--

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1040 Department of the Treasury-Internal Revenue Service (99)EO u.. U.S. Individual Income Tax Return 2019 OMS No. 1545-0074 IRS Use Only-Oo not write or staple in this space.

Filing o Single 0 Married filing jointly 0 Married filing separately (MFS) o Head of household (HOH) 0 Qualifying widow(er) (QW) Status

Check only one If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child's box. name if the qualifying person is a child but not your dependent -- JOHN SEPARATEFILER

Your first name and middle initial Last name

SEPARATEFILERJANE

If joint return, spouse's first name and middle initial Last name

Home address (number and street). If you have a P.O. box, see instructions. Apt. no.

101 ANYSTREET I City, town or post office, state, and ZIP code, If you have a foreign address, also complete spaces below (see instructions).

LOS ANGELES CA 90067 Foreign country name IForeign province/state/county IForeign postal code

Standard Someone can claim: 0 You as a dependent 0 Your spouse as a dependent Deduction IKI Spouse itemizes on a separate return or you were a dual-status alien

You: 0 Were born before January 2, 1955 Age/Blindness Spouse: 0 Was born before January 2, 1955 Dependents (see instructions):

(2) Social security number (1) First name Last name

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

2a Tax-exempt interest 2a

Standard 3a Qualified dividends. 3a Deduction

4a IRA distributions 4a

• Single or Marned C Pensions and annuities 4c fing: separately.

$12,200

• MalTiedfilmg

Jointly or

Qualitying

widow(er) ,

$24.400

• Head of

l1Ousehold,

$18.350

5a Social security benefits. 5a

0 Are blind D Is blind

(3) Relationship to you

. . . . . . . · .... - . . .

b Taxable interest

b Ordinary dividends.

b Taxable amount

d Taxable amount

I b Taxable amount

6 Capital gain or (loss). Attach Schedule 0 if required. If not required, check here

7a Other income from Schedule 1, line 9 ... . ... · ....

b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a This is your total income

8a Adjustments to income from Schedule 1, line 22 .. - · ...

• If you checked

any box under

Standard

Dec!uetion,

see instructions.

b

9 ,....- ­

10

Subtract line 8a from line 7b. This is your adjusted gross income

Standard deduction or itemized deductions (from Schedule A)

Qualified business income deduction. Attach Form 8995 or Form 8995-A .

11a Add lines 9 and 10 . . . . - .. .. . . · .

9

10

b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0­For Disclosure, Privacy Act, and Paperwork Reduction Act otice, see separate instructions. EEA

Your social security number

999-99-4321 Spouse's social security number

999-99-1234 Presidential Election Campaign Check here 11 you. or your spouse if fiing

jGintly. want S3 to go [0 tt!is fund.

Cr.ecking a box below 'hill not change your

lax or refund. oYou o Spouse

If more than four dependents,

see ins\. & check here --0

(4) check if qualifies for (see inst.):

Child tax credit Credit for other dependents

0 0 D 0

. --0

0 0 [J 0

1 157 500

2b 200

3b

4b

4d

5b

6

7a

7b 157 700

8a 0

Bb 157 700

33 300

i

11a

11b

33

124

300

400 Form 1040 (2019)

--

Form 1040 (2019) Page 2JANE SEPARATEFILER 999-99-4321

elf you have a qualifying child, attach Sch EIC.

elf you have nontaxable combat pay, see instructions.

Refund

Direct deposit? See instructions.

Amount

12a Tax (see instructions). Check if any from:

10 Form(s) 8814 20 Form 4972 30 112al

b Add Schedule 2, line 3, and line 12a and enter the total

13a Child tax credit or credit for other dependents . - - . . 113al~

b Add Schedule 3, line 7, and line 13a and enter the total

14 Su btract line 13b from line 12b. If zero or less, enter -0­

15 Other taxes, including self-employmen tax, from Sched Ie 2, line 10

16 Add lines 14 and 15. This is your total tax .......

17 Federal income tax withheld from Forms W-2 and 1099

18 Other payments and refundable credits:

a Earned income credit (EIC) ....... . . . . . . b Additional child tax credit. Attach Schedule 8812

e American opportunity credit from Form 8863, line 8

d Schedule 3, line 14 ....................

e Add lines 18a through 18d. These are your total 0 her payments and refundable credits

19 Add lines 17 and 18e. These are your total payments ........

20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid

21 a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here

18a

18b

18c

18d

.. b Routing number IX IX IX IX IX IX IX IX IX I .. e Type 0 Checking 0 .. d Account number IX IX IX IX IX IX IX IX IX IX IX IX IX IX xlxlxl 22

23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions

22 Amount of line 20 you want applied to your 2020 estimated tax ......

24 031

. . . . . .... ..... 12b 24 031

... 13b 0

14 24 031

15 232

.. 16 24 263

.. 17 24 750

.. 18e

.. 19 24 750

.. 20 487

.. 0 21a 487

Savings

....... 23 0You Owe

24 Estimated tax penalty (see instructions) ........... " 1241 Third Party Do you want to allow another person (olJ1er than your paid preparer) to discuss this return with the IRS? See instructions. U Yes. Complete below.

Designee oNo

(Other than Designee's Phone Personal idenbfication ITIIIJ paId preparer) name" no .. number (PIN) ..

Here of which preparer has any knowledge Your signature

Joint return? ~ See inSlruclions.

Spouse's signature. tf a joint return, both m st sign. Keep acopy for your records.

Phone no.

Preparer's signature Paid Preparer Preparer's name Ernest F Howard CPA

Use Only Firm's name .. Ernest F Howard CPA

Firm's address "PO Box 12709

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best ofSign my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information

Date

Date

Email address

MARINA DEL REY CA 90295

Your occupation

PSYCHOLOGIST Spouse's occupation

Date I PTIN

If the IRS sent you an Identity Protection PIN enter it here (see ins!.) I I I I I I I If the IRS sent your spouse an Identity Protection PIN enter it here (see ins!.) I I I I I I I

Check if:

6t] 3rd Party Designee07-15-2020 POO139504

6t] Self·employedPhone no. 310-821-3513

Firm's EIN" 95-3292035 Go to www.irs.gov/Form1040forinstrucbonsand the latest information Fonn 1040 (2019) EEA

SCHEDULE 2 Additional Taxes OMS No. 1545-0074

(Form 1040 or 1040-SR)

Department of the Treasury Internal Revenue Service

... Attach to Form 1040 or 1040-SR.

... Go to www.irs.govIForm1040 for instructions and the latest information.

2019 Attachment Sequence No. 02

Name(s) shown on Form 1040 or 1040-SR I Your social security number

JANE SEPARATEFILER 999-99-4321 IPart I ITax

1 Alternative minimum tax Attach Form 6251 1

2 Excess advance premium tax credit repayment. Attach Form 8962 2

3 Add lines 1 and 2. Enter here and include on Form 1040 or 1040-SR, line 12b 3 0 IPart II I Other Taxes

4 Self-employment tax. Attach Schedule SE

5 Unreported social security and Medicare tax from Form: a 04137 b 08919

6 Additional tax on IRAs, other qualified retirement plans, and other tax-favored acccunis. Attach Form

5329 if required

7a Household employment taxes. Attach Schedule H

b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required

8 Taxes from: a IKJ Form 8959 b IKJ Form 8960

cD Instructions; enter code(s)

4

5

6

7a

7b

8

9 I

10

232 9 Section 965 net tax liability installment from Form 965-A . I

10 Add lines 4 through 8. These are your total other taxes. Enter here and on Form 1040 or 1040-SR,

line 15 232 For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 2 (Fonn 1040 or 1040-SR) 2019

EEA

OMB No. 1545-0074

(Form 1040 or 1040-SR) SCHEDULE A Itemized eductions .. Go to www.irs.gov/SchedufeA for instructions and the latest information. 2019(Rev. January 2020) .. Attach to Form 1040 or 1040-SR. AttachmentDepartmenl of Ihe Treasury Internal Revenue Service (99) Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 16. Sequence No. 07 Name(s) shown on Form 1040 or 1040-SR

JANE SEPARATEFILER Medical Caution: Do not include expenses reimbursed or paid by others.

and 1 Medical and dental expenses (see instructions) Dental 2 Enter amount from Form 1040 or 1040-SR, line 8b . I 2 I Expenses 3 Multiply line 2 by 7.5% (0.075)

4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0­

Taxes You 5 State and local taxes. Paid a State and local income taxes or general sales taxes. You may include

either income taxes or general sales taxes on line 5a, but not both. If

you elect to include general sales taxes instead of income taxes,

check this box

b State and local real estate taxes (see instructions)

c State and local personal property taxes

d Add lines 5a through 5c

e Enter the smaller of line 5d or $10,000 ($5,000 if married filing

separately)

6 Other taxes. List type and amount .. 7 Add lines 5e and 6

Interest B Home mortgage interest and points. If you didn't use all of your home You Paid mortgage loan(s) to buy, build, or improve your home, see Caution: Your instructions and check this box mortgage interest decuct,on may be a Home mortgage interest and points reported to you on Form 1098. limited (see instructions). See instructions if limited

b Home mortgage interest not reported to you on Form 1098. See

instructions if limited. If paid to the person from whom you bought the

home, see instructions and show that person's name, identifying no.,

and address ..

c Points not reported to you on Form 1098. See instructions for special

rules

d Mortgage insurance premiums (see instructions)

e Add lines 8a through 8d

9 Investment interest. Attach Form 4952 if required. See instructions

10 Add lines 8e and 9

Gifts to 11 Gifts by cash or check. If you made any gift of $250 or more, see Charity instructions

12 Other than by cash or check. If you made any gift of $250 or more, Caution: If you made a gift and see instructions. You must attach Form 8283 if over $500 got a benefil for il. see instructions. 13 Carryover from prior year

14 Add lines 11 through 13

Casualty and 15 Casualty and theft loss(es) from a federally declared disaster (other than net qualified Theft Losses disaster losses). Attach Form 4684 and enter the amount from line 18 of that form. See

instructions

Other 16 Other - from list in instructions List type and amount .. Itemized Deductions

Total 17 Add the amounts in the far right column for lines 4 through 16. Also, enter this amount on Itemized Form 1040 or 1040-SR, line 9 Deductions 18 If you elect to itemize deductions even though they are less than your standard deduction,

check this box

For Paperwork Reduction Act Notice, see the Instructions for Forms 1040 and 1040-SR.

1

3

4

.. D Sa 8 200 5b 12 000 5c 350 5d 20 550

5e 5 000

6

7 5 000

.. D

8a 24 750

8b

Bc

Bd

8e 24 750 9

10 24 750

11 3 550

12

13

14 3 550

-

15

16

17 33 300

.. D I Schedule A (Fonn 1040 or 1040-5R) 2019

EEA

I Your social security number

999-99-4321

Form 8958 Allocation of ax Amoun s Between OMS No. 1545-0074

(Rev. November 2019) Certain Individual in Community Property States Department of the Treasury ~ Attach to Form 1040, 1040-SR, or 1040-NR. Attachment

Intemal Revenue Service (99) ~ Go to www.irs.govIForm8958for the latest informaUon. Sequence No. 63

Your first name and Initial Your last name Your social securitynwnber

John Separatefiler

9 9 919 91 1 2 3 4 Spouse's or partner's first name and initial SPOL.:Xl'S or partner's last name Spouse's or partne.-'s social

Jane Separatefiler security nurnber

919 I

9 9 91 4 3 2 1

A B C Total Amount Allocated to Spouse Allocated to Spouse

orRDP orRDP

SSN 999 - 99 - 1234 SSN 999-99-4321 ----­ ----­

1 Wages (each employer) Taxpayer 180000 135000 45000

Spouse 150000 37500 112500

2 Interest Income (each payer) Bank of America 150 150 0

Wells Fargo 200 0 200

3 Dividends (each payer)

4 State Income Tax Refund

5 Self-Employment Income (See instructions)

6 Capital Gains and Losses Taxpayer -1500 -1500 0

7 Pension Income

8 Rents, Royalties, Partnerships, Estates, Trusts

For Paperwoti< ReductIOn Act Notice. see your tax return instructions. Cat. No. 37779G Form 8958 (Rev. 11-2019)

Form 8958 (Rev 11-2019) Page2

A B C Total Amount Allocated to Spouse Allocated to Spouse

orRDP or RDP

SSN 999-99-1234----­ SSN 999 - 99 - 4321----­9 Deductible part of Self-Employment Tax (See

instructions)

10 Self-Employment Tax (See instr ctions)

11 Taxes Withheld Taxpayer 36000 27000 9000

Spouse 21000 5250 15750

Taxpayer - California 13300 9975 3325

Spouse - California 6500 1625 4875

12 Other items such as: Social Security Benefits, Unemployment Compensation, Deductions, Credits, etc.

Mortgage Interest 33000 8250 24750

Real Estate Taxes 16000 4000 12000

Form 8958 (Rev. 11-2019)

Form 8958 (Rev. 11-2019) Page 3

Genera Instructions Future developments. For the latest information about developments related to Form 8958 and jts instructions, such as legislation enacted after they were pUblished, go to www.irs.gov/Form8958.

Purpose of Form Use Form 8958 to determine the allocation of tax amounts betwee:l married filing separate spouses or registered domestic partners (ROPs) with community property rights. If you need more room, attach a statement listing the source of the item and the total plus the allocated amounts. Be sure to put your name and social security number (SSN) on the statements and attach them at the end of your return.

Community property laws affect how you figure yo r income on your federal income tax return if you are married, live in a community property state or country, and file separate retums.

This form is intended for individuals who:

1. Are subject to community property laws, and

2. File separate federal income tax returns.

See Pub. 555, Community Property, for more information.

Community or Separate Income In a community property state, if you file a federal tax return separately from your spouse, you must report half of all community income and all of your separate income. Likewise, a ROP must report half of all community income and all of his or her separate income on his or her federal tax return. Generally, the laws of the state in which you are domiciled govern whether you have community income or separate income for federal tax purposes.

Generally, community income is income from:

• Community property;

• Salaries, wages, or pay for services of you, your spouse or ROP, or both during your marriage or registered domestic partnership; or

• Real estate that is treated as community property under the laws of the state where the property is located.

Generally, income from separate property is the separate income of the spouse or ROP who owns the property.

Special rules apply for spouses living apart ail year and for spouses one or both of whom are nonresident aliens.

For more information, see Pub. 555, Community Property.

Identifying Income and Deductions You and your spouse or ROP must be able to identify your community and separate income, deductions, credits, and other return amounts according to the laws of your state.

Income The folloWing is a discussion of the general effect of community property laws on the federal income tax treatment of certain items of income.

Wages and self-employment income from sole proprietorship. A spouse's or ROP's wages and self-employment income from a sole proprietorship are community income and must be evenly split.

For ROPs, the self-employment income from a sole proprietorship is also split for self-employment tax purposes. See Self-employment tax, later.

Interest, dividends, and rents. Interest, dividends, and rents from community property are community income and must be e en y split.

Gains and losses. Gains and losses are classified as community or separate depending on how the property is held.

Withdrawals from ndividual retir ment arrangements (IRAs). There are several kinds of individual retirement arrangements (lRAs). Distributions of IRAs by law are deemed to be separate property, even if the funds in the account would otherwise be community property.

These distributions are wholly taxable to the spouse or ROP whose name is on the account. That spouse or ROP is also liable for any penalties and additional taxes on the distributions.

Pensio IS. Generally, distributions from pensions will be characterized as community or separate income depending on the respective periods of participation in the pension while married (or d ring the registered domestic partnership) and omiciled in a commu Ity property state or in a noncommunity property state dunng the total period of participation in the pension. These rules may vary between states.

Partnership income. If an interest is held in a partnership, and income from the partnership is attributable to the efforts of either spouse or RDP, the partnership income is community property.

8 For ROPs, the self-employment income from a TIP partnership is also split for self-employment tax

purposes. See Self-employment tax, later.

Tax-exempt income. For spouses, community income exempt from federal tax generally keeps its exempt status for both spouses. For example, under certain circumstances, income earned outside the United States is tax exempt. If you eamed income and met the conditions that made it exempt, the income is also exempt for your spouse even though he or she may not have met the conditions. ROPs should consult the particular exclusion provision to see if the exempt status applies to both.

ncome from separate property. In some states, income from separate property is separate income. Other states characterize income from separate property as community income.

For more information, see Pub. 555. For specific information that pertains to your situation, check with the laws of your state.

Deductions If you file separate returns, your deductions generally depend on whether the expenses involve community or separate income.

Busin ss and investment expenses. If you file separate returns, expenses incurred to earn or produce community business or investment income are generally divided equally between you and your spouse or ROP. Each of you is entitled to deduct one-half of the expenses on your separate returns. Separate business or investment income are deductible by the spouse or RDP who earns the Income.

Other limits may also apply to business and investment expenses. For more information, see Pub. 535, Business Expenses, Pub. 550, Investment Income and Expenses, and Pub. 555.

IRA deduction. Deductions for IRA contributions cannot be split betwee spouses or RDPs. The deduction for each spouse or ROP is figured separately and without regard to community property laws.

Personal expenses. Expenses that are paid out of separate funds, such as medical expenses, are deductible by the spouse or ROP who pays for them. If these expenses are paid from community funds, divide the deduction equally between you and your spouse or 80P.

Deductible portion of self-employment tax. The deductible portion of the self-employment tax is split only when the self-employment tax is split by the spouses or ROPs. See Self-employment tax, later.

Credits, Taxes, and Payments Self-employment tax. Although the self-employment tax rules contain a provision that overrides community income treatment in the case of spouses (IRC 1402(a)(5)), this provision does not apply to RDPs. RDPs split self-employment income from sole proplietorships and partnerships for self-employment tax purposes.

The following rules apply only to persons married for federal lax purposes.

Sole proprietorship. With regard to net income from a trade or usi ass (other than a partnership) that is community income, self­

employment tax is imposed on the spouse carrying on the trade or business

Form 8958 (Rev. 11-2019) Page 4

Partnerships. All of the distributive share of a married partner's income or loss from a partnership trade or business is attributable to the partner for computing any self-employment tax, even if a portion of the partner's distributive share of income or loss is community income or loss that is attributable to the partner's spouse for income tax purposes. If both spouses are partners, any self-employment tax is allocated based on their distributive shares.

Federal income tax withheld. If you and your spouse file separate returns on which each of you reports half the community wages, each of you is entitled to credit for half the income tax withheld on those wages. Likewise, each RDP is entitled to credit for half the income tax withheld on those wages.

To determine estimated tax payments, eamed income credit, and overpayments, see Pub. 555 for more information. For specific information that pertains to your situation, check with the laws of your state.

Specific Instructions

How To Complete Form 8958 To complete Form 8958, identify your community or separate income, deductions, credits and other return amounts on the separate lines under the item name on lines 1 through 12.

Enter the total amount of your community or separate income, deductions, credits, and other return amounts on their respective lines in Column A. Enter each spouse's or RDP's allocation of these amounts in Column Band C. Together, Columns Band C should equal Column A.

In a community property state, jf you file a federal tax return separately from your spouse, you must report half of all community income and all of your separate income. Likewise, a ROP must report half of all community income

and all of his or her separate income on his or her federal retum. The laws of the state in which you are domiciled govern INhether you have community income or separate income for federal tax purposes.

Line 1 Identify the wages from each payer on separate lines. Enter the tota! from each payer in Column A. Allocate the total from Column A between each spouse or RDP in Columns Band C.

Line 2 Identify the interest from each payer on separate lines. Enter the total from each payer in Column A and allocate the total from Column A between each spouse or RDP in Columns Band C.

Line 3 Identify the dividends from each payer on separate lines. Enter the total from each payer in Colur0n A anc allocate the total from Column A between each spouse or RDP in Columns Band C.

Line 4 Identify the state income tax refund from each payer on separate lines. Enter the total from each payer in Column A and allocate the total from Column A between each spouse or RDP in Columns Band C

Line 5 Identify the self-employment income from each entity on separate lines. Enter the total from each entity in Column A and allocate the total from Column A between each spouse or RDP in Columns Band C.

Line 6

Enter the gain or loss from each entity. Enter the total from each entity in Column A and allocate the total from Column A between each spouse or RDP in Columns Band C.

Line 7 Enter t e pension income from each payer on separate lines. Enter the total from each payer in Column A and allocate the total from Col mn A between each spouse or RDP In Columns Band C.

Line 8 Identify the rent, royalty, partnership, estate, or trust item(s) on separate lines. Enter the total(s) from each item(s) in Column A and allocate the total(s) from Column A between each spouse or ROP in Columns Band C.

Line 9 Identify the deductible part of self-employment tax from each entity on separate lines. Enter the total from each entity in Column A and allocate the total from Column A between each spouse or RDP in Columns Band C.

Line 10 Identify the self-employment tax from each entity on separate lines. Enter the total from each entity in Column A and allocate the total from Column A between each spouse or RDP in Columns Band C.

Une 11 Identify the taxes withheld from each payer or entity on separate lines. Enter the total from each payer or entity in Column A and allecate the total from Column A between each spouse or RDP in Columns Band C.

Line 12 Identify any item not previously reported, such as social security benefits, unemployment compensa:ion, deductions, credits, etc., on separate lines. Enter the total from each item in Column A; then allocate the total from each item from Column A between each spouse or RDP in Columns Band C.

Paperwor1<. Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of tax.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue I w. Generally, tax returns and return information are confidential, as required by section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances. For the estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

Additional Medic re Tax OMS No. 1545-00748959Form .. If any line does not apply to you, leave it blank. See separate instructions. 2019.. Attach to Form 1040, 1040·5R, 1040·NR, 1040·PR, or 1040-55. Attachment

Internal Revenue Service

Department of the Treasury .. Go to www.irs.gov/Form8959 for instructions and the latest information. Sequence No. 71 Name(s) sho\'lll on return IYour social security number

JANE SEPARATEFILER 999-99-4321 IPart II Additional Medicare Tax on Medicare Wages

1 Medicare wages and tips from Form W-2, box 5. If you have more than one

Form W-2, enter the total of the amounts from box 5

2 Unreported tips from Form 4137, line 6

3 Wages from Form 8919, line 6

4 Add lines 1 through 3

5 Enter the following amount for your filing status:

Married filing jointly $250,000

Married filing separately $125,000

Single, Head of household, or Qualifying widow(er) $200,000

6 Subtract line 5 from line 4. If zero or less, enter -0­

7 Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.009). Enter here and go to

Part II

IPart II I Additional Medicare Tax on Self-Employment Income 8 Self-employment income from Schedule SE (Form 1040 or 1040-SR), Section

A, line 4, or Section S, line 6. If you had a loss, enter -0- (Form 1040-PR or

1040-SS filers, see instructions.)

9 Enter the following amount for your filing status:

Married filing jointly

Married filing separately

Singe, Head of household, or Qualifying widow(er)

10 Enter the amount from line 4

11 Subtract line 10 from line 9. If zero or less, enter -0­

12 Subtract line 11 from line 8. If zero or less, enter -0­

8

$250,000

$125,000

$200,000 9

10

11

13 Additional Medicare Tax on self-employment income. Multiply line 12 by 0.9% (0.009) Enter here and

go to Part III

I Part III I Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation 14 Railroad retirement (RRTA) compensation and tips from Form(s) W-2, box 14

(see instructions) 14

15 Enter the following amount for your filing status:

Married filing jointly $250,000

Married filing separately $125,000

Single, Head of household, or Qualifying widow(er) $200,000 15

16 Subtract line 15 from line 14. If zero or less, enter -0­

17 Additional Medicare Tax on railroad retirement (RRTA) compensation. Multiply line 16 by 0.9% (0.009),

Enter here and go to Part IV

I Part IV I Total Additional Medicare Tax 18 Add lines 7, 13, and 17. Also include this amount on Schedule 2 (Form 1040 or 1040-SR), line 8 (check

box a) (Form 1040-NR, 1040-PR, or 1040-SS filers, see instructions), and go to Part V

IPart V I Withholding Reconciliation 19 Medicare tax withheld from Form W-2, box 6. If you have more ·;:la,~ one Form

W-2, enter the total of the amounts from box 6

20 Enter the amount from line 1

21 Multiply line 20 by 145% (0.0145). This is your regular Medicare tax

withholding on Medicare wages

22 Subtract line 21 from line 19. If zero or less, enter -0-. This is your Additional Medicare Tax

withholding on Medicare wages

23 Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-2, box

14 (see instructions)

24 Total Additional Medicare Tax withholding. Add lines 22 and 23. Also include this amount with

federal income tax withholding on Form 1040 or 1040-SR. :i,le 17 (Form 1040NR, 1040-PR, or

1040-SS filers, see instructions)

For Paperwork Reduction Act Notice, see your tax return Instructions.

EEA

1

2

3

4

150

150

000

000

5 125 000 6 25 000

7 225

12

13

I

16

17

18

19 2 175 20 150 000

21 2 175

22 0

23

24

Form 8959 (2019)

225

1 200 2

3

4c 0

,

5d 0 6

7

8 200

Net Investment Income Tax- OMS No. 1545-2227 FOfm 8960 Individual ,Estates, an Trus s 2019

• Attach to your lax return. Attacl1mentDepartment of the Treasury

Internal Revenue Service (99) • Go to www.irs.gov/FormS960 for instructions and the latest information. Sequence No 72 Name(s) sho'hTl on your tax return Your social security number or EfN

999-99-4321 Section 6013(g) election (see instructions)

o Section 6013(h) election (see instructions)

D Regulations section 1 1411-1 O(g) election (see instructions)

1 Taxable interest (see instructions)

2 Ordinary dividends (see instructions)

3 Annuities (see instructions)

4a Rental real estate, royalties, partnerships, S corporations, trusts,etc. (see

instructions) 4a

b Adjustment for net income or loss derived in the ordinary course of a non-

section 1411 trade or business (see instructions) 4b

5a

5b

5c

c Combine lines 4a and 4b

5a Net gain or loss from disposition of property (see instructions)

b Net gain or loss from disposition of property that is not subject to net

investment income tax (see instructions)

c Adjustment from disposition of partnership interest or S corporation stock (see

instructions)

d Combine lines 5a through 5c

6 Adjustments to investment income for certain CFCs and PFICs (see instructions)

7 Other modifications to investment income (see instructions)

8 Total investment income. Combine lines 1, 2, 3, 4c, 5d, 6, and 7

IPart III Investment Expenses Allocable to Investment Income and Modifications 9a Investment interest expenses (see instructions)

b State, local, and foreign income tax (see instructions)

c Miscellaneous investment expenses (see instructions)

d Add lines 9a, 9b, and 9c

10 Additional modifications (see instructions)

11 Total deductions and modifications. Add lines 9d and 10

IPart 1111 Tax Computation 12 Net investment income. Subtract Part II, line 11 from Part I, line 8. Individuals complete lines 13-17.

Estates and trusts complete lines 18a-21 If zero or less, enter -0­

Individuals: 13 Modified adjusted gross income (see instructions)

14 Threshold based on filing status (see instructions)

15 Subtract line 14 from line 13. If zero or less, enter -0­

16 Enter the smaller of line 12 or line 15

17 Net investment income tax for individuals. Multiply line 16 by 3.8% (0.038). E

on your tax return (see instructions)

Estates and Trusts: 18a Net investment income (line 12 above)

b Deductions for distributions of net investment income and deductions under

section 642(c) (see instructions)

c Undistributed net investment income. Subtract line 18b from 18a (see instructions).

If zero or less, enter -0­

19a Adjusted gross income (see instructions)

b Highest tax bracket for estates and trusts for the year (see instructions)

c Subtract line 19b from line 19a If zero or less, enter -0­

9a

9b 6 9c

9d 6 10

11 6

12 194

13 157 700 I 14 125 000 I15 32 700 I

16 194 ter here and include

17 7

20

21

Form 8960 (2019)

18a

18b

18c

19a

19b

19c

20 Enter the smaller of line 18c or line 19c

21 Net investment income tax for estates and trusts Multiply line 20 by 3.8% (0.038). Enter here and

include on your tax return (see instructions)

For Paperwork ReductIon Act Notice, see your tax return Instructions.

EEA

Department of the Treasury - Internal Revenue Service

Fonn 9325 A knowledgement and General Information for (January 2017)

Taxpayers Who File Returns Electronically Thank you for participating in IRS e-fJle

Taxpayer name

JANE SEPARATEFILER

Taxpayer address (optional)

101 ANYSTREET

LOS ANGELES I CA 90067

1. D Your federal income tax return for 2019 was filed electronically with the _-=.IR=S _ Submission

Processing Center. The electronic filing services were provided bYE'='.o;:r..:.:n:..::e:..::s:...:t:o.......:F:........:H:..::o=w.:::a""r"'d:........::C"-'P:.:A:..:...- _

2. D Your retum was accepted on using a Personal Identification Number (PIN) as your electronic

signature. You entered a PIN or authorized the Electronic Return Originator (ERO) to enter or generate a PIN

for you. The Submission ID assigned to your return is

3 D Your return was accepted on . Allow 4 to 6 weeks for the processing of your retum.

The Earned Income Credit or a dependent's exemption on your return may be reduced or disallowed due to a

child's name and social security number mismatch

4. D Your electronic funds withdrawal payment request was accepted for processing.

5. D Your electronic funds withdrawal payment request was not accepted for processing. Refer to the "If You Owe Tax" section.

6. D Your Form 4868, Application for Automatic Extension of Time to File U.S Individual Income Tax Return, was

accepted on . The Submission ID assigned to your extension

is _

DO NOT SEND A PAPER COPY OF YOUR RETURN TO THE IRS. IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN.

If You Need to Make a Change to Your Return

If you need to make a change or correct the return you filed electronically, you should send a Form 1040X, Amended U.S.

Individual Income Tax Return, to the IRS Submission Processing Center that processes paper retums for your area. The

address is available at www.irs.gov, or you can call the IRS toll-free at 1-800-829-1040.

If You Need to Ask About Your Refund

The IRS notifies your Electronic Return Originator (ERO) when your return is accepted, usually within 48 hours If your

retum was not accepted, the IRS notifies your ERO of the reasons for rejection. If it has been more than three weeks

since the IRS accepted your return and you have not received your refund, go to www.irs.gov and click on "Where's My

Refund?" to view your refund status Exception: If box 3 above is checked, allow 4 to 6 weeks for processing of your

return. A notice will be sent to you advising of changes to your return.

Also, you can call the TeleTax line at 1-800-829-4477, for automated refund information. You should have available the

first social security number shown on your return, your filing status, and the exact amount of the refund you expect.

TeleTax gives you the date for mailing or depositing your refund. You should receive your refund check within 30 days of

the date given by TeleTax, or within one week of that date, if you chose direct deposit. If you do not receive it by then, or if

TeleTax does not give your refund information, call the Refund Hotline at 1-800-829-1954.

EEA www.lrs.gov Form 9325 (Rev. 1-2017)

The IRS uses refunds to cover overdue taxes and notifies you when this occurs. The Fi&cal ervice offsets refunds

through the Treasury Offset Program to cover past due child support, federal agency non-tax debts such as student loans

and state income tax obligations. Fiscal Service sends you an offset notice if it applies your refund or part of your refund

to non-tax debts If you have questions about the offset, contact the agency identified in the notice. You may also call the

Treasury Offset Program Call Center at 1-800-304-3107, if you have addi ional questions.

If You Owe Tax If your return has a balance due, you must pay the amount you owe by the prescribed due date. If you paid by electronic

funds withdrawal (direct debit) or by credit card, no voucher is neeaed. The credit card service providers will charge a

convenience fee based on the amount of taxes you are paying. The fees and the type of credit or debit cards accepted

may vary between providers. You will be told the amount of the fee during the transaction and you will be given the option

to either continue or end the transaction. For information on paying your taxes electronically, including by credit or debit

card, go to wwwirs.gov/e-pay.

If you are not paying electronically you may use Form 1040-V, Payment Voucher, which you can obtain from your

Electronic Return Originator. If the IRS does not receive your payment by the prescribed due date, you will receive a

notice that requests full payment of the tax due, plus penalties and interest. If you can not pay the amount in full, complete

Form 9465, Installment Agreement Request, which you may file electronically. To apply for an installment agreement

online, go to wwvv-irs.gov. You may also order Form 9465 by calling 1-800-TAX-FORM (1-800-829-3676). If approved, the

IRS charges a user fee to set up an installment agreement.

If You Need to Inquire About Your Electronic Funds Withdrawal Payment

You may call 1-888-353-4537 to inquire about the status of your electronic funds withdrawal payment. If there is a change

to the bank account information included on your return, you should call this number to cancel a scheduled payment. You

should have available the social security number of the first person listed on the tax return, the payment amount, and the

bank account number. Cancellation requests must be received no later than 11 :59 p.m. E.T. two business days prior to

the scheduled payment date.

Tax Refund Related Financial Products

Financial institutions offer a variety of financial products to taxpayers based on their refunds. Contracts for financial

products are between you and the financial institution. The IRS is not associated with the contract. If you have questions

about tax refund related products, contact your Electronic Return Originator or the lender.

Instructions for Electronic Return Originators

Line 2 - PIN Presence Indicator - Check box 2 if the taxpayer entered a PIN or authorized the ERO to enter or generate

the PIN for the taxpayer, and the Acknowledgement File PIN Presence Indicator is a "Practitioner PI," "Self-Select PIN"

or "Online Filer PIN." Form 8879, IRS e-file Signature Authorization, is required if the ERO enters or generates the PIN or

if the Practitioner PIN method is used. Use Form 8453, U.S. Individoallnwme Tax Transmittal for an IRS e-file

Return, to send required paper fonns or supporting documentation listed nen to the fonn check boxes (do not

send Forms W-2, W-2G, or 1099R).

Line 3 - Exception Processing - Check box 3 if the Acknowledgement File Acceptance Code equals "Exception." The

acceptance code indicates that this return has been previously rejected and this subsequent submission stiil has invalid

data.

Line 4 - Payment Acknowledgement Literal - Check box 4 if the taxpayer requested to use electronic funds withdrawal to

pay the balance due, and the AcknOWledgement File Payment Acknowledgement Literal field equals "Payment Request

Received."

Line 5 - Payment Acknowledgement Literal - Check box 5 if the taxpayer requested to use electronic funds withdrawal to

pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field does not equal "Payment

Request Received." If box 5 is checked, inform the taxpayer that he/she must pay by check, money order, debit card, or

credit card.

Note: EROs can use the Acknowledgement File information, translated by the transmitter, to complete Form 9325.

JANE SEPARATEFILER

EEA www.irs.gov Form 9325 (Rev. 1-2017)

1040 Overflow Statement p~g191 Name(s) as shown on return IYour Social Security Number

JANE SEPARATEFILER 999-99-4321

EWT COMMUNITY PROPERTY ALLOCATION

DESCRIPTION AMOUNT W2 TAX WITHHELD $ 21,000 FWT COMMUNITY PROPERTY ALLOCATION 3,750

TOTAL: $ 24,750

SWT COMMUNITY PROPERTY ALLOCATION

DESCRIPTION AMOUNT W2 SWT $ 6,500 SWT COMMUNITY PROPERTY ALLOCATION 1,700

TOTAL: $ B,200

OVERFLOWLD