Software Evaluation Copy DO NOT MAIL: E-File Signature Authorization
Software Evaluation Copy DO NOT MAIL: E-File Signature Authorization
Software Evaluation Copy DO NOT MAIL: E-File Signature Authorization
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Submission Identification Number (SID) 756331202029403qmzo7
Taxpayer’s name Social security number
Daryl R Hobbs 455-47-2189
Spouse’s name Spouse’s social security number
Lauren E Hobbs 449-29-8195
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Part I Tax Return Information — Tax Year Ending December 31, 2019 (Whole dollars only)
1 Adjusted gross income (Form 1040 or 1040-SR, line 8b; Form 1040-NR, line 35) . . . . . . . 1 116,668.
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2 Total tax (Form 1040 or 1040-SR, line 16; Form 1040-NR, line 61) . . . . . . . . . . . . 2 12,573.
3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040 or 1040-SR, line 17; Form 1040-NR,
line 62a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 14,549.
4 Refund (Form 1040 or 1040-SR, line 21a; Form 1040-NR, line 73a; Form 1040-SS, Part I, line 13a) . 4 1,976.
5 Amount you owe (Form 1040 or 1040-SR, line 23; Form 1040-NR, line 75) . . . . . . . . . 5
Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
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Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and
statements for the tax year ending December 31, 2019, and to the best of my knowledge and belief, they are true, correct, and complete. I further
declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider,
transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason
for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize
the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution
account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the
financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial
I will enter my PIN as my signature on my tax year 2019 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
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Your signature a Date a
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I will enter my PIN as my signature on my tax year 2019 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.
Don’t enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the tax year 2019 electronically filed income tax return for the taxpayer(s)
indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Pub. 1345,
Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only 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
one box.
a child but not your dependent. a
Your first name and middle initial Last name Your social security number
Daryl R Hobbs 455-47-2189
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
Lauren E Hobbs 449-29-8195
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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
1024 S. Sharpshire
jointly, want $3 to go to this fund.
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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
Waxahachie TX 75165 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and here a
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Age/Blindness You: Were born before January 2, 1955 Are blind Spouse: Was born before January 2, 1955 Is blind
Dependents (see instructions): (2) Social security number (3) Relationship to you (4) if qualifies for (see instructions):
(1) First name Last name Child tax credit Credit for other dependents
Standard
Deduction for—
• Single or Married
filing separately,
1
2a
3a
4a
c
Wages, salaries, tips, etc. Attach Form(s) W-2 .
Tax-exempt interest .
Qualified dividends .
IRA distributions . .
Pensions and annuities .
.
.
.
.
.
.
.
.
.
.
.
2a
3a
4a
4c
opy D . . . . . . . . . . . . . .
b Taxable interest. Attach Sch. B if required
.
.
.
.
.
.
1
2b
3b
4b
4d
111,495.
ion C
$12,200 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b
• Married filing
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . a 6
jointly or Qualifying
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 7a 5,566.
$24,400
• Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . a 7b 117,061.
household, 393.
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a
• If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . a 8b 116,668.
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any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 24,400.
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Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10 1,035.
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 25,435.
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 91,233.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
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Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 11,787.
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b 11,787.
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 11,787.
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 786.
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . a 16 12,573.
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17 14,549.
• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . No
. . . 18a
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attach Sch. EIC.
• If you have b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b
nontaxable c American opportunity credit from Form 8863, line 8 . . . . . . . . 18c
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combat pay, see
instructions. d Schedule 3, line 14 . . . . . . . . . . . . . . . . . 18d
e Add lines 18a through 18d. These are your total other payments and refundable credits . . . . . a 18e
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19 14,549.
Refund 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 1,976.
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a 1,976.
Direct deposit? a b Routing number X X X X X X X X X a c Type: Checking Savings
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See instructions.
a d Account number X X X X X X X X X X X X X X X X X
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . a 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . a 23
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . . a 24
Third Party Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes. Complete below.
Designee No
(Other than
paid preparer)
Sign
Here
Designee’s
name a
Your signature
opy D Date
Phone
no. a
Your occupation
Personal identification
number (PIN) a
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.
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 05/19/20 PRO Form 1040 (2019)
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SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 01
Name(s) shown on Form 1040 or 1040-SR Your social security number
Daryl R & Lauren E Hobbs 455-47-2189
At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any
virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . 1
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2a Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Date of original divorce or separation agreement (see instructions) a
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3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . 3 5,566.
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 . . . . . . . . . . . . . . . . . . . . 6
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income. List type and amount a
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8
9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a . . . . . . . . 9 5,566.
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
13
14
15
16
17
opy D
Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . . .
Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . .
Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . .
Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . .
Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . .
Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . .
12
13
14
15
16
17
393.
ion C
18a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18a
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . . a
c Date of original divorce or separation agreement (see instructions) a
19 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . 20
21 Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . 21
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22 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040 or
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Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . 4 786.
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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
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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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 786.
For Paperwork Reduction Act Notice, see your tax return instructions. REV 05/19/20 PRO Schedule 2 (Form 1040 or 1040-SR) 2019
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SCHEDULE C Profit or Loss From Business OMB No. 1545-0074
2019
(Form 1040 or 1040-SR) (Sole Proprietorship)
a Go to www.irs.gov/ScheduleC for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
Lauren E Hobbs 449-29-8195
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
Drug testing a 6 2 1 5 1 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
Step One
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E Business address (including suite or room no.) a 201 E Main St suit 201
City, town or post office, state, and ZIP code Waxahachie, TX 75165
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F Accounting method: (1) Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2019? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . a
I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No
J If “Yes,” did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
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1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . a 1 288,570.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 288,570.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 288,570.
6
7
Part II
8
9
Advertising . . . .
Car and truck expenses (see
instructions) . . . . .
. 8
9
opy D
Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) .
Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . .
Expenses. Enter expenses for business use of your home only on line 30.
16,180.
18
19
20
Office expense (see instructions)
.
.
18
19
288,570.
965.
ion C
10 Commissions and fees . 10 90,702. a Vehicles, machinery, and equipment 20a 223.
11 Contract labor (see instructions) 11 2,174. b Other business property . . . 20b 31,673.
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21 1,179.
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 13,168.
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23 7,787.
instructions) . . . . . 13 24 Travel and meals:
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14 Employee benefit programs a Travel . . . . . . . . . 24a
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28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28 283,004.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 5,566.
30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method (see instructions).
Simplified method filers only: enter the total square footage of: (a) your home:
and (b) the part of your home used for business: . Use the Simplified
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}
• If a profit, enter on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or Form 1040-NR, line
13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and 31 5,566.
trusts, enter on Form 1041, line 3.
• If a loss, you must go to line 32.
}
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or
Form 1040-NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see the line 32a All investment is at risk.
31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
• If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 05/19/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
Schedule C (Form 1040 or 1040-SR) 2019 Page 2
Part III Cost of Goods Sold (see instructions)
33 Method(s) used to
value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35
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36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36
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37 Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . 37
39 Other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
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40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40
42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9
43
44
file Form 4562.
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and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must
When did you place your vehicle in service for business purposes? (month, day, year)
Of the total number of miles you drove your vehicle during 2019, enter the number of miles you used your vehicle for:
a 01/01/2019
ion C
a Business 27,896 b Commuting (see instructions) c Other 10,523
45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . Yes No
46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No
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Tolls/Parking 268.
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Subscriptions 881.
Gifts 683.
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Name of person with self-employment income (as shown on Form 1040, 1040-SR, or 1040-NR) Social security number of person
Lauren E Hobbs with self-employment income a 449-29-8195
Before you begin: To determine if you must file Schedule SE, see the instructions.
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May I Use Short Schedule SE or Must I Use Long Schedule SE?
Note: Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions.
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Did you receive wages or tips in 2019?
No Yes
d d d
Are you a minister, member of a religious order, or Christian
Yes Was the total of your wages and tips subject to social security Yes
O NO
Science practitioner who received IRS approval not to be taxed a or railroad retirement (tier 1) tax plus your net earnings from a
on earnings from these sources, but you owe self-employment
self-employment more than $132,900?
tax on other earnings?
No
No
d d
Are you using one of the optional methods to figure your net Did you receive tips subject to social security or Medicare tax Yes
Yes a
earnings (see instructions)? a that you didn't report to your employer?
d
No
d
No
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Yes
a
`
No
d
No
d
ion C
You may use Short Schedule SE below a You must use Long Schedule SE on page 2
Section A—Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE.
1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065),
box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a
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b If you received social security retirement or disability benefits, enter the amount of Conservation
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Reserve Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065),
box 20, code AH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b ( )
2 Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other
than farming). Ministers and members of religious orders, see instructions for types of income to
report on this line. See instructions for other income to report . . . . . . . . . . . . . 2 5,566.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . 3 5,566.
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4 Multiply line 3 by 92.35% (0.9235). If less than $400, you don't owe self-employment tax; don't file
this schedule unless you have an amount on line 1b . . . . . . . . . . . . . . . . a 4 5,140.
Note: If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see
instructions.
5 Self-employment tax. If the amount on line 4 is:
• $132,900 or less, multiply line 4 by 15.3% (0.153). Enter the result here and on Schedule 2 (Form
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Simplified Computation
a Attach
to your tax return.
2019
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form8995 for instructions and the latest information. Sequence No. 55
Name(s) shown on return Your taxpayer identification number
Daryl R & Lauren E Hobbs 455-47-2189
1 (a) Trade, business, or aggregation name (b) Taxpayer (c) Qualified business
identification number income or (loss)
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i Step One 449298195 5,173.
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ii
iii
iv
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7
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Total qualified business income. Combine lines 2 and 3. If zero or less, enter -0-
Qualified REIT dividends and publicly traded partnership (PTP) income or (loss)
(see instructions) . . . . . . . . . . . . . . . . . . . .
Qualified REIT dividends and qualified PTP (loss) carryforward from the prior
year . . . . . . . . . . . . . . . . . . . . . . . . .
4
Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . .
7 (
5,173.
0. )
5 1,035.
ion C
8 Total qualified REIT dividends and PTP income. Combine lines 6 and 7. If zero
or less, enter -0- . . . . . . . . . . . . . . . . . . . . 8 0.
9 REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . . 9 0.
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . 10 1,035.
11 Taxable income before qualified business income deduction . . . . . . 11 92,268.
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . 12 0.
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13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . 13 92,268.
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For Privacy Act and Paperwork Reduction Act Notice, see instructions. REV 05/19/20 PRO Form 8995 (2019)
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Form 4868 Application for Automatic Extension of Time
To File U.S. Individual Income Tax Return
OMB No. 1545-0074
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using your home computer or by using a tax professional who page 3).
uses e-file.
E-file Using Your Personal Computer
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3. You can file a paper Form 4868 and enclose payment of your
estimate of tax due (optional). or Through a Tax Professional
Refer to your tax software package or tax preparer for ways to file
It’s Convenient, electronically. Be sure to have a copy of your 2018 tax return—
Safe, and Secure you’ll be asked to provide information from the return for taxpayer
verification. If you wish to make a payment, you can pay by
IRS e-file is the IRS’s electronic filing program. You can get an electronic funds withdrawal or send your check or money order to
automatic extension of time to file your tax return by filing Form the address shown in the middle column under Where To File a
O NO
4868 electronically. You’ll receive an electronic acknowledgment Paper Form 4868 (see page 4).
once you complete the transaction. Keep it with your records. Don’t
mail in Form 4868 if you file electronically, unless you’re making a
payment with a check or money order (see page 3).
File a Paper Form 4868
Complete Form 4868 to use as a worksheet. If you think you may If you wish to file on paper instead of electronically, fill in the Form
owe tax when you file your return, you’ll need to estimate your total 4868 below and mail it to the address shown on page 4.
tax liability and subtract how much you’ve already paid (lines 4, 5,
and 6 below). For information on using a private delivery service, see page 4.
Several companies offer free e-filing of Form 4868 through the
Free File program. For more details, go to IRS.gov and click on
freefile.
Purpose of Form
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General Instructions
Note: If you’re a fiscal year taxpayer, you must file a paper Form
4868.
you don’t pay the amount due by the regular due date for Form 709, on page 2. Any remittance you make with your application for
you’ll owe interest and may also be charged penalties. If the donor extension will be treated as a payment of tax.
died during 2019, see the instructions for Forms 709 and 8892. You don’t have to explain why you’re asking for the extension.
We’ll contact you only if your request is denied.
Qualifying for the Extension Don’t file Form 4868 if you want the IRS to figure your tax or
To get the extra time, you must: you’re under a court order to file your return by the regular due date.
I DETACH HERE I
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Form 4868 Application for Automatic Extension of Time REV 05/19/20 PRO 1555
Department of the Treasury
Internal Revenue Service (99)
To File U.S. Individual Income Tax Return
For calendar year 2019, or other tax year beginning , 2019, ending , . 2019
Part I Identification Part II Individual Income Tax
1 4 Estimate of total tax liability for 2019. . . $ 11,390.
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Filing status MFJ MFJ MFJ MFJ
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Total income 70,707. 249,228. 175,014. 117,061.
O NO
Tax expense 1,200. 2,288. 1,894. 1,452.
Contributions
Misc. deductions
Total itemized/
standard deduction 12,600.
opy D 12,700. 24,000. 24,400.
ion C
Exemption amount 12,000. 12,150. 0. 0.
Applied to next
year’s estimated tax
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This return is NOT FINISHED until you complete the following instructions
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Prior to transmission of the return
Form 8879
The taxpayer should review, sign and date Form 8879 and return to
you prior to transmitting the tax return.
Refund Amount
O NO
There is a refund in the amount of $1976.00.
Receiving a paper check has been selected.
Note - PIN information is entered in Part VI of the Federal Information Worksheet. This worksheet only
serves as a record of the PIN information transmitted in the electronic return.
IL
QuickZoom to the Federal Information Worksheet to enter PIN information
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Taxpayer(s) entered PIN(s)
ERO entered Primary Taxpayer’s PIN
ERO entered Secondary Taxpayer’s PIN
ERO entered PIN(s) on behalf of taxpayer(s) X
O NO
B ' Signature of Electronic Return Originator
ERO Declaration:
I declare that the information contained in this electronic tax return is the information furnished to me by the
taxpayer. If the taxpayer furnished me a completed tax return, I declare that the information contained in
this electronic tax return is identical to that contained in the return provided by the taxpayer. If the furnished
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return was signed by a paid preparer, I declare I have entered the paid preparer’s identifying information in
the appropriate portion of this electronic return. If I am the paid preparer, under the penalties of perjury I
declare that I have examined this electronic return, and to the best of my knowledge and belief, it is true,
correct, and complete. This declaration is based on all information of which I have any knowledge.
Perjury Statement:
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Under penalties of perjury, I declare that I have examined this return, including any accompanying
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statements and schedules and, to the best of my knowledge and belief, it is true, correct, and complete.
Consent to Disclosure:
I consent to allow my Intermediate Service Provider, transmitter, or Electronic Return Originator (ERO) to
send my return to IRS and to receive the following information from IRS: (1) acknowledgement of receipt or
reason for rejection of transmission; (2) refund offset; (3) reason for any delay in processing or refund; and,
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I am signing this Tax Return and Electronic Funds Withdrawal Consent, if applicable,
with my Self-Select PIN below.
QuickZoom to the Federal Information Worksheet to enter PIN numbers
Taxpayer’s PIN (5 numbers) 72189
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Completion of this section indicates that I am requesting a refund of taxes overpaid by or on behalf of the
decedent. Under penalties of perjury, I declare that I have examined this Form 1310 claim, and to the best
of my knowledge and belief, it is true, correct, and complete.
IL
Date of death Date of death
Legally blind Legally blind
E-mail address E-mail address
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Work phone Ext Work phone Ext
Cell phone Cell phone
Home phone Note: Work phone is transmitted for electronic funds withdrawal.
Fax number
Best contact phone number
Print phone number on Form 1040 Home Taxpayer work Spouse work
Print Form 1040-SR instead of Form 1040 Yes No
O NO
X
US Address:
Address 1024 S. Sharpshire Apt no.
City Waxahachie State TX ZIP code 75165
Foreign Address: Check this box to use foreign address
Address Apt no.
City
Foreign code Foreign country
Foreign province/county
Foreign phone
APO/FPO/DPO address
DPO
ion C
1 Single
X 2 Married filing jointly
3 Married filing separately
Taxpayer did not live with spouse at any time during year
Taxpayer eligible to claim spouse’s exemption (state use), blind, or over age 65 (see Help)
4 Head of household
If qualifying person is child but not dependent:
Child’s First name MI Last Name Suff
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Child’s social security number
5 Qualifying widow(er)
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Part III ' Dependent/Earned Income Credit/Child and Dependent Care Credit Information
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Qualified
child/dep Not
Dependent care exps qual
Identity incurred credit
A Protection PIN and paid other
G (see tax help) 2019 dep
Date of birth E Lived Not qual
(mm/dd/yyyy) with Educ for child
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not present.
T MA
Note: Providing identification numbers helps the IRS and states verify taxpayer identity which can prevent
unnecessary delays in tax return processing.
All identity verification information should be entered here and will automatically flow to the
state return.
O NO
Taxpayer/Spouse does not have a driver’s license or state id
X Taxpayer Note: Alabama does not allow this option
X Spouse
Taxpayer/Spouse did not provide driver’s license or state id information
Taxpayer Note: Alabama, New York and Ohio do not allow this option
Spouse
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Check to confirm transferred driver’s license or state id information (which appears in green) is correct
Note: Transfer not available for returns with Alabama, Iowa, or New York state taxes. See tax help for
more information.
Taxpayer: Spouse:
Issuing state Issuing state
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* Enter the first 3 characters of the NY document number, which is the 8 or 10 number/letter combination
found at the bottom of the NY license (or NY state ID) or on the back if it was issued after January 28, 2014.
Client Status:
New client
Returning client to same preparer and firm
Returning client to same firm
Identity Verification Method (select one):
In person
Remote via email, phone, or fax
Both in person and remote
Identity not verified
IL
Account statement from financial institution
Utility billing statement
T MA
Credit card billing statement
Documents Used to Verify Spouse Identity (If you file joint return):
Driver’s license (complete detail above)
State issued identification card (complete detail above)
O NO
fdiv7101.SCR 12/18/19
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t ion C
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Electronic Filing Information Worksheet 2019
G Keep for your records
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The ERO Information below will automatically calculate based on the preparer code entered on the
Federal Information Worksheet.
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Calculates to the EFIN for the ERO that is responsible for filing this return based on the
preparer code. For returns that are marked as a "Non-Paid Preparer" (XNP) or
"Self-Prepared" (XSP) can be changed but is required.
For returns that are marked as a "Non-Paid Preparer" (XNP) or "Self-Prepared" (XSP)
enter a PIN for the ERO that is responsible for filing return
O NO
ERO Name ERO Electronic Filers Identification Number (EFIN)
Country
Firm Name
opy D Social Security Number or PTIN
ion C
Name Employer Identification Number
If the return was prepared or reviewed through an IRS tax assistance program, self-prepared by the
taxpayer, or was prepared by another person who was not paid to prepare the return, check one of the
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IRS-reviewed
IRS-prepared
Prepared by taxpayer or other non-paid preparer
Amended Returns
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File another Amended Form 114 Report of Foreign Bank and Financial Accounts (FBAR) electronically
Check this box to file another state and/or city amended return electronically
* Select the state and/or city amended return(s) to file electronically.
State/City *
Georgia
Michigan
New York
Vermont
Daryl R & Lauren E Hobbs 455-47-2189 Page 2
If the return was rejected for dependent name and SSN mismatch (business rule R0000-504-01) or
Schedule EIC qualifying child name and SSN mismatch (business rule SEIC-F1040-501-01),
check this box to retransmit this return as an imperfect return.
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Name of personal representative for deceased returns
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If married filing joint and one spouse is deceased, is the surviving spouse also the
personal representative? Yes No
Check this box if your client is in the U.S. Armed Forces with a stateside address
Select the appropriate combat zone from the picklist if the taxpayer (or spouse) last served in an area
O NO
designated as a combat zone or qualified hazardous duty area.
Other combat zone deployment date
Option of Transmitting the Forms as PDF with the Electronic Submission or Mailing the Forms with
Form 8453: U.S. Individual Income Tax Transmittal for an IRS e-file Return.
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Note: To Attach and Send a PDF file with this return, click on the "E-File" drop down menu, and then select "Attach PDF Files".
Check the applicable box(es) on forms to be attached and mail with form 8453 Transmit
PDF
Print & Mail
with 8453
ion C
Form 2848. Power of Attorney and Declaration of Representative
Form 3468, Historic Structure Certificate
Form 4136, Credit for Federal Tax Paid on Fuels
Form 8283, Noncash Charitable Contributions (Declaration of Appraiser)
Form 1098-C, Contributions of Motor Vehicles, Boats and Airplanes
Form 8332, Release of Claim to Exemption for Child by Custodial Parent or Other Doc
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Form 8885, Health Coverage Tax Credit
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Form 8949. Sales and Other Disp of Capital Assets.(or a stmt w/the same information)
Form 3115, Change in Accounting Method
These forms are not supported in ProSeries. You may print a completed form to Transmit Print & Mail
mail with your Form 8453, please check the applicable box(es) . PDF with 8453
Form 5713, International Boycott Report N/A
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Form W-2 Employer SP Wages Federal Tax State Wages State Tax
Step One X
Oracle Elevator Holdco Inc 111,495. 14,549.
IL
T MA
Totals 111,495. 14,549.
O NO
Form W-2 Summary
4
5
6
Foreign wages included in total wages
Unreported tips
Total federal tax withheld
3 & 7 Total social security wages/tips
Total social security tax withheld
Total Medicare wages and tips
Total Medicare tax withheld
opy D 0.
14,549.
119,295.
7,396.
119,295.
1,730.
0. 0.
14,549.
119,295.
7,396.
119,295.
1,730.
ion C
8 Total allocated tips
9 Not used
10 a Total dependent care benefits
b Offsite dependent care benefits
c Onsite dependent care benefits
11 Total distributions from nonqualified plans
12 a Total from Box 12
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29,393. 29,393.
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City Tampa State FL ZIP 33637
Foreign Province/County
Foreign Postal Code
T MA
Foreign Country
O NO
1 Wages, tips, other comp 111,495. 2 Federal tax withheld 14,549.
3 Social security wages 119,295. 4 Social sec tax withheld 7,396.
5 Medicare wages and tips 119,295. 6 Medicare tax withheld 1,730.
7 Social security tips 8 Allocated tips
13 b X Retirement plan
Foreign source income eligible for exclusion on Form 2555
Active duty military pay
Box 12
Code
D
DD
Box 12
Amount
7,800.
21,593.
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If Box 12 code is:
A: Enter amount attributable to RRTA Tier 2 tax
M: Enter amount attributable to RRTA Tier 2 tax
P: Double click to link to Form 3903, line 4
R: Enter MSA contribution for Taxpayer
Spouse
ion C
W: Enter HSA contribution for Taxpayer
Spouse
G: Employer is not a state or local government
9 9
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Part II Clergy, church employees, members of recognized religious sects
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Clergy only:
D Designated housing or parsonage allowance D
E Smallest of (a) the designated housing or parsonage allowance,
(b) amount spent on qualifying housing expenses, or (c) fair rental value E
F If no FICA was withheld, check the applicable box below
1 Pay self-employment tax on housing or parsonage allowance only
2 Pay self-employment tax on W-2 income only
3 Pay self-employment tax on W-2 income and housing allowance
O NO
4 Exempt from self-employment tax and has approved Form 4361
Non-Clergy only:
G If no FICA was withheld, check the applicable box below
1 Pay self-employment tax on this W-2 income
2 Exempt from self-employment tax and has approved Form 4029
H1
2
3
4
5
6
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Tips $20 or more in a month which were not reported to employer
Tips less than $20 in a month which were not required to be reported
Value of non-cash tips, such as tickets or passes, not reported
Actual amount of allocated tips if different than the amount in box 8
Tips paid out through a tip-sharing arrangement
Employer is a federal, state, or local government and tips are
only subject to Medicare tax
H1
H2
H3
H4
H5
ion C
Part IV Substitute Form W-2
I a If substitute Form W-2 needed, double-click to link this W-2 to a Form 4852
b Enter Form 4852, Line 9 information. "How did you determine amounts on line 7 of Form 4852?"
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c Form 4852, Line 10 information. "Explain your efforts to obtain Form W-2?"
Part VI Additional Information for Electronic Filing and Certain States (See Help)
Corrected W-2
Income from Paid Family Leave
Control number (optional)
Foreign Country
Form 1099-K Summary 2019
G Keep for your records
IL
1 Net Amount of Payment Card/Third Party
T MA
Network Transactions after Adjustments 74,736. 74,736.
O NO
4 Federal tax withheld
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t ion C
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Form 1099-K Payment Card and 2019
Third Party Network Transactions Worksheet
IL
CORRECTED (if checked)
T MA
X Spouse’s 1099-K Do not transfer this 1099-K to next year
O NO
Schedule F
Other Income
First State
Box 6
Box 8
Box 6
Box 8
State TX
State income tax withheld
Second State
State
State income tax withheld
Box 7
Box 7
opy D
State identification number
1099-K Reconciliation
IL
CORRECTED (if checked)
T MA
X Spouse’s 1099-K Do not transfer this 1099-K to next year
O NO
Schedule F
Other Income
First State
Box 6
Box 8
Box 6
Box 8
State
State income tax withheld
Second State
State
State income tax withheld
Box 7
Box 7
opy D
State identification number
1099-K Reconciliation
IL
1 Total Rents
T MA
A Schedule C
A Schedule E
A Form 4835
A Other Income
2 Total Royalties
O NO
A Schedule C
A Schedule E
A Schedule F
A Wages
A Other Income
8 Substitute payments
are E
IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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IL
Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
T MA
If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
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If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
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I confirm that the state withholding identification number(s) are accurate
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Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
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If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income 1,416.
Double click to link to: Schedule C Drug testing
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
t
I confirm that the state withholding identification number(s) are accurate
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Report on Form 1040, line 7 (or Form 1040NR, line 8) and Form 8919
If checked, enter Reason Code for Form 8919 (see Help) Code on 8919
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If Reason Code A or C, enter determination date
Other Income
Box 1 Rents
Box 2 Royalties
Double click to link rents or royalties to: Schedule C
Schedule E
Form 4835
O NO
Check to link Box 1 rents to: Other Income
Box 3 Other income
Double click to link to: Schedule C
Schedule F
Form 4835
For Form 1040, Other Income line:
Tribal Member Gaming Payments
Box 8
Box 4
Box 16
Winnings (Prizes, etc.)
opy D
Olympic or Paralympic Prize Money
Alaska Permanent Fund
First state
State tax withheld
Other income
ion C
Box 17 State Payer’s state no.
Box 18 State income
Second state
Box 16 State tax withheld
Box 17 State Payer’s state no.
Box 18 State income
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I confirm that the state withholding identification number(s) are accurate
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For multiple businesses being aggregated under Regulations section 1.199A-4, complete the
explanation statements below.
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Provide a description of the trade or business and an explanation of the factors met that allow the
aggregation in accordance with Regulations section 1.199A-4.
Has this trade or business aggregation changed from the prior year? This includes changes due to a
a trade or business being formed, acquired, disposed, or ceasing operations. If yes, explain.
O NO
Business name Tax ID QBI W2 wages UBIA
Step One 5,173. 101,786. 0.
2
3
4
5
Qualified business income (QBI)
16 Allocable UBIA
Tentative QBI component
17 Adjustments for QBI losses
18 Loss-adjusted QBI (line 14 plus line 17)
19 Tentative QBI component before limitations (20% of line 18)
Wages and assets limits
20 50% of W2 wages
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21 25% of W2 wages
22 2.5% of UBIA
23 Sum of 25% of W2 wages and 2.5% of UBIA
24 Wage and Asset Limit. Larger of line 20 or line 23
25 Subtract wage/asset limit (line 24) from tentative QBI component (line 19)
(But not less than 0)
26 Reduction Amount. Multiply line 6 by line 25
27 Subtract the Reduction Amount (line 26) from Tent. QBI Ded’n (line 19)
28 Qualified payments from agricultural or horticultural coop
29 Wages allocable to qualified payments from coop
30 Patron reduction (lesser of 9% of line 28 or 50% of line 29)
Qualified business income component amount
31 Subtract line 30 from line 27
Qualified Business Income Deduction Summary 2019
G Keep for your records
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1 Trade or business name Net QBI
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Step One 5,173.
2 Net qualified business income (QBI) from qualified trades or businesses 5,173.
3 Loss from previous year 0.
4 Sum of activities with gains (only positive amounts from table on line 1) 5,173.
O NO
5 Sum of activities with losses (only negative amounts from table on line 1) 0.
7 QBI component from Form 8995 line 5 or Form 8995A line 16 1,035.
8 QBI loss carryover from Form 8895 line 16 or Form 8995A Schedule C line 6 0.
9
10
11
12
13
Total REIT dividends
PTP Income from non-SSTBs
PTP Income from SSTBs
Allowed PTP Income from SSTBs
opy D
Total Allowed PTP income (sum of line 10 and line 12)
ion C
14 Carryover REIT/PTP losses from prior year 0.
15 Total REIT/PTP income
16 20% of total REIT/PTP income
17 Disallowed REIT/PTP loss 0.
18 Combined QBI Amount (QBI component plus 20% of REIT/PTP income) 1,035.
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Lesser of Combined QBI Amount or 20% of taxable income minus cap gains
Estimated Tax Payments for 2019 (If more than 4 payments for any state or locality, see Tax Help)
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1 04/15/19 04/15/19 04/15/19
O NO
4 01/15/20 01/15/20 01/15/20
Tot Estimated
Payments
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a Net self-employment income 5,566. 5,566.
b Optional Method and Church Employee income
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c Add lines 1a and 1b 5,566. 5,566.
d One-half of self-employment tax 393. 393.
e Subtract line 1d from line 1c 5,173. 5,173.
2 If not required to file Schedule SE:
a Net farm profit or (loss)
b Net nonfarm profit or (loss)
O NO
c Add lines 2a and 2b
3 If filing Schedule C as a statutory employee,
enter the amount from line 1 of that
Schedule C
4 Add lines 1e, 2c and 3. To EIC Wks, line 5 5,173. 5,173.
7a
b
opy D
Part II ' Form 2441 and Standard Deduction Worksheet Computations
111,495.
ion C
8 Add lines 5 through 7b. To Form 2441, lines 19
and 20 111,495. 5,173. 116,668.
9a Taxable dependent care benefits
b Nontaxable combat pay
10 Add lines 8, 9a & 9b . To Form 2441, lines
4 and 5 111,495. 5,173. 116,668.
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11 Scholarship or fellowship income not on W-2
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Part IV ' Schedule 8812 and Child Tax Credit Line 14 Worksheet Computations
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QuickZoom to the Long Schedule SE (Schedule SE, page 2)
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A Use Long Schedule SE, even if qualified to use Short Schedule SE
B Approved Form 4029. Exempt from SE tax on all income
C Chapter 11 bankruptcy net profit or loss for Schedule SE, line 3
D QuickZoom to the Explanation statement for any adjustment to
SE income/loss shown on a partnership K-1. (See Help)
O NO
Part I Farm Profit or (Loss) Schedule SE, line 1
1 Total Schedules F
2 Farm partnerships, Schedules K-1
3 Other SE farm profit or (loss) (See Help)
4 Less SE exempt farm profit or (loss) (See Help)
5 Total for Schedule SE, line 1
6
employment tax reported on:
a Schedule F, line 4b
opy D
Conservation Reserve Program payments not subject to self-
9 Exempt Notary Public income for Schedule SE, line 3 (See Help)
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Local ID Extension After 12/31 held/Pmts Return payment Amount
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Totals
O NO
2018 State Extension Information 2018 Locality Extension Information
(a)
State
(c)
opy D
Estimates Paid After 12/31
2018 Locality Estimates Information
(a)
Locality
(c)
Estimates Paid After 12/31
ion C
2018 State Taxes Due Information 2018 Locality Taxes Due Information
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(a) (e) (a) (e)
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2018 State Refund Applied Information 2018 Locality Refund Applied Information
are E
2018 State Tax Refund Information 2018 Locality Tax Refund Information
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4 Check box if required to itemize deductions 4
5 Adjusted gross income 5 172,404. 116,668.
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6 Tax liability for Form 2210 or Form 2210-F 6 27,737. 12,573.
7 Alternative minimum tax 7
8 Federal overpayment applied to next year estimated tax 8
O NO
Excess Contributions 2018 2019
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Taxpayer’s excess HSA contributions as of 12/31
Spouse’s excess HSA contributions as of 12/31
2018 2019
ion C
12 a Short-term capital loss 12 a
b AMT Short-term capital loss b
13 a Long-term capital loss 13 a
b AMT Long-term capital loss b
14 a Net operating loss available to carry forward 14 a
b AMT Net operating loss available to carry forward b
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15 a Investment interest expense disallowed 15 a
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f 2014 f
17 AMT Nonrecap’d net Sec 1231 losses from: a 2019 17 a
b 2018 b
c 2017 c
d 2016 d
e 2015 e
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f 2014 f
Federal Carryover Worksheet page 3 2019
Daryl R & Lauren E Hobbs 455-47-2189
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e 2015 e
f 2014 f
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20 Mortgage interest credit from: a 2019 20 a
b 2018 b
c 2017 c
d 2016 d
21 Credit for prior year minimum tax 21
22 District of Columbia first-time homebuyer credit 22
O NO
23 Residential energy efficient property credit 23
a 2018 0. 0.
b 2017
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c 2016
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d 2015
e 2014
a 2019
b 2018
c 2017
d 2016
e 2015
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1 Make and model of vehicle CHEVY TAHOE
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2 Date acquired
3 Date placed in service 01/01/2019
4 Type of vehicle A2 - Lt truck/van/SUV
5a Ending mileage reading
b Beginning mileage reading
c Total miles for the year 38,419
O NO
6 Business miles for the year 27,896
7 Commuting miles for the year
8 Other personal miles for the year 10,523
9 Percent of business use 72.61 % % %
10 Months for special allocation. See Tax Help
11 Is another vehicle available for personal use? X Yes No Yes No Yes No
12 Was the vehicle available for personal use
13
during off-duty hours?
Was the vehicle used primarily by a more
than 5% owner or related person?
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14 a Is there evidence to support the business use claimed?
b If ’Yes,’ is the evidence written?
X
X
Yes
Yes
No
No
Yes
Yes
No
No
X
X
Yes
Yes
Yes
Yes
No
No
No
No
ion C
Standard Mileage Rate
15 Does vehicle qualify for standard mileage rate? X Yes No Yes No Yes No
16 Was the vehicle leased? Yes X No Yes No Yes No
17 Standard mileage deduction 16,180.
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Actual Expenses
18 Expenses:
a Gasoline, oil, repairs, insurance, etc
b Vehicle registration, license (excluding
property taxes)
are E
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a Business-related parking fees, tolls, etc
b Property taxes (including property tax portion
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of registration)
c Less personal portion of property taxes
d Interest on vehicle
e Less personal portion of vehicle interest
27 Total expenses 16,180.
28 Less business portion of lease or rental fees
O NO
less inclusion amount (if actual expenses)
29 Less business portion of depreciation
(if actual expenses)
30 Total car and truck expenses 16,180.
31
32
33
34 a
Cost or basis
Section 179 expense elected
opy D
Depreciation and Sec 179 limit for automobiles
Economic Stimulus - Qualified Property
1 If yes, and if placed in service after 9/27/17, Yes
Yes
No N/A
No
Yes
Yes
No N/A
No
Yes
Yes
No N/A
No
ion C
was this property acquired after 9/27/17?
2 For post 9/27/17, elect 50% in place of 100% Yes No N/A Yes No N/A Yes No N/A
Special Depreciation Allowance
b Qualified Disaster Area - Qualified Property Yes No Yes No Yes No
c Kansas Disaster Zone - Qualified Property Yes No Yes No Yes No
Reg Ext No Reg Ext No Reg Ext No
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d Gulf Opportunity Zone - Qualified Property
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39 AMT adjustment/preference
40 QuickZoom to Asset Life History
MACRS Property Involved in a Like-Kind Exchange
or Involuntary Conversion
41 Elect OUT of regs under Sec 1.168(i)-6(i) Yes N/A Yes N/A Yes N/A
42 If asset represents entire basis of replacement
property, enter excess basis
Pre-02/28/04 transactions only (See TaxHelp):
43 Asset ID (Enter same ID on all related assets)
44 Check if asset represents exchanged basis of
replacement property
45 Total basis of all related parts
Sch C Drug testing Page 3
Daryl R & Lauren E Hobbs 455-47-2189
State Depreciation ' Complete for Actual Expenses only
46 QuickZoom to select or delete states
47 a State (CA info must be entered in CA state return, do not enter here)
b Asset status
c Vehicle description
d Vehicle number
e State cost or basis
f State Section 179 deduction
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g State Section 179 deduction allowed (enter for dispositions only)
h State Special Depreciation Allowance
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i State asset class
j State depreciation method
k State MACRS convention
l State recovery period
m State depreciable basis
n State prior depreciation
O NO
o State depreciation deduction
p If this asset represents entire basis of replacement property, enter excess basis
q Form 8824: If luxury auto, enter depreciation at 100% business use
r State gain/loss basis, if different from state cost
o Include vehicle in state return Yes No
Disposition of Vehicle
Complete for all vehicles
47
48
49
50
51
Date of disposition
Sales price (business portion only)
Expense of sale (business portion only)
Sec 179 deduction allowed
Double-click to link sale to Form 6252
opy D Vehicle 1
CHEVY TAHOE
Vehicle 2 Vehicle 3
ion C
52 Reserved
53 Gain/loss basis, if diff from ln 30 (enter 100%)
54 AMT gain/loss basis, if diff from ln 77 (100%)
55 Depreciation allowed or allowable
56 AMT depreciation allowed or allowable
57 Gain or loss
58 Alternative minimum tax gain or loss
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65 Eligible for Sec 179 (current yr assets only)? Yes No Yes No Yes No
66 Use IRS tables for MACRS property? Yes No Yes No Yes No
67 Qualified Indian reservation property? Yes No Yes No Yes No
68 Used Property? Yes No Yes No Yes No
69 Depreciation type
70 Asset class
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71 Depreciation method
72 Convention (HY assumed for MACRS property)
73 QZ to set 2019 convention
74 Recovery period
75 Year of depreciation
76 Depreciable basis
77 Alternative minimum tax basis, if diff from ln 30
78 Alternative minimum tax depreciation method
79 Alternative minimum tax recovery period
80 Alternative minimum tax depreciable basis
Section 199A (QBI Deduction) attributes
If this asset belongs to a qualified business under Section 199A, the following attributes will be used to
calculate the deduction for the qualified business.
UBIA for this asset 0. 0. 0.
This asset is ineligible for UBIA
Gains/(losses) from disposition of asset
Short term gain/(loss) 0. 0. 0.
Ordinary income from depreciation recapture 0. 0. 0.
Long term gain/(loss) 0. 0. 0.
Gain/(loss) is not eligible for 199A deduction
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O NO
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t ion C
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Two-Year Comparison 2019
IL
Business income (loss) 36,946. 5,566. -31,380. -84.93
Capital and other gains (losses)
T MA
IRA distributions
Pensions and annuities 0. 0.
Rents and royalties
Partnerships, S Corps, etc
Farm income (loss)
Social security benefits
O NO
Income other than the above 7,019. -7,019. -100.00
Total Income 175,014. 117,061. -57,953. -33.11
Adjustments to Income 2,610. 393. -2,217. -84.94
Adjusted Gross Income 172,404. 116,668. -55,736. -32.33
Itemized Deductions
Medical and dental
Income or sales tax
Real estate taxes
Personal property and other taxes
Interest paid
Gifts to charity
opy D
1,894. 1,452. -442. -23.34
ion C
Casualty and theft losses
Miscellaneous
Total Itemized Deductions 1,894. 1,452. -442. -23.34
Standard or Itemized Deduction 24,000. 24,400. 400. 1.67
Qualified Business Income Deduction 6,867. 1,035. -5,832. -84.93
Taxable Income 141,537. 91,233. -50,304. -35.54
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Note: Transferred data will not be displayed in the prior year column unless you have entered
current year data on the Schedule C.
IL
Percent Percent Comparison
of Net of Net X as amount
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Sales* Sales* as percent
Income:
1 Gross receipts or sales 222,584. 100.00 288,570. 100.00 65986.00
2 Returns & allowances
3 Net receipts or sales 222,584. 100.00 288,570. 100.00 65986.00
Cost of goods sold:
O NO
4 a Beginning inventory
b Purchases
c Cost of labor
d Materials & supplies
e Other costs
f Ending inventory
5 Cost of goods sold
6
7
8
9
10
Gross profit
Other income
Gross income
Expenses:
Advertising
Car & truck expenses
opy D
222,584.
222,584.
1,055.
100.00
100.00
0.47
288,570.
288,570.
16,180.
100.00
100.00
5.61
65986.00
65986.00
-1055.00
16180.00
ion C
11 Commissions and fees 85,766. 38.53 90,702. 31.43 4936.00
12 Contract labor 7,863. 3.53 2,174. 0.75 -5689.00
13 Depletion
14 Depreciation & Sec 179
15 Employee benefits
16 Insurance 1,042. 0.47 1,825. 0.63 783.00
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17 a Mortgage interest
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Gross Income
Wages and salaries 111,495.
Interest and dividend income
Business income (loss) 5,566.
Capital gains (losses)
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Pensions and annuities
Rents, royalties, partnerships, etc
T MA
Farm income (loss)
Social security benefits
Other income
Total Gross Income 117,061.
O NO
Adjusted Gross Income (Last year’s AGI) 172,404. 116,668.
Itemized/Standard Deductions
Medical and dental
Taxes 1,452.
Interest
Contributions
Casualty or theft loss(es)
Miscellaneous
Phaseout of itemized deductions
Total Itemized Deductions
Standard deduction
opy D 1,452.
24,400.
ion C
Taxable Income 91,233.
Total Credits
Self-employment tax 786.
Other taxes
Withholding 14,549.
are E
Refund 1,976.
Amount Due 0.
SMART WORKSHEET FOR: Schedule C (Drug testing): Profit or Loss from Business
IL
Business street address 201 E Main St suit 201
City, State and Zip Code (do not enter State and Zip Code if foreign address)
T MA
Waxahachie TX 75165
Or, foreign country information:
O NO
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t ion C
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are E
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Daryl R & Lauren E Hobbs 455-47-2189 2
SMART WORKSHEET FOR: Schedule C (Drug testing): Profit or Loss from Business
IL
B Trade or Business Name Step One
C Trade or Business ID Number
D 1 Specified Service Trade or Business (SSTB)? X Yes No
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2 If No, is income attributable to SSTB? Yes X No
3 QBI worksheet for SSTB income (this will auto-populate if Yes)
4 Percentage of qualified income attributable to SSTB %
O NO
2 Adjustments to qualified business income
3 Tentative Sch C profit (loss) from qualified business 5,566.
4 a Calculated QBI allowed after passive/at-risk limits 5,566.
b Adjustments to allowed QBI
c Allowable QBI after loss limits 5,566.
5 Self employed deductions connected to this business
6
opy D
a Self employed health insurance for this business
b Total deduction for 1/2 self employment tax
c Deduction for 1/2 S.E. tax connected to this business
d Total deduction for S.E. retirement contributions
e S.E. retirement deduction connected to this business
Total self employed deductions connected to this business
Sch C profit (loss) after S.E. deductions
393.
393.
393.
5,173.
ion C
7 Additional deductions related to this business reported on separate schedules
8 Net profit (loss) after adjustments, limitations, and deductions 5,173.
9 Allowable Sch C profit (loss) allocated to SSTB 0.
10 Allowable Sch C profit (loss) from this business 5,173.
SMART WORKSHEET FOR: Schedule C (Drug testing): Profit or Loss from Business
IL
b Adjustments to previously disallowed losses
c Previously disallowed QBI losses to be reported as separate business 0.
d QBI wksht for previously disallowed losses, if present
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I 1 Tentative wages 101,786.
2 Adjustments
3 Qualified wages 101,786.
4 Qualified wages allocated to SSTB 0.
O NO
J 1 Tentative Unadjusted Basis Immediately after Acquisition (UBIA) 0.
2 Adjustments
3 Qualified UBIA 0.
4 Qualified UBIA allocated to SSTB 0.
K 1
2
3
4 opy D
Net income allocable to qualified payments from agricultural or horticultural coop
Wages allocable to qualified payments from coop
Form 1099PATR line 6 (DPAD) from coop(s) w/ tax year starting before 1/1/2018
Form 1099PATR line 6 (DPAD) from coop(s) w/ tax year starting after 12/31/17
ion C
SMART WORKSHEET FOR: Schedule C (Drug testing): Profit or Loss from Business
A Ownership Spouse
B At risk status All
are E
SMART WORKSHEET FOR: Schedule C (Drug testing): Profit or Loss from Business
IL
Percentage of SSTB income (by category)
T MA
2018 100.00 100.00 100.00 100.00
O NO
Prior Year Carryovers by Year Regular Tax QBI
Before 2018
A Section 179 carryover
2018
B Section 179 carryover
A
B
C
2019 Section 179 election
Total deduction (all years)
Allowed deduction in 2019
opy D
Allowed deductions by year Regular Tax QBI
ion C
D Freed up deduction from before 2018
E Freed up deduction from 2018
F If SSTB, reduced loss from 2018
Before 2018
A Section 179 carryforward
2018
B Section 179 carryforward
2019
C Section 179 carryforward
are E
At-Risk Limits
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Before 2018
A Operating loss
B Form 4797 ordinary loss
C Form 4797 long-term loss
2018
D Operating loss
E Form 4797 ordinary loss
F Form 4797 long-term loss
Daryl R & Lauren E Hobbs 455-47-2189 5
MAIL FORM 4868 (WITH PAYMENT IF APPLICABLE) TO THE ADDRESS LISTED BELOW
IL
DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE CENTER
T MA
AUSTIN TX 73301-0045
USA
O NO
SMART WORKSHEET FOR: Federal Information Worksheet
Yes
opy D
Apply 15-year recovery period to qualified improvement property
(asset types J2, J3, J4 and J5)
placed in service after December 31, 2017?
No X
IMPORTANT NOTE: The Coronavirus Aid, Relief, and Economic Security (CARES) Act signed into
law on March 27, 2020 has retroactively made qualified improvement property 15-year property.
ion C
Refer to Tax Help
SMART WORKSHEET FOR: Form W-2 Worksheet (Oracle Elevator Holdco Inc)
IL
B QBI worksheet to report
C Specified Service Trade or Business (SSTB)?
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O NO
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Daryl R & Lauren E Hobbs 455-47-2189 1
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WAGES 101,786.
Total 101,786.
T MA
Schedule C (Drug testing): Profit or Loss from Business
Ln 24b: 50% limit Itemization Statement
Description Amount
O NO
Office/Meeting Meals 4,706.86
Travel Meals 1,587.52
Total 6,294.
Postage
Description
opy D Total
Itemization Statement
Amount
965.
965.
ion C
Schedule C (Drug testing): Profit or Loss from Business
Line 10 Itemization Statement
Description Amount
Lab Fees 74,982.39
Clinic Fees
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11,889.78
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Schedule C (Drug testing): Profit or Loss from Business
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Line 23 Itemization Statement
Description Amount
PAYROLL TAXES 7,786.63
Total 7,787.
O NO
Schedule C (Drug testing): Profit or Loss from Business
Line 15 Itemization Statement
Description Amount
Prof and Liability Ins 1,285.
Health Ins
opy D
Schedule C (Drug testing): Profit or Loss from Business
Line 25
Total
540.
1,825.
Itemization Statement
ion C
Description Amount
Utilities 9,356.70
Total 9,357.
Total 6.