Create Form 1040

* Your first name and middle initial * Your last name * Your Social Security Number Spouse’s full name Spouse’s Social Security Number Phone number

Country United States Canada Mexico Other * Home address (number and street) Apartment, suite, or room number City, town, or post office State SelectALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDC ZIP code Foreign province / county Foreign postal code Your main home was in the U.S. for more than half of the year Spouse’s main home was in the U.S. for more than half of the year

Tax year beginning Tax year ending

1a. Total amount from Form(s) W-2, box 1 1b. Household employee wages not reported on Form(s) W-2 1c. Tip income not reported on line 1a 1d. Medicaid waiver payments not reported on Form(s) W-2 1e. Taxable dependent care benefits from Form 2441, line 26 1f. Employer-provided adoption benefits from Form 8839, line 29 1g. Wages from Form 8919, line 6 1h. Other earned income 1h. Other earned income — type/description 1i. Nontaxable combat pay election 1z. Add lines 1a through 1h 2a. Tax-exempt interest 2b. Taxable interest 3a. Qualified dividends 3b. Ordinary dividends 3. Check if any dividend income is from Form(s) 1099-DIV 4a. IRA distributions 4b. Taxable amount of IRA distributions 4. Check if any IRA distribution is from Form(s) 1099-R 5a. Pensions and annuities 5b. Taxable amount of pensions and annuities 5. Check if any pension or annuity is from Form(s) 1099-R 6a. Social security benefits 6b. Taxable amount of social security benefits 6c. Lump-sum election method for social security benefits 6c. If you elect to use the lump-sum election method for social security benefits, check here 6d. Reserved for future use 7. Capital gain or (loss). Attach Schedule D if required 7. If Schedule D is not required, check here 7. Includes capital gain or (loss) of a child 8. Additional income from Schedule 1, line 10 9. Total income. Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8 10. Adjustments to income from Schedule 1 10a. Adjustments to income from Schedule 1, line 22 (TY2020) 10b. Charitable contributions if you take the standard deduction (TY2020) 10c. Add lines 10a and 10b (TY2020) 11. Adjusted gross income 12. Standard deduction or itemized deductions (from Schedule A) 12a. Standard deduction or itemized deductions (TY2021) 12b. Charitable contributions if you take the standard deduction (TY2021) 12c. Add lines 12a and 12b (TY2021) 13. Qualified business income deduction 13b. Additional deductions from Schedule 1-A, line 38 14. Add lines 12 and 13 15. Taxable income. Subtract line 14 from line 11. If zero or less, enter -0-

16. Tax (see instructions) 16. Tax from Form 8814 16. Tax from Form 4972 16. Tax from other form(s) 17. Amount from Schedule 2, line 3 18. Add lines 16 and 17 19. Child tax credit or credit for other dependents from Schedule 8812 20. Amount from Schedule 3, line 8 21. Add lines 19 and 20 22. Subtract line 21 from line 18. If zero or less, enter -0- 23. Other taxes, including self-employment tax, from Schedule 2, line 21 24. Total tax. Add lines 22 and 23

25a. Federal income tax withheld from Form(s) W-2 25b. Federal income tax withheld from Form(s) 1099 25c. Federal income tax withheld from other forms 25d. Add lines 25a through 25c 26. Estimated tax payments and amount applied from prior year’s return 26. Former spouse’s SSN (if you made estimated tax payments with a former spouse) 27. Earned income credit (EIC) 27b. Member of the clergy who files Schedule SE 27c. Do not want the earned income credit (EIC) 27. Check here if you want the IRS to figure the EIC for you 27a. Earned income credit (EIC) (TY2021) 27b. Nontaxable combat pay election (TY2021) 27c. Prior year (2019) earned income (TY2021) 28. Additional child tax credit from Schedule 8812 28. Do not want the additional child tax credit 29. American opportunity credit from Form 8863, line 8 31. Amount from Schedule 3, line 15 32. Total other payments and refundable credits 33. Total payments 34. Overpayment (if line 33 is more than line 24) 35a. Amount of line 34 you want refunded to you 35a. Form 8888 is attached (split refund) 35b. Routing number

35c. Type of account

Checking Savings

35d. Account number 36. Amount of line 34 you want applied to next year’s estimated tax

37. Amount you owe. Subtract line 33 from line 24 38. Estimated tax penalty (see instructions)

Designee’s name Designee phone no. Designee PIN

Date Your occupation Spouse occupation Your Identity Protection PIN Spouse Identity Protection PIN

Was this return prepared by a paid preparer?

Yes No

Preparer's name Preparer date PTIN Self-employed Firm's name Firm's EIN Firm's address Preparer phone no.

* Email address Alternate email address