, salaries, tips, etc. Attach Fomis) W-2 2a Tax-exempt interest 2a b Taxable interest. Attach Sch. B if required 3a 3a Qualified dividends Standard b Ordinary dividends. Attach Sch. Bit required Deduction for 4a IRA distributions. 4a b Taxable amount Single or Married filing separately Pensions and annuities d Taxable amount $12,200 5a Social security benefits 5a b Taxable amount Married ting jointly or Qualting Capital gain or loss). Attach Schedule D if required. If not required, check here widower Ta Other income from Schedule 1, line 9 $24.400 Head of b Add lines 1, 2b, 3b, 46, 4, 5, 6, and 7a. This is your total income household $18,350 Ba Adjustments to income from Schedule 1, line 22 you checked b Subtract line Ba from line 7b. This is your adjusted gross income any box under Standard 9 Standard deduction or itemized deductions (from Schedule A) 9 Deduction, 10 see instructions. 10 Qualified business income deduction. Attach Form 1995 or Form 1995-A 11a Add lines 9 and 10. b Taxable income. Subtract line 11a from line 8b. If zero or less, enter-O- For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 113200 7b Ba A Bb 11a 11b Form 1040 20191 SCHEDULE 2 (Form 1040 or 1040-SR) Additional Taxes Department of the Treasury Attach to Form 1040 or 1040-SR. Internal Revenue Service Go to www.irs.gov/Form 1040 for instructions and the latest information. Name(s) shown on Form 1040 or 1040-SR OMB No. 1545-0074 2019 Attachment Sequence No. 02 Your social security number 4 Part I Tax 1 Alternative minimum tax. Attach Form 6251 1 2 Excess advance premium tax credit repayment. Attach Form 8962. 2 3 Add lines 1 and 2. Enter here and include on Form 1040 or 1040-SR, line 12b Part II Other Taxes 4 Self-employment tax. Attach Schedule SE. 5 Unreported social security and Medicare tax from Form: a 4137 b 8919 5 6 Additional tax on IRAs, other qualified retirement plans, and other tax-favored accounts. Attach Form 5329 if required . . 6 7a Household employment taxes. Attach Schedule H 7a b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required 7b 8 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 8 9 Section 965 net tax liability installment from Form 965-A 9 10 Add lines 4 through 8. These are your total other taxes. Enter here and on Form 1040 or 1040-SR, line 15. For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71478U Schedule 2 (Form 1040 or 1040-SR) 2019 00 10 5329 Additional Taxes on Qualified Plans Form (Including IRAs) and Other Tax-Favored Accounts (Rev. January 2020 Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. intamal Revenue Service Go to www.irs.gov/Forms329 for instructions and the latest information Name of individual subject to additional tax. It married fing jointly, see instructions. OMENO 1545-6074 2019 Attachment Sequence Ne 29 Your social security number Home address number and street), or P.O. box Imail is not delivered to your home Apt.no Fill in Your Address Only if You Are Filing This Form by itself and Not With Your Tax Return City, town or post office, state, and ZIP code. If you have a foreign address, also complete the spaces below. See instructions If this is an amended retum, check here Foreign postal code Foreign country name Foreign province/statcounty if you only owe the additional 10% tax on early distributions, you may be able to report this tax directly on Schedule 2 Form 1040 or 1040-SA), line 6, or Form 1040-NR line 57, without filing Form 5329. See the instructions for Schedule 2 (Form 1040 or 1040-SA), line 6 or for Form 1040-NA, line 57 Part 1 Additional Tax on Early Distributions. Complete this part of you took a taxable distribution (other than a qualified disaster distribution) before you reached age 59% from a qualified retirement plan including an IRA) or modified endowment contract (unless you are reporting this tax directly on Form 1040,1040-SR, or 1040-NR-see above). You also may have to complete this part to indicate that you quality for an exception to the additional tax on earty distributions or for certain Roth IRA distributions. See instructions. 1 Early distributions included in income. For Roth IRA distributions, see instructions. 2 Early distributions included on line 1 that are not subject to the additional tax (see instructions) Enter the appropriate exception number from the instructions: 2 3 Amount subject to additional tax. Subtract line 2 from line 1 3 4 Additional tax. Enter 10% (0.10) of line 3. Include this amount on Schedule 2 (Form 1040 or 1040-SR), line 6, or Form 1040-NR, line 57 Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have to include 25% of that amount on line 4 instead of 10%. See instructions. Part II Additional Tax on Certain Distributions From Education Accounts and ABLE Accounts. Complete this part if you included an amount in income, on Schedule 1 (Form 1040 or 1040-SR), line 8. or Form 1040-NR, line 21, from a Coverdell education savings account (ESA), a qualified tuition program (OTP) or an ABLE account. 5 Distributions included in income from a Coverdell ESA, a QTP. or an ABLE account 5 6 Distributions included on line 5 that are not subject to the additional tax (see instructions 6 7 Amount subject to additional tax. Subtract line 6 from line 5 7 8 Additional tax. Enter 10% (0.10) of line 7. Include this amount on Schedule 2 Form 1040 or 1040- SR), line 6, or Form 1040-NR, line 57 Part III Additional Tax on Excess Contributions to Traditional IRAs. Complete this part if you contributed more to your traditional IRAs for 2019 than is allowable or you had an amount on line 17 of your 2018 Form 5329. 9 Enter your excess contributions from line 16 of your 2018 Form 5329. See instructions. If zero, go to line 15 9 10 If your traditional IRA contributions for 2019 are less than your maximum allowable contribution, see instructions. Otherwise, enter-O-. 10 11 2019 traditional IRA distributions included in income (see instructions) 11 12 2019 distributions of prior year excess contributions (see instructions) 12 13 Add lines 10, 11, and 12 13 Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter --- 14 15 Excess contributions for 2019 (see instructions) 15 16 Total excess contributions. Add lines 14 and 15 16 17 Additional tax. Enter 6% 0.06) of the smaller of line 16 or the value of your traditional IRAs on December 31, 2019 including 2019 contributions made in 2020). Include this amount on Schedule 2 Form 1040 or 1040-SR, line 6, ar Form 1040-NR, line 57 17 Part IV Additional Tax on Excess Contributions to Roth IRAs. Complete this part if you contributed more to your Roth IRAs for 2019 than is allowable or you had an amount on line 25 of your 2018 Form 5329. 18 Enter your excess contributions from line 24 of your 2018 Form 5329. See instructions. It zero, go to line 23 18 19 If your Roth IRA contributions for 2019 are less than your maximum allowable contribution, see instructions. Otherwise, enter-O- 19 20 2019 distributions from your Roth IRAS (see instructions) 20 21 Add lines 19 and 20 21 22 Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter-O-. 22 23 Excess contributions for 2019 (see instructions) 23 24 Total excess contributions. Add lines 22 and 23 24 25 Additional tax. Enter 6% (0.06) of the smaller of line 24 or the value of your Roth IRAs on December 31, 2019 including 2019 contributions made in 2020). Include this amount on Schedule 2 (Fam 1040 or 1040-SR), line 6. or Form 1040-NR, line 57 25 For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions Cat No. 133290 Form 5329 2019 Page 2 Form 5329 (2019) Part V Additional Tax on Excess Contributions to Coverdell ESAs. Complete this part if the contributions to your Coverdell ESAs for 2019 were more than is allowable or you had an amount on line 33 of your 2018 Form 5329. 26 Enter the excess contributions from line 32 of your 2018 Form 5329. See instructions. If zero, go to line 31 26 27 If the contributions to your Coverdell ESAs for 2019 were less than the maximum allowable contribution, see instructions. Otherwise, enter-O- 27 28 2019 distributions from your Coverdell ESAS (see instructions) 28 29 Add ines 27 and 28 29 30 Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter-O- 30 31 Excess contributions for 2019 (see instructions) 31 32 Total excess contributions. Add lines 30 and 31 32 33 Additional tax. Enter 6% (0.06) of the smaller of line 32 or the value of your Coverdel ESAs on December 31, 2019 (including 2019 contributions made in 2020). Include this amount on Schedule 2 (Form 1040 or 1040-SR), line 6. or Form 1040-NR, line 57 33 Part VI Additional Tax on Excess Contributions to Archer MSAs. Complete this part if you or your employer contributed more to your Archer MSAs for 2019 than is allowable or you had an amount on line 41 of your 2018 Form 5329 34 Enter the excess contributions from line 40 of your 2018 Form 5329. See instructions. If zero, go to line 39 34 35 If the contributions to your Archer MSAs for 2019 are less than the maximum allowable contribution, see instructions. Otherwise, enter-O-. 35 36 2019 distributions from your Archer MSAS from Form 8853, line 8 36 37 Add lines 35 and 36 37 38 Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter-O- 38 39 Excess contributions for 2019 (see instructions) 39 40 Total excess contributions. Add lines 38 and 39 40 41 Additional tax. Enter 6% (0.06) of the smaller of line 40 or the value of your Archer MSAs on December 31, 2019 (including 2019 contributions made in 2020). Include this amount on Schedule 2 (Form 1040 or 1040-SA), line 6, or Form 1040-NR, line 57 41 Part Vil Additional Tax on Excess Contributions to Health Savings Accounts (HSAs). Complete this part if you, someone on your behalf, or your employer contributed more to your HSAs for 2019 than is allowable or you had an amount on line 49 of your 2018 Form 5329 42 Enter the excess contributions from line 48 of your 2018 Form 5329. If zero, go to line 47 42 43 If the contributions to your HSAs for 2019 are less than the maximum allowable contribution, see instructions. Otherwise, enter-O-. 2019 distributions from your HSAs from Form 8889, line 16 44 45 Add lines 43 and 44 45 46 Prior year excess contributions. Subtract line 45 from line 42. If zero or less, enter-O- 46 47 Excess contributions for 2019 (see instructions) 47 48 Total excess contributions. Add lines 46 and 47 48 49 Additional tax. Enter 6% (0.06) of the smaller of line 48 or the value of your HSAS on December 31, 2019 including 2019 contributions made in 2020). Include this amount on Schedule 2 Form 1040 or 1040-SA), line 6. ar Form 1040-NR line 57 49 Part VIII Additional Tax on Excess Contributions to an ABLE Account. Complete this partit contributions to your ABLE account for 2019 were more than is allowable. 50 Excess contributions for 2019 (see instructions). 50 51 Additional tax. Enter 6% (0.06) of the smaller of line 50 or the value of your ABLE account on December 31, 2019. Include this amount on Schedule 2 (Form 1040 or 1040-SR), line 6, or Form 1040-NR, line 57 51 Part IX Additional Tax on Excess Accumulation in Qualified Retirement Plans (Including IRAs). Complete this part if you did not receive the minimum required distribution from your qualified retirement plan. 52 Minimum required distribution for 2019 (see instructions) 52 53 Amount actually distributed to you in 2019. 53 54 Subtract line 53 from line 52. If zero or less, enter-O- 54 55 Additional tax. Enter 50% (0.50) of line 54. Include this amount on Schedule 2 Form 1040 or 1040-SR), line 6, or Form 1040-NR, line 57 55 Sign Here Only If You tof Are Filing This Form beliat it is true, comect, and complete Declaration of prepare other than taxpayer is based on all information of which preparer has any knowledge by itself and Not With Your Tax Return Your signature Paid Print/Type preparer's name Preparar's signature Check OPTIN Preparer se employed Use Only Firm's name Firm's EIN Firm's address Form 5329 2019 Phone 2019) Department of the Treasury - Internal Revenue Service 1040 (99) U.S. Individual Income Tax Return OMB No 1545-0074 RS Use Onty- Do not write ar staple in this space Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH Qualifying widower) (OW) 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 if 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 retum, 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 spouse if filing jointly, want $3 to go to this fund. 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/state/county 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 alien Age/Blindness Your Were bom before January 2, 1955 Are blind Spouse: Was bom before January 2, 1955 Is blind Dependents (see instructions): (2) Social security number (3) Relationship to you 4 qualifies for see instructions (1) First name Last name Child tax credit Credit for other dependents 1 2b 3b 4b 4c 4d 5b 6 7a 1 Wages, salaries, tips, etc. Attach Fomis) W-2 2a Tax-exempt interest 2a b Taxable interest. Attach Sch. B if required 3a 3a Qualified dividends Standard b Ordinary dividends. Attach Sch. Bit required Deduction for 4a IRA distributions. 4a b Taxable amount Single or Married filing separately Pensions and annuities d Taxable amount $12,200 5a Social security benefits 5a b Taxable amount Married ting jointly or Qualting Capital gain or loss). Attach Schedule D if required. If not required, check here widower Ta Other income from Schedule 1, line 9 $24.400 Head of b Add lines 1, 2b, 3b, 46, 4, 5, 6, and 7a. This is your total income household $18,350 Ba Adjustments to income from Schedule 1, line 22 you checked b Subtract line Ba from line 7b. This is your adjusted gross income any box under Standard 9 Standard deduction or itemized deductions (from Schedule A) 9 Deduction, 10 see instructions. 10 Qualified business income deduction. Attach Form 1995 or Form 1995-A 11a Add lines 9 and 10. b Taxable income. Subtract line 11a from line 8b. If zero or less, enter-O- For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 113200 7b Ba A Bb 11a 11b Form 1040 20191
