Postal Security

Department ofthe Treasury—intemal **)

£**** U individual Income Tax Return 2021 OMB No. 1545-0074 IRS Use Only—Do not wre or staple inthis space.

Filing Status [[] single [[] Married filing jointly [_] Married filing separately (MFS) [{] Head of household (HOH) Qualifying widow(er) (QW)

oe 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

=o person is a child but not your dependent >

Your first name and middie initial Last name Your social security number

CATHERINE ***-**-****

Ijoint 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.

25736 CATALINA ST

City, town, or post office. If you have a foreign address, also complete spaces below.

SOUTHFIELD

Foreign country name

Apt. no. 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

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 viral currency? — []yes_ [x] No

Standard Someone can clai TL] Youas adependent [_] Your spouse as a dependent

Deduction oO ‘Spouse itemizes on a separate return or you were a dual-status alien

Age/Blindness You: [_] Were bom before January 2, 1957 ["] Are blind Spouse: ["] Was bom before January 2, 1957 [[] Is blind

Dependents (see instructions): (2) Social security (3) Relationship (4) “ if qualifies for (see instructions):

ttmore (1) First name Last name number to you Child tax credit credit for other dependents

than four DANIEL SIMS [***-**-**** SON

dependents,

poeath SARAH SIMS

and check MARY SIMS

here > oO

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

2a = Tax-exemptinterest . . . . 29 b Taxable interest... . 2. .

~— 3a Qualified dividends... . b Ordinary dividends... .

eS 4a iRAdistributions . . . . b Taxable amount...

5a Pensions and annuities. . . b Taxable amount... . . -

Standard 6a Social security benefits . . . b Taxable amount... . . . -

ae 7 Capital gain or (loss). Attach Schedule D ifrequired. If not required, check here. . . . *O

Married fing 8 Other income from Schedule 1, line 10

$12550 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your totalincome »

«Married fling 10 Adjustments to income from Schedule 1,line26 2. 2... ee ee ee ee ee

pee 44 Subtract line 10 from line 9. This is your adjusted gross income...

widow'er), 12a Standard deduction or itemized deductions (from Schedule A) . . .

+ Head of Charitable contributions if you take the standard deduction (see instructions)

Siaeoo © Add lines Qn and 12b lors ss % ALS & So ATS aS WRGe se Dee eee

+ youchecked 13 Qualified business income deduction from Form 8995 or Form 8995-A .. 2. 1 ee ee ee

‘Standard 46 Add Mee om 1S 6 cece ee aes oe cere we eee wee eee

Decucton. ns. 15 Taxable income. Subtract line 14 from line 11. If zero orless,enter-0

SPA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. 1037 CPTS 1US011 Form 1040 (2021)

This return was printed on: 04/27/22 Page 05

Contact this candidate