2021 TaxReturn

Review your print out for checklist items.
1040 U.S. Individual Income Tax Return 2021 (99)

Form Department of the Treasury—Internal Revenue Service
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
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 your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying
one box.
person is a child but not your dependent a
Your first name and middle initial Last name Your social security number
Shawntae L Adams 572-85-3164
If joint return, 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
2115 Constance Ave Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
North Las Vegas NV 890323607 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse
At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes No
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 You: Were born before January 2, 1957 Are blind Spouse: Was born before January 2, 1957 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four tony Jacob 558-09-2302 Other
dependents,
see instructions
and check
here a
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . 1
Attach 2a Tax-exempt interest . . . 2a 2b
b Taxable interest . . . . .
Sch. B if
3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
required.
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Standard 6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
Deduction for— a
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . 7
• Single or
Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8 98.
separately,
$12,550 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . a 9 98.
• Married filing 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
jointly or
11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . a 11 98.
Qualifying
widow(er),
$25,100
12a Standard deduction or itemized deductions (from Schedule A) . . 12a 12,550.
• Head of b Charitable contributions if you take the standard deduction (see instructions) 12b
household,
$18,800 c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . 12c 12,550.
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13 0.
any box under
Standard 14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . 14 12,550.
Deduction,
see instructions.
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . 15 0.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2021)
Form 1040 (2021) Page 2
16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 0.
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 0.
19 Nonrefundable child tax credit or credit for other dependents from Schedule 8812 . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 0.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 0.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . a 24 0.
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d
26 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . . 26
If you have a
qualifying child, 27a Earned income credit (EIC) . . . . . . . . . . . . . . 27a 11.
attach Sch. EIC.
Check here if you were born after January 1, 1998, and before
January 2, 2004, and you satisfy all the other requirements for
taxpayers who are at least age 18, to claim the EIC. See instructions a
b Nontaxable combat pay election . . . . 27b
c Prior year (2019) earned income . . . . 27c
28 Refundable child tax credit or additional child tax credit from Schedule 8812 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Recovery rebate credit. See instructions . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits a 32 11.
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . a 33 11.
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 11.
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . a 35a 11.
Direct deposit? ab Routing number X X X X X X X X X a c Type: Checking Savings
See instructions. a
d Account number X X X X X X X X X X X X X X X X X
36 Amount of line 34 you want applied to your 2022 estimated tax . . a 36
Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions . a 37
You Owe 38 Estimated tax penalty (see instructions) . . . . . . . . . a 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . a Yes. Complete below. No
Designee’s Phone Personal identification
name a no. a 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
Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
F
Joint return? Hairdresser (see inst.) a

See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.) a
Phone no. (702)289-6787 Email address
Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name a Self-Prepared Phone no.
Use Only a a
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 09/09/22 Intuit.cg.cfp.sp Form 1040 (2021)
SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
(Form 1040)
Department of the Treasury
a Attach to Form 1040, 1040-SR, or 1040-NR. 2021
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, 1040-SR, or 1040-NR Your social security number
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . 1
2a Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Date of original divorce or separation agreement (see instructions) a
3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . 3 98.
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:
a Net operating loss . . . . . . . . . . . . . . . . . . 8a ( )
b Gambling income . . . . . . . . . . . . . . . . . . . 8b
c Cancellation of debt . . . . . . . . . . . . . . . . . . 8c
d Foreign earned income exclusion from Form 2555 . . . . . 8d ( )
e Taxable Health Savings Account distribution . . . . . . . . 8e
f Alaska Permanent Fund dividends . . . . . . . . . . . . 8f
g Jury duty pay . . . . . . . . . . . . . . . . . . . . 8g
h Prizes and awards . . . . . . . . . . . . . . . . . . 8h
i Activity not engaged in for profit income . . . . . . . . . 8i
j Stock options . . . . . . . . . . . . . . . . . . . . 8j
k Income from the rental of personal property if you engaged in
the rental for profit but were not in the business of renting such
property . . . . . . . . . . . . . . . . . . . . . . 8k
l Olympic and Paralympic medals and USOC prize money (see
instructions) . . . . . . . . . . . . . . . . . . . . . 8l
m Section 951(a) inclusion (see instructions) . . . . . . . . . 8m
n Section 951A(a) inclusion (see instructions) . . . . . . . . 8n
o Section 461(l) excess business loss adjustment . . . . . . . 8o
p Taxable distributions from an ABLE account (see instructions) . 8p
z Other income. List type and amount a
8z
9 Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . 9
10 Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or
1040-NR, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 98.
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040) 2021
Schedule 1 (Form 1040) 2021 Page 2
Part II Adjustments to Income

11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Certain business expenses of reservists, performing artists, and fee-basis government
officials. Attach Form 2106 . . . . . . . . . . . . . . . . . . . . . . . 12
13 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . 13
14 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . 14
15 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . 15
16 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . 16
17 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . 17
18 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . 18
19a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19a
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . a
c Date of original divorce or separation agreement (see instructions) a
20 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . 21
22 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Archer MSA deduction . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Other adjustments:
a Jury duty pay (see instructions) . . . . . . . . . . . . . 24a
b Deductible expenses related to income reported on line 8k from
the rental of personal property engaged in for profit . . . . . 24b
c Nontaxable amount of the value of Olympic and Paralympic
medals and USOC prize money reported on line 8l . . . . . 24c
d Reforestation amortization and expenses . . . . . . . . . 24d
e Repayment of supplemental unemployment benefits under the
Trade Act of 1974 . . . . . . . . . . . . . . . . . . . 24e
f Contributions to section 501(c)(18)(D) pension plans . . . . . 24f
g Contributions by certain chaplains to section 403(b) plans . . 24g
h Attorney fees and court costs for actions involving certain
unlawful discrimination claims (see instructions) . . . . . . 24h
i 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 . . . . . . . . . . . . . . 24i
j Housing deduction from Form 2555 . . . . . . . . . . . 24j
k Excess deductions of section 67(e) expenses from Schedule K-1
(Form 1041) . . . . . . . . . . . . . . . . . . . . . 24k
z Other adjustments. List type and amount a
24z
25 Total other adjustments. Add lines 24a through 24z . . . . . . . . . . . . . 25
26 Add lines 11 through 23 and 25. These are your adjustments to income. Enter
here and on Form 1040 or 1040-SR, line 10, or Form 1040-NR, line 10a . . . . . 26
BAA REV 09/09/22 Intuit.cg.cfp.sp Schedule 1 (Form 1040) 2021
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074
2021
(Form 1040) (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 must generally file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
hairdresser a 8 1 2 1 1 2
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
Gettin it together
E Business address (including suite or room no.) a 2115 Constance Ave
City, town or post office, state, and ZIP code North Las Vegas, NV 89032-3607
F Accounting method: (1) Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2021? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2021, check here . . . . . . . . . . . . . . . . . a
I Did you make any payments in 2021 that would require you to file Form(s) 1099? See instructions . . . . . . . . Yes No
J If “Yes,” did you or will you file required Form(s) 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
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 6,558.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 6,558.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 6,558.
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . a 7 6,558.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 400. 18 Office expense (see instructions) . 18
9 Car and truck expenses (see 19 Pension and profit-sharing plans . 19
instructions) . . . . 9 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a
11 Contract labor (see instructions) 11 b Other business property . . . 20b 1,000.
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 2,660.
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23
instructions) . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a
(other than on line 19) . 14 b Deductible meals (see
15 Insurance (other than health) 15 instructions) . . . . . . . 24b
16 Interest (see instructions): 25 Utilities . . . . . . . . 25 2,400.
a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) 26
b Other . . . . . . 16b 27a Other expenses (from line 48) . . 27a
17 Legal and professional services
17 b Reserved for future use . . . 27b
28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28 6,460.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 98.
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
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30
}
31 Net profit or (loss). Subtract line 30 from line 29.
• If a profit, enter on both Schedule 1 (Form 1040), line 3, and on Schedule SE, line 2. (If you
checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3. 31 98.
• 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), line 3, and on Schedule
SE, line 2. (If you checked the box on line 1, see the line 31 instructions.) Estates and trusts, enter on 32a All investment is at risk.
Form 1041, line 3. 32b Some investment is not
• If you checked 32b, you must attach Form 6198. Your loss may be limited. at risk.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 09/09/22 Intuit.cg.cfp.sp Schedule C (Form 1040) 2021
Schedule C (Form 1040) 2021 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
36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36
37 Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . 37
38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38
39 Other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40
41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41
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 and
are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file
Form 4562.
43 When did you place your vehicle in service for business purposes? (month/day/year) a
44 Of the total number of miles you drove your vehicle during 2021, enter the number of miles you used your vehicle for:
a Business b Commuting (see instructions) c Other
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
47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . Yes No
b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part V Other Expenses. List below business expenses not included on lines 8–26 or line 30.
48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48

REV 09/09/22 Intuit.cg.cfp.sp Schedule C (Form 1040) 2021
SCHEDULE 8812 Credits for Qualifying Children `
OMB No. 1545-0074
(Form 1040) . .1040
and Other Dependents .......
a Attach to Form 1040, 1040-SR, or 1040-NR.

1040-SR
.........
1040-NR 2021
Department of the Treasury 8812 Attachment
Internal Revenue Service (99) a Go to www.irs.gov/Schedule8812 for instructions and the latest information. Sequence No. 47
Name(s) shown on return Your social security number

Part I-A Child Tax Credit and Credit for Other Dependents
1 Enter the amount from line 11 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . 1 98.
2a Enter income from Puerto Rico that you excluded . . . . . . . . . . . 2a
b Enter the amounts from lines 45 and 50 of your Form 2555 . . . . . . . . 2b 0.
c Enter the amount from line 15 of your Form 4563 . . . . . . . . . . . 2c
d Add lines 2a through 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d 0.
3 Add lines 1 and 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 98.
4a Number of qualifying children under age 18 with the required social security number 4a 0.
b Number of children included on line 4a who were under age 6 at the end of 2021 . . 4b 0.
c Subtract line 4b from line 4a . . . . . . . . . . . . . . . . . 4c 0.
5 If line 4a is more than zero, enter the amount from the Line 5 Worksheet; otherwise, enter -0- . . . . . . 5
6 Number of other dependents, including any qualifying children who are not under age
18 or who do not have the required social security number . . . . . . . . 6 1.
Caution: Do not include yourself, your spouse, or anyone who is not a U.S. citizen, U.S. national, or U.S. resident
alien. Also, do not include anyone you included on line 4a.
7 Multiply line 6 by $500 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 500.
8 Add lines 5 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 500.
9 Enter the amount shown below for your filing status.
• Married filing jointly—$400,000
• All other filing statuses—$200,000 }
. . . . . . . . . . . . . . . . . . . . . . 9 200,000.
10 Subtract line 9 from line 3.
}
• If zero or less, enter -0-.
• If more than zero and not a multiple of $1,000, enter the next multiple of $1,000. For
example, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc. . . . . . . . 10 0.
11 Multiply line 10 by 5% (0.05) . . . . . . . . . . . . . . . . . . . . . . . . . 11 0.
12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 12 500.
13 Check all the boxes that apply to you (or your spouse if married filing jointly).
A Check here if you (or your spouse if married filing jointly) had a principal place of abode in the United States
for more than half of 2021 . . . . . . . . . . . . . . . . . . . . . . . .
B Check here if you (or your spouse if married filing jointly) were a bona fide resident of Puerto Rico for 2021
Part I-B Filers Who Check a Box on Line 13
Caution: If you did not check a box on line 13, do not complete Part I-B; instead, skip to Part I-C.
14a Enter the smaller of line 7 or line 12 . . . . . . . . . . . . . . . . . . . . . . . 14a
b Subtract line 14a from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . 14b
c If line 14a is zero, enter -0-; otherwise, enter the amount from the Credit Limit Worksheet A . . . . . . 14c
d Enter the smaller of line 14a or line 14c . . . . . . . . . . . . . . . . . . . . . . 14d
e Add lines 14b and 14d . . . . . . . . . . . . . . . . . . . . . . . . . . . 14e
f Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received
for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the
instructions before entering an amount on this line. If you didn’t receive any advance child tax credit payments
for 2021, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14f
Caution: If the amount on this line doesn’t match the aggregate amounts reported to you (and your spouse if
filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
g Subtract line 14f from line 14e. If zero or less, enter -0- on lines 14g through 14i and go to Part III . . . . 14g
h Enter the smaller of line 14d or line 14g. This is your credit for other dependents. Enter this amount on line
19 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . 14h
i Subtract line 14h from line 14g. This is your refundable child tax credit. Enter this amount on line 28 of
your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . 14i
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 09/09/22 Intuit.cg.cfp.sp Schedule 8812 (Form 1040) 2021
Part I-C Filers Who Do Not Check a Box on Line 13
Caution: If you checked a box on line 13, do not complete Part I-C.
15a Enter the amount from the Credit Limit Worksheet A . . . . . . . . . . . . . . . . . 15a
b Enter the smaller of line 12 or line 15a . . . . . . . . . . . . . . . . . . . . . . 15b
Additional child tax credit. Complete Parts II-A through II-C if you meet each of the following items.
1. You are not filing Form 2555.
2. Line 4a is more than zero.
3. Line 12 is more than line 15a.
c If you completed Parts II-A through II-C, enter the amount from line 27; otherwise, enter -0- . . . . . . 15c
d Add lines 15b and 15c . . . . . . . . . . . . . . . . . . . . . . . . . . . 15d
e Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received
for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the
instructions before entering an amount on this line. If you didn’t receive any advance child tax credit payments
for 2021, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15e
Caution: If the amount on this line doesn’t match the aggregate amounts reported to you (and your spouse if
filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
f Subtract line 15e from line 15d. If zero or less, enter -0- on lines 15f through 15h and go to Part III . . . . 15f
g Enter the smaller of line 15b or line 15f. This is your nonrefundable child tax credit and credit for other
dependents. Enter this amount on line 19 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . 15g
h Subtract line 15g from line 15f. This is your additional child tax credit. Enter this amount on line 28 of your
Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . 15h
Part II-A Additional Child Tax Credit (use only if completing Part I-C)
Caution: If you file Form 2555, do not complete Parts II-A through II-C; you cannot claim the additional child tax credit.
Caution: If you checked a box on line 13, do not complete Parts II-A through II-C; you cannot claim the additional child tax credit.
16a Subtract line 15b from line 12. If zero, skip Parts II-A and II-B and enter -0- on line 27 . . . . . . . . 16a 500.
b Number of qualifying children under 18 with the required social security number: 0 x $1,400.
Enter the result. If zero, skip Parts II-A and II-B and enter -0- on line 27 . . . . . . . . . . . . 16b 0.
TIP: The number of children you use for this line is the same as the number of children you used for line 4a.
17 Enter the smaller of line 16a or line 16b . . . . . . . . . . . . . . . . . . . . . . 17
18a Earned income (see instructions) . . . . . . . . . . . . . . . . 18a 98.
b Nontaxable combat pay (see instructions) . . . . . . 18b
19 Is the amount on line 18a more than $2,500?
No. Leave line 19 blank and enter -0- on line 20.
Yes. Subtract $2,500 from the amount on line 18a. Enter the result . . . . 19
20 Multiply the amount on line 19 by 15% (0.15) and enter the result . . . . . . . . . . . . . . 20
Next. On line 16b, is the amount $4,200 or more?
No. If line 20 is zero, enter -0- on line 15c. Otherwise, skip Part II-B and enter the smaller of line 17 or line
20 on line 27.
Yes. If line 20 is equal to or more than line 17, skip Part II-B and enter the amount from line 17 on line 27.
Otherwise, go to line 21.
Part II-B Certain Filers Who Have Three or More Qualifying Children
21 Withheld social security, Medicare, and Additional Medicare taxes from Form(s) W-2,
boxes 4 and 6. If married filing jointly, include your spouse’s amounts with yours. If
your employer withheld or you paid Additional Medicare Tax or tier 1 RRTA taxes, see
instructions . . . . . . . . . . . . . . . . . . . . . . 21
22 Enter the total of the amounts from Schedule 1 (Form 1040), line 15; Schedule 2 (Form
1040), line 5; Schedule 2 (Form 1040), line 6; and Schedule 2 (Form 1040), line 13 . 22
23 Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . . 23
24 1040 and
}
1040-SR filers: Enter the total of the amounts from Form 1040 or 1040-SR, line 27a,
and Schedule 3 (Form 1040), line 11.
1040-NR filers: Enter the amount from Schedule 3 (Form 1040), line 11. 24
25 Subtract line 24 from line 23. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 25
26 Enter the larger of line 20 or line 25 . . . . . . . . . . . . . . . . . . . . . . . 26
Next, enter the smaller of line 17 or line 26 on line 27.
Part II-C Additional Child Tax Credit
27 Enter this amount on line 15c . . . . . . . . . . . . . . . . . . . . . . . . . 27
REV 09/09/22 Intuit.cg.cfp.sp Schedule 8812 (Form 1040) 2021
BAA
Part III Additional Tax (use only if line 14g or line 15f, whichever applies, is zero)
28a Enter the amount from line 14f or line 15e, whichever applies . . . . . . . . . . . . . . . 28a
b Enter the amount from line 14e or line 15d, whichever applies . . . . . . . . . . . . . . . 28b
29 Excess advance child tax credit payments. Subtract line 28b from line 28a. If zero, stop; you do not owe the
additional tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
30 Enter the number of qualifying children taken into account in determining the annual advance amount you
received for 2021. See your Letter 6419 for this number. If you are missing your Letter 6419, you are filing a joint
return, or you received more than one Letter 6419, see the instructions before entering a number on this line . . 30
Caution: If the amount on this line doesn’t match the number of qualifying children reported to you (and your
spouse if filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
31 Enter the smaller of line 4a or line 30 . . . . . . . . . . . . . . . . . . . . . . . 31
32 Subtract line 31 from line 30. If zero, skip to line 40 and enter the amount from line 29; otherwise, continue to
line 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
}
• Married filing jointly or Qualifying widow(er)—$60,000
• Head of household—$50,000
• All other filing statuses—$40,000 . . . . . . . . . . . . . . . 33
34 Subtract line 33 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 34
35 Enter the amount from line 33 . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Divide line 34 by line 35. Enter the result as a decimal (rounded to at least three places). If the result is 1.000 or
more, enter 1.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
37 Multiply line 32 by $2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 37
38 Multiply line 37 by line 36 . . . . . . . . . . . . . . . . . . . . . . . . . . 38
39 Subtract line 38 from line 37 . . . . . . . . . . . . . . . . . . . . . . . . . 39
40 Subtract line 39 from line 29. If zero or less, enter -0-. This is your additional tax. If more than zero, enter
this amount on Schedule 2 (Form 1040), line 19 . . . . . . . . . . . . . . . . . . . 40
BAA REV 09/09/22 Intuit.cg.cfp.sp Schedule 8812 (Form 1040) 2021
Form 8995 Qualified Business Income Deduction OMB No. 1545-2294
Simplified Computation
a Attach
to your tax return.
2021
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
Note. You can claim the qualified business income deduction only if you have qualified business income from a qualified trade or
business, real estate investment trust dividends, publicly traded partnership income, or a domestic production activities deduction
passed through from an agricultural or horticultural cooperative. See instructions.
Use this form if your taxable income, before your qualified business income deduction, is at or below $164,900 ($164,925 if married
filing separately; $329,800 if married filing jointly), and you aren’t a patron of an agricultural or horticultural cooperative.
1 (a) Trade, business, or aggregation name (b) Taxpayer (c) Qualified business
identification number income or (loss)
i Gettin it together 572-85-3164 98.
ii
iii
iv
2 Total qualified business income or (loss). Combine lines 1i through 1v,

column (c) . . . . . . . . . . . . . . . . . . . . . . 2 98.
3 Qualified business net (loss) carryforward from the prior year . . . . . . . 3 ( )
4 Total qualified business income. Combine lines 2 and 3. If zero or less, enter -0- 4 98.
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . 5 20.
6 Qualified REIT dividends and publicly traded partnership (PTP) income or (loss)
(see instructions) . . . . . . . . . . . . . . . . . . . . 6
7 Qualified REIT dividends and qualified PTP (loss) carryforward from the prior
year . . . . . . . . . . . . . . . . . . . . . . . . . 7 ( )
8 Total qualified REIT dividends and PTP income. Combine lines 6 and 7. If zero
or less, enter -0- . . . . . . . . . . . . . . . . . . . . 8
9 REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . . 9
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . 10 20.
11 Taxable income before qualified business income deduction (see instructions) 11 0.
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . 12 0.
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . 13 0.
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . 14 0.
15 Qualified business income deduction. Enter the smaller of line 10 or line 14. Also enter this amount on
the applicable line of your return (see instructions) . . . . . . . . . . . . . . . . a 15 0.
16 Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . . 16 ( 0. )
17 Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 6 and 7. If greater than
zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 ( 0. )
For Privacy Act and Paperwork Reduction Act Notice, see instructions. REV 09/09/22 Intuit.cg.cfp.sp Form 8995 (2021)
Tax History Report 2021
G Keep for your records
Name(s) Shown on Return

Shawntae L Adams
Five Year Tax History:
2017 2018 2019 2020 2021
Filing status Single
Total income 98.
Adjustments to income
Adjusted gross income 98.
Tax expense 0.
Interest expense
Contributions
Misc. deductions
Other itemized ded’ns
Total itemized/
standard deduction 12,550.
Exemption amount 0.
QBI deduction 0.
Taxable income 0.
Tax
Alternative min tax
Total credits
Other taxes
Payments 11.
Form 2210 penalty
Amount owed
Applied to next
year’s estimated tax
Refund 11.
Effective tax rate % -11.22
**Tax bracket %
**Tax bracket % is based on Taxable income.

IMPORTANT DISCLOSURES
If you are owed federal tax refund(s), you have a right to choose how you will receive the refund(s). There
are several options available to you. Some options cost money and some options are free. Please read
about these options below.
You can file your federal tax return(s) electronically or by paper and obtain your federal tax refund(s)
directly from the Internal Revenue Service ("IRS") for free. If you file your tax return(s)
electronically, you can receive refund checks directly from the IRS through the U.S. Postal Service
in 21 to 28 days from the time you file your tax return(s) or the IRS can deposit your refund(s)
directly into your bank account in less than 21 days from the time you file your tax return(s) unless
there are delays by the IRS. If you file a paper return through the U.S. Postal Service, you
can receive refund checks directly from the IRS through the U.S. Postal Service in 6 to 8 weeks
from the time the IRS receives your return(s) or the IRS can deposit your refund(s) directly
into your bank account in 6 to 8 weeks from the time the IRS receives your return(s). However, if
your return(s) contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS will
issue your refund(s) no earlier than February 15, 2022.
You can file your federal tax return(s) electronically, select the Refund Processing Service ("RPS") for an
additional fee of $ (the "RPS fee"), and have your federal tax refund(s) processed through a processor using
banking services of a financial institution. The RPS allows your refund(s) to be deposited into a bank account
at Green Dot Bank ("Bank") and deducts your TurboTax fees and other amounts that you authorize from your
federal refund(s). The balance of your federal refund(s) is delivered to you via the disbursement method you select.
If you file your tax return(s) electronically and select the RPS, the IRS will deposit your refund(s) with Bank. Upon
Bank's receipt of your refund(s), Santa Barbara Tax Products Group, LLC, a division of Green Dot Corporation, a Delaware
corporation, a processor, will deduct from your federal refund(s) the RPS fee, any fees charged by TurboTax for the
preparation and filing of your tax return(s) and any other amounts authorized by you and disburse the balance of your
refund proceeds to you. Unless there are unexpected delays, federal refunds are received in less than 21 days from the
time you file your tax return(s) electronically. However, if your return(s) contains Earned Income Tax Credit or
Additional Child Tax Credit, the IRS will issue your refund(s) no earlier than February 15, 2022.
The RPS is not necessary to obtain your refund(s). If you have an existing bank account, you do not need
to use the RPS, which requires the payment of a fee, in order to receive a direct deposit from the IRS.
You may consult the IRS website (IRS.gov) for information about tax refund processing.
If you select the RPS, no prior debt you may owe to Bank will be deducted from your refund(s).
You can change your income tax withholdings which might result in you receiving additional funds
throughout the year rather than waiting to receive these funds potentially in tax refund(s) next year.
Please consult your employer or tax advisor for additional details.
This Agreement requires all disputes to be resolved by way of binding arbitration.

The terms of the arbitration provision appear in Section 11.
Information regarding low-cost deposit accounts may be available at www.mymoney.gov
The chart below shows the options for filing your federal tax returns (e-file or paper returns), the
RPS product, refund disbursement options, estimated timing for obtaining your federal tax refund
proceeds, and costs associated with the various options.
WHAT TYPE WHAT ARE YOUR WHAT IS THE WHAT COSTS DO YOU
OF FILING DISBURSEMENT ESTIMATED TIME TO INCUR IN ADDITION
METHOD? OPTIONS? RECEIVE REFUND(S)? TO TAX PREPARATION
FEES?
PAPER RETURN IRS direct deposit to Approximately No additional cost.

your personal bank 6 to 8 weeks 1
No Refund Processing account.
Service
Check mailed by IRS Approximately
to address on tax 6 to 8 weeks 1
return(s).
ELECTRONIC IRS direct deposit to Usually within No additional cost.

FILING your personal bank 21 days 1
(E-FILE) account.
No Refund Processing Check mailed by IRS Approximately

Service to address on tax 21 to 28 days 1
return(s).
ELECTRONIC Direct deposit to Usually within $ 2

(E-FILE) account.
Refund Processing
Service
1You may experience delays with your tax refund(s) if, for example, you enter incorrect bank account or contact
information, you enter a bank account in someone else's name, or if possible suspicious activity is detected.
If your return(s) contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS will issue your
refund(s) no earlier than February 15, 2022.
2Thecharges here consist of an RPS Fee, a TurboTax fee and any fees for additional products and services purchased.
See Section 3 of the Refund Processing Service Agreement for the cost of the service you have chosen.
Questions? Call 877-908-7228
sbia5201.ptform 12/02/21 12/02/2021

FORM 1040 or FORM 1040-SR WORKSHEET 2021
NOTE: Form 1040, 1040-SR and Schedules 1 - 3 are fully calculated.
Use this worksheet to enter all data which will flow to the Form 1040 or Form 1040SR and Schedules 1- 3.
Use these QuickZooms to jump to the entry sections for Schedules 1- 3 on this Worksheet:
Form 1040 or Form 1040SR Worksheet Navigation QuickZooms
QuickZoom to Schedule 1 ' Additional Income and Adjustments to Income
QuickZoom to Schedule 2 ' Additional Taxes
QuickZoom to Schedule 3 ' Additional Credits and Payments
Form 1040 or Form 1040-SR ' Personal Info, Filing Status, Dependent Info
For the year January 1 - December 31, 2021, or other tax year
beginning , 2021, ending , 20 .
Your First Name MI Last Name Your Social Security No.

If Joint Return, Spouse’s First Name MI Last Name Spouse’s Social Security No.
Home Address (No. and Street). If You Have a P.O. Box, See Instructions. Apt. No.
2115 Constance Ave
City, Town or Post Office. If you have a foreign address, also complete below. State ZIP Code
North Las Vegas NV 89032-3607
Foreign country name Foreign province/state/county Foreign postal code
QuickZoom to explanation statement for overseas extension
Presidential Election Campaign
Check here if you, or your spouse if filing jointly, want $3 to go to this fund.
Checking a box will not change your tax or refund You Spouse
At any time during 2021, did you receive, sell, exchange, or otherwise
dispose of any financial interest in any virtual currency? Yes No
Filing Status Check only one box.

All entries for filing status and dependents should be made on the Federal Information Worksheet.
X Single
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse’s SSN above and full name here.
Head of household (with qualifying person). (See instructions) If the qualifying person is a child
but not your dependent, enter the child’s name here.
Qualifying widow(er) (See instructions)
Dependents If more than four dependents, see instructions and check here
(1) First name Last name (2) Social (3) (4)

security Relationship b if qualifies for:
number to you under age 18 Credit for
qualifying other
for child dependents
tax credit
tony Jacob 558-09-2302 Other X
QuickZoom to the Federal Information Worksheet

QuickZoom to the Dependent and Nondependent Information Worksheet
Shawntae L Adams 572-85-3164 Page 2
Standard Deduction
Someone can claim you as a dependent

Someone can claim your spouse as a dependent
a Check if: You were born before January 2, 1957 Blind

Spouse was born before January 2, 1957 Blind
Total boxes checked a
b If your spouse itemizes on a separate return or you were a
dual-status alien, check here b
QuickZoom to required PPP loan forgiveness statement to report tax-exempt income
Form 1040 or Form 1040-SR, Lines 1 - 7
1 Wages, salaries, tips, etc. Attach Form(s) W-2 1

2a Tax-exempt interest 2a
b Taxable interest 2b
3a Qualified dividends 3a
b Ordinary dividends 3b
4a IRA distributions 4a
b Taxable amount 4b
5a Pensions and annuities 5a
b Taxable amount 5b
6a Social security benefits 6a
b Taxable amount 6b
7 Capital gain or (loss). Attach Schedule D if required.
If not required, check here 7
QuickZoom to Schedule 1 ' Additional Income and Adjustments to Income
8 Other income from Schedule 1, line 10 8 98.

9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income 9 98.
10 Adjustments to income from Schedule 1, line 26 10
11 Subtract line 10 from line 9. This is your adjusted gross income. 11 98.
AGI including excludable Puerto Rico Income 98.
Form 1040 or Form 1040-SR, Line 12 ' Standard or Itemized Deduction
12 Standard deduction or itemized deductions (from Schedule A)

Standard Deduction for '
@ People who checked blind or over 65 or who can be claimed
as a dependent, see instructions.
@ All others:
? Single or Married filing separately: $12,550
? Married filing jointly or Qualifying widow(er): $25,100
? Head of household: $18,800
? If you checked any box under Standard Deduction, see instructions.
QuickZoom to the Standard Deduction Worksheet
a Itemized deductions (from Schedule A) or your
standard deduction, see above 12 a 12,550.
Enter the smaller of these cash contributions
made or $300 ($600 if married filing jointly)
on line12b below if you take the standard
deduction
b Charitable contributions if you take the
standard deduction 12 b
c Add lines 12a and 12b 12 c 12,550.
Subtract itemized or standard deduction from adjusted gross income amount -12,452.
13 Qualified business income deduction from Form 8995 or Form 8995-A 13 0.

14 Add lines 12c and 13 14 12,550.
15 Taxable income. Subtract line 14 from line 11. If zero
or less, enter -0- 15 0.
16 Tax. Check if any from Forms(s):

1 8814
2 4972
3
0.
17 Amount from Schedule 2, line 3 17
18 Add lines 16 and 17 18 0.
QuickZoom to Schedule 2 ' Additional Tax section
Form 1040 or Form 1040-SR, Line 19 - 24
19 Nonrefundable child tax credit or credit for other dependents

from Schedule 8812 19
21 Add lines 19 and 20 21
22 Subtract line 21 from line 18. If zero or less, enter -0- 22 0.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 23 0.
24 Add lines 22 and 23. This is your total tax 24 0.
25 Federal income tax withheld from:

a
Form(s) W-2 25 a
b
Form(s) 1099 25 b
c
Other forms 25 c
d
Add lines 25a through 25c 25 d
26 2021 estimated tax payments and
amount applied from 2020 return 26
27 If you have a qualifying child, attach Sch. EIC.
a Earned income
credit (EIC) 27 a 11.
Check here if you were born after January 1, 1998,
and before January 2, 2004, and you satisfy all the
other requirements for taxpayers who are at least
age 18, to claim the EIC
b Nontaxable
combat pay
election 27 b
c Prior year (2019)
earned income 27 c
28 Refundable child tax credit or additional child
tax credit from Schedule 8812 28
29 American opportunity credit from Form 8863, line 8 29
30 Recovery rebate credit 30
32 Add lines 27a and 28 through 31.
These are your other payments and refundable credits 32 11.
33 Add Lines 25d, 26, and 32.
These are your total payments 33 11.
QuickZoom to Schedule EIC Worksheet, pg. 2 if credit is not calculated

QuickZoom to "due diligence checklist" substitute for Form 8867

Refund:
34 If total Payments is more than total tax, subtract total tax from payments
This is the amount you overpaid 34 11.
35 a Amount of overpayment you want refunded to you.
If Form 8888 is attached, check here 35 11.
Direct deposit?
G b Routing number XXXXXXXXX
G c Type:
Checking
Savings
G d Account number XXXXXXXXXXXXXXXXX
36 Amount of overpayment on line 34 you want
applied to your 2022 estimated tax 36
Form 1040 or Form 1040-SR, Lines 37 and 38

Amount You Owe:
37 Subtract total payments from total tax 37
Note: Schedule H and Schedule E SE filers, line 37 may not represent
all of the taxes you owe for 2021. See Schedule 3, line 12e, and its
instructions for details.
38 Estimated tax penalty 38
QuickZoom to Late Penalties and Interest Worksheet QuickZoom
Schedule 1 ' Additional Income and Adjustments to Income

Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes 1
Alimony Received Smart Worksheet

Taxpayer Spouse Date of divorce/sep *
A
B
* Check the box if the pre-2019 decree was modified after 2018 to treat the payments as nontaxable
2a Alimony received Taxpayer Spouse 2a

b Date of original divorce or separation agreement
3 Business income or (loss). Attach Schedule C 3 98.
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:
a Net operating loss 8a
b Gambling income 8b
c Cancellation of debt 8c
d Foreign earned income exclusion from Form 2555 8d
e Taxable Health Savings Account distribution 8e
f Alaska Permanent Fund dividends 8f
g Jury duty pay 8g
h Prizes and awards 8h
i Activity not engaged in for profit income 8i
j Stock options 8j
k Income from the rental of personal property if you
engaged in the rental for profit but were not in the
business of renting such property 8k
l Olympic and Paralympic medals and USOC
prize money 8l
m Section 951(a) inclusion 8m
n Section 951A(a) inclusion 8n
o Section 461(l) excess business loss adjustment 8o
p Taxable distributions from an ABLE account 8p
8z Other income. List type and amount:
8z
9 Total other income. Add lines 8a through 8z 9
10 Combine lines 1 through 7 and 9.
Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8 10 98.
Total Income. Combine Form 1040 lines 1- 7 and
Schedule 1, line 10, enter on Form 1040, line 9 98.
Quickzoom to 1040 Worksheet, line 9 ' Total Income QuickZoom
Part II Adjustments to Income
11 Educator expenses 11
12 Certain business expenses of reservists, performing artists, and fee-basis
government officials. Attach Form 2106 12
13 Health savings account deduction. Attach Form 8889 13
14 Moving expenses for members of the Armed Forces.
Attach Form 3903 14
15 Deductible part of self-employment tax. Attach Schedule SE 15
16 Self-employed SEP, SIMPLE, and qualified plans 16
17 Self-employed health insurance deduction 17
18 Penalty on early withdrawal of savings 18
Alimony Paid Smart Worksheet
Recipient’s name Recipient’s SSN Date of divorce/sep * Alimony paid

A
B
* Check the box if the pre-2019 decree was modified after 2018 to treat the payments as nondeductible
19 a Alimony paid 19 a
b Recipient’s SSN
c Date of original divorce or separation agreement
20 IRA deduction 20
21 Student loan interest deduction 21
22 Reserved for future use 22
23 Archer MSA deduction 23
24 Other adjustments:
a Jury duty pay 24 a
b Deductible expenses related to income reported on
line 8k from the rental of personal property engaged
in for profit 24 b
c Nontaxable amount of the value of Olympic and
Paralympic medals and USOC prize money reported
on line 8l 24 c
d Reforestation amortization and expenses 24 d
e Repayment of supplemental unemployment
benefits under the Trade Act of 1974 24 e
f Contributions to section 501(c)(18)(D) pension plans 24 f
g Contributions by certain chaplains to section
403(b) plans 24 g
h Attorney fees and court costs for actions involving
certain unlawful discrimination claims 24 h
i 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 24 i
j Housing deduction from Form 2555 24 j
k Excess deductions of section 67(e) expenses from
Schedule K-1 (Form 1041) 24 k
z Other adjustments. List type and amount:
G
24 z
25 Total other adjustments. Add lines 24a through 24z 25
26 Add lines 11 through 23 and 25
These are your adjustments to income. Enter here and on Form 1040 or
1040-SR, line 10, or Form 1040-NR, line 10a 26
Schedule 2 ' Additional Taxes
Part I Tax
1 Alternative minimum tax (see instructions). 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, 1040-SR, or 1040-NR, line 17 3
Part II Other Taxes
4 Self-employment tax.
Attach Schedule SE 4
5 Social security and Medicare tax
on unreported tip income.
Attach Form 4137 5
6 Uncollected social security and Medicare tax on
wages. Attach Form 8919 6
7 Total additional social security and Medicare tax. Add lines 5 and 6 7
8 Additional tax on IRAs or other tax-favored accounts.
Attach Form 5329 if required 8
9 Household employment taxes from Schedule H 9
10 Repayment of first-time homebuyer credit. Attach Form 5405 if required 10
11 Additional Medicare Tax. Attach Form 8959 11
12 Net investment income tax. Attach Form 8960 12
13 Uncollected social security and Medicare or RRTA tax on tips or group-term
life insurance from W-2, box 12 13
14 Interest on tax due on installment income from the sale of certain
residential lots and timeshares 14
15 Interest on the deferred tax on gain from certain installment sales with a
sales price over $150,000 15
16 Recapture of low-income housing credit. Attach Form 8611 16
17 Other additional taxes:
a Recapture of other credits. List type, form number,
and amount:
G
17 a
b Recapture of federal mortgage subsidy. If you sold
your home in 2021, see instructions 17 b
c Additional tax on HSA distributions. Attach Form 8889 17 c
d Additional tax on an HSA because you didn’t remain
an eligible individual. Attach Form 8889 17 d
e Additional tax on Archer MSA distributions.
Attach Form 8853 17 e
f Additional tax on Medicare Advantage MSA
distributions. Attach Form 8853 17 f
g Recapture of a charitable contribution deduction
related to a fractional interest in tangible
personal property 17 g
h Income you received from a nonqualified deferred
compensation plan that fails to meet the requirements
of section 409A 17 h
i Compensation you received from a nonqualified
deferred compensation plan described in
section 457A 17 i
j Section 72(m)(5) excess benefits tax 17 j
k Golden parachute payments 17 k
l Tax on accumulation distribution of trusts 17 l
m Excise tax on insider stock compensation from an
expatriated corporation 17 m
n Look-back interest under section 167(g) or 460(b)
from Form 8697 or 8866 17 n
o Tax on non-effectively connected income for any
part of the year you were a nonresident alien from
Form 1040-NR 17 o
p Any interest from Form 8621, line 16f, relating to
distributions from, and dispositions of, stock of
a section 1291 fund 17 p
q Any interest from Form 8621, line 24 17 q
z Any other taxes. List type and amount:
G
17 z
18 Total additional taxes. Add lines 17a through 17z 18
19 Additional tax from Schedule 8812 19
20 Section 965 net tax liability installment from
Form 965-A 20
21 Add lines 4, 7 through 16, 18, and 19.
These are your total other taxes.
Enter here and on Form 1040 or 1040-SR, line 23, or Form 1040-NR, line 23b 21 0.
Total tax (add line 21 and Schedule 3, line 7b) 0.
Page 7
Schedule 3 ' Additional Credits and Payments
Part I Nonrefundable Credits
1 Foreign tax credit. Attach Form 1116 if required 1

2 Credit for child and dependent care expenses from Form 2441, line 11.
2 Attach Form 2441 2
3 Education credits from Form 8863, line 19 3
4 Retirement savings contributions credit. Attach Form 8880 4
5 Residential Energy Credit. Attach Form 5695 5
6 Other nonrefundable credits:
a General business credit. Attach Form 3800 6a
b Credit for prior year minimum tax. Attach Form 8801 6b
c Adoption credit. Attach Form 8839 6c
d Credit for the elderly or disabled. Attach Schedule R 6d
e Alternative motor vehicle credit. Attach Form 8910 6e
f Qualified plug-in motor vehicle credit.
Attach Form 8936 6f
g Mortgage interest credit. Attach Form 8396 6g
h District of Columbia first-time homebuyer credit.
Attach Form 8859 6h
i Qualified electric vehicle credit. Attach Form 8834 6i
j Alternative fuel vehicle refueling property credit.
Attach Form 8911 6j
k Credit to holders of tax credit bonds. Attach Form 8912 6k
l Amount on Form 8978, line 14 6l
z Other nonrefundable credits. List type and amount:
G
6z
7 Total other nonrefundable credits. Add lines 6a through 6z 7
8 Add lines 1 through 5 and 7.
Enter here and on Form 1040, 1040-SR, or 1040-NR, line 20 8
a Add line 8 plus child tax/other dep. credit on line 19 above
b Subtract total credits on line 8a from tax on line 18 above 0.
Quickzoom to 1040 Worksheet, line 24 ' Total Tax QuickZoom
Part II Other Payments and Refundable Credits
9 Net premium tax credit. Attach Form 8962 9

10 Amount paid with request for extension to file 10
11 Excess social security and tier 1 RRTA tax withheld 11
12 Credit for federal tax on fuels. Attach Form 4136 12
13 Other payments or refundable credits:
a Form 2439 13 a
b Qualified sick and family leave credits from
Schedule(s) H and Form(s) 7202 for leave
taken before April 1, 2021 13 b
c Health coverage tax credit from Form 8885 13 c
d Credit for repayment of amounts included in
income from earlier years 13 d
e Reserved for future use 13 e
f 13 f
g Credit for child and dependent care expenses from
Form 2441, line 10. Attach Form 2441 13 g
h Qualified sick and family leave credits from
Schedule(s) H and Form(s) 7202 for leave
taken after March 31, 2021 13 h
z Other payments or refundable credits. List type and
amount
13 z
14 Total other payments or refundable credits. Add lines 13a through 13z 14
15 Total Payments: Part II, lines 9 through 12 and 14,
Withholding (Form 1040, line 25d),
Estimated Tax Payments (Form 1040, line 26) and Form 1040, lines 27-30 15 11.
Other Payments and Refundable Credits (Form 1040, line 32) 11.
Page 8
Third Party Designee
Do you want to allow another person to discuss this return

with the IRS (see instructions)? Yes. Complete the following. X No
Designee’s Name
Phone Number Personal Identification Number (PIN)
Signature and Paid Preparer
Sign Here
Joint return? See instructions.
Keep a copy of this return for your records.
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 accurately list all
amounts and sources of income I received during the year. Declaration of preparer (other than taxpayer)
is based on all information of which preparer has any knowledge.
If the IRS sent you
an Identity Protection
Your Signature Date Your Occupation PIN, enter it here
Hairdresser G
Spouse’s Signature. If joint, both must sign. Date Spouse’s Occupation
G
Daytime Phone No. Email Address
(702)289-6787
Paid Preparer’s Use Only
Print/Type Preparer’s name Preparer’s PTIN Check if:
Preparer’s Signature Date Self-employed
Firm’s Adress (or yours if self-employed) Firm’s EIN. Phone No.

Self-Prepared
State ZIP Code
Filing Address Information
Send Form 1040 to: Department of the Treasury

Internal Revenue Service
Ogden, UT 84201-0002
Form 8960 Form 8960 Worksheet 2021
Lines 4b, 5b, 7, 9, 10
Name(s) Shown on Return Your SSN

Line 4b - Adjustment for trade or business income or loss
(a) Activity name (b) Gain or

loss
Enter additional adjustments not included above:
Adjustment for trade or business income not subject to net investment tax
Line 5b - Adjustment for gain or loss on dispositions
(a) Activity name (b) Gain or

loss
Capital loss carryover adjustment from 2020 for net investment tax purposes
Enter additional adjustments not included above and check the box if a capital gain or loss:
Net gain or loss from disposition of property not subject to net investment tax
Capital gain/loss not included in net investment income
(a) Activity name (b) Capital

Gain or Loss
Capital gain or loss from sale of property not subject to net investment income tax
Calculation of line 5b adjustment due to capital loss carryforward
1 Net capital loss not included in net investment income 1 0.

2 Capital loss carryover to next year 2
3 Lesser of line 1 or line 2 (Included as an adjustment on line 5b table above) 3 0.
Line 7 - Other modifications to investment income
1 Casualty and theft losses reported on Schedule A, line 15 1

2 Amounts reported on Form 8814, line 12 2
3 Adjustment for distributions from estates and trusts 3
4 Schedules C and F income/loss included in net investment income 4
5 Substitute interest and dividend payments 5
6 Recovery of a prior year deduction 6
7 7
8 Total other modifications to investment income 8

Line 9b - State, local, and foreign income taxes allocable to net investment income
1 State and local income taxes 1

2 Investment income 2
3 Total adjusted gross income 3
4 Divide line 2 by line 3. Enter result as a decimal amount 4
5 State and local income taxes allocable to investment income 5
6 State and local taxes (Schedule A, line 5e) 6
7 Lesser of line 5 or line 6 7
8 Foreign income taxes 8
9 Foreign income taxes allocable to investment income. Line 8 times line 4. 9
10 Add lines 7 and 9. State, local and foreign income taxes allocable to
investment income 10
Lines 9 and 10 - Application of Itemized Deduction Limitations Worksheet
Part III - Application of Section 68 to Deductions Properly Allocable to Investment Income
1 Reserved 1
2 Enter the amount of state, local, and foreign income taxes that are properly
allocable to investment income 2
3 Enter the amount of other Itemized Deductions subject to the section 68
limitation and properly allocable to investment income before any itemized
deduction limitation:
3
4 Enter the total deductions properly allocable to investment income subject to
the section 68 limitation. Enter the sum of lines 1 through 3 4
5 Enter the amount of total itemized deductions allowed after the section 68
limitation. Form 1040, line 12 5
6 Enter all other itemized deductions allowed but not subject to the section 68
deduction limitation: 6
7 Subtract line 6 from line 5 7
8 Enter the lesser of line 7 or line 4 8
Part IV - Reconciliation of Schedule A Deductions to Form 8960 plus additional expenses, lines 9 and 10
(A) (B) (C)
Reenter the amounts and descriptions from Part III, lines 1-3 Fraction Column A
(see Help) times B
Miscellaneous Itemized Deductions properly allocable to Investment
Income reportable on Form 8960, line 9c:
1 Reserved
2 State, local, and foreign income taxes x =
Itemized Deductions Subject to Section 68 reportable on Form 8960, line 10:

3 x =
x =
x =
x =
Penalty on early withdrawal of savings
Other modifications:
Total additional modifications to Form 8960, line 10
Calculation of Former Passive Activity Suspended Losses Allowed as Deduction Against NII
1) Former Passive Activity Suspended Losses
(a) Activity name (b) Suspended (c) Suspended (d) Used against (e) Used against
12/31/2020 12/31/2021 activity other passive
2) Former Passive Activity Suspended Losses - Schedule D
3) Former Passive Activity Suspended Losses - Form 4797
Schedule 1 Other Income Statement 2021
Line 8
Statement L8
Name(s) Shown on Return Social Security Number

(a) (b)
Taxpayer Spouse
1 Child’s investment income, from Form 8814

2 Winnings:
a From Form W-2G
b Gambling winnings not reported on Form W-2G
c Total gambling winnings
d Winnings (prizes, etc.) from Form 1099-MISC, box 3
e Other non-gambling awards and prizes
3 Taxable income from Forms 1099-MISC or 1099-NEC:
a Substitute payments in lieu of interest or dividends
b1 Other income from box 3 (Excluding Olympic prize money)
b2 Other income from box 3 Olympic prize money
b Total Other income from box 3
c Alaska Permanent Fund
d Tribal Gaming
e Non-Employee Compensation from Form 1099-NEC box 1
f Rent from personal property from Form 1099-MISC box 1
4 Taxable income from Form 1099-Q or 1099-QA:
a Qualified tuition program distributions
b Coverdell ESA distributions
c ABLE account distributions
5 Taxable income from Form 1099-G:
a Grants
b RTAA payments
6 Foreign earned income and housing exclusion, from Form 2555
7 Net operating loss carryover from a prior year
8 Other income, from Schedule(s) K-1
9 Taxable distribution from:
a Form 8853:
1 Taxable Archer MSA distributions MSA
2 Taxable Medicare Advantage distributions Med MSA
3 Taxable long term care distributions LTC
4 Total Form 8853
b Form 8889, Health Savings Accounts
1 Taxable HSA Distributions from Form 1099-SA
2 Last month rule and qualified HSA funding distribution amt
3 Total Form 8889
10 Refunds or reimbursements of deductions claimed
in a prior year:
a Reimbursement for deducted medical expenses
b Refunds of deducted taxes (not state or local income taxes)
Type of Tax State or
Local ID
c
Recapture of deducted moving expenses
d
Reimbursement for deducted casualty or theft loss
e
Reimbursement for deducted employee business expenses
f
Other refunds or reimbursements
11 Recoveries of bad debts deducted in a prior year
12 Jury duty pay
13 Bartering income not reported elsewhere
14 Income from the rental of personal property
15 Income from the Cancellation of Debt:
a From Form 1099-C:
1 Amount of debt canceled from box 2
2 Amount of canceled debt excluded from income
3 Taxable amount of canceled debt
b From Schedule(s) K-1
16 Taxable income from Form 1099-K:
a Payment Card/Third Party Network Transactions
17 Income from "not for profit" activities (hobbies):
18 Limitation on business losses (Form 461)

19 Global intangible low-taxed income (Form 8992)
19 Does not apply to Form 1040NR
20 Does not apply to Form 1040NR
20 Section 965 deferred foreign income (Form 965)
21 Unemployment income and repayment
a Union unemployment benefits
b Private fund unemployment benefits
c State employee unemployment benefits
d Repayment of non-government unemployment benefits
22 Other taxable income:
a Employer stock compensation income for non-employee
b
23 Income from Community Property:

a Positive community property adjustment
b Negative community property adjustment (enter as positive)
24 Total. Add lines 1 through 14, 15a(3), 15b, 16 through 23.

Enter here and on Schedule 1, line 8
Federal Information Worksheet 2021
Part I ' Personal Information
Information in Part I is completely calculated from entries on Personal Information Worksheets.
Taxpayer: Spouse:
First name Shawntae First name
Middle initial L Suffix Middle initial Suffix
Last name Adams Last name
Social security no. 572-85-3164 Social security no.
Occupation Hairdresser Occupation
Date of birth 08/03/1985 (mm/dd/yyyy) Date of birth (mm/dd/yyyy)
Age as of 1-1-2022 36 Age as of 1-1-2022
Daytime phone (702)289-6787 Ext Daytime phone Ext
Legally blind Legally blind
Date of death Date of death
Dependent of Someone Else: Dependent of Someone Else:
Can taxpayer be claimed as dependent of another Can spouse be claimed as dependent of another
person (such as parent)? Yes X No person (such as parent)? Yes No
If yes, was taxpayer claimed as dependent on that If yes, was spouse claimed as dependent on that
person’s return? Yes X No person’s return? Yes No
Credit for the Elderly or Disabled (Schedule R): Credit for the Elderly or Disabled (Schedule R):
Is the taxpayer retired on total Is the spouse retired on total
and permanent disability? Yes No and permanent disability? Yes No
Presidential Election Campaign Fund: Presidential Election Campaign Fund:
Does the taxpayer want $3 to go to the Presidential Does the spouse want $3 to go to the Presidential
Election Campaign Fund? Yes No Election Campaign Fund? Yes No
Part II ' Address and Federal Filing Status (enter information in this section)
US Address:
Address 2115 Constance Ave Apt no.
City North Las Vegas State NV ZIP code 89032-3607
Foreign Address: Check this box to use foreign address
Address Apt no.
City
Foreign code Foreign country
Foreign province/county Foreign postal code
APO/FPO/DPO address, check if appropriate APO FPO DPO
Home phone
Check to print phone number on Form 1040 Home X Taxpayer daytime Spouse daytime
Print Form 1040-SR instead of Form 1040 Yes X No
Federal filing status:
X 1 Single
2 Married filing jointly
3 Married filing separately
Check this box if you did not live with your spouse at any time during the year
Check this box if you are eligible to claim your spouse’s exemption/blind/over age 65 (see Help)
4 Head of household
If the ’qualifying person’ is your child but not your dependent:
Child’s First name MI Last Name Suff
Child’s social security number
5 Qualifying widow(er)
Check the appropriate box for the year your spouse died 2019 2020
Are you a dependent with a qualifying child Yes No
Enter qualifying person’s name:
Child’s First name MI Last Name Suff
Child’s social security number
Part III ' Dependent/Earned Income Credit/Child and Dependent Care Credit Information
Information in Part III is completely calculated from entries on Dependent/Nondependent Info Worksheets.
Date of birth Date of death Not
(mm/dd/yyyy) (mm/dd/yyyy) qual
credit
Qualified other
Not child/dep Lived dep
C qual care exps with Educ *
Social security o for incurred E taxpyr Tuitn D
First name MI number d child and paid I in and e
Last name Suff Relationship Age e tax cr 2021 C U.S. Fees p
tony 558-09-2302 02/06/2020
Jacob Other 1 O N Yes
* "Yes" - qualifies as dependent, "No" - does not qualify as dependent

Part IV ' Earned Income Credit Information (you must answer these questions to calculate EIC)
Is the taxpayer or spouse a qualifying child for EIC for another person? Yes No
Was the taxpayer’s (and spouse’s if married filing jointly) home in the United States
for more than half of 2021? Yes No
If the SSN of the taxpayer, or spouse if married filing jointly, was obtained to
get a federally funded benefit, such as Medicaid, and the Social Security card
contains the legend Not Valid for Employment, check this box (see Help)
Check if you are filing head of household and your spouse is a nonresident alien
and you lived with your spouse during the last six months of 2021
Check if you were notified by the IRS that EIC cannot be claimed in 2021 or
if you are ineligible to claim the EIC in 2021 for any other reason
Part V ' Direct Deposit or Direct Debit Information (not applicable for Form 9465)
Do you want to elect direct deposit of any federal tax refund? Yes No
Do you want to elect direct debit of federal balance due (Electronic filing only)? Yes No
If you selected either of the options above, fill out the information below:
Name of Financial Institution (optional)
Check the appropriate box Checking Savings
Routing number Account number
Enter the following information only if you are requesting direct debit of balance due:
Enter the payment date to withdraw from the account above
Balance-due amount from this return
Amended Returns:
Do you want to elect direct debit of federal amended balance due (e-File only)? Yes No
Enter the payment date to withdraw from the account above
Balance-due amount from this amended return
Part VI ' Additional Information for Your Federal Return

Standard Deduction/Itemized Deductions:
Check this box if you are itemizing for state tax or other purposes even though your itemized
deductions are less than your standard deduction
Check this box if you are married filing separately and your spouse itemized deductions
Check this box to take the standard deduction even if less than itemized deductions
Real Estate Professionals:

Do you or your spouse qualify for the special passive activity rules for
taxpayers in real property business? (see Help) Yes No
Credit for Qualified Retirement Savings Contributions (Form 8880):

Is the taxpayer a full-time student? Yes No
Is the spouse a full-time student? Yes No
American Opportunity and Lifetime Learning Credit (Form 8863)

For 2021, were you (or your spouse if married) a nonresident alien for any part
of the year, and did not elect to be treated as a resident alien? Yes No
Foreign Tax Credit (Form 1116):

Check this box to file Form 1116 even if you’re not required to file Form 1116
Resident country USA
Excludable Income from Am. Samoa, Guam, Commonwealth of the N. Mariana Islands, or Puerto Rico:
Excludable income of bona fide residents of American Samoa, Guam, or the
Commonwealth of the Northern Mariana Islands
Excludable income from Puerto Rico
Dual Status Alien Return:

Check this box if you are a dual-status alien
Check this box to print ’DUAL-STATUS STATEMENT’ on Form 1040
Third Party Designee:

Caution: Review transferred information for accuracy.
Do you want to allow another person to discuss this return with the IRS? Yes No
If Yes, complete the following:
Third party designee name
Third party designee phone number
Personal Identification number (enter any 5 numbers)
Disaster Tax Relief:

Check if you took a disaster distribution between 2018 and 2020
Part VI ' Additional Information for Your Federal Return ' Continued
Personal Representative for deceased taxpayers:

Name of personal representative required for E-filed
returns when Form 1310 is not filed or it is not the
surviving spouse
Part VII ' State Filing Information
Identity Protection PIN:

If the IRS sent the taxpayer an Identity Protection PIN, enter it here
If the IRS sent the spouse an Identity Protection PIN, enter it here
Taxpayer:
Enter the taxpayer’s state of residence as of December 31, 2021 NV
Check the appropriate box:
Taxpayer is a resident of the state above for the entire year X
Taxpayer is a resident of the state above for only part of year
Date the taxpayer established residence in state above
In which state (or foreign country) did the taxpayer reside before this change?
Spouse:
Enter the spouse’s state of residence as of December 31, 2021
Spouse is a resident of the state above for the entire year
Spouse is a resident of the state above for only part of year
Date the spouse established residence in state above
In which state (or foreign country) did the spouse reside before this change?
Nonresident states:
Nonresident State(s) Taxpayer/Spouse/Joint
Check this box if you are in a Registered Domestic Partnership or a civil union
If you checked the box on the line above, also check the appropriate box below:
Check if this is your individual federal return you are filing with the IRS
Check if this is the joint return created to file joint state tax return (see Help)
Use the PIN that you signed last year’s tax return with.
Taxpayer’s Prior year PIN
Spouse’s Prior year PIN
These signature PINs are chosen by the taxpayer and spouse and used for e-filing your tax return
Taxpayer’s PIN used to sign the return
Spouse’s PIN used to sign the return
Taxpayer:
Drivers license or state ID number
Issued by what state
License or ID license ID neither decline
Spouse
Drivers license or state ID number
Issued by what state
License or ID license ID neither decline
Personal Information Worksheet 2021
For the Taxpayer
QuickZoom to another copy of Personal Information Worksheet

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Part I ' Taxpayer's Personal Information
First name Shawntae Middle initial Last name

L Adams
Suffix
Social security no. 572-85-3164 Member of U.S. Armed Forces in 2021? Yes X No
Date of birth 08/03/1985 (mm/dd/yyyy) age as of 1-1-2022 36
Occupation Hairdresser Daytime phone (702)289-6787 Ext
Marital status Single

If widowed, check the appropriate box for the year your spouse died:
After 2021 2021 2020 2019 Before 2019
Are you retired on total and permanent disability? (for Schedule R, see Help). Yes No
Check if this person is legally blind Yes X No
If deceased, enter the date of death (mm/dd/yyyy)
Were you under the age of 16 as of 1-1-2022 and this is the first year you
are filing a tax return? Yes No
Language in which you want the IRS to communicate with you
Do you want $3 to go to Presidential Election Campaign Fund? Yes No
Part II ' Questions for Individuals Who Could Be Or Are Dependents of Another Taxpayer
1 Can someone (such as your parent) claim you as a dependent? Yes X No

2 If you answered ’Yes’ to question 1, are you actually claimed as a dependent
on that person’s tax return? Yes X No
Questions 3 through 5 are only required for individuals who claim the
American Opportunity Credit.
3 Were you a full-time student during any part of five months during 2021? Yes No
4 Did your earned income exceed one-half of your support? Yes No
5 Was at least one of your parents alive on December 31, 2021? Yes No
Part III ' Taxpayer's State Residency Information
Enter this person’s state of residence as of December 31, 2021 NV

This person is a resident of the state above for the entire year X
This person is a resident of the state above for only part of year
Date this person established residence in state above
In which state (or foreign country) did this person reside before this change?
Part IV ' Dependent Care Expenses
Qualified dependent care expenses incurred and paid for this person in 2021
Unreimbursed medical expenses paid for qualifying person in 2021
Employment taxes paid for dependent care providers in 2021
Full-time student for 5 calendar months during 2021? Yes No
Disabled person who was not physically or mentally capable of self-care? Yes No
This person is a qualifying person for the child and dependent care credit Yes X No
Dependent and Nondependent Information Worksheet 2021
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Part I ' Personal Information
First name tony Middle initial Last name Jacob

Suffix
Social security no. 558-09-2302
Date of birth 02/06/2020 (mm/dd/yyyy) age as of 12-31-2021 1

Did this person pass away in 2021 (deceased)? Yes X No Date of death
Relationship to taxpayer or spouse Other

CAUTION: If claiming a child other than your own, see Relationship in the Tax Help.
NOTE: The ability to set your answers to being the same as last year for the
dependent is only available in Step-by-Step mode and not in Forms mode.
Are the answers to the questions below for this person, to determine
whether they are your dependent, the same as they were last year? Yes No
Dependency code * O Other dependent
*Dependency code is set based on your selections in the Dependency Exemption/EIC Smart Worksheet
Dependent is disabled
Check this box if:

- The taxpayer filing this return is filing as Qualifying Widow(er)
- This dependency code for this dependent is type X
- This dependent would qualify as a qualifying child for the Qualifying Widow(er) filing status,
except the dependent’s gross income was $4,300 or more, or was filing a married filing joint
return, or the taxpayer could be claimed as a dependent
Part II ' Earned Income Credit and Child Tax Credit
Is this person a U.S. citizen, U.S. national, or a U.S. resident? X Yes No

Is this person a resident of Canada or Mexico? Yes X No
This person is adopted and you are a U.S. citizen or U.S. national
TurboTax Web Only:
Was the adoption final as of December 31, 2021? Yes No
Was the person placed with you for adoption after 2021, or was the adoption
final in 2021 or later? Yes No
The adopted child lived with you all year Yes No
*If the child is adopted, you are a U.S. citizen or U.S. national and they lived with you
all year, they are considered to meet the citizen test and the U.S. citizen box will
automatically be checked yes.
Child is a potentially qualifying child for earned income credit Yes X No

Child is a nondependent, but may qualify for earned income credit Yes No
You, and no one else, is claiming this nondependent for the earned income credit Yes No
Months lived with taxpayer in the United States
Qualifying for the earned income credit * N Non-qualifying person
*EIC code is set based on your selections in the Dependency Exemption/EIC Smart Worksheet
Check if Social Security number is not valid for employment
Check if this person is not a qualifying child for the child tax credit
Check if this person is not a qualifying person for the credit for other dependents
Dependent has ITIN

Dependent name tony Jacob Page 2
Part III ' Dependent Care Expenses
Qualified child or dependent care expenses incurred and paid in 2021

Unreimbursed medical expenses paid for qualifying person in 2021
Employment taxes paid for dependent care providers in 2021
Child or dependent is a qualifying person for the child and dependent care credit X Yes No
Child is a nondependent, but may qualify for the child and dependent care credit Yes No
Part V ' Dependent’s State Residency Information
Enter this person’s state of residence as of December 31, 2021

This person is a resident of the state above for the entire year
This person is a resident of the state above for only part of year
Date this person established residence in state above
In which state (or foreign country) did this person reside before this change?
Part VI ' Identity Protection Pin
If the IRS sent an Identity Protection PIN for this dependent, enter it here
Part-Year Resident State Allocation Worksheet 2021
Check the box to activate this worksheet

INCOME Federal Resident Source Allocated

Amount State State Amount
1 T Wages, salaries, tips
S Wages, salaries, tips
* Enter state of source only if income is associated with a trade or a business B

Federal Residency Info * Allocated
Amount From To Res Src Amount
mm/dd mm/dd St St
2 T Taxable interest
S Taxable interest
3 T Dividends
S Dividends
4 T State/local tax refund
S State/local tax refund
5 T Alimony received
S Alimony received
* Enter the state of source for this income B
INCOME Federal Amount Residency Info * Allocated
(continued) From To Res Src Amount
Total Subtotal mm/dd mm/dd St St
6 T Business inc or loss
S Business inc or loss
7 T Farm income or loss
S Farm income or loss
8 Total Schedule E T See Sch E Income Allocation Smart Worksheet

S
* Enter the state of source for this income (See Tax Help) B
INCOME Federal Residency Info * Allocated
(continued) Amount From To Res Src Amount
mm/dd mm/dd St St
9 T Capital gain or loss
S Capital gain or loss
10 T Other gains/losses
S Other gains/losses
11 T Unemployment compensation
S Unemployment compensation
Federal Residency Info Allocated

Amount From To Res Amount
mm/dd mm/dd State
12 T Taxable IRA distributions
S Taxable IRA distributions
13 T Taxable pensions/annuities
S Taxable pensions/annuities
14a T Taxable social security benefits
S Taxable social security benefits
b T Taxable railroad retirements
S Taxable railroad retirements
15 Total other income T

S
16 Total Income T
S
ADJUSTMENTS Federal Residency Info Allocated

mm/dd mm/dd St
17 T Educator expenses
S Educator expenses
18 Certain business expenses T

S
19 T Health savings account deduction
S Health savings account deduction
20 T Moving expenses
S Moving expenses
21 T Penalty - early withdrawal of savings
S Penalty - early withdrawal of savings

ADJUSTMENTS Federal Residency Info Allocated

(continued) Amount From To Res Amount
mm/dd mm/dd St
22 T Alimony paid
S Alimony paid
23 T IRA deduction
S IRA deduction
24 T Student loan interest deduction
S Student loan interest deduction

* Enter the state of source for this adjustment B
ADJUSTMENTS Federal Residency Info * Allocated
(continued) Amount From To Res Src Amount
mm/dd mm/dd St St
25 T Self-employment tax
S Self-employment tax
26 T SEP, SIMPLE and qualified plans
S SEP, SIMPLE and qualified plans
27 T Self-employed health insurance
S Self-employed health insurance
28 T Reserved
S Reserved
29 Other adjustments T
S
Federal Residency Info Allocated

mm/dd mm/dd St
30 Total adjustments T
S
31 Adjusted gross income T
S
Form 1040 Forms W-2 & W-2G Summary 2021

Form W-2 Summary
Box No. Description Taxpayer Spouse Total
1 Total wages, tips and compensation:

Non-statutory & statutory wages not on Sch C
Statutory wages reported on Schedule C
Foreign wages included in total wages
Unreported tips
2 Total federal tax withheld
3 & 7 Total social security wages/tips
4 Total social security tax withheld
5 Total Medicare wages and tips
6 Total Medicare tax withheld
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
b Elective deferrals to qualified plans
c Roth contrib. to 401(k), 403(b), 457(b) plans
d Deferrals to government 457 plans
e Deferrals to non-government 457 plans
f Deferrals 409A nonqual deferred comp plan
g Income 409A nonqual deferred comp plan
h Uncollected Medicare tax
i Uncollected social security and RRTA tier 1
j Uncollected RRTA tier 2
k Income from nonstatutory stock options
l Non-taxable combat pay
m QSEHRA benefits
n Total other items from box 12
14 a Total deductible mandatory state tax
b Total deductible charitable contributions
c This line does not apply to TurboTax
d Total RR Compensation
e Total RR Tier 1 tax
f Total RR Tier 2 tax
g Total RR Medicare tax
h Total RR Additional Medicare tax
i Total RRTA tips
j Total other items from box 14
k Total sick leave subject to $511 limit
l Total sick leave subject to $200 limit
m Total emergency family leave wages
16 Total state wages and tips
17 Total state tax withheld
19 Total local tax withheld
Form 1099-G Certain Government Payments 2021
Name(s) Shown on Return Your Social Security No.

Ownership:
Taxpayer X Spouse Joint CORRECTED
Note: If filing electronically, all payer and recipient information must be entered. See page 2 for
additional information required for boxes 1 through 9.
PAYER’S name, street address, city, state, ZIP code, 1 Unemployment compensation $
and telephone no.
2 State or local income tax refunds, credits, or offsets.
Do not enter here. Enter on Federal Carryover Worksheet.
QuickZoom to Federal Carryover Worksheet
Check box to use Foreign Address 3 Box 2 amount is for 4 Federal income
Foreign Street Address tax year tax withheld
$
Foreign City
Foreign Province 5 RTAA payments 6 Taxable grants
Foreign Postal Code $ $
Country
Payer’s TIN Telephone number 7 Agriculture payments 8 State or local income tax
refunds, credits, or offsets
Recipient’s TIN from a trade or business
572-85-3164 $ $
Recipient’s name, street address, city, state, ZIP code.
Shawntae L Adams 9 Market gain $
2115 Constance Ave
North Las Vegas NV 89032-3607 10 a State 10 b State identification no.
Check box to use Foreign Address
Foreign Street Address
I confirm that the state withholding identification
Foreign City number(s) are accurate
Foreign Province
Foreign Postal Code 11 State income tax withheld $
Country $
Account number (optional) 12 a Locality name 13 Local income tax withheld

$
Additional Government Payments Information Page 2
Name(s) Shown on Return Your Social Security No.

State or local abbreviations: State Local

Enter the abbreviation of the state or locality issuing the payment
Unemployment repaid:
Enter the portion of the amount entered in box 1 that was repaid, if any
Agriculture payments:
(If there is an amount in box 7)
Required: Double-click to select the form on which to report this income:
Schedule F line 4a or 39a Form 4835 line 3a
Schedule F line 6a or 41 Form 4835 line 5a
Trade or business income:

Enter the taxable portion of the refund amount reported in box 8
Schedule C line 6 Schedule F line 8 or 43
Market gain:
Schedule F line 4a or 39a Form 4835 line 3a
QuickZoom to another copy of Form 1099-G

Forms 1099-MISC / 1099-NEC Summary 2021

Box Description Taxpayer Spouse Total
Form 1099-MISC Summary

1 Total Rents
A Schedule C
A Schedule E
A Form 4835
A Other Income
2 Total Royalties
A Schedule C
A Schedule E
3 Total Other income

A Schedule C
A Schedule F
A Form 4835
For Form 1040:
A Winnings (Prizes, etc.)
A Tribal Gaming
A Alaska Permanent Fund
A Other Income
4 Federal tax withheld

5 Fishing boat proceeds
6 Medical and health care payments
8 Substitute payments
9 Total Crop insurance proceeds

A Schedule F
A Form 4835
10 Gross proceeds paid to an attorney

A Taxable amount
11 Fish purchased for resale
12 Section 409A deferrals
13 Excess golden parachute payments
14 Nonqualified deferred compensation
15 State tax withheld ' total
Total Boxes 1-3, 5-14
Form 1099-NEC Summary

1 Total Nonemployee compensation
A Schedule C
A Schedule F
A Wages
A Other Income
4 Federal tax withheld
5 State tax withheld ' total
Wages, Salaries, & Tips Worksheet 2021

The following amounts are included in the total entered on line 1 of Form 1040 or on line 8 of Form 1040NR:
Taxpayer Spouse Total
1 Wages, from Form W-2

2 Miscellaneous income, from Form 8919
3 Items from Form 1099-R:
a Disability before minimum retirement age
b Return of contributions
4 Excess reimbursement, from Form 2106
5a Taxable tips, from Form 4137
b Noncash tips
6 Excess moving expense reimbursement,
from Form 3903
7 Wages earned as a household employee (if
less than $2,100 and without a Form W-2)
8 Items not on Form W-2 or Form 1099-R:
a Sick pay or disability payments
b Total foreign source income
c Check this box if the amount on line 8b is
eligible for the foreign exclusion/deduction
d Ordinary income from employer stock
transactions not reported on Form W-2
9 Other earned income:
a Non-gov unemployment received/repaid 2021
b
10 Subtotal.
Add lines 1 through 9
11 Taxable employer-provided dependent care
benefits, from Form 2441
12 Taxable employer-provided adoption benefits
less any excluded benefits from Form 8839
13 Scholarship/fellowship income not on
Form W-2
14 Other non-earned income:
15 Total of lines 10 through 14

Qualified Business Income Component Worksheet 2021

Aggregate trade or business name Gettin it together

Aggregate trade or business ID number (EIN)
Social Security Number of owner if no EIN available 572-85-3164
Reason for no EIN or SSN if none available
For multiple businesses being aggregated under Regulations section 1.199A-4, complete the
explanation statements below.
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.
Business name Tax ID QBI W2 wages UBIA

Gettin it together 98. 0. 0.
1 Qualified business income (QBI) 98.

If using Simplified Worksheet, stop here.
2 Taxable Income
3 Threshold Amount. $329,800 if MFJ, $164,925 if MFS, otherwise $164,900
4 Subtract line 3 from line 2. If less than 0, enter 0.
5 Phase-in range amount. Enter $100,000 if filing joint, otherwise $50,000
6 Reduction ratio. If line 4 is less than line 5, divide line 4 by line 5.
Otherwise, enter 1.
7 Applicable percentage. Subtract the reduction ratio (line 6) from 1.0000
8 Wages allocable to qualified business income
9 Unadjusted Basis Immediately after Acquisition of Assets (UBIA) allocable
to qualified business income
Reductions for Specified Service Trades or Businesses
Check if Specified Service Trade or Business (SSTB)
11 SSTB reduction to QBI
12 SSTB reduction to allocable wages
13 SSTB reduction to allocable UBIA
QBI, wages, and UBIA after applicable SSTB reductions
14 Qualified business income
15 Allocable wages
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
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 2021

QuickZoom to QBI Component Worksheet

QuickZoom to Form 8995
QuickZoom to Form 8995-A
1 Trade or business name Net QBI

Gettin it together 98.
2 Net qualified business income (QBI) from qualified trades or businesses 98.
3 Loss from previous year
4 Sum of activities with gains (only positive amounts from table on line 1) 98.
5 Sum of activities with losses (only negative amounts from table on line 1)
6 Check if using Simplified Computation (Form 8995) X
7 QBI component from Form 8995 line 5 or Form 8995A line 16 20.
8 QBI loss carryover from Form 8895 line 16 or Form 8995A Schedule C line 6 0.
9 Total REIT dividends

10 PTP Income from non-SSTBs
11 PTP Income from SSTBs
12 Allowed PTP Income from SSTBs
13 Total Allowed PTP income (sum of line 10 and line 12)
14 Carryover REIT/PTP losses from prior year
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) 20.
19 Taxable income before qualified business income deduction 0.

20 Net capital gains 0.
21 Taxable income minus net capital gains. If zero or less, enter -0- 0.
22 20% of taxable income minus net capital gains 0.
23 QBI deduction before DPAD 0.

Lesser of Combined QBI Amount or 20% of taxable income minus cap gains
24 Section 199A(g) deduction for domestic production activities
25 Total 199A (QBI) deduction (sum of lines 23 and 24) 0.

Schedule D Unrecaptured Section 1250 Gain Worksheet 2021
Line 19 G Keep for your records

Regular Alternative
Tax Minimum Tax
If you are not reporting a gain on Form 4797, line 7, skip lines 1
through 9 and go to line 10.
1 If you have a section 1250 property in Part III of Form 4797 for
which you made an entry in Part I of Form 4797 (but not Form
6252), enter the smaller of line 22 or line 24 of Form 4797 for that
property. If you did not have any such property, go to line 4. 1
2 Enter the amount from Form 4797, line 26g, for the property for
which you made an entry on line 1 2
4 Enter the total unrecaptured section 1250 gain included on lines
26 or 37 of Form(s) 6252 from installment sales of trade or
business property held more than one year 4
5 Enter the total of any amounts reported on a Schedule K-1 from a
partnership or an S corporation as "unrecaptured section 1250
gain". 5
6 Add lines 3 through 5 6
7 Enter the smaller of line 6 or the gain from Form
4797, line 7 7
8 Enter the amount, if any, from Form 4797, line 8 8
9 Subtract line 8 from line 7. If zero or less, enter -0- 9
10 Enter the amount of any gain from sale of an interest in a
partnership attributable to unrecaptured section 1250 gain 10
11 Enter the total of any amounts reported to you as "unrecaptured
section 1250 gain" from an estate, trust, real estate investment
trust or mutual fund
Regular AMT
a On Form 1099-DIV
b On Form 2439
c On Schedule(s) K-1
d On Form 1099-R
e From Form 8814
f Other
Total 11
12 Enter the total of any unrecaptured section 1250 gain from sales
(including installment sales) or other dispositions of section 1250
property held more than 1 year for which you did not make
an entry in Part I of Form 4797 for the year of sale 12
13 Add lines 9 through 12 13
14 If you had any section 1202 gain or collectibles gain or (loss),
enter the total of lines 1 thru 4 of the 28% Rate Gain Worksheet.
Otherwise, enter -0- 14 0. 0.
15 Enter the (loss), if any, from Schedule D, line 7. If Schedule D, line
7, is zero or a gain, enter -0- 15 0. 0.
16 Enter your long-term capital loss carryovers from Schedule D, line
14, and Schedule K-1 (Form 1041), line 11, code D 16
a Enter your capital gain excess, if you are filing Form 2555 a 0.
17 Combine lines 14 through 16a. If the result is a (loss), enter it as a
positive amount. If the result is zero or a gain, enter -0- 17 0. 0.
18 Unrecaptured section 1250 gain. Subtract line 17 from line 13. If
zero or less, enter -0-. If more than zero, enter the result here and
on Schedule D, line 19 18
Schedule D 28% Rate Gain Worksheet 2021

Regular Alternative
Tax Minimum Tax
1 Enter the total of all collectibles gain or (loss) from items you
reported on Form 8949, Part II 1
2 Enter as a positive number the amount of any section 1202
exclusion you reported in column (g) of Form 8949, Part II, with
code "Q" in column (f), that is 50% of the gain, plus 2/3 of any
section 1202 exclusion you reported in column (g) of Form
8949, Part II, with code "Q" in column (f), that is 60% of the
gain, plus 1/3 of any section 1202 exclusion you reported in
column (g) of Form 8949, Part II, with code "Q" in column (f),
that is 75% of the gain.
50 % 60 % 75%
Exclusion Exclusion Exclusion
a Schedule D
b Form 8814
c Schedule B
d Form 6252
e Form 2439
f Other
Total 2
3 Enter the total of all collectibles gain or (loss) from:
Regular AMT
a Form 4684, line 4 (but only
if line 15 is more than zero)
b Form 6252
c Form 6781, Part II
d Form 8824
Total 3
4 Enter the total of any collectibles gain reported to you on:
Regular AMT
a Form 1099-DIV, box 2d
b Form 2439, box 1d
c Schedule K-1 from a
partnership, S corporation,
estate, or trust
d Disposition of interest in
partnership or S corporation
e Other
Total 4
5 Enter your long-term capital loss carryovers from Schedule D,
line 14, and Schedule K-1 (Form 1041), line 11, code C 5
6 If Schedule D, line 7, is a (loss), enter that (loss) here.
Otherwise, enter -0-. 6
7 Combine lines 1 through 6. If zero or less, enter -0-. If more
than zero, also enter this amount on Schedule D, line 18 7
8 Enter the amount of any capital gain excess 8 0.
9 Subtract line 8 from line 7. If zero or less, enter -0-.
Enter this amount on Schedule D Tax Worksheet, line 11a 9 0. 0.
Form 1040 Schedule D Tax Worksheet 2021

1 a Enter your taxable income from Form 1040, line 15 1a 0.

b Enter amount on line 2c of your (and spouse’s) Foreign Earned Income Tax Wksht b
c Add lines 1a and 1b 1c 0.
2 a Enter your qualified dividends
from Form 1040, line 3a 2a
b Enter any capital gain excess
attributable to qualified dividends b
c Subtract line 2b from line 2a 2c
3 Amount from Form 4952, line 4g 3
4 a Amount from Form 4952, line 4e 4 a
b Amount from the dotted line
next to Form 4952, line 4e b
c Line 4b, if applicable, 4a, if not c
5 Subtract line 4c from line 3. 5 0.
6 Subtract line 5 from line 2c. If zero or less, enter -0- 6 0.
7 a Enter line 15 of Schedule D 7a
b Enter line 16 of Schedule D b
c Enter the smaller of line 7a or line 7b 7c 0.
8 Enter the smaller of line 3 or line 4c 8
9 a Subtract line 8 from line 7. 9a 0.
b Enter any capital gain excess attributable to
capital gains b
c Subtract line 9b from line 9a 9c 0.
10 Add lines 6 and 9c 10 0.
11 a Enter the amount from Schedule D, line 18 11 a 0.
b Enter the amount from Schedule D, line 19 b
c Add lines 11a and 11b 11 c 0.
12 Enter the smaller of line 9c or line 11c 12 0.
13 Subtract line 12 from line 10 13 0.
14 Subtract line 13 from line 1c. If zero or less, enter -0- 14 0.
15 Enter:
? $40,400 if single or married filing separately,
? $80,800 if married filing jointly or qualifying widow(er), or 15 40,400.
? $54,100 if head of household.
16 Enter the smaller of line 1c or line 15 16 0.
17 Enter the smaller of line 14 or line 16 17 0.
18 Subtr ln 10 from ln 1c. If zero or less, enter -0- 18 0.
19 Enter the smaller of line 1c or:
? $164,925 if single or married filing sep,
? $329,850 if MFJ or qual widow(er), or 19 0.
20 Enter the smaller of line 14 or line 19 20 0.
21 Enter the larger of line 18 or line 20 21 0.
22 Subtract line 17 from line 16. This amount is taxed at 0% 22 0.
If lines 1c and 16 are the same, skip lines 23 through 43 and go to line 44. Otherwise, go to line 23.
23 Enter the smaller of line 1c or line 13 23
24 Enter the amount from line 22 (if line 22 is blank, enter -0-) 24
26 Enter:
? $445,850 if single,
? $250,800 if married filing separately, 26
? $501,600 if married filing jointly or qualifying widow(er), or
27 Enter the smaller of line 1c or line 26 27
30 Enter the smaller of line 25 or line 29 30
31 Multiply line 30 by 15% (0.15) 31
If lines 1 and 32 are the same, skip lines 33 through 43 and go to line 44. Otherwise, go to line 33
34 Multiply line 33 by 20% (0.20) 34
If Schedule D, line 19, is zero or blank, skip lines 35 through 40 and go to line 41. Otherwise, go to line 35.
35 Enter the smaller of line 9c above or Schedule D, line 19 35
37 Enter the amount from line 1c above 37
40 Multiply line 39 by 25% (0.25) 40
If Schedule D, line 18, is zero or blank, skip lines 41 through 43 and go to line 44. Otherwise, go to line 41.
41 Add lines 21, 22, 30, 33, and 39 41
42 Subtract line 41 from line 1c 42
43 Multiply line 42 by 28% (0.28) 43
44 Figure the tax on the amount on line 21. If the amount on line 21 is less than $100,000,
use the Tax Table to figure this tax. If the amount on line 21 is $100,000 or more,
use the Tax Computation Worksheet 44
45 Add lines 31, 34, 40, 43, and 44 45 0.
46 Figure the tax on the amount on line 1c. If the amount on line 1c is less than $100,000,
use the Tax Table to figure this tax. If the amount on line 1c is $100,000 or more,
use the Tax Computation Worksheet 46
47 Tax on all taxable income (including capital gains and qualified dividends).
Enter the smaller of line 45 or line 46. Also include this amount on Form 1040, line 16 47
Form 1040 Qualified Dividends and Capital Gain Tax Worksheet 2021

1 Enter the amount from Form 1040 or 1040-SR, line 15 1

2 Enter the amount from Form
1040 or 1040-SR, line 3a 2
3 Are you filing Schedule D?
Yes. Enter the smaller of line 15
or 16 of Schedule D. If
either line 15 or 16 is blank
or loss, enter -0- 3
No. Enter the amount from Form
1040 or 1040-SR, line 7.
6 Enter:
$40,400 if single or married filing separately,
$80,800 if married filing jointly or qualifying widow(er), 6
$54,100 if head of household.
9 Subtract line 8 from line 7 (this amount taxed at 0%) 9
11 Enter the amount from line 9 11
12 Subtract line 11 from line 10. 12
13 Enter:
$445,850 if single,
$250,800 if married filing separately, 13
$501,600 if married filing jointly or qualifying widow(er),
$473,750 if head of household.
18 Multiply line 17 by 15% (0.15) 18
21 Multiply line 20 by 20% (0.20) 21
22 Figure the tax on the amount on line 5. If the amount on line 5 is less than
$100,000, use the Tax Table to figure the tax. If the amount on line 5 is
$100,000 or more, use the Tax Computation Worksheet 22
23 Add lines 18, 21, and 22 23
24 Figure the tax on the amount on line 1. If the amount on line 1 is less than
$100,000, use the Tax Table to figure this tax. If the amount on line 1 is
$100,000 or more, use the Tax Computation Worksheet 24
25 Tax on all taxable income. Enter the smaller of line 23 or line 24 here and on
Form 1040 or 1040-SR, line 16. 25
IRA Contributions Worksheet 2021

Traditional IRA Contributions
Regular Traditional IRA Contributions Taxpayer Spouse
1 Enter traditional IRA contributions made for 2021, including

any made between 1/1/2022 and 4/18/2022, any amounts
later recharacterized to a Roth IRA, and any excess
contributions, but not including any rollovers. Also include any
contributions to deemed IRAs under an employer plan
2 Contributions recharacterized from a Roth IRA (from line 24)
3 Traditional IRA contributions, from Schedule(s) K-1
4 Contributions recharacterized (not converted) to a Roth IRA
A If there is a recharacterization indicated on line 4, an
explanation must be attached to the tax return.
5 Traditional IRA contributions. Combine lines 1 through 4
6 Enter any contribution included on line 5 withdrawn before
the due date of the tax return. See Help
7 Excess traditional IRA contribution credit
8 Repayments of qualified reservist distributions
9 Total traditional IRA contributions.
Additional Traditional IRA Contribution Information Taxpayer Spouse
10 Check if covered by a retirement plan at work. If married filing

a separate return, check box in spouse column, if applicable
11 Enter any contributions included on line 9 that were made
during 1/1/2022 to 4/18/2022 (See Help)
Deductible and Non-deductible Traditional IRA Contributions Taxpayer Spouse
12 Deductible traditional IRA contributions from worksheet

13 Nondeductible traditional IRA contributions from worksheet
QuickZoom to worksheet indicated by the check:

IRA deduction worksheet
Worksheet for social security recipients
14 Amount on line 13 you elect to make nondeductible

15 Excess traditional IRA contributions, to Form 5329, line 15
Note: You may avoid a penalty by withdrawing the amount
on line 15 before due date of return, including extensions.
16 Deductible traditional IRA contributions, to Schedule 1

(Form 1040), Line 19
17 Qualified reservist repayments
18 Nondeductible traditional IRA contributions, to Form 8606, ln 1
IRA Contributions Worksheet 2021
Roth IRA Contributions
Regular Roth IRA Contributions Taxpayer Spouse
19 Enter regular Roth IRA contributions made for 2021, including

any made between 1/1/2022 and 4/18/2022, any amounts
later recharacterized to a traditional IRA, and any excess
contributions, but not including any rollovers or conversions.
Also include any contributions to deemed Roth IRAs under an
employer plan
20 Contributions recharacterized from a traditional IRA, (from ln 4)
21 Roth IRA contributions, from Schedule(s) K-1
22 Enter contributions recharacterized to a traditional IRA
A If there is a recharacterization indicated on line 23, an
explanation must be attached to the tax return.
23 Disallowed Roth IRA conversions
24 Roth IRA contributions. Combine lines 20 through 23
25 Enter any contribution included on line 24 withdrawn before
the due date of the tax return. See Help
26 Excess Roth IRA contribution credit
27 Total Roth IRA contributions
28 Repayments of qualified Roth reservist distributions
Roth IRA Contributions After Limitations Taxpayer Spouse
29 Roth IRA contributions after limitation

30 Excess Roth IRA contributions, to Form(s) 5329, line 23
Note: You may avoid a penalty by withdrawing the amount

on line 31 before due date of return, including extensions.
Coverdell Education Savings Account (Education IRA) Contributions
Excess Coverdell Education Savings Account Contributions Taxpayer Spouse
31 Enter any excess contributions made to Coverdell Education

Savings Accounts (ESAs) of which you are the beneficiary
Note: You do not need to report any Coverdell ESA

contributions which are not excess contributions..
Schedule A Tax and Interest Deduction Worksheet 2021
Lines 5 - 12 G Keep for your records

Tax Deductions
1 State and local taxes:

Optional Sales Tax Tables
a Available Income:
(1) Income from Form 1040, line 7 98.
(2) Nontaxable income entered elsewhere on return
(3) Available income: 2020 refundable credits in excess of tax 0.
(4) Enter any additional nontaxable income
(5) Total available income 98.
b Sales Tax Per State of Residence:
Enter state in column (1), then enter total (combined) state and local sales tax rate in column (4).
Arizona, Colorado, Louisiana, Mississippi, New York or South Carolina only:
Double-click in column (4) to select your locality for each state entered.
(1) (2) (3) (4) (5) (6) (7) (8) (9)

S Date Date Enter State Local State Local Prorated
t Lived in Lived in Total Sales Sales Sales Sales or Total
a State State State & Tax Tax Tax Tax Amount
t From To Local Rate Rate (%) Table Amount
e Rate (%) (%) (4) - (5) Amount
c Total general sales tax using tables

d Sales Tax Paid on Specific Items (see help):
(1) (2) (3) (4) (5) (6) (7) (8)

ST Total Description Type Cost Rate if Actual Specific
State & Different Sales Tax Item
Local Amount Deduction
Rate Paid
e Total sales tax deduction on specific items

f Total general sales tax per tables plus sales tax on specific items
g Actual State and Local General Sales Tax:
Actual sales taxes (enter the total sales taxes paid during the year on all items)
h State and Local Income Taxes:
State and Local Income taxes
i State and Local Tax Deduction to Schedule A, line 5a:
Greater of line 1f, line 1g, or line 1h (to Schedule A, line 5a)
j Check a box to choose to use income taxes paid, sales taxes paid, or whichever
provides the greater deduction:
Income Taxes Sales Taxes Greater amount X
2 State and local real estate taxes:

a Real estate taxes paid on principal residence not entered on Form 1098
b Real estate taxes paid on principal residence entered on Home Mortgage Int. Wks
c Real estate taxes paid on additional homes or land
Personal portion of real estate taxes from Schedule E Worksheet for:
d Principal residence
e Vacation home
f Less real estate taxes deducted on Form 8829
g Foreign real propety taxes included in lines 2a-2f above
h Add lines 2a through 2f, less line 2g (to Schedule A, line 5b)
3 State and local personal property taxes:
a Auto registration fees based on the value of the vehicle.
2020 Amount Enter 2021 description:
b Non-business portion of personal property taxes from Car & Truck Exp Wks
c Other personal property taxes
d Add lines 3a through 3c (to Schedule A, line 5c)
4 Other taxes:
a Other taxes from Schedule(s) K-1
b Foreign taxes from interest and dividends
c Foreign taxes from Schedule(s) K-1
d Other foreign taxes (not used to claim a foreign tax credit)
e Other taxes.
2020 Amount Enter 2021 description:
f Foreign real propety taxes included in lines 4a-4e above

g Add lines 4a through 4e, less line 4f (to Schedule A, line 6)
Interest Deductions
5 Home mortgage interest and points reported on Form 1098:

a Mortgage interest and points from the Home Mortgage Interest Worksheet
b Qualified mortgage interest from Schedule E Worksheet
c Less home mortgage interest/points deducted on Form 8829
d Less home mortgage interest from Form 8396, line 3
e Add lines 5a through 5d (to Sch A, line 8a) or line A2 from above
6 Home mortgage interest not reported on Form 1098:
a Mortgage interest from the Home Mortgage Interest Worksheet
b Less home mortgage interest deducted on Form 8829
c Add lines 6a and 6b (to Sch A, line 8b) or line B2 from above
7 Points not reported on Form 1098:
a Amortizable points from the Home Mortgage Interest Worksheet
b Other points not on Form 1098 from the Home Mortgage Interest Worksheet
c Less points deducted on Form 8829
d Add lines 7a through 7c (to Schedule A, line 8c) or line C2 from above
Schedule A State and Local Tax Deduction Worksheet 2021

State and Local Income Taxes
State income taxes:

1 State income tax withheld 1
2 2021 state estimated taxes paid in 2021 2
3 2020 state estimated taxes paid in 2021 3
4 Amount paid with 2020 state application for extension 4
5 Amount paid with 2020 state income tax return 5
6 Overpayment on 2020 state income tax return applied to 2021 tax 6
7 Other amounts paid in 2021 (amended returns, installment payments, etc.) 7
8 State estimated tax from Schedule(s) K-1 (Form 1041) 8
Local income taxes:
9 Local income tax withheld 9
10 2021 local estimated taxes paid in 2021 10
11 2020 local estimated taxes paid in 2021 11
12 Amount paid with 2020 local application for extension 12
13 Amount paid with 2020 local income tax return 13
14 Overpayment on 2020 local income tax return applied to 2021 tax 14
15 Other amounts paid in 2021 (amended returns, installment payments, etc.) 15
16 Local estimated tax from Schedule(s) K-1 (Form 1041) 16
Other:
17 17
18 Total Add lines 1 through 17 18
19 State and local refund allocated to 2021 19
20 Nondeductible state income tax from line 28 20
21 Total reductions Add lines 19 and 20. 21
22 Total state and local income tax deduction Line 18 less line 21 22
Nondeductible State Income Tax (Hawaii Only)
23 Nontaxable federal employee cost of living allowance 23

24 Adjusted gross income 24
26 Nondeductible percent. Line 23 divided by line 25 26 %
27 Hawaii state income tax included in line 18 27
28 Nondeductible Hawaii state income tax. Multiply line 26 by line 27. 28
Charitable Deduction Limits Worksheet 2021
For Current Year Contributions

Step 1 ' Enter your other charitable contributions made during the year.
1 Enter your cash contributions to 100% limit organizations 1
2 Enter your contributions of capital gain property "for the use of" any qualified
organization 2
3 Enter your other contributions "for the use of" any qualified organization.
Don’t include any contributions you entered on a previous line 3
4 Enter your other contributions to qualified organizations that aren’t 50% limit
organizations. Don’t include any contributions you entered on a previous line 4
5 Enter your contributions of capital gain property to 50% limit organizations
deducted at fair market value. Don’t include any contributions you entered on
a previous line. 5
6 Enter your noncash contributions to 50% limit organizations other than capital
gain property you deducted at fair market value. Be sure to include
contributions of capital gain property to 50% limit organizations if you reduced
the property’s fair market value. Don’t include any contributions you entered
on a previous line 6
7 Enter your cash contributions to 50% limit organizations. Don’t include any
contributions you entered on a previous line 7
Step 2 ' Figure your deduction for the year (if any result is zero or less, enter -0-)
8 Enter your adjusted gross income (AGI) 8 98.
A Cash contributions subject to the limit based on 60% of AGI
(If line 7 is zero, leave lines 9 through 11 blank)
9 Multiply line 8 by 0.6 9
10 Deductible amount. Enter the smaller of line 7 or line 9 10
11 Carryover. Subtract line 10 from line 7 11
B Noncash contributions subject to the limit based on 50% of AGI
C Contributions (other than capital gain property) subject to limit based on 30% of AGI
(If lines 3 and 4 are both zero, leave lines 16 through 22 blank)
17 Add lines 5, 6, and 7 17
21 Deductible amount. Enter the smallest of line 18, 19, or 20 21
a Cash portion of deductible amount - for Sch A line 11 a
b Non-cash portion of deductible amount - for Sch A line 12 b
D Contributions of capital gain property subject to limit based on 30% of AGI
E Contributions subject to the limit based on 20% of AGI
30 Add lines 10, 14, 21, and 27 30
36 Deductible amount. Enter the smallest of line 2, 31, 33, 34,
or 35 36
F Qualified contributions subject to limit based on 100% of AGI
39 Add lines 10, 14, 21, 27, and 36 39
G Deduction for the year
43 Add lines 10, 14, 21, 27, 36 and 41. Enter the total here
and include the deductible amounts on Schedule A (Form
1040), line 11 or line 12 whichever is appropriate. 43
44 Carryover to next year. Add lines 11, 15, 22, 28 and 37 44
Note: Any amounts in the carryover column are not deductible this year but can be carried over to next
year. See Carryovers, later, for more information about how you will use them next year.
Charitable Deduction Limits Worksheet 2021
For Carryover Contributions

Step 1 ' Enter your other charitable contributions made during the year.
1 Enter your cash contributions to 100% limit organizations 1
2 Enter your contributions of capital gain property "for the use of" any qualified
organization 2
3 Enter your other contributions "for the use of" any qualified organization.
Don’t include any contributions you entered on a previous line 3
4 Enter your other contributions to qualified organizations that aren’t 50% limit
organizations. Don’t include any contributions you entered on a previous line 4
5 Enter your contributions of capital gain property to 50% limit organizations
deducted at fair market value. Don’t include any contributions you entered on
a previous line. 5
6 Enter your noncash contributions to 50% limit organizations other than capital
gain property you deducted at fair market value. Be sure to include
contributions of capital gain property to 50% limit organizations if you reduced
the property’s fair market value. Don’t include any contributions you entered
on a previous line 6
7 Enter your cash contributions to 50% limit organizations. Don’t include any
contributions you entered on a previous line 7
Step 2 ' Figure your deduction for the year (if any result is zero or less, enter -0-)
8 Enter your adjusted gross income (AGI) 8 98.
Percentage Used in
of line 8 Current Year
a 60% AGI limit to line 9 59. Less 0. a 59.
b 50% AGI limit to line 12 49. Less 0. b 49.
c 30% AGI limit, Section C to line 19 29. Less 0. c 29.
d 30% AGI limit, Section D to line 26 29. Less 0. d 29.
e 20% AGI limit to line 35 20. Less 0. e 20.
A Cash contributions subject to the limit based on 60% of AGI
B Noncash contributions subject to the limit based on 50% of AGI
C Contributions (other than capital gain property) subject to limit based on 30% of AGI
(If lines 3 and 4 are both zero, leave lines 16 through 22 blank)
17 Add lines 5, 6, and 7 17
a Cash portion of deductible amount - for Sch A line 11 a
b Non-cash portion of deductible amount - for Sch A line 12 b
D Contributions of capital gain property subject to limit based on 30% of AGI
E Contributions subject to the limit based on 20% of AGI
30 Add lines 10, 14, 21, and 27 30
36 Deductible amount. Enter the smallest of line 2, 31, 33, 34,
or 35 36
F Qualified contributions for certain disaster relief efforts (Not applicable for carryovers)
39 Add lines 10, 14, 21, 27, and 36 39
G Deduction for the year
43 Add lines 10, 14, 21, 27, 36 and 41. Enter the total here
and include the deductible amounts on Schedule A (Form
1040), line 11 or line 12 whichever is appropriate. 43
44 Carryover to next year. Add lines 11, 15, 22, 28 and 37 44
Note: Any amounts in the carryover column are not deductible this year but can be carried over to next
year. See Carryovers, later, for more information about how you will use them next year.
Charitable Contributions Summary 2021
Part I Cash Contributions Summary
(a) (b) (c) (d)
Name of Charitable Organization Total 60% 30% 100%
Limit Limit Limit
Totals:
Part II Non-Cash Contributions Summary

Total Other Property Capital Gain Property
(a) (b) (c) (d) (e)

Name of Charitable Organization Total 50% 30% 30% 20%
Limit Limit Limit Limit
Totals:
Part III Contribution Carryovers to 2022
Total Cash and Other Capital Gain
Non-Capital Gain Property Property
(a) (b) (c) (d) (e) (f) (g)

Total 100% 60% 50% 30% 30% 20%
Limit Limit Limit Limit Limit Limit
1 2021 contributions
2 2021 contributions
allowed
3 Carryovers from:
a 2020 tax year N/A
b 2019 tax year N/A
c 2018 tax year N/A
d 2017 tax year N/A
e 2016 tax year N/A
4 Carryovers
allowed in 2021 N/A
5 Carryovers
disallowed in 2021 N/A
6 Carryovers to 2022:
a From 2021
b From 2020 N/A
c From 2019 N/A
d From 2018 N/A
e From 2017 N/A
f From 2016 N/A
Part IV Special Situations in Your Return for Current Year Donations

1 Was the entire interest given for all property donated to all charities? X Yes No
2 Were restrictions attached to any charities’s right
to use or dispose of any property donated to any charity? Yes X No
3 Did you give to anyone other than the charity the right to income from any
of the donated property or to possession of any of the donated property? Yes X No
4 Was any charity other than a 60%/50% charity? Yes X No
Schedule A Miscellaneous Itemized Deductions Worksheet 2021
Lines 16 G Keep for your records

FOR STATE USE ONLY: Employee Business Expenses ' Subject to 2% Limitation
1 Deductible expenses from Form 2106, line 10 less deductions for

performing artists and armed forces reservists claimed elsewhere 1
2 a Qualified Educator Expenses (from Educator Expenses Worksheet) 2a
b Educator Expense Deduction (from 1040, line 23) 2b
c Excess Educator Expenses (line 2a less line 2b) 2c
3 Union and professional dues 3
4 Professional subscriptions 4
5 Uniforms and protective clothing 5
6 Job search costs 6
7 Tax preparation fees 7
8 Entertainment expenses 8
9 Other:
9
10 Combine lines 1 through 9 10
FOR STATE USE ONLY: Investment

Miscellaneous Expenses ' Subject to 2% Limitation Expense T
Check the box in investment column if an investment expense
11 Depreciation and amortization deductions X 11

12 Casualty/theft losses of property used in services as an employee 12
13 REMIC expenses, from Schedule E X 13
14 Investment expenses related to interest and dividend income X 14
15 Expenses related to portfolio income, from Schedule(s) K-1 X 15
16 Miscellaneous deductions, from Schedule(s) K-1 16
17 RESERVED 17
18 Investment counsel and advisory fees X 18
19 Certain attorney and accounting fees X 19
20 Safe deposit box rental fees X 20
21 IRA custodial fees X 21
22 Loss incurred from total distribution of all traditional IRAs 22
23 Loss incurred from total distribution of all Roth IRAs 23
24 Loss incurred from final distribution of a QTP investment 24
25 Hobby expense (limited to hobby income) 25
26 Other:
a Prior year government unemployment benefits repaid in 2021 26
b
27 Combine lines 11 through 26 27
FOR FEDERAL AND STATE USE:

Other Miscellaneous Deductions ' Not Subject to 2% Limitation
28 Expenses related to portfolio income, from Schedule(s) K-1 X 28

29 Federal estate tax paid on decedent’s income reported on this return 29
30 Impairment-related expenses of a handicapped employee, from Form 2106 30
31 Amortizable bond premiums on bonds acquired before 10/23/86 31
32 Gambling losses 32
33 Deduction for repayment of amounts under claim of right if over $3,000 33
34 Casualty/theft losses of income-producing property 34
35 Unrecovered investment in annuity 35
36 Ordinary loss attributable to certain debt instruments 36
37 Net Qualified Disaster Loss 37
38 Combine lines 28 through 37 (to Schedule A, line 16) 38
Form 1040 or Standard Deduction Worksheet for Dependents 2021
1040-SR, Line 12 G Keep for your records

Use this worksheet only if someone can claim you, or your spouse if filing jointly, as a dependent.
1 Is your earned income* more than $750?
Yes. Add $350 to your earned income. Enter the total 1
No. Enter $1,100
? Single or married filing separately ' $12,550
? Married filing jointly ' $25,100 2 12,550.
? Head of household ' $18,800
3 Standard deduction.
3 a Enter the smaller of line 1 or line 2. If born after January 1, 1956, and not
blind, stop here and enter this amount on Form 1040 or 1040-SR, line 12.
Otherwise, go to line 3b 3a
3 b If born before January 2, 1956, or blind, multiply the number claimed on top of
page 2 of Form 1040 Wkst by $1,350 ($1,700 if single or head of household) 3b
3 c Add lines 3a and 3b. Enter the total here and on Form 1040 or 1040-SR, line 12 3c
*Earned income includes wages, salaries, tips, professional fees, and other compensation received for
personal services you performed. It also includes any taxable scholarship or fellowship grant. Generally,
your earned income is the total of the amount(s) you reported on Form 1040 or 1040-SR, line 1,
and Schedule 1, lines 3 and 6, minus the amount, if any, on Schedule 1, line 14. Earned income, for
the purpose of figuring your standard deduction, doesn’t include qualified disability trust distributions.
Earned Income Worksheet 2021

Part I ' Earned Income Credit Worksheet Computation
Taxpayer Spouse Total

1 If filing Schedule SE:
a Net self-employment income 98. 98.
b Optional Method and Church Employee income
c Add lines 1a and 1b 98. 98.
d One-half of self-employment tax
e Subtract line 1d from line 1c 98. 98.
2 If not required to file Schedule SE:
a Net farm profit or (loss)
b Net nonfarm profit or (loss)
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 98. 98.
Part II ' Form 2441 and Standard Deduction Worksheet Computations
5 Net self-employment earnings (line 4 above) 98. 98.

6 Wages, salaries, and tips less distributions
from nonqualified or section 457 plans, etc
7a Taxable employer-provided adoption benefits
b Foreign earned income exclusion
8 Add lines 5 through 7b. To Form 2441, lines 18
and 19 98. 98.
9a Taxable dependent care benefits
b Nontaxable combat pay
10 Add lines 8, 9a & 9b . To Form 2441, lines
4 and 5 98. 98.
11 Scholarship or fellowship income not on W-2
12 SE exempt earnings less nontaxable income
13 Distributions from nonqualified/Sec. 457 plans
14 Add lines 5, 6, 7a, 9a and 11 through 13.
To Standard Deduction Worksheet 98. 98.
Part III ' IRA Deduction Worksheet Computation
15 Net self-employment income or (loss) 98. 98.

16 Wages, salaries, tips, etc
17 Net self-employment loss
18 Alimony received
19 Nontaxable combat pay
20 Foreign earned income exclusion
21 Keogh, SEP or SIMPLE deduction
22 Combine lines 15 through 21. To IRA Wks, ln 2 98. 98.
Part IV ' Schedule 8812 and Child Tax Credit Line 14 Worksheet Computations
23 Self-employed, church and statutory employees 98. 98.

24 Wages, salaries, tips, etc
25 Nontaxable combat pay
26 Combine lines 23 through 25. To Schedule
8812, line 6a & Line 14 Wks, line 2 98. 98.
Form 1040 Earned Income Credit Worksheet 2021

QuickZoom to Schedule EIC

QuickZoom to Dependent Information Worksheet to enter qualifying children information
QuickZoom to Wages, Salaries, & Tips Worksheet to enter earned and non-earned income
QuickZoom to page 2 of this worksheet, if credit is not calculated on line 7
1 Enter the amount from Form 1040 line 1

less amounts considered not earned for EIC purposes 1
2 Adjustments to line 1 amount:
a Income reported as wages and as self-employment income 2a
b Other income entered as wages that is not considered earned income b
c Distributions from section 457 and other nonqualified plans reported on W-2 c
3 Subtract lines 2a, 2b and 2c from line 1 3
4a Taxpayer’s nontaxable combat pay election for EIC 4a
b Spouse’s nontaxable combat pay election for EIC b
c Total nontaxable combat pay election 4c
5 If you were self-employed or used Schedule C
as a statutory employee, enter the amount from the
Earned Income Worksheet, line 4 5 98.
6 Medicaid Waiver Payments reported as nontaxable 6
7 Earned income. Add lines 3, 4, 5, and 6 7 98.
8 Enter the credit, from the EIC Table, for the amount on line 7. Be sure to use
the correct column for filing status and number of children 8 11.
If line 8 is zero, stop. You cannot take the credit.

Enter "No" on the dotted line next to Form 1040, line 27.
9 Enter your AGI from Form 1040, line 11 9 98.
10 If you have:
? No qualifying children, is the amount on line 9 less than $11,650
($17,600 if married filing jointly)?
? 1 or more qualifying children, is the amount on line 9 less than $19,550
($25,500 if married filing jointly)?
X Yes. Go to line 11 now.

No. Enter the credit, from the EIC Table, for the amount on line 9. Be
sure to use the correct column for filing status and number of children 10
11 Earned income credit.
? If ’Yes’ on line 10, enter the amount from line 8
? If ’No’ on line 10, enter the smaller of line 8 or line 10 11 11.
Enter line 11 amount on Form 1040, line 27.

Compliance and Due Diligence Information
1 Is this how long your dependents lived with you in the U.S in 2021?
Yes, all of the above is correct.

No, I’ll go back and review my dependent information.
The IRS may ask you for documents to prove you lived with anyone you’re claiming for the Earned
Income Credit.
Is this where you lived with your dependents the longest in 2021?
2 Yes, my dependents lived with me at this address.

No, I’d like to add an additional address where I lived with my dependents. Use the Interview to
add an additional address where you lived with your dependents the longest in 2021.
Compliance and Due Diligence Indicator X

Disqualified from Earned Income Credit Yes X No
Potential qualifying child count 0

Non dependent potential qualifying child count 0
Qualifying child count (max 3) 0
Schedule SE Adjustments Worksheet 2021

(a) Taxpayer (b) Spouse
QuickZoom to the Long Schedule SE X
A Approved Form 4029. Exempt from SE tax on all income

B Chapter 11 bankruptcy net profit or loss for Schedule SE, line 3
C QuickZoom to the Explanation statement for any adjustment to
SE income/loss shown on a partnership K-1. (See Help)
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 Conservation Reserve Program payments not subject to self-
employment tax reported on:
a Schedule F, line 4b
b Schedule K-1 (Form 1065), box 20, code AH
c Total CRP payments not subject to SE tax
Part II Nonfarm Profit or (Loss) Schedule SE, line 2

1a Total Schedules C 98.
b Less SE exempt Schedules C (approved Form 4361)
2 Nonfarm partnerships, Schedules K-1
3 Forms 6781
4 Other SE income reported as income on Form 1040, line 7
5a Clergy Form W-2 wages
b Clergy housing allowance
c Less clergy business deductions
d QuickZoom to the Explanation statement for entry on line 5c
6 Other SE nonfarm profit or (loss) (See Help)
7 Less other SE exempt nonfarm profit or (loss) (See Help)
8 Total for Schedule SE, line 2 98.
9 Exempt Notary Public income for Schedule SE, line 3 (See Help)
Part III Farm Optional Method Schedule SE, page 2, Part II

1 Use Farm Optional Method
2 Gross farm income from Schedules F
3 Gross farming or fishing income from partnership Schedules K-1
4 Other gross farming or fishing self-employment income
5 Total gross income for Farm Optional Method
Part IV Nonfarm Optional Method Schedule SE, page 2, Part II

1 Use Nonfarm Optional Method (Must have had net SE earnings
of $400 or more in 2 of prior 3 years and used the
Nonfarm Optional Method less than 5 times)
2 Gross nonfarm income from Schedules C
3 Gross nonfarm income from partnership Schedules K-1
4 Other gross nonfarm self-employment income
5 Total gross income for Nonfarm Optional Method
Form 6251 Schedule D Tax Worksheet 2021
Line 37 as refigured for the
Alternative Minimum Tax

(a) (b) (c)

Before Allocation of After
Allocation of Capital Gain Allocation of
Capital Gain Excess * Capital Gain
Excess * Excess
1 Not applicable
2 Enter your total qualified dividends as refigured for
the Alternative Minimum Tax (AMT):
a Total qualified dividends
b Adjustment from Schedules K-1
c Other adjustments to qualified dividends
d Total. Combine lines 2a, 2b, and 2c 0. 0.
3 Enter the amount from Form 4952 for AMT, line 4g
4 Enter the amount from Form 4952 for AMT, line 4e
5 Subtract line 4 from line 3. If zero or less, enter -0- 0. 0.
6 Subtract line 5 from line 2. If zero or less, enter -0- 0. 0.
7 Net long-term capital gain:
a Enter the gain from line 15 of Schedule D
as refigured for the AMT 0.
b Enter the gain from line 16 of Schedule D
c Enter the smaller of line 7a or line 7b 0. 0.
8 Enter the smaller of line 3 or line 4
9 Subtract line 8 from line 7c. If zero or less, enter -0- 0. 0. 0.
10 Add lines 6 and 9 0. 0.
A Enter the amount from Form 6251, line 6. 0.
B Capital gain excess. Subtract line A from line 10. * 0.
11 Total 28% rate and unrecaptured section 1250 gain:
a Enter the gain from line 18 of Schedule D
b Enter the gain from line 19 of Schedule D
as refigured for the AMT
c Add lines 11a and 11b 0.
12 Enter the smaller of line 9 or line 11c 0.
13 Subtract line 12 from line 10. Also enter this amount
on Form 6251, line 13. 0.
* Capital gain excess applies only if filing Form 2555, Foreign Earned Income.
Form 6251 Alternative Minimum Tax Worksheet 2021

Taxable Income ' Line 1
1 Enter the amount from Form 1040 or 1040-SR, line 15, if more than zero. If
Form 1040 or 1040-SR, line 15, is zero, subtract line 14 of Form
1040 of 1040-SR from line 11 of Form 1040 or 1040-SR and enter the result
here. (If less than zero, enter as a negative amount.) 1 -12,452.
2 Additions to income 2
3 Add lines 1 and 2 3 -12,452.
4 Subtractions from income 4
5 Subtract line 4 from line 3. Enter on Form 6251, line 1 5 -12,452.
Taxes ' Line 2a
1 Generation skipping transfer taxes included on Schedule A, line 6 1
Refund of Taxes ' Line 2b
1 Taxable refund of state and local income tax 1

2 Amount and description of any refund of state and local personal property
taxes, foreign income or real property taxes 2
3 Total tax refund adjustment. Enter on Form 6251, line 2b 3
Alternative Tax Net Operating Loss Deduction (ATNOLD) ' Line 2f
1 Alternative minimum taxable income (AMTI) without ATNOLD 1 98.

2 Enter adjustments 2
3 Adjustment for domestic production activities deduction 3
4 Adjusted AMTI without ATNOLD. Add lines 1-3 4 98.
5 ATNOLD limitation. Multiply line 4 by 90% 5 88.
6 Enter ATNOL carried to 2020 from other year(s) 6
7 Enter ATNOL included above attributable to qualified disaster losses 7
8 ATNOL above not attributable to qualified disaster losses. Line 6 minus 7 8
9 ATNOL deduction other than qualified disaster losses. Lesser of line 5 or 8 9
10 ATNOL Disaster Deduction. Lesser of line 7 or (line 4 minus line 9) 10
11 ATNOLD. Add lines 9 and 10. Enter on Form 6251, line 2f, as neg 11
Incentive Stock Options ' Line 2i
1 Incentive stock options adjustment from Schedule K-1 worksheets 1

2 Incentive stock options from Employer Stock Transaction Worksheets 2
3 Incentive stock options from Exercise of Stock Options Worksheets 3
4 Other incentive stock options 4
5 Total incentive stock options. Enter on Form 6251, line 2i 5
Alternative Minimum Taxable Income ' Line 4
If married filing separately and Form 6251, line 4, is more than $752,800:
1 Alternative minimum taxable income, Form 6251 1
2 Threshold amount 2
4 Multiply line 3 by 25% (.25) 4
5 Smaller of line 4 or $57,300 5
6 Add line 1 and line 5. Enter on Form 6251, line 4 6
Exemption ' Line 5
1 Enter $73,600 if single or head of household, $114,600 if married filing jointly

or qualifying widow(er), $57,300 if married filing separately 1 73,600.
2 Enter your alternative minimum taxable income from Form 6251, line 4 2 98.
3 Enter $523,600 if single or head of household, $1,047,200 if married filing
jointly or qualifying widow(er), $523,600 if married filing separately 3 523,600.
4 Subtract line 3 from line 2. If zero or less, enter -0- 4 0.
5 Multiply line 4 by 25% (.25) 5 0.
6 Subtract line 5 from line 1. If zero or less, enter -0-. Enter on 6251, line 5 6 73,600.
Form 6251 Foreign Earned Income 2021
Line 7 Alternative Minimum Tax Worksheet

1 Enter the amount from Form 6251, line 6 1

2 a Enter the amount from your (and your spouse’s if filing jointly) Form 2555,
lines 45 and 50 2a
b Enter the total amount of any itemized deductions or exclusions you couldn’t
claim because they are related to excluded income 2b
c Subtract line 2b from line 2a. If zero or less, enter 0 2c
3 Add line 1 and line 2c 3
4 Tax on the amount on line 3.
? If you reported capital gain distributions directly on Form 1040 or 1040-SR,
line 7; or you reported qualified dividends on Form 1040 or 1040-SR, line
3a; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040 or
1040-SR) (as refigured for the AMT, if necessary), enter the amount from
line 3 of this worksheet on Form 6251, line 12. Complete the rest of Part III
of Form 6251. However, before completing Part III, see Form 2555, later, to
see if you must complete Part III with certain modifications. Then enter the
amount from Form 6251, line 40, here.
? All Others: If line 3 is $199,900 or less ($99,950 or less if married filing
separately), multiply line 3 by 26% (0.26). Otherwise, multiply line 3 by
28% (0.28) and subtract $3,998 ($1,999 if married filing separately) from
the result. 4
5 Tax on amount on line 2c. If line 2c is $199,900 or less ($99,950 or less if
married filing separately), multiply line 2c by 26% (0.26). Otherwise, multiply
line 2c by 28% (0.28) and subtract $3,998 ($1,999 if married filing separately)
from the result 5
6 Subtract line 5 from line 4. Enter the result here and on Form 6251, line 7. 6
Federal Carryover Worksheet 2021

2020 State and Local Income Tax Information
(a) (b) (c) (d) (e) (f) (g)

State or Paid With Estimates Pd Total With- Paid With Total Over- Applied
Local ID Extension After 12/31 held/Pmts Return payment Amount
Totals
2020 State Extension Information 2020 Locality Extension Information
(a) (b) (a) (b)

State Paid With Extension Locality Paid With Extension
2020 State Estimates Information 2020 Locality Estimates Information
(a) (c) (a) (c)

State Estimates Paid After 12/31 Locality Estimates Paid After 12/31
2020 State Taxes Due Information 2020 Locality Taxes Due Information
(a) (e) (a) (e)

State Paid With Return Locality Paid With Return
2020 State Refund Applied Information 2020 Locality Refund Applied Information
(a) (g) (a) (g)

State Applied Amount Locality Applied Amount
2020 State Tax Refund Information 2020 Locality Tax Refund Information
(a) (d) (f) (a) (d) (f)

Total Total Total Total
State Withheld/Pmts Overpayment Locality Withheld/Pmts Overpayment
Federal Carryover Worksheet page 2 2021
Other Tax and Income Information 2020 2021
1 Filing status 1 1 Single

2 Number of exemptions for blind or over 65 (0 - 4) 2
3 Itemized deductions 3 0.
4 Check box if required to itemize deductions 4
5 Adjusted gross income 5 98.
6 Tax liability for Form 2210 or Form 2210-F 6 0.
7 Alternative minimum tax 7
8a Federal overpayment applied to next year estimated tax 8a
b Federal extension payment for 2020 return b
QuickZoom to the IRA Information Worksheet for IRA information
Excess Contributions 2020 2021
9a Taxpayer’s excess Archer MSA contributions as of 12/31 9a

b Spouse’s excess Archer MSA contributions as of 12/31 b
10 a Taxpayer’s excess Coverdell ESA contributions as of 12/31 10 a
b Spouse’s excess Coverdell ESA contributions as of 12/31 b
11 a Taxpayer’s excess HSA contributions as of 12/31 11 a
b Spouse’s excess HSA contributions as of 12/31 b
Loss and Expense Carryovers 2020 2021

Note: Enter all entries as a positive amount
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
15 a Investment interest expense disallowed 15 a
b AMT Investment interest expense disallowed b
16 Nonrecaptured net Section 1231 losses from: a 2021 16 a
b 2020 b
c 2019 c
d 2018 d
e 2017 e
f 2016 f
17 AMT Nonrecap’d net Sec 1231 losses from: a 2021 17 a
b 2020 b
c 2019 c
d 2018 d
e 2017 e
f 2016 f
Form 8582 Modified Adjusted Gross Income Worksheet 2021

Description Amount
Income
Wages
Interest income before Series EE bond exclusion
Dividend income
Tax refund
Alimony received
Nonpassive business income or loss 98.
Royalty and nonpassive rental activities income or loss
Nonpassive partnership income or loss
Nonpassive S corporation income or loss
Nonpassive farm rental income or loss
Nonpassive farm income or loss
Nonpassive estate and trust income or loss
Real estate mortgage investment conduits
Business gains and losses from nonpassive activities
Capital gains and losses
Taxable IRA distributions
Taxable pension distributions
Unemployment compensation
Other income
Total income 98.
Adjustments
Educator expenses
Certain business expenses of reservists, performing artists, and government officials
Health savings account deduction
Moving expenses
Self-employed SEP, SIMPLE, and qualified plans
Self-employed health insurance deduction
Penalty on early withdrawals of savings
Alimony paid
Other adjustments
Total adjustments
Modified adjusted gross income 98.

Two-Year Comparison 2021

Shawntae L Adams
Income 2020 2021 Difference %
Wages, salaries, tips, etc

Interest and dividend income
State tax refund
Business income (loss) 98. 98.
Capital and other gains (losses)
IRA distributions
Pensions and annuities
Rents and royalties
Partnerships, S Corps, etc
Farm income (loss)
Social security benefits
Income other than the above
Total Income 98. 98.
Adjustments to Income
Adjusted Gross Income 98. 98.
Itemized Deductions
Medical and dental
Income or sales tax
Real estate taxes
Personal property and other taxes
Interest paid
Gifts to charity
Casualty and theft losses
Miscellaneous
Total Itemized Deductions 0. 0. 0.
Standard or Itemized Deduction 12,550. 12,550.
Qualified Business Income Deduction 0. 0.
Taxable Income 0. 0.
Income tax 0. 0.
Additional income taxes
Alternative minimum tax
Total Income Taxes 0. 0.
Nonbusiness credits
Business credits
Total Credits
Self-employment tax
Other taxes
Total Tax After Credits 0. 0.
Withholding
Estimated and extension payments
Earned income credit 11. 11.
Additional child tax credit
Other payments
Total Payments 11. 11.
Form 2210 penalty
Applied to next year’s estimated tax
Refund 11. 11.
Balance Due
Current year effective tax rate -11.22 %

Tax Summary 2021
Name (s)
Shawntae L Adams
Total income 98.

Adjustments to income
Adjusted gross income 98.
Itemized/standard deduction 12,550.
Qualified business income deduction 0.
Taxable income 0.
Tentative tax 0.
Additional taxes
Alternative minimum tax
Total credits
Other taxes
Total tax 0.
Total payments 11.
Estimated tax penalty
Amount Overpaid 11.
Refund 11.
Amount Applied to Estimate
Balance due 0.
Recovery Rebate Credit Worksheet 2021
Name(s) Shown on Return Social Security No.

This worksheet is used to compute the allowed recovery rebate credit for line 30 of Form 1040 or 1040-SR
after accounting for any economic stimulus payment previously received.
1 Can you be claimed as a dependent on another person’s 2021 return?

X No. Go to line 2
Yes. Stop. You can’t take the credit. Don’t complete the rest of this worksheet
2 Does your 2021 return include a social security number that was issued on or
before the due date of your 2021 return (including extensions) for you and, if filing
a joint return, your spouse?
X Yes. Go to line 6
No. If you are filing a joint return, go to line 3.
If you aren’t filing a joint return, go to line 5.
3 Was at least one of you a member of the U.S. Armed Forces at any time during
2020, and does at least one of you have a social security number that was issued
on or before the due date of your 2021 return (including extensions)?
Yes. Your credit is not limited. Go to line 6.
No. Go to line 4.
4 Does one of you have a social security number that was issued on or before the
due date of your 2021 return (including extensions?)
Yes. Your credit is limited. Go to line 6.
No. Go to line 5
5 Do you have any dependents listed in the Dependents section on page 1 of Form
1040 or 1040-SR for whom you entered a social security number that was issued on
or before the due date of your 2021 return (including extensions) or an adoption
taxpayer identification number?
Yes. Enter 0 on line 6 and go to line 7.
No. Stop. You can’t take the credit. Don’t complete the rest of this worksheet
and don’t enter any amount on Form 1040, line 30.
6 Enter: @ $1,400 if single, head of household, married filing separately, qualifying
widow(er).
@ $1,400 if married filing jointly and you answered "Yes" to question 4, or
@ $2,800 if married filing jointly and you answered "Yes" to question 2 or 3 6 1,400.
7 Multiply $1,400 by the number of dependents listed in the Dependents section on
page 1 of Form 1040 or 1040-SR for whom you entered a social security number
that was issued on or before the due date of your 2021 return (including
identification number 7 1,400.
8 Add lines 6 and 7 8 2,800.
9 Is the amount on line 11 of Form 1040 or 1040-SR more than the amount shown
below for your filing status?
@ Single or married filing separately-$75,000
@ Married filing jointly or qualifying widow(er)-$150,000
@ Head of household-$112,500
Yes. Enter the amount from line 11 of Form 1040 or 1040-SR and go to line 10 9
X No. Enter the amount from line 8 on line 12 and skip lines 10 and 11
10 Is line 9 more than the amount shown below for your filing status?
@ Head of household-$120,000
Yes. Stop. You can’t take the credit. Don’t complete the rest of this worksheet
and don’t enter any amount on Form 1040, line 30.
No. Subtract line 9 from the amount shown above for your filing status 10
11 Divide line 10 by the amount shown below for your filing status. Enter the result as
a decimal (rounded to at least 2 places).
@ Head of household-$7,500 11
12 Multiply line 8 by line 11 12 2,800.
13 Enter the amount, if any, of EIP 3 that was issued to you. If filing a joint return,
include the amount, if any, of your spouse’s EIP 3. You may refer to Notice 1444-C
or your tax account information at IRS.gov/Account for the amount to enter here 13
14 Recovery rebate credit. Subtract line 13 from line 12. If zero or less, enter -0-. If
line 13 is more than line 12, you don’t have to pay back the difference. Enter the
result here and, if more than zero, on line 30 of Form 1040 or 1040-SR 14
Compare to U. S. Averages 2021
Name(s) Shown on Return Social Security No

Your 2021 adjusted gross income (AGI) 98.

National adjusted gross income range used below from 0. to 14,999.
Note: National average amounts have been adjusted for inflation. See Help for details.
Actual National
Selected Income, Deductions, and Credits Per Return Average
Salaries and wages 9,304.

Taxable interest 1,984.
Tax-exempt interest 5,870.
Dividends 3,203.
Business net income less loss 98. 3,116.
Net capital gain 23,844.
Net capital loss 2,228.
Taxable IRAs pensions and annuities 8,253.
Rent and royalty net income less loss -4,184.
Partnership and S corporation net income less loss -104,007.
Taxable social security benefits 1,956.
Medical and dental expenses deduction 14,235.

Taxes paid deduction 0. 4,689.
Interest paid deduction 11,552.
Charitable contributions deduction 2,052.
Total itemized deductions 0. 23,492.
Child care credit 197.

Education tax credits 174.
Child tax credit 190.
Retirement savings contributions credit 117.
Earned income credit 11. 1,734.
Other Information Actual National

Per Return Average
Adjusted gross income 98. 836.

Taxable income 0. 1,567.
Income tax 0. 189.
Alternative minimum tax 62,804.
Total tax liability 0. 593.
ELECTRONIC POSTMARK - CERTIFICATION OF ELECTRONIC FILING
Taxpayer: Shawntae L Adams

Primary SSN: 572-85-3164
Federal Return Submitted:

Federal Return Acceptance Date:
Your return has not been electronically transmitted yet
The Intuit Electronic Postmark shows the date and time Intuit received your federal tax return. The Intuit
Electronic Postmark documents the filing date of your income tax return, and the electronic postmark
information should be kept on file with your tax return and other tax-related documentation.
There are two important aspects of the Intuit Electronic Postmark:
1. THE INTUIT ELECTRONIC POSTMARK.

The electronic postmark shows the date and time Intuit received the federal return, and is deemed the
filing date if the date of the electronic postmark is on or before the date prescribed for filing of the
federal individual income tax return.
TIMELY FILING:
For your federal return to be considered filed on time, your return must be postmarked on or before
midnight April 18, 2022 . Intuit’s electronic postmark is issued in the Pacific Time (PT) zone.
If you are not filing in the PT zone, you will need to add or subtract hours from the Intuit Electronic
Postmark time to determine your local postmark time. For example, if you are filing in the Eastern Time
(ET) zone, and you electronically file your return at 9 AM on April 18, 2022 , your Intuit
electronic postmark will indicate April 18, 2022 , 6 AM. If your federal tax return is rejected,
the IRS still considers it filed on time if the electronic postmark is on or before April 18, 2022 ,
and a corrected return is submitted and accepted before April 23, 2022 . If your return is
submitted after April 23, 2022 , a new time stamp is issued to reflect that your return was
submitted after the IRS deadline, and consequently, is no longer considered to have been filed on time.
If you request an automatic six-month extension, your return must be electronically postmarked by
midnight October 17, 2022 . If your federal tax return is rejected, the IRS will still consider
it filed on time if the electronic postmark is on or before October 17, 2022 , and the
corrected return is submitted and accepted by October 22, 2022
2. THE ACCEPTANCE DATE.

Once the IRS accepts the electronically filed return, the acceptance date will be provided by the Intuit
Electronic Filing Center. This date is proof that the IRS accepted the electronically filed return.
We need your consent - Early Access
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consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not
specify the duration of your consent, your consent is valid for one year from the date of signature."
If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) at https://www.treasury.gov/tigta/.
To agree, enter your name and date in the boxes below and select the "I Agree" button on the
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Please type the date below:
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F7216U01 SBIA5001
Read and accept this Disclosure Consent
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consent will not be valid. If you agree to the disclosure of your tax return information, your consent is
valid for the amount of time that you specify. If you do not specify the duration of your consent, your
consent is valid for one year from the date of signature."
bottom of the page.
Sign this agreement by entering your name:
Date
sbia5101 05/16/22
Read and accept this Disclosure Consent
To, enable the Tax Identity restoration protection service that you purchased
as part of a bundle, we need your consent to send some of your
personal information to our partner, ID Notify.
Entering your name and date below allows us to disclose the data below to IDNotify,
provided by CSIdentity Corp., an Experian company. With your consent, we will send the following:
First Name, Middle Initial, Last Name, Date of Birth, Phone Number, Street Address, City, State,
Zip, Social Security Number, Email Address, Username, and a randomly generated Subscriber Number.
"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot
disclose your tax return information to third parties for purposes other than the preparation and filing of
your tax return without your consent. If you consent to the disclosure of your tax return information,
Federal law may not protect your tax return information from further use or distribution.
consent will not be valid. If you agree to the disclosure of your tax return information, your consent is
valid for the amount of time that you specify. If you do not specify the duration of your consent, your
consent is valid for one year from the date of signature."
bottom of the page.
I authorize Intuit to send my information listed above to CSIdentity Corporation.
Sign this agreement by entering your name:
Date
sbia5102 05/16/22
IMPORTANT DISCLOSURES
If you are owed federal tax refund(s), you have a right to choose how you will receive the refund(s).
There are several options available to you. Please read about these options below.
You can file your federal tax return(s) electronically or by paper and obtain your federal tax refund(s)
directly from the Internal Revenue Service ("IRS") for free. If you file your tax return(s)
electronically, you can receive refund checks directly from the IRS through the U.S. Postal Service
in 21 to 28 days from the time you file your tax return(s) or the IRS can deposit your refund(s)
directly into your bank account in less than 21 days from the time you file your tax return(s)
unless there are delays by the IRS. If you file a paper return through the U.S. Postal Service, you
can receive refund checks directly from the IRS through the U.S. Postal Service in 6 to 8 weeks
from the time the IRS receives your return(s) or the IRS can deposit your refund(s) directly
into your bank account in 6 to 8 weeks from the time the IRS receives your return(s). However, if
your return(s) contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS will
issue your refund(s) no earlier than February 15, 2022.
You can file your federal tax return(s) electronically, select the Refund Processing Service ("RPS"), and have
your federal tax refund(s) processed through a processor using banking services of a financial institution. The RPS
allows your refund(s) to be deposited into a bank account at Green Dot Bank ("Bank") and deducts your
TurboTax fees and other amounts that you authorize from your federal refund(s). The balance of your federal
refund(s) is delivered to you via the disbursement method you select. If you file your tax return(s) electronically
and select the RPS, the IRS will deposit your refund(s) with Bank. Upon Bank's receipt of your refund(s), Santa
Barbara Tax Products Group, LLC, a division of Green Dot Corporation, a Delaware corporation, a processor, will
deduct from your federal refund(s) any fees charged by TurboTax for the preparation and filing of your tax return(s)
and any other amounts authorized by you and disburse the balance of your refund proceeds to you. Unless there are
unexpected delays, federal refunds are received in less than 21 days from the time you file your tax return(s)
electronically. However, if your return(s) contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS
will issue your refund(s) no earlier than February 15, 2022.
The RPS is not necessary to obtain your refund(s). If you have an existing bank account, you do not need
to use the RPS in order to receive a direct deposit from the IRS. You may consult the IRS website
(IRS.gov) for information about tax refund processing.
If you select the RPS, no prior debt you may owe to Bank will be deducted from your refund(s).
You can change your income tax withholdings which might result in you receiving additional funds
throughout the year rather than waiting to receive these funds potentially in tax refund(s) next year.
Please consult your employer or tax advisor for additional details.
This Agreement requires all disputes to be resolved by way of binding arbitration.

The terms of the arbitration provision appear in Section 10.
Information regarding low-cost deposit accounts may be available at www.mymoney.gov
The chart below shows the options for filing your federal tax returns (e-file or paper returns), the
RPS product, refund disbursement options, estimated timing for obtaining your federal tax refund
proceeds, and costs associated with the various options.
WHAT TYPE WHAT ARE YOUR WHAT IS THE WHAT COSTS DO YOU
OF FILING DISBURSEMENT ESTIMATED TIME TO INCUR IN ADDITION
METHOD? OPTIONS? RECEIVE REFUND(S)? TO TAX PREPARATION
FEES?
PAPER RETURN IRS direct deposit to Approximately Free

your personal bank 6 to 8 weeks 1
No Refund Processing account.
Service
Check mailed by IRS Approximately
to address on tax 6 to 8 weeks 1
return(s).
ELECTRONIC IRS direct deposit to Usually within Free

(E-FILE) account.
No Refund Processing Check mailed by IRS Approximately

Service to address on tax 21 to 28 days 1
return(s).
ELECTRONIC Direct deposit to Usually within Free option with

FILING your personal bank 21 days 1 your purchase of
(E-FILE) account. a Tax Product 2
Refund Processing
Service
1You may experience delays with your tax refund(s) if, for example, you enter incorrect bank account or
contact information, you enter a bank account in someone else's name, or if possible suspicious activity
is detected. If your return(s) contains Earned Income Tax Credit or Additional Child Tax Credit, the IRS
will issue your refund(s) no earlier than February 15, 2022.
2The charges here consist of a TurboTax Fee, the cost of the Tax Product, and any fees for additional
products and services purchased. Note that the cost of the Tax Product may vary depending on the edition
of TurboTax purchased. See Section 3 of the Refund Processing Service Agreement for the cost of the
service you have chosen.
Questions? Call 877-908-7228

sbia5202.ptform 12/02/21 12/02/2021
Pro Delegation Worksheet 2021
Check this box if you are preparing this return as a PRO preparer
Preparer / Electronic Return Originator (ERO) Information
Print name in signature area?

Preparer Name
Preparer Tax ID # (PTIN)
NY Tax Preparer Registration # or NY Exclusion Code
For NM, OR Preparers Only: State ID#
Preparer E-mail Print date on return?
Preparer Phone CAF #
Electronic Filing Only: ERO Practitioner PIN
Electronic Filing and Printing of Tax Return Information
Electronic Filing: Print and Mail Selections (use only if e-file ineligible):
File federal return electronically Federal return printed and mailed to IRS
File state returns electronically State return printed and mailed to state agency
File other returns electronically Other return printed and mailed
Select state returns to file electronically: Select state returns to file by mail:
State(s) State(s)
Select other returns to file electronically: Select other returns to file by mail:
Other Return(s) Other Return(s)
Electronic Filing and Printing of Amended Return Information
Electronic Filing: Print and Mail Selections (use only if e-file ineligible):
File federal amended return(s) electronically Federal amended return printed and mailed
File state amended return(s) electronically State amended return printed and mailed
Select state amended return(s) to file electronically: Select state amended return(s) to file by mail:
State(s) State(s)
New! State e-file disclosure consent:
By using a computer system and software to prepare and transmit my client’s return electronically, I
consent to the disclosure of all information pertaining to my use of the system and software to create my
client’s return and to the electronic transmission of my client’s return to the state Department of
Revenue, as applicable by law.
Practitioner PIN Program:

Sign return electronically using Practitioner PIN
Choose one:
Automatically generate PIN equal to last 5 digits of taxpayer(s) SSN (See help)
Taxpayer(s) entered own PIN(s)
Preparer entered PIN(s) on behalf of taxpayer(s)
Taxpayer’s PIN (enter any 5 numbers).
Spouse’s PIN filing a joint return (enter any 5 numbers)
Date PIN entered
Identity Verification Information
Driver’s License and/or State Id:

Taxpayer and Spouse (if applicable) driver’s license and/or state identification must be completed on the
federal information worksheet prior to e-filng the return.
Documents Used to Verify Primary Taxpayer Identity:

Driver’s license
State issued identification card
Passport
Account statement from financial institution
Utility billing statement
Credit card billing statement
Finish and File Info:

To indicate a client return download in FnF
New Finish and File enabled
PDF ATTACHMENTS
Attachment Type File Name PDF Name Entity Version

Description Key
Pro Expert Suggestions 2021
Please fill out the survey at the link below to help us better understand your experience
working with the tax optimization features.
https://forms.gle/ugi2CxnyuAXNW2Kb7
Suggestions For Customer
Suggestion ID Suggestion
0000 No pilot project expert suggestion was determined for this customer
Pro Notes About Suggestions

Suggestion ID Suggestion
fdiv8003.SCR 02/20/20
Shawntae L Adams 572-85-3164 1
Smart Worksheets From 2021 Federal Tax Return

Schedule C (hairdresser): Profit or Loss from Business -- Smart Worksheet
Business Address Information Smart Worksheet
Business street address 2115 Constance Ave

City, State, and ZIP Code (do not enter State and ZIP Code if foreign address)
North Las Vegas NV 89032-3607
Or, foreign country information:
Qualified Business Income Deduction Smart Worksheet

Completing this worksheet is generally only necessary if Form 8995A must be filed (i.e., taxable
income is above threshold amounts or qualified coop payments are present).
A QBI worksheet to report (double-click to link) Gettin it together

B Trade or Business Name Gettin it together
C Trade or Business ID Number
D 1 Is this a Specified Service Trade or Business (SSTB)? Yes No
2 If No, is income attributable to a SSTB? (see Help) Yes No
3 QBI worksheet for SSTB income (this will auto-populate if Yes)
4 Percentage of qualified income attributable to SSTB %
E 1 Tentative Sch C profit (loss) from this business 98.
2 Adjustments to qualified business income 0.
3 Tentative Sch C profit (loss) from qualified business 98.
4 a Calculated QBI allowed after passive/at-risk limits 98.
b Adjustments to allowed QBI
c Allowable QBI after loss limits 98.
5 Self employed deductions connected to this business
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
6 Sch C profit (loss) after S.E. deductions 98.
7 Additional deductions related to this business reported on separate schedules
8 Net profit (loss) after adjustments, limitations, and deductions 98.
9 Allowable Sch C profit (loss) allocated to SSTB 0.
10 Allowable Sch C profit (loss) from this business 98.
F 1 Ordinary gain (loss) from business assets 0.

2 Ordinary gain (loss) adjustments
3 Qualified ordinary gain (loss) 0.
c Allowable short-term qualified gain (loss) after passive/at-risk limits 0.
5 Allowable ordinary gain (loss) allocated to SSTB 0.
6 Allowable ordinary gain (loss)/recapture from this business 0.
G 1 Section 1231 gain (loss) from business assets 0.

2 Section 1231 gain (loss) adjustments
3 Section 1231 gain (loss) from qualified business 0.
c Allowable ordinary 1231 qualified gain (loss) 0.
5 Allowable ordinary 1231 gain (loss) allocated to SSTB 0.
6 Allowable ordinary 1231 gain (loss) from this business 0.
Qualified Business Income Deduction Smart Worksheet, Continued
H 1 Allowable QBI (E10 plus F6 plus G6) 98.

2 Qualified business income allocated to SSTB 0.
3 a Previously disallowed losses freed up in current year
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
I 1 Tentative wages 0.
2 Adjustments
3 Qualified wages 0.
4 Qualified wages allocated to SSTB 0.
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 Net income allocable to qualified payments from agricultural or horticultural coop

2 Wages allocable to qualified payments from coop
3 Form 1099PATR line 6 (DPAD) from coop(s) w/ tax year starting before 1/1/2018
4 Form 1099PATR line 6 (DPAD) from coop(s) w/ tax year starting after 12/31/17
Carryovers to 2021 Smart Worksheet, Continued
Regular Tax QBI

Disallowed Section 179 Deduction by Year
Before 2018 A Section 179 carryover 0.
2018 B Section 179 carryover
2019 C Section 179 carryover
2020 D Section 179 carryover
Disallowed At-Risk Losses by Year and Type
Before 2018 A Operating loss 0.
B Form 4797 ordinary loss 0.
C Form 4797 long-term loss 0.
2018 D Operating loss
E Form 4797 ordinary loss
F Form 4797 long-term loss
2019 G Operating loss
H Form 4797 ordinary loss
I Form 4797 long-term loss
2020 J Operating loss
K Form 4797 ordinary loss
L Form 4797 long-term loss
Disallowed Passive Losses by Year and Type
Activity Summary Smart Worksheet

Supporting information provided by program. NO ENTRIES ARE NEEDED.
Regular Tax QBI Alternative

Minimum Tax
A Ownership Taxpayer
B At risk status All
C Passive status Nonpassive
Schedule C
D Tentative profit (loss) 98. 98. 98.
E Other adjustments
F At risk disallowed loss
G Passive carryover loss
H Passive disallowed loss
I Net profit (loss) allowed 98. 98. 98.
Related Dispositions
J Tentative profit (loss) 0.
K At risk disallowed loss
L Passive carryover loss
M Passive disallowed loss
N Net profit (loss) allowed 0.
QBI (Section 199A) Losses by Year Smart Worksheet, Continued
At-risk losses Regular Tax QBI

Previously disallowed at-risk losses by year
Operating Loss 1 Total loss in 2021
2 Total allowed loss (all years)
3 Allowed loss in 2021
4 Freed up loss from before 2018
5 Freed up loss from 2018
6 If SSTB, reduced loss from 2018
Form 4797 ordinary loss 11 Total loss in 2021
Form 4797 long term loss 21 Total loss in 2021
At-risk loss carryforwards to 2022
2021 M Operating loss
N Form 4797 ordinary loss
O Form 4797 long-term loss
QBI (Section 199A) Losses by Year Smart Worksheet, Continued
Passive losses Regular Tax QBI

Previously disallowed passive losses by year
Operating Loss 1 Total loss in 2021
Form 4797 ordinary loss 11 Total loss in 2021
Form 4797 long term loss 21 Total loss in 2021
Passive loss carryforwards to 2022
Before 2018 A Operating Loss 0.
2018 D Operating Loss
2021 M Operating loss
N Form 4797 ordinary loss
O Form 4797 long-term loss
1040/1040SR Wks: Form 1040 or Form 1040-SR Worksheet -- Smart Worksheet
Tax Smart Worksheet
A Tax 0.
Check if from:
1 Tax table X
2 Tax Computation Worksheet (see instructions)
3 Schedule D Tax Worksheet
4 Qualified Dividends and Capital Gain Tax Worksheet
5 Schedule J
6 Form 8615
7 Foreign Earned Income Tax Worksheet
B Additional tax from Form 8814
C Additional tax from Form 4972
D Tax from additional Form(s) 4972
E Recapture tax from Form 8863
F IRC Section 197(f)(9)(B)(ii) election for an additional tax
G Health Coverage Tax Credit Recovery, Form 8885, Line 5, if negative
H Additional tax from Form 8621
I Tax. Add lines A through G. Enter the result here and include in tax below 0.
J Form 8621 tax deferal from line 9c (to line 24)
1040/1040SR Wks: Form 1040 or Form 1040-SR Worksheet -- Smart Worksheet
Excess Social Security and Tier I RRTA Tax Withheld Smart Worksheet
The calculated amount for Excess social security and tier 1 RRTA tax withheld could include
a portion that needs to be removed. When a taxpayer has multiple W-2’s, each with the same
EIN, excess withholding can only be claimed if the Employer’s Name’s in box c of the W-2’s
reflect separate business entities. This could occur when a parent company has multiple
subsidiaries, or when a temp agency issues W-2’s for distinctly different jobs. If you have
multiple W-2’s with the same EIN, for the same taxpayer, and for the same job, reduce the
amount calculated on Line A below by the excess withholdings from only those W-2’s.
A Total Excess Social Security or Tier I RRTA tax withheld claimed as a credit 0.
Federal Information Worksheet -- Smart Worksheet
TurboTax for the Web Filing Status Smart Worksheet
Check this box to override the filing status selected thru Interview
Marital Status
Filing Status Selected
Dependent Information Worksheet (tony) -- Smart Worksheet
Dependency/EIC Smart Worksheet

NOTE: It is recommended that you answer the questions below using the Step-by-Step mode.
That will help insure that answers to the questions are not inconsistent.
A How many months did this person live with you? The whole year
Note: If born or died in current year and lived with you entire time or qualified
missing child select "The whole year". If more than one-half the year select 7
or more
B Who are the parents of this person?
(Used to determine if additional questions are necessary for children of divorced parents.)
Both Taxpayer and spouse
Taxpayer
Spouse
C Did this person provide more than 1/2 of their own support? Yes X No
D Was this person married on December 31, 2021 and filing a joint return
for the year (You may answer no if the only reason the joint return is filed
is to get a refund of tax withheld or estimated tax payments and neither
spouse would have a tax liability on their return if they filed separate
returns)? Yes No
Detailed answers for this question. This dependent:
- Was married on December 31, 2021 Yes No
- If married, filed a joint return for the year Yes No
- If filed joint return, only filed to get a refund of
tax withheld or estimated tax payments Yes No
- If filed married filing separate, neither spouse
had a tax liability on their return if they had
filed separately Yes No
E Is this person a Full time student? Yes No
F Is this person’s gross income less than $4,300? X Yes No
1 Did you provide over 1/2 the support for this person?
or
Did you provide over 10% of the support for the person and with other
individuals who would be able to claim the person except for the
support test over 1/2 the support and all of you have agreed that you
alone will claim the person and you have filled out the Multiple Support
Declaration, Form 2120, to attach to your return? X Yes No
G Is there an agreement with this person’s other parent about who can claim
this person as a dependent? Yes No
Note: The noncustodial parent claiming the exemption for the child must
attach to their return Form 8332 from the custodial parent releasing the
claim to the exemption for the child
1 TurboTax Web Only:
Is the other parent claiming this dependent per the custody
agreement? Yes No
Has the other parent waived their legal right so you can claim this
dependent on your tax return? Yes No
H Who will be claiming this person as a dependent as a result of:
- an agreement between the parents
- the rules controlling who can claim a qualifying child when the child meets the
conditions to be a qualifying child of more than one person?
Taxpayer (includes spouse if married filing joint) in this return? X
Other parent in different return?
Someone else in different return?
Dependent Information Worksheet (tony) -- Smart Worksheet
Child and Dependent Care Expenses, Form 2441, Special Situations Worksheet
Check this box if this person is a qualifying person only for the dependent care
expenses because they were not your dependent but would have been except that:
* They received gross income greater than $4,300 or more or
* They filed a joint return
Part-Year State Allocation Worksheet -- Smart Worksheet
Additional Other Income Allocation Smart Worksheet

* Enter the state of source for this income (See Tax Help) B
Federal Residency Info * Allocated
Amount From To Res Src Amount
mm/dd mm/dd St St
Y Not-for-profit (hobby) income T
Not-for-profit (hobby) income S
Z Stock options T
Stock options S
AA Miscellaneous other income T
Miscellaneous other income S

Tax and Interest Deduction Worksheet -- Smart Worksheet
Mortgage Interest Limited Smart Worksheet

If your mortgage interest deduction needs to be limited for one of the following reasons, use
the Deductible Home Mortgage Interest Worksheet to determine the amount to be reported on
lines A, B, and C below:
' The principal amount of your mortgage and home equity debt is over $750,000 ($375,000 if
married filing separate), or
' You had home debt that was not used to buy, build or substantially improve your home that
secures the loan
QuickZoom to Deductible Home Mortgage Interest Worksheet
Does your mortgage interest need to be limited: Yes No X
A Home mortgage interest and points reported on Form 1098:

1 Sum of lines 5a through 5d below
2 Limited amount to report on line 5a below
B Home mortgage interest not reported on Form 1098:
1 Sum of lines 6a and 6b below
C Points not reported on Form 1098:
1 Sum of lines 7a through 7c below
Misc Itemized Deductions Wks -- Smart Worksheet
Depreciation Smart Worksheet

A Enter Section 179 carryover from prior year
B QuickZoom to the Asset Entry Worksheet
C QuickZoom to the Depreciation/Amortization Reports
D QuickZoom to Form 4562 for Schedule A
E Treat all MACRS assets for activity as qualified Indian reservation property? Yes X No
F Treat all assets acquired after Aug. 27, 2005 as
qualified GO Zone property? Regular Extension X No
G Treat all assets acquired after May 4, 2007 as
qualified Kansas Disaster Zone property? Yes X No
H Was this property located in a Qualified Disaster Area? Yes X No
Earned Income Credit Worksheet -- Smart Worksheet
Nontaxable Combat Pay Election Smart Worksheet
QuickZoom to enter nontaxable combat pay on Form W-2

A Taxpayer:
1 Taxpayer, nontaxable combat pay
1a Taxpayer, prior year nontaxable combat pay from 2019
2 Election for earned income credit (EIC):
Elect taxpayer’s nontaxable combat pay as earned income for EIC? Yes No
3 Election for dependent care benefits (DCB):
Elect taxpayer’s nontaxable combat pay as earned income for DCB? Yes No
4 Election for child and dependent care credit:
Elect taxpayer’s nontaxable combat pay as earned income
for child and dependent care credit? Yes No
B Spouse:
1 Spouse, nontaxable combat pay
1a Spouse, prior year nontaxable combat pay from 2019
2 Election for earned income credit (EIC):
Elect spouse’s nontaxable combat pay as earned income for EIC? Yes No
3 Election for dependent care benefits (DCB):
Elect spouse’s nontaxable combat pay as earned income for DCB? Yes No
4 Election for child and dependent care credit:
Elect spouse’s nontaxable combat pay as earned income
for child and dependent care credit? Yes No
C You may compare the tax benefit of electing or not electing by checking a box on line A or
line B and reviewing the overpayment or amount due below:
Overpayment 11. Amount due
Prior Year Earned Income Election Smart Worksheet

Election to use 2019 earned income for Earned Income Credit
The "Yes" box must be marked on Line A for 2019 earned income to be used
for EIC calculations.
A Elect to use 2019 earned income for EIC Yes No
B Earned income for EIC from your 2019 return
C Current year earned income for EIC 98.
If Line C is equal to or greater than Line B the taxpayer is not eligible
to use 2019 earned income for EIC calculations.
D You may compare the tax benefit of electing to use 2021 Earned
Income by checking the boxes on line A
Overpayment 11. Amount due

Investment Income Smart Worksheet
A Taxable and tax exempt interest

B Dividend income
C Capital gain net income
D Royalty and rental of personal property net income
E Passive activity net income:
1 Rental real estate net income or loss
2 Farm rental net income or loss
3 Partnerships and S corporations net income or loss
4 Estates and trusts net income or loss
5 Total of lines 1 through 4
6 Total passive activity net income, line 5 if greater than zero
F Interest and dividends from Forms 8814
G Adjustments
H Total investment income, add lines A through G 0.
Is line H, total investment income over $10,000?

X No. You may take the credit.
Yes. Stop. You cannot take the credit.
Age Requirements Smart Worksheet

Filers without a qualifying child have certain age requirements. Answer the questions below:
Taxpayer is a qualified former foster youth, or a qualified homeless youth

Spouse is a qualified former foster youth, or a qualified homeless youth
You qualify as a specified student if you were enrolled in a program that leads to a degree, certificate,
or other recognized educational credential and carried at least one-half the normal workload for your
course of study during at least 5 calendar months of the year. For purposes of determining whether
you were enrolled during at least 5 calendar months, count any month during which you were enrolled
for at least part of the month. The 5 months do not need to be consecutive.
Taxpayer qualifies as a specified student for EIC purposes when filing without a qualifying child
Spouse qualifies as a specified student for EIC purposes when filing without a qualifying child
Married Filing Separately Smart Worksheet (with one or more qualifying child)
MFS filers with a qualifying child have additional requirements. Answer the questions below:
Did you and your spouse have the same principal residence for the last 6 months of 2021? Yes No
Are you legally separated according to your state law under a written separation agreement or a
decree of separate maintenance and you lived apart from your spouse at the end of 2021? Yes No

2021 TaxReturn

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1040 U.S. Individual Income Tax Return 2021 (99)

Standard Someone can claim: You as a dependent Your spouse as a dependent

Joint return? Hairdresser (see inst.) a

Part II Adjustments to Income

36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36

37 Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . 37

38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38

40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40

41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41

a Business b Commuting (see instructions) c Other

47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48

a Attach to Form 1040, 1040-SR, or 1040-NR.

Name(s) shown on return Your social security number

i Gettin it together 572-85-3164 98.

2 Total qualified business income or (loss). Combine lines 1i through 1v,

Name(s) Shown on Return

Five Year Tax History:

2017 2018 2019 2020 2021

Filing status Single

Total income 98.

Adjusted gross income 98.

Other itemized ded’ns

Alternative min tax

Form 2210 penalty

Effective tax rate % -11.22

**Tax bracket % is based on Taxable income.

This Agreement requires all disputes to be resolved by way of binding arbitration.

Information regarding low-cost deposit accounts may be available at www.mymoney.gov

PAPER RETURN IRS direct deposit to Approximately No additional cost.

ELECTRONIC IRS direct deposit to Usually within No additional cost.

No Refund Processing Check mailed by IRS Approximately

ELECTRONIC Direct deposit to Usually within $ 2

FILING your personal bank 21 days 1

Questions? Call 877-908-7228

sbia5201.ptform 12/02/21 12/02/2021

Your First Name MI Last Name Your Social Security No.

QuickZoom to explanation statement for overseas extension

Presidential Election Campaign

Filing Status Check only one box.

(1) First name Last name (2) Social (3) (4)

tony Jacob 558-09-2302 Other X

QuickZoom to the Federal Information Worksheet

Someone can claim you as a dependent

a Check if: You were born before January 2, 1957 Blind

QuickZoom to required PPP loan forgiveness statement to report tax-exempt income

Form 1040 or Form 1040-SR, Lines 1 - 7

1 Wages, salaries, tips, etc. Attach Form(s) W-2 1

QuickZoom to Schedule 1 ' Additional Income and Adjustments to Income

Form 1040 or Form 1040-SR, Lines 8 - 11

8 Other income from Schedule 1, line 10 8 98.

Form 1040 or Form 1040-SR, Line 12 ' Standard or Itemized Deduction

12 Standard deduction or itemized deductions (from Schedule A)

Form 1040 or Form 1040-SR, Lines 13 - 18

13 Qualified business income deduction from Form 8995 or Form 8995-A 13 0.

16 Tax. Check if any from Forms(s):

QuickZoom to Schedule 2 ' Additional Tax section