1040 U.S.

Individual Income Tax Return 2019

Form Department of the Treasury—Internal Revenue Service (99)
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying person is
one box.
a child but not your dependent. a
Your first name and middle initial Last name Your social security number
Marius Popescu 879-47-5788
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
Check here if you, or your spouse if filing
23 Pier Point Dr 23
jointly, want $3 to go to this fund.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your
Millville DE 19967-6750 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and  here a

Standard Someone can claim: You as a dependent Your spouse as a dependent

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

Age/Blindness You: Were born before January 2, 1955 Are blind Spouse: Was born before January 2, 1955 Is blind
Dependents (see instructions): (2) Social security number (3) Relationship to you (4)  if qualifies for (see instructions):
(1) First name Last name Child tax credit Credit for other dependents

1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . 1 11,435.

2a Tax-exempt interest . . . . 2a b Taxable interest. Attach Sch. B if required 2b
3a Qualified dividends . . . . 3a b Ordinary dividends. Attach Sch. B if required 3b
Standard
Deduction for— 4a IRA distributions . . . . . 4a b Taxable amount . . . . . . 4b
• Single or Married
filing separately,
c Pensions and annuities . . . 4c d Taxable amount . . . . . . 4d
$12,200 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b
• Married filing
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . a 6
jointly or Qualifying
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 7a 0.
$24,400
• Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . a 7b 11,435.
household,
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a
• If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . a 8b 11,435.
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 12,200.
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 12,200.
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 0.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
 Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 0.
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b 0.
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 0.
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 0.
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . a 16 0.
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17 815.
• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . . . . 18a
attach Sch. EIC.
• If you have b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b
nontaxable c American opportunity credit from Form 8863, line 8 . . . . . . . . 18c
combat pay, see
instructions. d Schedule 3, line 14 . . . . . . . . . . . . . . . . . 18d
e Add lines 18a through 18d. These are your total other payments and refundable credits . . . . . a 18e
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19 815.
Refund 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 815.
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a 815.
Direct deposit? a b Routing number 0 3 1 3 0 2 9 5 5 a c Type: Checking Savings
See instructions.
a d Account number 9 8 7 9 4 1 4 6 6 3
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . a 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . a 23
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . . a 24
Third Party Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes. Complete below.
Designee No
(Other than Designee’s Phone Personal identification
paid preparer) name a no. a number (PIN) a

Sign 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.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
F

Joint return? Student (see inst.)

See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)

Phone no. Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid 3rd Party Designee
Preparer Self-employed
Firm’s name a Self-Prepared Phone no.
Use Only
Firm’s address a Firm’s EIN a

Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 02/06/20 Intuit.cg.cfp.sp Form 1040 (2019)
 DE-8453 DELAWARE INDIVIDUAL INCOME TAX 201
DECLARATION FOR ELECTRONIC FILING
FOR THE YEAR JANUARY 1 - DECEMBER 31, 201
DO NOT MAIL!
YOUR SOCIAL SECURITY NUMBER SPOUSE’S SOCIAL SECURITY NUMBER
879475788
FIRST NAME(S) AND INITIAL(S)
MARIUS
LAST NAME
POPESCU
S
HOME ADDRESS (NUMBER AND STREET INCLUDING RURAL ROUTE)
23 PIER POINT DR, APT. 23 T
CITY, TOWN OR POST OFFICE, STATE & ZIP CODE

DAYTIME TELEPHONE NUMBER

MILLVILLE DE 199676750 A
T
(407)312-7742

PART 1 TAX RETURN INFORMATION (WHOLE DOLLARS ONLY)

E
1. TOTAL DELAWARE ADJUSTED GROSS INCOME (FORM 200-01, LINE 1 or FORM 200-02, LINE 37.......................................... 1. 11435
2. TOTAL DELAWARE TAX (FORM 200-01, LINE 8 or FORM 200-02, LINE 42)................................................................................... 2. 190
3.
4.
DELAWARE INCOME TAX WITHHELD (FORM 200-01, LINE 17 or FORM 200-02, LINE 48)........................................................
NET REFUND (FORM 200-01, LINE 28 or FO RM 200-02, LINE 59)...............................................................................................
3. 287
205
O
4.
5. NET BALANCE DUE (FORM 200-01, LINE 27 or FORM 200-02, LINE 58)...................................................................................... 5. F
PART 2 Direct Deposit of Refund (Optional - See instructions.)

6. Type of Account X Checking Savings 7. Routing number 0 3 1 3 0 2 9 5 5

D
9 8 7 9 4 1 4 6 6 3
8. Account number
E
9. Is this refund going to or through an account that is located outside of the United States? Yes X No

PART 3 DECLARATION OF TAXPAYER

L
10.X I consent that my refund be directly deposited as designated in Part 2, and declare that the information shown on lines 6 through 9 is correct. If I have filed a
joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund.
A
I do not want direct deposit of my refund or am not receiving a refund.
I authorize the Division of Revenue and its designated financial agent to initiate an electronic funds withdrawal (direct Debit) entry to the financial institution
W
account indicated in the tax preparation software for payment of my state taxes owed on this return.
If I have filed a balance due return, I understand that if the Delaware Division of Revenue does not receive full and timely payment of my tax liability, I will remain liable
A
R
for the tax liability and all applicable interest and penalties. If I have filed a joint Federal and State tax return and there is an error on my state return, I understand my
Delaware return will be rejected.

E
Under penalties of perjury, I declare that the information I have given my ERO and the amounts in Part 1 above agree with the amounts on the corresponding lines of
the electronic portion of my 201 Delaware income tax return. To the best of my knowledge and belief, my return is true, correct, and complete. I consent to my ERO
sending my return, this declaration, and accompanying schedules and statements and the disclosure of all information pertaining to my use of the system and software,
and to the transmission of my tax return electronically to the Delaware Division of Revenue. I also consent to the Delaware Division of Revenue sending my ERO and/or
transmitter an acknowledgment of receipt of transmission and an indication of whether or not my return is accepted, and, if rejected, the reason(s) for the rejection. If the
processing of my return or refund is delayed, I authorize the IRS to disclose to my ERO and/or transmitter the reason(s) for the delay, or when the refund was sent.

SIGN
HERE
SIGNATURE DATE SPOUSE’S SIGNATURE DATE

PART 4 DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER

I DECLARE THAT I HAVE REVIEWED THE ABOVE TAXPAYER’S RETURN AND THAT THE ENTRIES ON THIS FORM ARE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
I HAVE OBTAINED THE TAXPAYER'S SIGNATURE ON FORM DE-8453 BEFORE SUBMITTING THIS RETURN TO THE INTERNAL REVENUE SERVICE (IRS) AND THE DELAWARE DIVISION
OF REVENUE (DDOR). I HAVE PROVIDED THE TAXPAYER WITH A COPY OF ALL FORMS AND INFORMATION TO BE FILED WITH THE IRS AND DDOR, AND HAVE FOLLOWED ALL
OTHER REQUIREMENTS DESCRIBED IN THE “201 DELAWARE INDIVIDUAL MEF E-FILE HANDBOOK FOR SOFTWARE DEVELOPERS, TRANSMITTERS, AND EROs WHO FILE
DELAWARE INDIVIDUAL INCOME TAX RETURNS” AND ANY REQUIREMENTS SPECIFIED BY THE DELAWARE DIVISION OF REVENUE. IF I AM ALSO THE PAID PREPARER, UNDER
PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THE ABOVE TAXPAYER’S RETURN AND ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE BEST OF
MY KNOWLEDGE AND BELIEF, THEY ARE TRUE, CORRECT AND COMPLETE. DECLARATION OF PREPARER IS BASED ON ALL INFORMATION OF WHICH PREPARER HAS ANY
KNOWLEDGE.

SIGN
ERO’S SIGNATURE DATE EIN, SSN, OR PTIN.
HERE

FIRM’S NAME (OR YOURS IF SELF-EMPLOYED) CHECK IF ALSO PREPARER CHECK IF SELF-EMPLOYED
ERO

ADDRESS (STREET, CITY, STATE & ZIP CODE) Business phone #

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THE ABOVE TAXPAYER’S RETURN AND ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE
BEST OF MY KNOWLEDGE AND BELIEF, THEY ARE TRUE, CORRECT, AND COMPLETE. DECLARATION OF PREPARER IS BASED ON ALL INFORMATION OF WHICH THE PREPARER
HAS ANY KNOWLEDGE.

SIGN
PREPARER’S SIGNATURE DATE EIN, SSN, OR PTIN
HERE
SELF-PREPARED
FIRM’S NAME (OR YOURS IF SELF-EMPLOYED) CHECK IF SELF-EMPLOYED
PAID
PRE-
PARER ADDRESS (STREET, CITY, STATE & ZIP CODE)

1555 REV 01/31/20 INTUIT.CG.CFP.SP (Revised  )

 R
DELAWARE INDIVIDUAL RESIDENT
2019 INCOME TAX RETURN DO NOT WRITE OR STAPLE IN THIS AREA
FORM 200-01

For Fiscal year beginning and ending

Your Social Security No. Spouse’s Social Security No.

8 7 9 4 7 5 7 8 8
ATTACH LABEL HERE

Your Last Name First Name and Middle Initial Jr., Sr., III, etc.
POPESCU MARIUS
Spouse’s Last Name Spouse’s First Name, Jr., Sr., III, etc.

Present Home Address (Number and Street) Apt. #

23 PIER POINT DR 23
City State Zip Code FILING STATUS (MUST CHECK ONE)
MILLVILLE DE 199676750 1. Single, Divorced, 3. Married & Filing Separate 5. Head of
X Widow(er) Forms Household
Form DE2210 If you were a part-year resident in 2019, give the dates you resided in Delaware:
2019 2019 2. Joint 4. Married & Filing Combined Separate on this form
Attached
Column A Column B
1. DELAWARE ADJUSTED GROSS INCOME. Begin Return on Page 2, Line 29, then enter amount from Line 42 here.. > 1 11435
2a. If you elect the DELAWARE STANDARD DEDUCTION check here.............. X
Filing Statuses 1, 3 & 5 enter $3250 in Column B; Filing Status 2 enter $6500 in Column B;
Filing Status 4 enter $3250 in Column A and in Column B
If you elect the DELAWARE ITEMIZED DEDUCTIONS check here............... DF20119011555
b. Filing Statuses 1, 2, 3 and 5, enter itemized deductions from reverse side, Line 48 in Column B
Filing Status 4 enter itemized deductions from reverse side, Line 48 in Columns A and B 2 3250
3. ADDITIONAL STANDARD DEDUCTIONS (Not Allowed with Itemized Deductions - see instructions)
4), enter the total for each appropriate column. All others enter total in Column B.
Column A - if SPOUSE was: 65 or over Blind Column B - if YOU were: 65 or over Blind 3
4. TOTAL DEDUCTIONS - Add line 2 & 3 and enter here...................................................................................................... 4 3250
5. TAXABLE INCOME - Subtract Line 4 from Line 1, and Compute Tax on this amount................................................ 5 8185
STAPLE W-2 FORMS HERE

6. Tax Liability from Tax Rate Table/Schedule Column A Column B 6

See Instructions.......................................................... 190 7
7. Tax on Lump Sum Distribution (Form 329).................
8. TOTAL TAX - Add Lines 6 and 7 and enter here......................................................................................................> 8 190
9a. PERSONAL CREDITS If you are Filing Status 3, see instructions on Page 6.
If you use Filing Status 4, enter the total for each appropriate column. All others enter total in Column B.
Enter number of exemptions .................................... 1 x $110.................................................... 9a 110
On Line 9a, enter the number of exemptions for: Column A Column B 1
9b. CHECK BOX(ES) Spouse 60 or over (Column A) Self 60 or over (Column B)
Enter number of boxes checked on Line 9b x $110........................................................................... 9b
10. Tax imposed by State of . (Must attach copy of DE Schedule I and other state return.) ..................... 10
11. Self (Column B) . Enter credit amount.............. 11
12. Other Non-Refundable Credits (see instructions on Page 7) ................................................................................. 12
13. Child Care Credit. Must attach Form 2441. (Enter 50% of Federal credit) ....................................................... 13
14. Earned Income Tax Credit. See instructions on Page 8 for ALL required documentation............................. 14 0
15. Total Non-Refundable Credits. Add Lines 9a, 9b, 10, 11, 12, 13 & 14 and enter here ........................................... 15 110
16. BALANCE. Subtract Line 15 from Line 8. If Line 15 is greater than Line 8, enter “0” (Zero)................................ 16 80
17. Delaware Tax Withheld (Attach W2s/1099s)................... 287 17
18. Estimated Tax Paid & Payments with Extensions..... 18
19. S Corp Payments and Refundable Business Credits.... 19
20. Capital Gains Tax Payments (Attach Form 5403).. 20
21. TOTAL Refundable Credits. Add Lines 17, 18, 19, and 20 and enter here.............................................................> 21 287
STAPLE CHECK HERE

22. BALANCE DUE. If Line 16 is greater than Line 21, subtract 21 from 16 and enter here........................................> 22 0
23. OVERPAYMENT. If Line 21 is greater than Line 16, subtract 16 from 21 and enter here.......................................> 23 207
24. CONTRIBUTIONS TO SPECIAL FUNDS If electing a contribution, complete and attach DE Schedule III................................................ 24 2
25. AMOUNT OF LINE 23 TO BE APPLIED TO 2020 ESTIMATED TAX ACCOUNT.................................................................................ENTER > 25
26. PENALTIES AND INTEREST DUE. If Line 22 is greater than $800, see estimated tax instructions....................................................ENTER > 26
27. NET BALANCE DUE (For Filing Status 4, see instructions, page 9)............................................................................................PAY IN FULL >
27
28. NET REFUND (For Filing Status 4, see instructions, page 9) ......................................................................ZERO DUE/TO BE REFUNDED > 28 205

1555 REV 01/31/20 INTUIT.CG.CFP.SP

 2019 R DELAWARE RESIDENT FORM 200-01, PAGE 2 Page 2
COLUMNS: (Reconcile your Federal

Filing Status 4 ONLY

Spouse Information You or You plus Spouse
MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME COLUMN A COLUMN B
SECTION A - ADDITIONS (+)
29. Enter Federal AGI amount from Federal 1040............................................................................................................. 29 11435

30. Interest on State & Local obligations other than Delaware ......................................................................................... 30
31.Fiduciary adjustment, oil depletion ............................................................................................................................. 31
32.TOTAL - Add Lines 30 and 31 .................................................................................................................................... 32
33. Subtotal. Add Lines 29 and 32 ........................................... 11435 33
SECTION B - SUBTRACTIONS (-)
34. Interest received on U.S. Obligations ......................................................................................................................... 34
35. Pension/Retirement Exclusions ............ 35
36. carry forward -
please see instructions on Page 10 ............................................................................................................................ 36

37. 37
38. SUBTOTAL. Add Lines 34, 35, 36 and 37, and enter here ........................................................................................ 38
39. Subtotal. Subtract Line 38 from Line 33 ............................ 11435 39
40. Exclusion for certain persons 60 and over or disabled (See instructions on Page 11) ............................................... 40
41. TOTAL - Add Lines 38 and 40 ..................................................................................................................................... 41
42. DELAWARE ADJUSTED GROSS INCOME. Subtract line 41 from Line 33. Enter here and on Front, Line 1 ........... 42 11435
SECTION C - ITEMIZED DEDUCTIONS (MUST ATTACH DELAWARE SCHEDULE A) If columns A and B are used and you are unable to specifically
allocate deductions between spouses, you must prorate in accordance with income.
43. Enter total Itemized Deduction from Federal Schedule A (PIT-RSA)........................................................................... 43
44. Enter Foreign Taxes Paid (See instructions on Page 11) ........................................................................................... 44
45. Enter Charitable Mileage Deduction (See instructions on Page 11) ........................................................................... 45
46. SUBTOTAL - Add Lines 43, 44, and 45 and enter here .............................................................................................. 46

47. Enter Form 700 Tax Credit Adjustment (See instructions on Page 11) ....................................................................... 47
48. TOTAL - Subtract Line 47 from Line 46. Enter here and on Front, Line 2 (See instructions) ..................................... 48

SECTION D - DIRECT DEPOSIT INFORMATION If you would like your refund deposited directly to your
checking or savings account, complete boxes a, b, c and d below. See instructions for details.

a. Routing Number 0 3 1 3 0 2 9 5 5 b. Type: Checking X Savings

c. Account Number d. Is this refund going to or through an account that

is located outside of the United States?
9 8 7 9 4 1 4 6 6 3 Yes No X
NOTE: If your refund is adjusted by $100.00 or more, a paper check will be issued and mailed to the address on your return.
BE SURE TO SIGN YOUR RETURN BELOW AND KEEP A COPY FOR YOUR RECORDS
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and believe it is true, correct and complete.
Your Signature Date Signature of Paid Preparer Date
SELF-PREPARED
Date Address

Home Phone Business Phone City State Zip

(407)312-7742
E-Mail Address EIN, SSN or PTIN Business Phone E-Mail Address

BALANCE DUE W/PAYMENT ENCLOSED (LINE 27) REFUND (LINE 28): ALL OTHER RETURNS:
DELAWARE DIVISION OF REVENUE DELAWARE DIVISION OF REVENUE DELAWARE DIVISION OF REVENUE
P.O. BOX 508 P.O. BOX 8710 P.O. BOX 8711
WILMINGTON, DE 19899-0508 WILMINGTON, DE 19899-8710 WILMINGTON, DE 19899-8711
MAKE CHECK PAYABLE TO: DELAWARE DIVISION OF REVENUE
PLEASE REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN

(Rev 20191125) 1555 REV 01/31/20 INTUIT.CG.CFP.SP

DF20119021555
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Names: MARIUS POPESCU Social Security Number: 8 7 9 4 7 5 7 8 8

&2/8016

Filing Status 4 ONLY

Spouse Information You or You plus Spouse
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(Rev 0/201) 1555 REV 01/31/20 INTUIT.CG.CFP.SP

DF20219011555
 1040 U.S. Individual Income Tax Return 2019
Form Department of the Treasury—Internal Revenue Service (99)
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying person is
one box.
a child but not your dependent. a
Your first name and middle initial Last name Your social security number
Marius Popescu 879-47-5788
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
Check here if you, or your spouse if filing
23 Pier Point Dr 23
jointly, want $3 to go to this fund.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your
Millville DE 19967-6750 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and  here a

Standard Someone can claim: You as a dependent Your spouse as a dependent

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

Age/Blindness You: Were born before January 2, 1955 Are blind Spouse: Was born before January 2, 1955 Is blind
Dependents (see instructions): (2) Social security number (3) Relationship to you (4)  if qualifies for (see instructions):
(1) First name Last name Child tax credit Credit for other dependents

1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . 1 11,435.

2a Tax-exempt interest . . . . 2a b Taxable interest. Attach Sch. B if required 2b
3a Qualified dividends . . . . 3a b Ordinary dividends. Attach Sch. B if required 3b
Standard
Deduction for— 4a IRA distributions . . . . . 4a b Taxable amount . . . . . . 4b
• Single or Married
filing separately,
c Pensions and annuities . . . 4c d Taxable amount . . . . . . 4d
$12,200 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b
• Married filing
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . a 6
jointly or Qualifying
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 7a 0.
$24,400
• Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . a 7b 11,435.
household,
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a
• If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . a 8b 11,435.
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 12,200.
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 12,200.
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 0.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
 Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 0.
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b 0.
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 0.
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 0.
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . a 16 0.
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17 815.
• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . . . . 18a
attach Sch. EIC.
• If you have b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b
nontaxable c American opportunity credit from Form 8863, line 8 . . . . . . . . 18c
combat pay, see
instructions. d Schedule 3, line 14 . . . . . . . . . . . . . . . . . 18d
e Add lines 18a through 18d. These are your total other payments and refundable credits . . . . . a 18e
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19 815.
Refund 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 815.
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a 815.
Direct deposit? a b Routing number 0 3 1 3 0 2 9 5 5 a c Type: Checking Savings
See instructions.
a d Account number 9 8 7 9 4 1 4 6 6 3
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . a 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . a 23
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . . a 24
Third Party Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes. Complete below.
Designee No
(Other than Designee’s Phone Personal identification
paid preparer) name a no. a number (PIN) a

Sign 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.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
F

Joint return? Student (see inst.)

See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)

Phone no. Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid 3rd Party Designee
Preparer Self-employed
Firm’s name a Self-Prepared Phone no.
Use Only
Firm’s address a Firm’s EIN a

Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 02/06/20 Intuit.cg.cfp.sp Form 1040 (2019)