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Page 2 b Form(s) 1099 c Other forms (see instructions) d Add lines 25a through 25c 262022 estimated tax payments and amount applied from 2021 return \begin{tabular}{|c|c|c|c|c|c|} \hline & b Form(s) 1099 & 25b & 10,500 & & \\ \hline & c Other forms (see instructions) & 25c & 0 & & \\ \hline & d Add lines 25a through 25c & & & 25d & 10,500 \\ \hline & 262022 estimated tax payments and amount applied from 2021 return & & & 26 & \\ \hline \begin{tabular}{l} - If you have \\ a qualifying \\ child, attach \\ Sch. EIC \end{tabular} & 27 Earned income credit (EIC) & 27 & & & \\ \hline & 28 Additional child tax credit from Schedule 8812 & 28 & 0 & & \\ \hline & 29 American opportunity credit from Form 8863, line 8 . & 29 & 0 & & \\ \hline & 30 Reserved for future use & 30 & & & \\ \hline & 31 Amount from Schedule 3, line 15 & 31 & & & \\ \hline & 32 Add lines 27,28,29, and 31 . These are your total other payments and refundable credits & & & 32 & 0 \\ \hline & 33 Add lines 25d,26, and 32 . These are your total payments & & & 33 & 10,500 \\ \hline \end{tabular} 34 If line 33 is more than line 24 , subtract line 24 from line 33 . This is the amount vou overpaid Part I 1 2a b 3 4 5 6 7 8 a b c d e Additional Income 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: Net operating loss Gambling Cancellation of debt Foreign earned income exclusion from Form 2555 Income from Form 8853 \begin{tabular}{|c|c|c|c|c|} \hline & & & & \\ \hline r & Scholarship and fellowship grants not reported on Form W-2 & 8r & & \\ \hline s & \multirow{2}{*}{\begin{tabular}{l} Nontaxable amount of Medicaid waiver payments included on Form \\ 1040 , line 1a or 1d \\ Pension or annuity from a nonqualifed deferred compensation plan or \\ a nongovernmental section 457 plan \end{tabular}} & 8s & & \\ \hline t & & 8t & & \\ \hline u & Wages earned while incarcerated & 8u & & \\ \hline z & Other income. List type and amount & 8z & & \\ \hline 9 & \multicolumn{2}{|l|}{ Total other income. Add lines 8a through 8z } & 9 & \\ \hline 10 & \multicolumn{2}{|c|}{ Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8} & 10 & 0 \\ \hline \end{tabular} Part II Adjustments to Income 11 Educator expenses 12 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 13 Health savings account deduction. Attach Form 8889 14 Moving expenses for members of the Armed Forces. Attach Form 3903 15 \begin{tabular}{|c|c|} \hline 11 & \\ \hline 12 & \\ \hline 13 & \\ \hline 14 & \\ \hline 15 & \\ \hline \end{tabular} \begin{tabular}{|c|c|} \hline b & \begin{tabular}{l} Deductible expenses related to income reported on line 81 from the \\ rental of personal property engaged in for profit \end{tabular} \\ \hline c & \begin{tabular}{l} Nontaxable amount of the value of Olympic and Paralympic medals \\ and USOC prize money reported on line 8m \end{tabular} \\ \hline d & Reforestation amortization and expenses \\ \hline e & \begin{tabular}{l} Repayment of supplemental unemployment benefits under the Trade Act of \\ 1974 \end{tabular} \\ \hline f & Contributions to section 501(c)(18)(D) pension plans \\ \hline g & Contributions by certain chaplains to section 403(b) plans \\ \hline h & \begin{tabular}{l} Attorney fees and court costs for actions involving certain unlawful \\ discrimination claims (see instructions) \end{tabular} \\ \hline i & \begin{tabular}{l} Attorney fees and court costs you paid in connection with an award from the \\ IRS for information you provided that helped the IRS detect tax law violations \end{tabular} \\ \hline j & Housing deduction from Form 2555 \\ \hline k & Excess deductions of section 67(e) expenses from Schedule K-1(Form 1041) \\ \hlinez & \begin{tabular}{l} Other adjustments: List type and \\ amount \end{tabular} \\ \hline \end{tabular} \begin{tabular}{|l|rr|} \hline Gross Income: & & \\ \hline Salary & $ & 37,800 \\ \hline Alimony received & $ & 14,400 \\ \hline Rental receipts & $ & 51,000 \\ \hline Disability insurance payments & $ & 1,200 \\ \hline Interest income from corporate bonds & $ & 0 \\ \hline Interest income from municipal bonds & $ & 106,600 \\ \hline (1) Gross income & & \\ \hline Deductions for AGI: & $ & 19,500 \\ \hline Expenses for rental property & $ & 19,500 \\ \hline (2) Total for AGI deductions & & \\ \hline (3) AGI & $ & 3,100 \\ \hline From AGl deductions: & $ & 6,100 \\ \hline Medical expenses & $ \\ \hline State income taxes & $ & \\ \hline \end{tabular} \begin{tabular}{|l|rr|} \hline \multicolumn{1}{|l|}{ Charitable contributions } & $ & 13,150 \\ \hline (4) Total itemized deductions & $ & 22,768 \\ \hline (5) Standard deduction & $ & 20,800 \\ \hline (6) Greater of itemized deductions or standard deduction & $ & 22,768 \\ \hline (7) Taxable income & $ & 64,332 \\ \hline(8) Tax on taxable income & $ & (64,854 \\ \hline(9) Credits & $ & 10,500 \\ \hline(10) Tax prepayments & $ & (3,291) \\ \hline Tax refund & $ & $ \\ \hline \end{tabular}