PLEASE USE THE INFORMATION ABOVE TO FILL OUT SCHEDULE 1,2 AND 3 FORM 1040!

Tammy Campbell 789-78-6789 32 5798 Main Street New York New York 10014 Married Filing Separately Peter Campbell 754-21-9517 34 Elizabeth Campbell 824-92-3467 6 Name SSN Age Other Street Address City State Zip Filing Status Spouse Name Spouse SSN Spouse Age Dependent Name Dependent SSN Dependent Age Dependent Name Dependent SSN Dependent Age Dependent Name Dependent Age Dependent SSN Additional tax on IRAs Business Income (QBI) Charitable Contributions by Check Credit for Childcare Expenses Education Credits Educator Expenses Eligible for Child Tax Credit Federal Income Tax Withheld Home Mortgage Interest Medical Expenses Non-Taxable Interest Ordinary Dividends Other Income Real Estate Taxes Rental Income Residential Energy Credit Self Employment Tax State Income Taxes State Sales Taxes Student Loan Interest deduction Taxable Interest Unreported Social security and Medicare Tax Wages 25,934 18,000 419 1,500 1,200 Yes 25,368 5,219 6,582 3,128 4,208 6,218 7,368 1,800 5,641 10,236 6,512 3,418 163,800 SCHEDULE 1 (Form 1040 or 1040-SR) Additional Income and Adjustments to Income 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. 01 Your social security number 1 3 6 9 At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency? . Yes No Part Additional Income 1 Taxable refunds, credits, or offsets of state and local income taxes 2a Alimony received 2a b Date of original divorce or separation agreement (see instructions) 3 Business income or (loss). Attach Schedule C. 4 Other gains or losses). Attach Form 4797. 4 5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. 5 6 Farm income or loss). Attach Schedule F 7 Unemployment compensation 7 8 Other income. List type and amount 8 9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a Part II Adjustments to Income 10 Educator expenses 10 11 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 .. 11 12 Health savings account deduction. Attach Form 8889 12 13 Moving expenses for members of the Armed Forces. Attach Form 3903 13 14 Deductible part of self-employment tax. Attach Schedule SE 14 15 Self-employed SEP, SIMPLE, and qualified plans. 15 16 Self-employed health insurance deduction 16 17 Penalty on early withdrawal of savings 17 18a Alimony paid. 18a b Recipient's SSN C Date of original divorce or separation agreement (see instructions) IRA deduction 19 20 Student loan interest deduction 20 21 Tuition and fees. Attach Form 8917 21 22 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040 or 1040-SR, line 8a 22 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71479F Schedule 1 (Form 1040 or 1040-SR) 2019 19 WN - SCHEDULE 2 OMB No. 1545-0074 (Form 1040 or 1040-SR) Additional Taxes 2019 Department of the Treasury Attach to Form 1040 or 1040-SR. Attachment Internal Revenue Service Go to www.irs.gov/Form 1040 for instructions and the latest information. Sequence No. 02 Name(s) shown on Form 1040 or 1040-SR Your social security number Part 1 Alternative minimum tax. Attach Form 6251 1 2 Excess advance premium tax credit repayment. Attach Form 8962 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 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 10 Add lines 4 through 8. These are your total other taxes. Enter here and on Form 1040 or 1040-SR, line 15 10 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 71478U Schedule 2 (Form 1040 or 1040-SR) 2019 8 8 9