Income Tax Digital Asset
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Income Tax Return
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Federal Return
2022
2022
2023
2024
2023
Printed on 01/13/2024 12:51 PM
Form
1040 U.S. Individual Income Tax Return 2022
Department of the Treasury—Internal Revenue Service OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space. Filing Status
Check only
one box.
Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying surviving spouse (QSS)
If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s name if the qualifying person is a child but not your dependent:
Your first name and middle initial Last name Your social security number 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. City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code Foreign country name Foreign province/state/county Foreign postal code Presidential Election Campaign
Check here if you, or your
spouse if filing jointly, want $3
to go to this fund. Checking a
box below will not change
your tax or refund.
You Spouse
Digital
Assets
At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Yes No Standard
Deduction
Someone can claim: You as a dependent Your spouse as a dependent Spouse itemizes on a separate return or you were a dual-status alien Age/Blindness You: Were born before January 2, 1958 Are blind Spouse: Was born before January 2, 1958 Is blind Dependents (see instructions):
If more
than four
dependents,
see instructions
and check
here . .
(2) Social security
number
(3) Relationship
to you
(4) Check the box if qualifies for (see instructions):
(1) First name Last name Child tax credit Credit for other dependents Income
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a Form
W-2, see
instructions.
1 a Total amount from Form(s) W-2, box 1 (see instructions) 1a b Household employee wages not reported on Form(s) W-2 1b c Tip income not reported on line 1a (see instructions) 1c d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) 1d e Taxable dependent care benefits from Form 2441, line 26 1e f Employer-provided adoption benefits from Form 8839, line 29 1f g Wages from Form 8919, line 6 1g h Other earned income (see instructions) 1h i Nontaxable combat pay election (see instructions) 1i z Add lines 1a through 1h 1z Attach Sch. B
if required.
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 c If you elect to use the lump-sum election method, check here (see instructions) 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here 7 8 Other income from Schedule 1, line 10 8 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income 9 10 Adjustments to income from Schedule 1, line 26 10 11 Subtract line 10 from line 9. This is your adjusted gross income 11 Standard
Deduction for—
• Single or
Married filing
separately,
$12,950
• Married filing
jointly or
Qualifying
surviving spouse,
$25,900
• Head of
household,
$19,400
• If you checked
any box under
Standard
Deduction,
see instructions.
12 Standard deduction or itemized deductions (from Schedule A) 12 13 Qualified business income deduction from Form 8995 or Form 8995-A 13 14 Add lines 12 and 13 14 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income 15 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2022) X
REBEKAH L HAYNES 285 68 4959
2724 DUNSTAN DR NW
WARREN OH 44485
X
BRANDON L SCARBERRY'HAYNES 281 04 3239 SON X
KENNISHA L HAYNES 299 04 7276 DAUGHTER X
17,987.
17,987.
0.
17,987.
0.
17,987.
19,400.
19,400.
0.
CDA
Form 1040 (2022) Page 2
Tax and
Credits
16 Tax (see instructions). Check if any from Form(s): 1-881*-*-**** 3 .. 16 17 Amount from Schedule 2, line 3 17 18 Add lines 16 and 17 18 19 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 23 Other taxes, including self-employment tax, from Schedule 2, line 21 23 24 Add lines 22 and 23. This is your total tax 24 Payments 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 2022 estimated tax payments and amount applied from 2021 return 26 If you have a
qualifying child,
attach Sch. EIC.
27 Earned income credit (EIC) 27
28 Additional child tax credit from Schedule 8812 28 29 American opportunity credit from Form 8863, line 8 29 30 Reserved for future use 30
31 Amount from Schedule 3, line 15 31 32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits .. 32 33 Add lines 25d, 26, and 32. These are your total payments 33 Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid .. 34 35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here 35a Direct deposit?
See instructions.
b Routing number c Type: Checking Savings
d Account number
36 Amount of line 34 you want applied to your 2023 estimated tax ... 36 Amount
You Owe
37 Subtract line 33 from line 24. This is the amount you owe. For details on how to pay, go to www.irs.gov/Payments or see instructions 37 38 Estimated tax penalty (see instructions) 38 Third Party
Designee
Do you want to allow another person to discuss this return with the IRS? See instructions Yes. Complete below. No Designee’s
name
Phone
no.
Personal identification
number (PIN)
Sign
Here
Joint return?
See instructions.
Keep a copy 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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date Your occupation If the IRS sent you an Identity Protection PIN, enter it here
(see inst.)
Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an Identity Protection PIN, enter it here
(see inst.)
Phone no. Email address
Paid
Preparer
Use Only
Preparer’s name Preparer’s signature Date PTIN Check if: Self-employed
Firm’s name Phone no.
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2022) REBEKAH L HAYNES ***-**-****
0.
0.
0.
0.
0.
0.
652.
652.
6,164.
6,164.
6,816.
6,816.
6,816.
*SEE NOTE
0 9 6 0 1 7 4 1 8
5 1 1 7 2 3 5 5 8 7 5 6
X
0.
X
CREW MEMBER
SELF-PREPARED
* The bank info printed here is for the temporary bank account used to pay your fees, not your personal bank account.
CDA
SCHEDULE EIC
(Form 1040) 2022
Earned Income Credit
Qualifying Child Information
Department of the Treasury
Internal Revenue Service
Complete and attach to Form 1040 or 1040-SR only if you have a qualifying child. Go to www.irs.gov/ScheduleEIC for the latest information. OMB No. 1545-0074
Attachment
Sequence No. 43
Name(s) shown on return Your social security number If you are separated from your spouse, filing a separate return, and meet the requirements to claim the EIC (see instructions), check here Before you begin: • See the instructions for Form 1040, line 27, to make sure that (a) you can take the EIC, and (b) you have a qualifying child.
• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card. Otherwise, at the time we process your return, we may reduce your EIC. If the name or SSN on the child’s social security card is not correct, call the Social Security Administration at 800-***-****.
• If you have a child who meets the conditions to be your qualifying child for purposes of claiming the EIC, but that child doesn’t have an SSN as defined in the instructions for Form 1040, line 27, see the instructions. F!
CAUTION
• You can’t claim the EIC for a child who didn’t live with you for more than half of the year.
• If your child doesn’t have an SSN as defined in the instructions for Form 1040, line 27, see the instructions.
• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.
• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child. Qualifying Child Information Child 1 Child 2 Child 3 1 Child’s name
If you have more than three qualifying
children, you have to list only three to get
the maximum credit.
First name Last name First name Last name First name Last name 2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040, line 27,
unless the child was born and died in 2022
or you are claiming the self-only EIC (see
instructions). If your child was born and
died in 2022 and did not have an SSN,
enter “Died” on this line and attach a copy
of the child’s birth certificate, death
certificate, or hospital medical records
showing a live birth.
3 Child’s year of birth Year
If born after 2003 and the child is
younger than you (or your spouse,
if filing jointly), skip lines 4a and
4b; go to line 5.
Year
If born after 2003 and the child is
younger than you (or your spouse,
if filing jointly), skip lines 4a and
4b; go to line 5.
Year
If born after 2003 and the child is
younger than you (or your spouse,
if filing jointly), skip lines 4a and
4b; go to line 5.
4a Was the child under age 24 at the end of
2022, a student, and younger than you (or
your spouse, if filing jointly)?
Yes.
Go to
line 5.
No.
Go to line 4b.
Yes.
Go to
line 5.
No.
Go to line 4b.
Yes.
Go to
line 5.
No.
Go to line 4b.
b Was the child permanently and totally
disabled during any part of 2022? Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
Yes.
Go to
line 5.
No.
The child is not a
qualifying child.
5 Child’s relationship to you
(for example, son, daughter, grandchild,
niece, nephew, eligible foster child, etc.)
6 Number of months child lived
with you in the United States
during 2022
• If the child lived with you for more than
half of 2022 but less than 7 months,
enter “7.”
• If the child was born or died in 2022 and
your home was the child’s home for more
than half the time he or she was alive
during 2022, enter “12.”
months
Do not enter more than 12
months.
months
Do not enter more than 12
months.
months
Do not enter more than 12
months.
For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 13339M Schedule EIC (Form 1040) 2022 REBEKAH L HAYNES ***-**-****
BRANDON SCARBERR
***-**-****
1 9 9 9
X
X
SON
12
KENNISHA HAYNES
***-**-****
2 0 0 0
X
DAUGHTER
12
CDA
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