The following items reflect the amount as shown on the return (PR), and the amount as adjusted (PC),
if applicable. They do not show subsequent activity on the account.
|
| Income |
| TOTAL WAGES: | $263,093.00 |
| FORM W-2 WAGES: | $263,093.00 |
| TAXABLE INTEREST INCOME: SCH B: | $58.00 |
| TAX-EXEMPT INTEREST: | $0.00 |
| ORDINARY DIVIDEND INCOME: SCH B: | $211.00 |
| QUALIFIED DIVIDENDS: | $18.00 |
| REFUNDS OF STATE/LOCAL TAXES: | $0.00 |
| ALIMONY RECEIVED: | $0.00 |
| BUSINESS INCOME OR LOSS (Schedule C): | $0.00 |
| BUSINESS INCOME OR LOSS: SCH C PER COMPUTER: | $0.00 |
| CAPITAL GAIN OR LOSS: (Schedule D): | $-3,000.00 |
| CAPITAL GAINS OR LOSS: SCH D PER COMPUTER: | $-3,000.00 |
| OTHER GAINS OR LOSSES (Form 4797): | $0.00 |
| TOTAL IRA DISTRIBUTIONS: | $0.00 |
| TAXABLE IRA DISTRIBUTIONS: | $0.00 |
| TOTAL PENSIONS AND ANNUITIES: | $0.00 |
| TAXABLE PENSION/ANNUITY AMOUNT: | $0.00 |
| ADDITIONAL INCOME: | $0.00 |
| ADDITIONAL INCOME PER COMPUTER: | $0.00 |
| REFUNDABLE CREDITS PER COMPUTER: | $0.00 |
| REFUNDABLE EDUCATION CREDIT PER COMPUTER: | $0.00 |
| QUALIFIED BUSINESS INCOME DEDUCTION: | $0.00 |
| RENT/ROYALTY/PARTNERSHIP/ESTATE (Schedule E): | $0.00 |
| RENT/ROYALTY/PARTNERSHIP/ESTATE (Schedule E) PER COMPUTER: | $0.00 |
| RENT/ROYALTY INCOME/LOSS PER COMPUTER: | $0.00 |
| ESTATE/TRUST INCOME/LOSS PER COMPUTER: | $0.00 |
| PARTNERSHIP/S-CORP INCOME/LOSS PER COMPUTER: | $0.00 |
| FARM INCOME OR LOSS (Schedule F): | $0.00 |
| FARM INCOME OR LOSS (Schedule F) PER COMPUTER: | $0.00 |
| UNEMPLOYMENT COMPENSATION: | $0.00 |
| TOTAL SOCIAL SECURITY BENEFITS: | $0.00 |
| TAXABLE SOCIAL SECURITY BENEFITS: | $0.00 |
| TAXABLE SOCIAL SECURITY BENEFITS PER COMPUTER: | $0.00 |
| OTHER INCOME: | $0.00 |
| SCHEDULE EIC SE INCOME PER COMPUTER: | $0.00 |
| SCHEDULE EIC EARNED INCOME PER COMPUTER: | $0.00 |
| SCH EIC DISQUALIFIED INC COMPUTER: | $0.00 |
| EXCESS ADV CHILD TAX CREDIT PER COMPUTER: | $0.00 |
| PRIMARY ECONOMIC IMPACT PAYMENT 2: | $0.00 |
| SECONDARY ECONOMIC IMPACT PAYMENT 2: | $0.00 |
| PRIMARY ADVANCED CTC PAYMENTS: | $0.00 |
| SECONDARY ADVANCED CTC PAYMENTS: | $0.00 |
| ADDITIONAL CTC EARNED INCOME: | $0.00 |
| EIC PRIOR YEAR EARNED INCOME: | $0.00 |
| CTC PRIOR YEAR EARNED INCOME: | $0.00 |
| QUALIFIED BUSINESS INCOME DEDUCTION: | $0.00 |
| F8995 QUALIFIED BUSINESS INCOME DEDUCTION COMPUTER: | $0.00 |
| PRIMARY ECONOMIC IMPACT PAYMENT: | $0.00 |
| SECONDARY ECONOMIC IMPACT PAYMENT: | $0.00 |
| SCHOLARSHIP FELLOWSHIP GRANT: | $0.00 |
| TOTAL INCOME: | $260,362.00 |
| TOTAL INCOME PER COMPUTER: | $260,362.00 |
|
| Adjustments to Income |
| EDUCATOR EXPENSES: | $0.00 |
| EDUCATOR EXPENSES PER COMPUTER: | $0.00 |
| RESERVIST AND OTHER BUSINESS EXPENSE: | $0.00 |
| HEALTH SAVINGS ACCT DEDUCTION: | $0.00 |
| HEALTH SAVINGS ACCT DEDUCTION PER COMPTR: | $0.00 |
| MOVING EXPENSES: F3903: | $0.00 |
| SELF EMPLOYMENT TAX DEDUCTION: | $0.00 |
| SELF EMPLOYMENT TAX DEDUCTION PER COMPUTER: | $0.00 |
| SELF EMPLOYMENT TAX DEDUCTION VERIFIED: | $0.00 |
| KEOGH/SEP CONTRIBUTION DEDUCTION: | $0.00 |
| SELF-EMP HEALTH INS DEDUCTION: | $0.00 |
| EARLY WITHDRAWAL OF SAVINGS PENALTY: | $0.00 |
| ALIMONY PAID SSN: | |
| ALIMONY PAID: | $0.00 |
| SCHOLARSHIP FELLOWSHIP EXCLUDED: | $0.00 |
| IRA DEDUCTION: | $0.00 |
| IRA DEDUCTION PER COMPUTER: | $0.00 |
| STUDENT LOAN INTEREST DEDUCTION: | $0.00 |
| STUDENT LOAN INTEREST DEDUCTION PER COMPUTER: | $0.00 |
| STUDENT LOAN INTEREST DEDUCTION VERIFIED: | $0.00 |
| TUITION AND FEES DEDUCTION: | $0.00 |
| TUITION AND FEES DEDUCTION PER COMPUTER: | $0.00 |
| OTHER ADJUSTMENTS: | $0.00 |
| ARCHER MSA DEDUCTION: | $0.00 |
| ARCHER MSA DEDUCTION PER COMPUTER: | $0.00 |
| TOTAL ADJUSTMENTS: | $0.00 |
| TOTAL ADJUSTMENTS PER COMPUTER: | $0.00 |
| ADJUSTED GROSS INCOME: | $260,362.00 |
| ADJUSTED GROSS INCOME PER COMPUTER: | $260,362.00 |
|
| Tax and Credits |
| 65-OR-OVER: | NO |
| BLIND: | NO |
| SPOUSE 65-OR-OVER: | NO |
| SPOUSE BLIND: | NO |
| STANDARD DEDUCTION PER COMPUTER: | $25,900.00 |
| ADDITIONAL STANDARD DEDUCTION PER COMPUTER: | $0.00 |
| TAX TABLE INCOME PER COMPUTER: | $234,462.00 |
| EXEMPTION AMOUNT PER COMPUTER: | $0.00 |
| TAXABLE INCOME: | $234,462.00 |
| TAXABLE INCOME PER COMPUTER: | $234,462.00 |
| TOTAL POSITIVE INCOME PER COMPUTER: | $263,362.00 |
| TENTATIVE TAX: | $43,941.00 |
| TENTATIVE TAX PER COMPUTER: | $43,941.00 |
| FORM 8814 ADDITIONAL TAX AMOUNT: | $0.00 |
| TAX ON INCOME LESS SOC SEC INCOME PER COMPUTER: | $0.00 |
| FORM 6251 ALTERNATIVE MINIMUM TAX: | $0.00 |
| FORM 6251 ALTERNATIVE MINIMUM TAX PER COMPUTER: | $0.00 |
| FOREIGN TAX CREDIT: | $0.00 |
| FOREIGN TAX CREDIT PER COMPUTER: | $0.00 |
| FOREIGN INCOME EXCLUSION PER COMPUTER: | $0.00 |
| FOREIGN INCOME EXCLUSION TAX PER COMPUTER: | $0.00 |
| EXCESS ADVANCE PREMIUM TAX CREDIT REPAYMENT AMOUNT: | $0.00 |
| EXCESS ADVANCE PREMIUM TAX CREDIT REPAYMENT VERIFIED AMOUNT: | $0.00 |
| CHILD & DEPENDENT CARE CREDIT: | $0.00 |
| CHILD & DEPENDENT CARE CREDIT PER COMPUTER: | $0.00 |
| CREDIT FOR ELDERLY AND DISABLED: | $0.00 |
| CREDIT FOR ELDERLY AND DISABLED PER COMPUTER: | $0.00 |
| EDUCATION CREDIT: | $0.00 |
| EDUCATION CREDIT PER COMPUTER: | $0.00 |
| GROSS EDUCATION CREDIT PER COMPUTER: | $0.00 |
| RETIREMENT SAVINGS CNTRB CREDIT: | $0.00 |
| RETIREMENT SAVINGS CNTRB CREDIT PER COMPUTER: | $0.00 |
| PRIM RET SAV CNTRB: F8880 LN6A: | $0.00 |
| SEC RET SAV CNTRB: F8880 LN6B: | $0.00 |
| TOTAL RETIREMENT SAVINGS CONTRIBUTION: F8880 CMPTR: | $0.00 |
| RESIDENTIAL ENERGY CREDIT: | $0.00 |
| RESIDENTIAL ENERGY CREDIT PER COMPUTER: | $0.00 |
| CHILD AND OTHER DEPENDENT CREDIT: | $500.00 |
| CHILD AND OTHER DEPENDENT CREDIT PER COMPUTER: | $500.00 |
| ADOPTION CREDIT: F8839: | $0.00 |
| ADOPTION CREDIT PER COMPUTER: | $0.00 |
| FORM 8396 MORTGAGE CERTIFICATE CREDIT: | $0.00 |
| FORM 8396 MORTGAGE CERTIFICATE CREDIT PER COMPUTER: | $0.00 |
| TOTAL OTHER NON REFUNDABLE CREDIT: | $0.00 |
| FORM 3800 GENERAL BUSINESS CREDITS: | $0.00 |
| FORM 3800 GENERAL BUSINESS CREDITS PER COMPUTER: | $0.00 |
| PRIOR YR MIN TAX CREDIT: F8801: | $0.00 |
| PRIOR YR MIN TAX CREDIT: F8801 PER COMPUTER: | $0.00 |
| EARLIER YEAR INCOME REPAYMENT CREDIT: | $0.00 |
| F8936 ELECTRIC MOTOR VEHICLE CREDIT AMOUNT: | $0.00 |
| F8936 ELECTRIC MOTOR VEHICLE CREDIT PER COMPUTER: | $0.00 |
| F8910 ALTERNATIVE MOTOR VEHICLE CREDIT AMOUNT: | $0.00 |
| F8910 ALTERNATIVE MOTOR VEHICLE CREDIT PER COMPUTER: | $0.00 |
| SICK FAMILY LEAVE CREDIT: | $0.00 |
| NON ITEMIZED CHARITABLE CONTRIBUTION DEDUCTION: | $0.00 |
| NON ITEMIZED CHARITABLE CONTRIBUTION PER COMPUTER: | $0.00 |
| REFUNDABLE CHILD CARE CREDIT: | $0.00 |
| SICK FAMILY LEAVE CREDIT AFTER 3-31-21: | $0.00 |
| REFUNDABLE CHILD CARE CREDIT VERIFIED: | $0.00 |
| RECOVERY REBATE CREDIT: | $0.00 |
| RECOVERY REBATE CREDIT PER COMPUTER: | $0.00 |
| RECOVERY REBATE CREDIT VERIFIED: | $0.00 |
| OTHER CREDITS: | $0.00 |
| TOTAL CREDITS: | $500.00 |
| TOTAL CREDITS PER COMPUTER: | $500.00 |
| INCOME TAX AFTER CREDITS PER COMPUTER: | $43,441.00 |
|
| Other Taxes |
| SE TAX: | $0.00 |
| SE TAX PER COMPUTER: | $0.00 |
| SOCIAL SECURITY AND MEDICARE TAX ON UNREPORTED TIPS: | $0.00 |
| SOCIAL SECURITY AND MEDICARE TAX ON UNREPORTED TIPS PER COMPUTER: | $0.00 |
| TAX ON QUALIFIED PLANS F5329 (PR): | $0.00 |
| TAX ON QUALIFIED PLANS F5329 PER COMPUTER: | $0.00 |
| IRAF TAX PER COMPUTER: | $0.00 |
| TP TAX FIGURES (REDUCED BY IRAF) PER COMPUTER: | $43,687.00 |
| IMF TOTAL TAX (REDUCED BY IRAF) PER COMPUTER: | $43,687.00 |
| TOTAL OTHER TAXES PER COMPUTER: | $246.00 |
| UNPAID FICA ON REPORTED TIPS: | $0.00 |
| F8959 ADDITIONAL MEDICARE TAX: | $246.00 |
| F8960 NET INVESTMENT INCOME TAX: | $0.00 |
| INTEREST ON DEFERRED TAX: | $0.00 |
| TOTAL OTHER TAXES: | $246.00 |
| RECAPTURE TAX: F8611: | $0.00 |
| HOUSEHOLD EMPLOYMENT TAXES: | $0.00 |
| HOUSEHOLD EMPLOYMENT TAXES PER COMPUTER: | $0.00 |
| INTEREST DUE ON INSTALLMENT: | $0.00 |
| SCH 8812 ADDITIONAL TAX COMPUTER: | $0.00 |
| REFUNDABLE CHILD CARE COMPUTER: | $0.00 |
| HEALTH COVERAGE RECAPTURE: F8885: | $0.00 |
| DEFERRED TAX SCH H SE: | $0.00 |
| MAX DEFERRED TAX PER COMPUTER: | $0.00 |
| TOTAL ADDITIONAL TAXES: | $0.00 |
| TOTAL ASSESSMENT PER COMPUTER: | $43,687.00 |
| TOTAL TAX LIABILITY TP FIGURES: | $43,687.00 |
| TOTAL TAX LIABILITY TP FIGURES PER COMPUTER: | $43,687.00 |
|
| Payments |
| FEDERAL INCOME TAX WITHHELD: | $49,889.00 |
| SCH 8812 ADDITIONAL TAX: | $0.00 |
| ESTIMATED TAX PAYMENTS: | $0.00 |
| OTHER PAYMENT CREDIT: | $0.00 |
| REFUNDABLE EDUCATION CREDIT: | $0.00 |
| REFUNDABLE EDUCATION CREDIT PER COMPUTER: | $0.00 |
| REFUNDABLE EDUCATION CREDIT VERIFIED: | $0.00 |
| REFUNDABLE CREDITS: | $0.00 |
| EARNED INCOME CREDIT: | $0.00 |
| EARNED INCOME CREDIT PER COMPUTER: | $0.00 |
| NONTAXABALE COMBAT PAY: | $0.00 |
| SCHEDULE 8812 NONTAXABLE COMBAT PAY: | $0.00 |
| EXCESS SOCIAL SECURITY & RRTA TAX WITHHELD: | $0.00 |
| SCHEDULE 8812 TOT SS/MEDICARE WITHHELD: | $0.00 |
| SCHEDULE 8812 ADDITIONAL CHILD TAX CREDIT: | $0.00 |
| SCHEDULE 8812 ADDITIONAL CHILD TAX CREDIT PER COMPUTER: | $0.00 |
| SCHEDULE 8812 ADDITIONAL CHILD TAX CREDIT VERIFIED: | $0.00 |
| AMOUNT PAID WITH FORM 4868: | $0.00 |
| FORM 2439 REGULATED INVESTMENT COMPANY CREDIT: | $0.00 |
| FORM 4136 CREDIT FOR FEDERAL TAX ON FUELS: | $0.00 |
| FORM 4136 CREDIT FOR FEDERAL TAX ON FUELS PER COMPUTER: | $0.00 |
| HEALTH COVERAGE TX CR: F8885: | $0.00 |
| SEC 965 TAX INSTALLMENT: | $0.00 |
| SEC 965 TAX LIABILITY: | $0.00 |
| PREMIUM TAX CREDIT AMOUNT: | $0.00 |
| PREMIUM TAX CREDIT VERIFIED AMOUNT: | $0.00 |
| PRIMARY NAP FIRST TIME HOME BUYER INSTALLMENT AMT: | $0.00 |
| SECONDARY NAP FIRST TIME HOME BUYER INSTALLMENT AMT: | $0.00 |
| FIRST TIME HOMEBUYER CREDIT REPAYMENT AMOUNT: | $0.00 |
| FORM 5405 TOTAL HOMEBUYERS CREDIT REPAYMENT PER COMPUTER: | $0.00 |
| SMALL EMPLOYER HEALTH INSURANCE PER COMPUTER: | $0.00 |
| SMALL EMPLOYER HEALTH INSURANCE PER COMPUTER (2): | $0.00 |
| TOTAL OTHER PAYMENTS REFUNDABLE: | $0.00 |
| TOTAL PAYMENTS: | $49,889.00 |
| TOTAL PAYMENTS PER COMPUTER: | $49,889.00 |
|
| Refund or Amount Owed |
| REFUND AMOUNT: | $-6,202.00 |
| ESTIMATED TAX CREDIT APPLIED TO NEXT YEAR: | $0.00 |
| ESTIMATED TAX PENALTY: | $0.00 |
| TAX ON INCOME LESS STATE REFUND PER COMPUTER: | $0.00 |
| BAL DUE/OVER PYMT USING TP FIG PER COMPUTER: | $-6,202.00 |
| BAL DUE/OVER PYMT USING COMPUTER FIGURES: | $-6,202.00 |
| FORM 8888 TOTAL REFUND PER COMPUTER: | $0.00 |
|
| Third Party Designee |
| THIRD PARTY DESIGNEE ID NUMBER: | X3912 |
| AUTHORIZATION INDICATOR: | 1 |
| THIRD PARTY DESIGNEE NAME: | SHAN NORT CP |
|
| Schedule D--Capital Gains and Losses |
|
| SHORT TERM CAPITAL GAINS AND LOSSES |
| SHORT TERM BASIS NO ADJUSTMENTS SALE AMOUNT: | $0.00 |
| SHORT TERM BASIS NO ADJUSTMENTS COST AMOUNT: | $0.00 |
| SHORT TERM BASIS SALE AMOUNT: | $47,155.00 |
| SHORT TERM BASIS COST AMOUNT: | $57,412.00 |
| SHORT TERM BASIS ADJUSTMENTS: | $7,047.00 |
| SHORT TERM NO BASIS SALE AMOUNT: | $0.00 |
| SHORT TERM NO BASIS COST AMOUNT: | $0.00 |
| SHORT TERM NO BASIS ADJUSTMENTS: | $0.00 |
| SHORT TERM NO 1099B SALE AMOUNT: | $0.00 |
| SHORT TERM NO 1099B COST AMOUNT: | $0.00 |
| SHORT TERM NO 1099B ADJUSTMENTS: | $0.00 |
| SHORT TERM SCHEDULE K-1 AMOUNT: | $0.00 |
| NET SHORT-TERM GAIN/LOSS: | $-3,210.00 |
| F8949 Y QUALIFIED OPPORTUNITY FUNDS SHORT TERM INVESTMENTS: | 0 |
| F8949 Y QUALIFIED OPPORTUNITY FUNDS SHORT TERM EIN: | |
| F8949 Y QUALIFIED OPPORTUNITY FUNDS SHORT TERM SOLD DATE: | 00000000 |
| F8949 Y QUALIFIED OPPORTUNITY FUNDS SHORT TERM DEFERRED: | $0.00 |
| F8949 Z QUALIFIED OPPORTUNITY FUNDS SHORT TERM ADJUSTMENTS: | $0.00 |
| F8949 Z QUALIFIED OPPORTUNITY FUNDS SHORT TERM INVESTMENTS: | 0 |
| F8949 Z QUALIFIED OPPORTUNITY FUNDS SHORT TERM EIN: | |
| F8949 Z QUALIFIED OPPORTUNITY FUNDS SHORT TERM ACQUIRED DATE: | 00000000 |
|
| LONG TERM CAPITAL GAINS AND LOSSES |
| LONG TERM BASIS NO ADJUSTMENTS SALE AMOUNT: | $0.00 |
| LONG TERM BASIS NO ADJUSTMENTS COST AMOUNT: | $0.00 |
| LONG TERM BASIS SALE AMOUNT: | $0.00 |
| LONG TERM BASIS COST AMOUNT: | $0.00 |
| LONG TERM BASIS ADJUSTMENTS: | $0.00 |
| LONG TERM NO BASIS SALE AMOUNT: | $0.00 |
| LONG TERM NO BASIS COST AMOUNT: | $0.00 |
| LONG TERM NO BASIS ADJUSTMENTS: | $0.00 |
| LONG TERM NO 1099B SALE AMOUNT: | $0.00 |
| LONG TERM NO 1099B COST AMOUNT: | $0.00 |
| LONG TERM NO 1099B ADJUSTMENTS: | $0.00 |
| LONG TERM SCHEDULE K-1 AMOUNT: | $0.00 |
| CAPITAL GAIN DISTRIBUTIONS (PR): | $0.00 |
| NET LONG-TERM GAIN/LOSS: | $0.00 |
| F8949 Y QUALIFIED OPPORTUNITY FUNDS LONG TERM INVESTMENTS: | 0 |
| F8949 Y QUALIFIED OPPORTUNITY FUNDS LONG TERM EIN: | |
| F8949 Y QUALIFIED OPPORTUNITY FUNDS LONG TERM SOLD DATE: | 00000000 |
| F8949 Y QUALIFIED OPPORTUNITY FUNDS LONG TERM DEFERRED: | $0.00 |
| QUALIFIED OPPORTUNITY FUNDS DISPOSAL: | 2 |
| F8949 Z QUALIFIED OPPORTUNITY FUNDS LONG TERM INVESTMENTS: | 0 |
| F8949 Z QUALIFIED OPPORTUNITY FUNDS LONG TERM EIN: | |
| F8949 Z QUALIFIED OPPORTUNITY FUNDS LONG TERM ACQUIRED DATE: | 00000000 |
| F8949 Z QUALIFIED OPPORTUNITY FUNDS LONG TERM ADJUSTMENTS: | $0.00 |
|
| TAX COMPUTATION USING MAXIMUM CAPITAL GAINS RATES |
| 28% RATE GAIN: | $0.00 |
| UNRECAPTURED SECT: 1250 GAIN: | $0.00 |
| SCH D 15% TAX CMPTR: | $2.70 |
| CAPITAL GAINS LESS INVEST INCOME PER COMPUTER: | $0.00 |
| CAP GAINS PER COMPUTER: | $18.00 |
| CAP GAINS TAX PER COMPUTER: | $43,937.56 |
| CAP GAINS PER COMPUTER: | $0.00 |
| CAP GAINS TAX AMT PER COMPUTER (5): | $0.00 |
| CAP GAINS TAX AMT PER COMPUTER (6): | $0.00 |
| SCHEDULE D TAX PER COMPUTER: | $43,940.26 |
|
| Form 1116--Foreign Tax Credit |
|
| PART I TAXABLE INCOME OR LOSS FROM FOREIGN SOURCES |
| GROSS FOREIGN SOURCE INCOME: | $9.00 |
| TOTAL APPLICABLE DEDUCTIONS/LOSSES: | $1.00 |
| TAXABLE FOREIGN SOURCE INCOME: | $8.00 |
|
| PART II FOREIGN TAXES PAID OR ACCRUED |
| TOTAL FOREIGN TAX PAID/ACCRUED: | $0.00 |
|
| PART III FIGURING THE CREDIT |
| TOTAL FOREIGN TAX AVAILABLE FOR CREDIT: | $0.00 |
| FOREIGN LOSS ADJUSTMENTS TO TAXABLE INCOME: | $0.00 |
| NET FOREIGN SOURCE TAXABLE INCOME: | $8.00 |
| MAX ALLOWABLE AMOUNT OF CREDIT: | $1.00 |
| LIMIT INCREASE S960C: | $0.00 |
| TOTAL LIMITATION: | $1.00 |
| GROSS FOREIGN TAX CREDIT: | $0.00 |
|
| PART IV SUMMARY |
| INTERNATIONAL BOYCOTT CREDIT REDUCTION: | $0.00 |
| FOREIGN TAX CREDIT: | $0.00 |
| NUM OF ADDITIONAL F1116'S FILED: | 0 |
|
| Form 8863 - Education Credits (Hope and Lifetime Learning Credits) |
|
| PART III - ALLOWABLE EDUCATION CREDITS |
| GROSS EDUCATION CR PER COMPUTER: | $0.00 |
| TOTAL EDUCATION CREDIT AMOUNT: | $0.00 |
| TOTAL EDUCATION CREDIT AMOUNT PER COMPUTER: | $0.00 |
|
| Form 8959 Additional Medicare Tax |
| MEDICARE WAGES: | $277,358.00 |
| UNREPORTED TIPS: | $0.00 |
| WAGES FROM FORM 8919: | $0.00 |
| ADDITIONAL MEDICARE TAX ON MEDICARE WAGES: | $246.00 |
| ADDITIONAL MEDICARE TAX ON MEDICARE WAGES PER COMPUTER: | $246.00 |
| SELF EMPLOYMENT INCOME: | $0.00 |
| ADDITIONAL MEDICARE TAX ON SELF-EMPLOYMENT INCOME: | $0.00 |
| ADDITIONAL MEDICARE TAX ON SELF-EMPLOYMENT INCOME PER COMPUTER: | $0.00 |
| RAILROAD RETIREMENT COMPENSATION: | $0.00 |
| TIER I EMPLOYEE ADDITIONAL MEDICARE TAX ON RAILROAD COMPENSATION: | $0.00 |
| TIER I EMPLOYEE ADDITIONAL MEDICARE TAX ON RAILROAD COMPENSATION PER COMPUTER: | $0.00 |
| MEDICARE TAX WITHHELD W-2 BOX 6: | $4,480.00 |
| ADDITIONAL MEDICARE TAX W-2 BOX 14: | $0.00 |
| TOTAL ADDITIONAL MEDICARE TAX: | $246.00 |
| TOTAL ADDITIONAL MEDICARE TAX WITHHOLDING: | $458.00 |
| TOTAL ADDITIONAL MEDICARE TAX WITHHOLDING VERIFIED: | $0.00 |
| TOTAL ADDITIONAL MEDICARE TAX WITHHOLDING PER COMPUTER: | $458.00 |
|
| Form 8960 Net Investment Income Tax - Individuals, Estates, and Trusts |
| TAXABLE INTEREST AMOUNT: | $58.00 |
| ORDINARY DIVIDENDS: | $211.00 |
| ANNUITIES: | $0.00 |
| RENT, ROYALTIES, PARTNERSHIPS, ETC.: | $0.00 |
| ADJUSTMENT FOR DERIVED INCOME OR LOSS: | $0.00 |
| NET GAIN OR LOSS FROM DISPOSITION OF PROPERTY: | $-3,000.00 |
| NET GAIN OR LOSS FROM DISPOSITION OF PROPERTY NOT SUBJECT TO NET INVESTMENT INCOME TAX: | $0.00 |
| ADJUSTMENT FROM DISPOSITION OF PARTNERSHIP INTEREST: | $0.00 |
| CHANGES FOR CERTAIN CFCS AND PFICS: | $0.00 |
| OTHER MODIFICATIONS TO INVESTMENT INCOME: | $0.00 |
| TOTAL INVESTMENT INCOME: | $-2,731.00 |
| TOTAL INVESTMENT INCOME PER COMPUTER: | $-2,731.00 |
| INVESTMENT INTEREST EXPENSES: | $0.00 |
| STATE INCOME TAX: | $0.00 |
| INVESTMENT EXPENSES: | $0.00 |
| ADDITIONAL MODIFICATIONS: | $0.00 |
| TOTAL DEDUCTIONS AND MODIFICATIONS: | $0.00 |
| TOTAL DEDUCTIONS AND MODIFICATIONS PER COMPUTER: | $0.00 |
| MODIFIED ADJUSTED GROSS INCOME: | $260,362.00 |
| TAXABLE INVESTMENT INCOME: | $0.00 |
| TAXABLE INVESTMENT INCOME PER COMPUTER: | $0.00 |
| NET INVESTMENT INCOME TAX FOR INDIVIDUALS: | $0.00 |
| NET INVESTMENT INCOME TAX FOR INDIVIDUALS VERIFIED: | $0.00 |
| NET INVESTMENT INCOME TAX FOR INDIVIDUALS PER COMPUTER: | $0.00 |
|
| Form 8867 Paid Preparer's Earned Income Credit Checklist |
| INCORRECT INFORMATION AOTC: | |
| F8867 CERTIFICATION: | Yes box checked |
| EIC CLAIMED: | Neither box checked |
| CTC ACTC CLAIMED: | Yes box checked |
| AOTC CLAIMED: | Neither box checked |
| HEAD OF HOUSEHOLD FILING STATUS CLAIMED: | Neither box checked |
