JOHN WILSON 2018 INCOME TAX RETURN - Empire ......TAX YEAR: 2018 PROCESS DATE: 01/10/2019 CLIENT :...

JOHN WILSON1 WEST MAIN ST

ROCHESTER, NY 146112018 INCOME TAX RETURN

INVOICE

Description Amount

Total Invoice

Amount Paid

Balance Due

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PRACTICE LAB15 PRACTICE LAB WAYWASHINGTON DC 20005

(202) 202-2022

JOHN WILSON1 WEST MAIN STROCHESTER NY 14611(585) 333-2222

Preparer No.: 995Client No. : XXX-XX-7890Invoice Date: 01/10/2019

PREPARATION OF 2018 FEDERAL/STATE FORMS & WORKSHEETS:

FORM 1040FORM W-2 (WAGES AND TAX)FORM 8879 (E-FILE SIGNATURE AUTHORIZATION)NY STATE RESIDENT RETURN

$0.00

$0.00

$0.00

TAX YEAR: 2018 PROCESS DATE: 01/10/2019

CLIENT : 700-00-7890 JOHN WILSON BIRTH DATE : 11/11/1980 Age:38

ADDRESS : 1 WEST MAIN ST PREPARER : 995 : ROCHESTER NY 14611

Home : (585) 333-2222 PREPARER FEE : Work : - ELECTRONIC : Cell : - TOTAL FEES : STATUS : 1FED TYPE: Electronic MailST TYPE : Regular Tax EFFECTIVE RATE: 10.44%E-MAIL :

_____________________________________________________________________________________LISTING OF FORMS FOR THIS RETURN________________________________

FORM 1040FORM W-2FORM 8879 (E-FILE SIGNATURE AUTHORIZATION)NY STATE RESIDENT RETURN

* QUICK SUMMARY *_____________________________________________________________________________________SUMMARY__________________________________________________________________________FILING STATUSTOTAL INCOMETOTAL ADJUSTMENTSADJUSTED GROSS INCOMEDEDUCTIONSEXEMPTIONSTAXABLE INCOMETAXCREDITSPAYMENTSEARNED INCOME CREDITREFUNDAMOUNT DUE

FEDERAL 1 24000 0 24000 12000 0 12000 1253 0 2400 0 1147 0

NY RESIDENT 1 24000 1800 25800 8000 0 17800 792 0 1721 521 929 0

* W-2 INCOME FORMS SUMMARY *_____________________________________________________________________________________

T/S EMPLOYER WAGES FED WITH FICA MED TAX STATE WITH ST ____________________________________________________________________________1. T MONROE CO DSS 24000 2400 1600 374 1200 NY

TOTALS...... 24000 2400 1600 374 1200

a Employee’s social security number

OMB No. 1545-0008

Safe, accurate, FAST! Use

Visit the IRS website at www.irs.gov/efile

b Employer identification number (EIN)

c Employer’s name, address, and ZIP code

d Control number

e Employee’s first name and initial Last name Suff.

f Employee’s address and ZIP code

1 Wages, tips, other compensation 2 Federal income tax withheld

3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8 Allocated tips

9 Verification code 10 Dependent care benefits

11 Nonqualified plans 12a See instructions for box 12Co d e

12bCo d e

12cCo d e

12dCo d e

13 Statutory employee

Retirement plan

Third-party sick pay

14 Other

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form W-2 Wage and Tax Statement

Department of the Treasury—Internal Revenue Service

a Employee’s social security number

OMB No. 1545-0008

Safe, accurate, FAST! Use

Visit the IRS website at www.irs.gov/efile

b Employer identification number (EIN)

c Employer’s name, address, and ZIP code

d Control number

e Employee’s first name and initial Last name Suff.

f Employee’s address and ZIP code

1 Wages, tips, other compensation 2 Federal income tax withheld

3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8 Allocated tips

9 Verification code 10 Dependent care benefits

11 Nonqualified plans 12a See instructions for box 12Co d e

12bCo d e

12cCo d e

12dCo d e

13 Statutory employee

Retirement plan

Third-party sick pay

14 Other

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form W-2 Wage and Tax Statement

Department of the Treasury—Internal Revenue Service

2018

2018

700-00-7890

16-1309424

MONROE CO DSS100 WESTFALL RDROCHESTER NY 14603

JOHN WILSON1 WEST MAIN STROCHESTER NY 14611

24000 2400

25800 1600

25800 374

DD 3000

X

414HSUB 1800

NY 161309424 24000 1200

Consent to Disclose Tax Return Information to VITA/TCE Tax Prep Sites

Federal Disclosure

Federal law required this consent form be provided to you ("you" refers to each taxpayer, if more than one). Unless authorized by law, we cannot disclose, without your consent, your tax return information to third parties for purposes other than the preparation and filing of your tax return. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.

I JOHN WILSON authorize The Practice Lab:

Global Carry Forward of data allows TaxSlayer LLC, the provider of the VITA/TCE tax software-to make your tax return information available to ANY volunteer site participating in the IRS's VITA/TCE program that you select to prepare a tax return in the next filing season.

This means-you will be able to visit any volunteer site using TaxSlayer next year and have your tax return populate with your current year data, regardless of where you filed your tax return this year.

This consent is valid-through November 14, 2020

The tax return information that will be disclosed includes, but is not limited to,-demographic, financial and other personally identifiable information, about you, your tax return and your sources of income, which was input into the tax preparation software for the purpose of preparing your tax return.

This information includes-your name, address, date of birth, phone number, SSN, filing status, occupation, employer's name and address, and the amounts and sources of income, deductions and credits that were claimed on, or contained within, your tax return.

The tax return information that will be disclosed also includes-the name, SSN, date of birth, and relationship of any dependents that were claimed on your tax return.

You do not need to provide consent for the VITA/TCE partner preparing your tax return this year-Global Carry Forward will assist you only if you visit a different VITA or TCE partner next year.

Limitation on the Duration of Consent:-I/we, the taxpayer, do not wish to limit the duration of the consent of the disclosure of tax return information to a date earlier than presented above (November 14, 2020). If I/we wish to limit the duration of the consent of the disclosure to an earlier

Limitation on the Scope of Disclosure:-I/we, the taxpayer, do not wish to limit the scope of the disclosure of tax return information further than presented above. If I/we wish to limit the scope of the disclosure of tax return information further than presented above, I/we will deny consent.

Taxpayer PIN: 12345 PIN Date 12/7/2018

Signature: ______________________________________________ Date: _______________

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email to: [email protected].

Form 8879Department of the Treasury Internal Revenue Service

IRS e-file Signature Authorization

Return completed Form 8879 to your ERO. (Don’t send to the IRS.)

Go to www.irs.gov/Form8879 for the latest information.

OMB No. 1545-0074

2018

Submission Identification Number (SID)

Taxpayer’s name Social security number

Spouse’s name Spouse’s social security number

Part I Tax Return Information — Tax Year Ending December 31, 2018 (Whole dollars only)1 Adjusted gross income (Form 1040, line 7; Form 1040NR, line 35) . . . . . . . . . . . . 1

2 Total tax (Form 1040, line 15; Form 1040NR, line 61) . . . . . . . . . . . . . . . . 2

3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040, line 16; Form 1040NR, line 62a) . 3

4 Refund (Form 1040, line 20a; Form 1040-SS, Part I, line 13a; Form 1040NR, line 73a) . . . . . . 4

5 Amount you owe (Form 1040, line 22; Form 1040NR, line 75) . . . . . . . . . . . . . . 5

Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)

Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements for the tax year ending December 31, 2018, and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent.

Taxpayer’s PIN: check one box only

I authorize ERO firm name

to enter or generate my PIN Enter five digits, but

don’t enter all zerosas my signature on my tax year 2018 electronically filed income tax return.

I will enter my PIN as my signature on my tax year 2018 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.

Your signature Date

Spouse’s PIN: check one box only

I authorize ERO firm name

to enter or generate my PIN Enter five digits, but

don’t enter all zerosas my signature on my tax year 2018 electronically filed income tax return.

I will enter my PIN as my signature on my tax year 2018 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.

Spouse’s signature Date

Practitioner PIN Method Returns Only—continue belowPart III Certification and Authentication — Practitioner PIN Method Only

ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.Don’t enter all zeros

I certify that the above numeric entry is my PIN, which is my signature for the tax year 2018 electronically filed income tax return for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.

ERO’s signature Date

ERO Must Retain This Form — See Instructions

Don’t Submit This Form to the IRS Unless Requested To Do So

For Paperwork Reduction Act Notice, see your tax return instructions. Form 8879 (2018)

QNA

JOHN WILSON 700-00-7890

24000 1253 2400 1147

01/10/2019

X PRACTICE LAB 1 7 8 9 0

3 6 9 2 5 8 9 8 7 6 5

IRS PREPARER 01/10/2019

Form 1040 Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return 2018 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

(99)

Filing status: Single Married filing jointly Married filing separately Head of household Qualifying widow(er)

Your first name and initial Last name Your social security number

Your standard deduction: Someone can claim you as a dependent You were born before January 2, 1954 You are blind

If joint return, spouse's first name and initial Last name Spouse’s social security number

Spouse standard deduction: Someone can claim your spouse as a dependent Spouse was born before January 2, 1954

Spouse is blind Spouse itemizes on a separate return or you were dual-status alien

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

City, town or post office, state, and ZIP code. If you have a foreign address, attach Schedule 6.

Full-year health care coverage or exempt (see inst.)

Presidential Election Campaign (see inst.) You Spouse

If more than four dependents, see inst. and here

Dependents (see instructions): (2) Social security number (3) Relationship to you (4) if qualifies for (see inst.):

(1) First name Last name Child tax credit Credit for other dependents

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 you an Identity Protection PIN, enter it here (see inst.)

Paid Preparer Use Only

Preparer’s name Preparer’s signature PTIN Firm’s EIN

Firm’s name Phone no.

Check if:

3rd Party Designee

Self-employed

Firm’s address

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2018) QNA

x


1 WEST MAIN ST

ROCHESTER, NY 14611

X

01/10/19 MAINTENANCE

S14015260 -

PRACTICE LAB15 PRACTICE LAB WAY WASHINGTON DC 20005

202-202-2022

Form 1040 (2018) Page 2

Attach Form(s) W-2. Also attach Form(s) W-2G and 1099-R if tax was withheld.

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

2a Tax-exempt interest . . . 2a b Taxable interest . . . 2b

3a Qualified dividends . . . 3a b Ordinary dividends . . 3b

4a IRAs, pensions, and annuities . 4a b Taxable amount . . . 4b

5a Social security benefits . . 5a b Taxable amount . . . 5b

6 Total income. Add lines 1 through 5. Add any amount from Schedule 1, line 22 . . . . . 67

Adjusted gross income. If you have no adjustments to income, enter the amount from line 6; otherwise, subtract Schedule 1, line 36, from line 6 . . . . . . . . . . . . . . . . . 7Standard

Deduction for—

• Single or married filing separately, $12,000

• Married filing jointly or Qualifying widow(er), $24,000

• Head of household, $18,000

• If you checked any box under Standard deduction, see instructions.

8 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . . . 8

9 Qualified business income deduction (see instructions) . . . . . . . . . . . . . . 9

10 Taxable income. Subtract lines 8 and 9 from line 7. If zero or less, enter -0- . . . . . . . . 10

11 a Tax (see inst.) (check if any from: 1 Form(s) 8814 2 Form 4972 3

b Add any amount from Schedule 2 and check here . . . . . . . . . . . .

)

11

12 a Child tax credit/credit for other dependents b Add any amount from Schedule 3 and check here 12

13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . 13

14 Other taxes. Attach Schedule 4 . . . . . . . . . . . . . . . . . . . . 14

15 Total tax. Add lines 13 and 14 . . . . . . . . . . . . . . . . . . . . 15

16 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . 16

17 Refundable credits: a EIC (see inst.) b Sch. 8812 c Form 8863

Add any amount from Schedule 5 . . . . . . . . . . . . . . 17

18 Add lines 16 and 17. These are your total payments . . . . . . . . . . . . . . 18

Refund

Direct deposit? See instructions.

19 If line 18 is more than line 15, subtract line 15 from line 18. This is the amount you overpaid . . . . 19

20a Amount of line 19 you want refunded to you. If Form 8888 is attached, check here . . . . 20a

b Routing number c Type: Checking Savings

d Account number

21 Amount of line 19 you want applied to your 2019 estimated tax . . 21

Amount You Owe 22 Amount you owe. Subtract line 18 from line 15. For details on how to pay, see instructions . . . 22

23 Estimated tax penalty (see instructions) . . . . . . . . 23

Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2018)

QNA

WILSON 700-00-7890

24000

24000

24000 12000

12000 1253

1253

1253 0 1253 2400

2400 1147 1147

X X X X X X X X XX X X X X X X X X X X X X X X X X

QNA


1200

1200

1200

1200

1200

Department of Taxation and Finance

Resident Income Tax ReturnNew York State • New York City • Yonkers • MCTMT

IT-201

Single

(enter spouse’s social security number above)

(enter spouse’s social security number above)

(with qualifying person)

or t e u year anuary 1 201 t rou ecem er 1 201 or sca year e innin ... 18and ending ...

A Filingstatus (mark anX in one box):

B Did you itemize............

C Can you be claimed...........

Taxpayer’s permanent home address (see instructions, page 14) (number and street or rural route)

NY (mmddyyyy) (mmddyyyy)

Decedentinformation

For help completing your return, see the instructions, Form IT-201-I.Your (for a joint return, enter spouse’s name on line below) (mmddyyyy)

Spouse’s (mmddyyyy)

(see instructions, page 14) (number and street or PO box)

(if not United States)

...............

(mmddyyyy)

H Dependent information (see page 16)

X

or of ce use only

D1(see page 15) ..............................

D2 Yonkers residents and Yonkers part-year residents only:

(see page 15) .................................................

... .

D3(see page 15) ..............

E maintain livingquarters in NYC (see page 15) ..

(any part of a day spent in NYC is considered a day).........

F NYC residents and NYC part-yearresidents only (see page 15):

you ................

your spouse .....

G 2-character special condition code(s) if applicable (see page 15) ......................

NO HANDWRITTEN ENTRIES, OTHER THAN SIGNATURE, ON THIS FORM

***** DO NOT MAIL *****

JOHN WILSON 11111980 700007890

1 WEST MAIN ST

ROCHESTER NY 14611

MONR

ROCHESTER

538

X

X

X

X

X

X

***** DO NOT MAIL *****

20 20 . 21 (see page 17) 21 . 22 New York’s (see page 17) .......................................... 22 . 23 Other (Form IT-225, line 9) ............................................................................................................. 23 . 24 19 23 .............................................................................................................. 24 .

New York additions (see page 17)

Page 2 IT-201

1 ........................................................................................................... 1 .

2 ............................................................................................................... 2 . 3 ...................................................................................................................... 3 . 4 (also enter on line 25) ........... 4 . 5 ......................................................................................................................... 5 . 6 (submit a copy of federal Schedule C or C-EZ, Form 1040) .......................... 6 . 7 (if required, submit a copy of federal Schedule D, Form 1040) .............................. 7 . 8 (submit a copy of federal Form 4797) ............................................................. 8 . 9 X ... 9 . 10 X 10 . 11 (submit copy of federal Schedule E, Form 1040) 11 .

Federal income and adjustments (see page 16)Whole dollars only

New York subtractions (see page 18)

Standard deduction or itemized deduction (see page 21)

34 standard deduction (table on page 21) or itemized deduction (from Form IT-196) X Standard - or - Itemized 34 .

35 (if line 34 is more than line 33, leave blank) .......................................... 35 . 36 (enter the number of dependents listed in item H; see page 21) ..................... 36 000.00

37 Taxable income (subtract line 36 from line 35) ............................................................................... 37 .

12 ................................. 12 . 13 (submit a copy of federal Schedule F, Form 1040) ............................................. 13 . 14 ..................................................................................................... 14 . 15 (also enter on line 27) .................................................. 15 . 16 Other income (see page 16) Identify: 16 .

17 1 through 11 and 13 through 16 ................................................................................ 17 . 18 (see page 16) Identify: 18 .

19 Federal adjusted gross income (subtract line 18 from line 17) ..................................................... 19 .

25 (from line 4) 25 . 26 (see page 18) 26 . 27 (from line 15) .... 27 . 28 ...................... 28 . 29 (see page 19) ........ 29 . 30 New York’s 30 . 31 Other (Form IT-225, line 18) ................................................... 31 . 32 .............................................................................................................. 32 .

33 New York adjusted gross income (subtract line 32 from line 24) .................................................. 33 .


***** DO NOT MAIL *****

700007890

24000

24000

24000

1800

25800

25800

X 8000

17800

17800

***** DO NOT MAIL *****

Tax computation, credits, and other taxes

38 Taxable income (from line 37 on page 2) ....................................................................................... 38 .

39 (see page 22) ..................................................................................... 39 . 40 (page 21, table 1, 2, or 3) ................... 40 . 41 (see page 23) ............................................... 41 . 42 (Form IT-201-ATT, line 7) ... 42 . 43 .............................................................................................................. 43 .

44 (if line 43 is more than line 39, leave blank) .......................................... 44 . 45 (Form IT-201-ATT, line 30) ............................................................................. 45 .

46 Total New York State taxes (add lines 44 and 45) ........................................................................ 46 .

See instructions on pages 23 through 26 to compute New York City and Yonkers taxes, credits, and surcharges, and MCTMT.

47 (see instructions) ................................ 47 . 47a (see page 23) ............. 47a . 48 (page 23) ........................................ 48 . 49 (if line 48 is more than line 47a, leave blank) ........................................................ 49 . 50 (Form IT-360.1) ....................... 50 . 51 (Form IT-201-ATT, line 34) ........................ 51 . 52 .................................................. 52 . 53 (Form IT-201-ATT, line 10) ........ 53 . 54 (if line 53 is more than line 52, leave blank) ......................................................... 54 . 54a MCTMT net

.... 54a . 54b MCTMT ............................................................................ 54b . 55 (see page 26) ..... 55 . 56 (Form Y-203) ............... 56 . 57 (Form IT-360.1) 57 .

IT-201 Page 3

58 Total New York City and Yonkers taxes / surcharges and MCTMT (add lines 54 and 54b through 57) .. 58 .

59 Sales or use tax (see page 27; do not leave line 59 blank) .......................................................... 59 .

New York City and Yonkers taxes, credits, and surcharges, and MCTMT

60 Total voluntary contributions (add lines 60a through 60s) ........................................................... 60 .

61 Total New York State, New York City, Yonkers, and sales or use taxes, MCTMT, and voluntary contributions (add lines 46, 58, 59, and 60) .............................................................. 61 .

Voluntary contributions ( see page 28)

60a 60a . 60b 60b . 60c 60c . 60d 60d . 60e ($2 or $4) 60e . 60f 60f . 60g 60g . 60h 60h . 60i 60i . 60j 60j . 60k 60k . 60l 60l . 60m 60m . 60n 60n .

60o 60o . 60p 60p . 60q 60q . 60r 60r . 60s 60s .


***** DO NOT MAIL *****

JOHN WILSON 700007890

17800

832 40

40

792

792

0

792

***** DO NOT MAIL *****

(if joint return)

Page 4 IT-201

Payments and refundable credits (see pages 29 through 32)

Your refund, amount you owe, and account information (see pages 33 through 35)

See page 37 for the proper assembly of your return.

See instructions for where to mail your return.

Refund?

Form(s) IT-2 and/or IT-1099-R

(see page 13).Do not send federal Form W-2 with your return.

77 Amount overpaid (see instructions) ............................................................................................ 77 . 78 available for refund (subtract line 79 from line 77) .......................................... 78 . 78a (Form IT-195, line 4) (also submit Form IT-195) 78a .

78b (subtract line 78a from line 78) .................................. 78b . direct deposit

- or - paper

Mark one refund choice: ( ll in line 83) check 79

(see instructions) ...................................... 79 . 80 owe (if line 76 is less than line 62, subtract line 76 from line 62).

X must .................. 80 .

81 (include this amount in line 80 or reduce the overpayment on line 77; see page 34) ................ 81 . 82 (see page 34) ........................ 82 . 83 (see page 35).

X (see pg. 35)

62 ........................................................................................................... 62 .

83a - or - - or - - or -

83b 83c

84 (see page 35) ................ .

63 .................................................. 63 . 64 ...................... 64 . 65 ............................... 65 . 66 .......................................... 66 . 67 .................................................... 67 . 68 ......................................................... 68 . 69 (also complete F on page 1) 69 . 69a ................. 69a . 70 ........................................ 70 . 70a ............................ 70a . 71 (Form IT-201-ATT, line 18) ............. 71 .

72 Total New York State ................................... 72 . 73 Total New York City ..................................... 73 . 74 Total Yonkers ............................................... 74 . 75 and 75 .

76 Total payments (add lines 63 through 75) ..................................................................................... 76 .

Third-party

designee? (see instr.)

Yes No

Taxpayer(s) must sign here Paid preparer must complete (see instructions) excl. code

(or yours, if self-employed)

Date

See page 34 for payment options.


***** DO NOT MAIL *****

700007890 792

521

1200

1721

929 929

929

X

x

MAINTENANCE

10001

S14015260PRACTICE LAB

15 PRACTICE LAB WAY

WASHINGTON DC 20005 01102019 01102019 585 333 2222

***** DO NOT MAIL *****

N Y

N Y

IT-2Department of Taxation and Finance

Summary of W-2 StatementsNew York State • New York City • Yonkers

Box b

Box b

Box 12a

.00Box 12b

.00Box 12c

.00Box 12d

.00

Box 12a

.00Box 12b

.00Box 12c

.00Box 12d

.00

Box 1 Wages, tips, other compensation

.00Box 8 Allocated tips

.00Box 10

.00Box 11

.00

Box 1 Wages, tips, other compensation

.00Box 8 Allocated tips

.00Box 10

.00Box 11

.00

W-2 Record 1

W-2 Record 2

Employer’s name

Employer’s name

Box c Employer’s information

Box c Employer’s information

Employer’s address (number and street)

Employer’s address (number and street)



Do not detach or separate

Box a Employee’s for this W-2 Record

Box a Employee’s for this W-2 Record

Box 16b Box 17b

.00 .00

Box 16b Box 17b

.00 .00

Box 14a

.00Box 14b

.00Box 14c

.00Box 14d

.00

Box 14a

.00Box 14b

.00Box 14c

.00Box 14d

.00

Box 16a Box 17a

.00 .00

Box 16a Box 17a

.00 .00

NY

NY

Other

Other

NYC and Yonkersinformation (see instr.)

NYC and Yonkersinformation (see instr.)

Do not detach.

Box 15a

Box 15a

Box 15bother state

Box 15bother state

Box 18 Box 19 Box 20 Locality name

Locality a .00 Locality a .00 Locality a

.00 .00

Box 18 Box 19 Box 20 Locality name

Locality a .00 Locality a .00 Locality a

.00 .00

Box 13

Box 13

Retirement plan

Retirement plan

MONROE CO DSS

700007890 100 WESTFALL RD

ROCHESTER NY 14603161309424

24000 3000 D D

X

1800 414HSUB

24000 1200

***** DO NOT MAIL *****

1 Were you a full-year resident of New York State? ....................................................................................... 1 Yes No If No, stop; you do not qualify for this credit. 2 Were you age 18 or older as of December 31? ........................................................................................... 2 Yes No If No, stop; you do not qualify for this credit. 3 Were you the parent of a child who did not reside with you and was under the age of 18 on December 31? ... 3 Yes No If No, stop; you do not qualify for this credit. If Yes, list up to three children who did not reside with you in the spaces below (see instructions).

IT-209Department of Taxation and Finance

Claim for Noncustodial ParentNew York State Earned Income CreditNew York State Earned Income Credit • New York City Earned Income Credit

4 Did you have a child support order payable through a New York State Support Collection Unit (SCU) for at least one-half of the tax year? ...................................................................................... 4 Yes No If No, stop; you do not qualify for this credit. 5 For the tax year, have you paid an amount in child support equal to or more than the amount due for every order requiring you to make child support payments? ................................................................... 5 Yes No If No, stop; you do not qualify for this credit. 6 Is your federal AGI from Form IT-201, line 19, less than $40,320? ............................................................. 6 Yes No If No, stop; you do not qualify for this credit. 7 work or is valid for federal earned income tax purposes? (see instructions) ............................................. 7 Yes No If No, stop; you do not qualify for this credit, the NYS EIC, or the NYC EIC. 8 .................................................................................. 8 Yes No If Yes, stop; you do not qualify for this credit, the NYS EIC, or the NYC EIC. 9 ........................... 9 Yes No If Yes, stop; you do not qualify for this credit, the NYS EIC, or the NYC EIC. 10 (see instructions) .............................................................. 10 Yes No If Yes, stop; you do not qualify for this credit, the NYS EIC, or the NYC EIC.

The noncustodial parent New York State earned income credit (noncustodial EIC) may be claimed instead of the New York State earned income credit (NYS EIC). If you claimed a federal earned income credit, compute both the noncustodial EIC (Schedule A) and

EIC and the NYS EIC.

Part 1 – EligibilityIf you answer No to any question on lines 1 through 6, you do not qualify for the noncustodial EIC. However, if you claimed a federal EIC, you

. See instructions.

Schedule A – Noncustodial parent New York State earned income credit (noncustodial EIC)

Submit this form with Form IT-201.Name(s) as shown on return Your social security number

Social security numberRelationship Date of birthFirst name MI Last name

JOHN WILSON 700007890

X

X

X

BRIAN WILSON SON 123565656 08262008

X

X

X

X

X

X

X

***** DO NOT MAIL *****

of 4 IT-209 (2018)

11 ................................................................. 11 Yes No If Yes, 12 Do you want the Tax Department to compute your noncustodial EIC and NYS EIC and give you the greater of the two? .................................................................................................................................... 12 Yes No If Yes, complete lines 13 through 17 (also complete lines 33 and 34 if you claimed the federal EIC, and lines 46 and 47 if you are a New York City part-year resident). If No, complete lines 13 through 32 (also complete lines 33 through 43 if you claimed the federal EIC, and lines 44 through 47 if you are a New York City resident or part-year resident).

13 Wages, salaries, tips, etc. from Worksheet A ............................. 13 .00 14 (see instructions) .......................................................................................... 14 .00 15 Business income or loss from Worksheet B, line 4, on page 2 of the instructions ............................... 15 .00

Part 2 – Claiming the credit

Part 3 – Earned income

Credit computed at 20% of federal EIC with one qualifying child 18 Find the line 16 amount in the noncustodial EIC tables (beginning on page 4 of the instructions), and enter the amount from column a ............................. 18 .00

19 Are the amounts on lines 16 and 17 the same? ........................................................................................... 19 Yes No If Yes, skip lines 20 and 21, and enter the line 18 amount on line 22. If No, continue on line 20.20 Is the amount on line 17 less than $18,700? ................................................................................................ 20 Yes No If Yes, skip line 21, and enter the line 18 amount on line 22. If No, continue on line 21.21 Find the line 17 amount in the noncustodial EIC tables (beginning on page 4 of the instructions), and enter the amount from column a ................................................................................................ 21 .00 22 Enter the amount from line 18 or line 21, whichever is less .................................................................. 22 .00 23 Noncustodial EIC rate 20% (.20) ........................................................................................................... 23 .20

24 Noncustodial EIC ............................................................................................. 24 .00

Credit computed at 2.5 times the federal EIC without a qualifying child 25 Find the line 16 amount in the noncustodial EIC tables (beginning on page 4 of the instructions). , column c column b.) .......................................................... 25 .00

26 Are the amounts on lines 16 and 17 the same? ......................................................................................... 26 Yes No If Yes, If No, continue on line 27.

Part 4 – Credit computation

16 Total earned income ................................................................... 16 .00

If line 16 is zero or less, stop; you do not qualify for this credit. 17 Enter your federal AGI from Form IT-201, line 19 .................................................................................. 17 .00

(see instr.)X ................................... -or- loss

Whole dollars only

X

X

24000

24000

24000

2604

X

X

2604

521

X

***** DO NOT MAIL *****

33 Did you claim the federal EIC? .................................................................................................................... 33 Yes No If No, stop; you do not qualify for the NYS EIC If Yes, continue on line 34. 34 Did you claim qualifying children on your federal Schedule EIC? .............................................................. 34 Yes No If No, If Yes, in the spaces below, list up to three of the same children you claimed on federal Schedule EIC. Note: The children listed below must not be the same children as those you listed at line 3 on page 1.

IT-209 (2018) Page 3 of 4

Schedule B – New York State earned income credit (NYS EIC)

* Mark an X in these boxes only if you checked Yes in the same box on your federal Schedule EIC (box 4a or 4b).

35 Amount of federal EIC claimed ............................................................. 35 .00

36 NYS EIC rate 30% (.30) ....................................................................................................................... 36 .30

37 Tentative NYS EIC ........................................................................................... 37 .00

38 Complete lines 38a through 38e, and enter the line 38e amount on line 38 .......................................... 38 .00

38a Amount from Form IT-201, line 39 ................................................ 38a .00 38b Resident credit (see instructions) ..................................................... 38b .00 38c Accumulation distribution credit (see instructions) ........................... 38c .00 38d Add lines 38b and 38c ................................................................... 38d .00 38e Subtract line 38d from line 38a enter 0 .............................. 38e .00

Part 4 – Credit computation (continued)

27 , ? ..... 27 Yes No If Yes, If No, continue on line 28.28 Find the line 17 amount in the noncustodial EIC tables (beginning on page 4 of the instructions). , column c. column b.)........................................................................... 28 .00

29 .................................................................. 29 .00

30 ................................................................................................................. 30 2.50

31 Noncustodial EIC calculation .......................................................................... 31 .00

32 Noncustodial EIC ) ..................................................... 32 .00

Your social security number

Social security number Date of birth



No. of monthslived with you



Full-time student*

Full-time student*

Full-time student*

Person with disability*



1stChild

2ndChild

3rdChild

700007890

X

521

X

X

***** DO NOT MAIL *****

44 Were you a resident of New York City? ........................................................................................................ 44 Yes No If No, stop; you do not qualify for the NYC EIC. 45 New York City EIC: Enter amount from Worksheet C on page 3 in the instructions here and on Form IT-201, line 70. Part-year New York City residents must also complete lines 46 and 47 below.......................................................................................................... 45 .00

46 Part-year New York City AGI: Enter the amount from Worksheet C, line 7 ........................................... 46 .00

47 Part-year New York City AGI: Enter the amount from Worksheet C, line 6 ........................................... 47 .00

Page 4 of 4 IT-209 (2018)

Caution: You must be a full-year or part-year New York City resident and qualify for a federal EIC to claim the NYC EIC.

39 Enter the amount from line 38 on page 3 .............................................................................................. 39 .00

40 New York State household credit (from Form IT-201, line 40) ............................................................... 40 .00

41 Enter the amount from line 39 or line 40, whichever is less .................................................................. 41 .00

42 Allowable NYS EIC 37) ..................................................................................... 42 .00

43 Noncustodial EIC 32) ...................................................................................... 43 .00

You can only claim the NYS EIC from line 42 or the noncustodial EIC from line 43. You cannot claim both.

If line 43 is greater than line 42, enter the line 43 amount on Form IT-201, line 66.

Schedule C – New York City earned income credit (NYC EIC) for NYC full-year and part-year residents

Schedule B – New York State earned income credit (continued)

521

X

***** DO NOT MAIL *****

JOHN WILSON 2018 INCOME TAX RETURN - Empire ......TAX YEAR: 2018 PROCESS DATE: 01/10/2019 CLIENT :...

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