Preparer Tax

Form

**** *.*. ********** ****** Tax Return ****

Department of the Treasury—Internal Revenue Service (99) 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 widow(er) (QW) 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 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

At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? 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, 1957 Are blind Spouse: Was born before January 2, 1957 Is blind Dependents (see instructions):

If more

than four

dependents,

see instructions

and check

here

(2) Social security

number

(3) Relationship

to you

(4) if qualifies for (see instructions):

(1) First name Last name Child tax credit Credit for other dependents 1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . 1 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 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 1, 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,

$12,550

• Married filing

jointly or

Qualifying

widow(er),

$25,100

• Head of

household,

$18,800

• If you checked

any box under

Standard

Deduction,

see instructions.

12a Standard deduction or itemized deductions (from Schedule A) . . 12a b Charitable contributions if you take the standard deduction (see instructions) 12b c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . 12c 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13 14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . 14 15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . 15 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2021) Form 1040 (2021) Page 2

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 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 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 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,

attach Sch. EIC.

27a Earned income credit (EIC) . . . . . . . . . . . . . . 27a 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 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 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 2022 estimated tax . . 36 Amount

You Owe

37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, 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 (2021)

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