1O40-SR ira tar detent sarios [2024 | min won| mmor-nmmseannse Filing Single CF Married fing jointly Ti Mariied filing separately (MFS) Status 1 Head of household (HOH) 0 Qualifying widow(er) (QW) Grackanty Ifyou checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the chie’s jenebox. __name ifthe qualifying person is a child but not your dependent be Your rst name and mil intal asi name Your social secarly number Digna Bobonagua--Diaz 116-78-2432 Tint ean, spouse's trstrame and mide wital [Last nano ‘Spouse's socal seu umber Homie adress (number and steed) I you have a P.O, box, see neiutons, ‘APL ne. | prescential Eecton Campaign 7 Royal Crest us Check hare you, or your Cy, town, oF Bost fice I youhave aToragn addres, aloo comple sauces below. [Sale ZP code {eee ng oye Randolph MA 02368 Precteaatee ce Foreign county name Foreign provncalstateloourty Fores posal ace | not change you tax or rotund: CJ¥ou CO) Spouse At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? .. i eae . > Ores Standard “Someone can claim: C] You as a dependent [1 Your spouse as a dependent Deduction Ci Spouse itemizes on a separate return or you were a dual-status alien You: Were born before January 2, 1957 1 Are blind Spouse: (Was born before January 2, 1957 CIs blind Age/Blindness Dependents et Seca sc marbe]GRalaershioto| wo wpa fio aos (eich) Fe rane ee m0 naar [ont ee ose mere than four O O Sane so o oF. ‘ebacans er a a Suto) Lt = 1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . f ~ Es 53,333. 8hug 24 Tacexomptinterest . | 2a b Taxable interest 2b requires. 3a Qualified dividends . . [3a 'b Ordinary dividends 3b ae 4a IRA distributions... [4a |b Taxable amount. [4b Sa Pensions and annuities [a b Taxable amount... [5b 6a Social security benefits . [ea b Taxable amount . . [eb - 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here ea teacei rolz 8 Other income from Schedule 1, line 10 » ~ 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income. . » | 9 53,333. 10 Adjustments to income from Schedule 1, line 26 . o* 410 250. 14 Subtract line 10 from line 9. This is your adjusted gross income. . » | 11 53,083. For isos, racy Ac, and Paperwork Reduction At Note, se sepa siucion, gag ROYSTON ran TOAD SR oyFoy 100-8202) Page eae Standard 12a Standard deduction or itemized deductions (from Deduction’ Schedule A) ees - Se Sas Ceawrcut |b Charitable contributions if you take the standard [ sntetstee | deduction (see instructions) . —— ¢ Addiines 12a and 12b 14,550 13° Qualfied business income deduction from Form 8906 or Form 8G96-A [43 14° Addlines 12¢ and 13 : : - +» [ra] tasss0. 15 Taxable income. Subtract line 14 from line 11, zero or less, enter-0-. [48| 33,533 16 Tax (see instructions). Check if any from: 1G) Form(s) 8814 20) Formao72 30 17 Amount from Schedule 2, line 3 18 Add lines 16 and 17 : are 19 _Nonrefundable child tax credit or credit for other dependents from ‘Schedule 8812. cee eee = 19 20 Amount from Schedule 8, line 8 21 Add lines 19 and 20. : oe [21] 22 Subtract line 21 from line 18. If zero or less, enter -0- . | 22| 23 Other taxes, including self-employment tax, from Schedule 2, ine 21. . [2a 24. Add lines 22 and 2. This is your total tax see em [be 4,424 25 Federal income tax withheld from: x a Form(s) W-2 b Form(s) 1099 © Other forms (see instructions) ae d Add lines 28a through 256 ses Sd) 5,199 26 2021 estimated tax payments and amount anpied from 2020 return 26 ualying 27a Earned income credit (EIC). . . : [27a| (eee Check here if you were bom after January 1, 1998, and before January 2, 2004, and you satisty all the other requirements for taxpayers who are at least age 18 10 claim the EIG. See instructions oO 2 b Nontaxable combat pay election. [27 : © Prior year (2019) earned income. |27e| iE 28 Refundable child tax oredit or additional child tax credit from Schedule 8812 . : 28 29 American opportunity credit from Form 8863, line 8 . | 29 30 Recovery rebate credit. See instructions 30 81 Amount from Schedule 3, line 15 Ed 32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits... . . © > [32 33 _Add lines 25d, 26, and 32. These are your total payments . > |33 5,183 {Go to mins goviFormTO405R for insiuctions and he lest inven BAA RevenmeaTw Form 1040-SR econForm 1040.5 (202) Foo 3 Refund 34 If line 33 is more than line 24, subtract line 24 from line 83. This is the amount you overpaid . 34 165. 35a Amount of line 34 you want refunded to you, If Form 8868 is attached, check here a : < -> O [38a) Dresces? wt Rowing number Lo |1 {1 jolo[ol1ise| ye Type: necking C)Savings | ‘rewctors, md Accountnumber (ofolaisi2isielalalriolel | } 36 Amount of line 34 you want applied to your 2022 re estimatedtax. fac > | 36 [ae Amount 37 Amount you owe. Subtract line 83 from line 24. For details on how to YouOwe pay, see instructions... : Sear ere BLT, 38 Estimated tax penalty (ee instructions)...» [98 g Third Party Do you want to allow ante person to ciscuss this etum wth the IRS? Seo ignee instructions ‘ cone C1¥e8, Compete toiow. —fEINo Oesgnes ene Ferra sorieton con roe ureer NB ‘Under penaites of parury, | declare that have examined hs urn and accompanying schedules and slalarerie and tothe bea aT Sign ‘my knowledge and belle, they are true, correct, and complote. Declaration of preparer (other than taxpayer) is based on al information Here ‘of which preparer has any Inowledge. Your sgratue Dato | Youroxeupeson pots set mien oot? freacher cen PETS Kapssmpyas [ S90080 sigaiue lla jorirstum, bothmustsgn, | Dale] Spouse's occupation aS arty soasean nearer ‘Identity Prot PIN, eater it here. ‘your records, [see mst) 1 ene (6 GTB ero Rad a peerenene Fara saghaure Baise Chak Preparer D Set-employed Coen mms — Sele-Propared os ssa fis en ‘Go to wir govlFonmtO40SR for natuctions and We alent Worms, om RevsaaaTw Fem 1040-SR 02)Form 1060882027) Standard Deduction Chart* Foge ‘Add the number of boxes checked in the “Age/Biindness” section of Standard Deduction on page 1. > IF your filing AND the number of THEN your standard status is... boxes checked is. deduction is... Single 1 $14,250 2 15,950 1 $26,450 Married 2 27,800 filing jointly 3 29,150 4 30,500 Qualifying 1 $26,450 widowler) 2 27,800 Head of 1 $20,500 household 2 22,200 1 $13,900 Married filing 2 15,260 separately” 3 16,600 4 17,950 “Don't use this chart if someone can claim you (or your spouse if fin Separate return, or you were a dual-status alien. Instead, see instru icions. ig jointly) as a dependent, your spouse Remizes on a “You can check the boxes for your spouse if your filing status is marriod fling separately and your spouse had no income, isnt filing a return, and can’t be claimed as a dependent on another person's return, ‘Go to ww.is goviFormTO40SR for neiaslons and ihe et Nomaton BAA Fern 1040-SR 025)oe Additional Income and Adjustments to Income soot sap ie Tem > Attach to Form 1040, 1040-SR, oF 1060-NR. a eee > G0 to wwwirgoniFomt O40 for natrastions andthe tet Information Ser ot Namo) shown on Frm 1040, 1040-5R, or 1030-NA ‘Your social security number Digna Bobonague--Diaz 16-76-2432 Additional Income 1 Taxable refunds, credits, or offsets of state and local income taxes i 2a Alimony received . . 2a b Date of original divorce or separation agreement (see instructions) _f 3 Business income or (loss). Attach Schedule C 3 4 Other gains or (losses). Attach Form 4797 4 5 Rental real estate, aes a ceed Ss corporations, rasta, etc. Attach Schedule E Page tae ~ es 6 Farm income or (loss). attach ‘Schedule F e ate +. 16 7 Unemployment compensation 7 8 Other income: ‘ a Net operating loss ~ewne 8a | J b Gambling income . = = 8b ¢ Cancellation of debt . oe w “* 8c d_ Foreign earned income exclusion from Form 2555. . 8d | ) e Taxable Health Savings Account distribution . i 8e f Alaska Permanent Fund dividends . (St g Jury dutypay . . . . “ . 8g h Prizesand awards... fee 8h _| i Activity not engaged in for profit income j Stock options k Income from the rental of personal property’ if you engaged it in the rental for profit but were not in the business of renting such property et 8k 1 Olympic and Paraympie medals and USOC prize money (eee a instructions) . . . ' act 'm Section 951 (a) inclusion (see instructions) 38m nm Section 951A(a) inclusion (see instructions) aa 8n a © Section 461()) excess business loss adjustment . EE 7 80. Taxable distributions irom an ABLE account (see instructions) . | gp | Z Other income. List type and amount > i z 9 Total other income. Add lines 8a through 8z = 9 410 Combine lines 1 through 7 and 9. Enter here and on Form todo, 1040-SR, or 1040-NR, line 8 * - 10 For Paperwork Reduction AGt Notice, see your tax rum instructions. Sehodule (Ferm 1080) 2024Schwtie 1 Fo 0402005 Page ‘Adjustments to Income 11 Educator expenses i i a ail 250. 12 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 12 13 Health savings account deduction. Attach Form 8889 . 13 14 Moving expenses for members of the Armed Forces. Attach Form 3903. 14 15 Deductible part of self-employment tax. Attach Schedule SE 15 16 Self-employed SEP, SIMPLE, and qualified plans . . 16 17 Self-employed health insurance deduction af eee 18 Penalty on early withdrawal of savings 18 19a Alimony paid peace reece cent 19a b Recipient's SSN 7 3 . oe el © Date of original divorce or separation agreement (see instructions) > ie 20 IRAdeduction 20 21° Student loan interest deduction 21 22 Reserved for future use 22 23 Archer MSA deduction . 23 24 Other adjustments: : a Jury duty pay (see instructions) \24a) b Deductible expenses related to income reported ‘on line 8k from z the rental of personal property engaged in for profit. ‘2ab| ¢ Nontaxable amount of the value of Olympic and Paralympic medals and USOC prize money reported on line 81 \24c| if d Reforestation amortization and expenses a 24d) e Repayment of supplemental memporent benefits ander ‘the Trade Act of 1974. . ee [etal 1 Contibutions to section 501(6\18)0) pension plans eae] 9 Contributions by certain chaplains to section 403(b) plans |24g| h Attorney fees and court costs for actions involving certain unlawful discrimination claims (see instructions). 24h) i Attorney fees and court costs you paid in connection with an award from the IRS for information you provided that helped the IRS detect tax law violations pe 2ai| 2 i. Housing deduction from Form 2655 24) ; k Excess deductions of section 67(e) expenses from Schedule K-1 orm 1041)... eeeapataas l2a| 2 Z Other adjustments. List type and amount e l2az! 25 Total other adjustments. Add lines 24a through 24z 25 26 Add lines 11 through 23 and 25. These are your adjustments | to income. Enter here and on Form 1040 or 1040-SR, line 10, or Form 1040-NR, line 10a . 26 250 BAA, Reveansaa Tm ‘Sched (Form 1040) 2021