Rolando Mariano

Department of the Treasury - Internal Revenue Service Form 9325 (January 2017) Acknowledgement and General Information for Taxpayers Who File Returns Electronically Thank you for participating in IRS e-file. Taxpayer name PONDEROSA PINE Taxpayer address (optional) 1. ARE 100 EVERGREEN LANE Atlanta, GA 30302 Your federal income tax return for was filed electronically with the 2021 Processing Center. The electronic filing services were provided by Firm Name . Submission IRS . Your return 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. Your return was accepted on . Allow 4 to 6 weeks for the processing of your return. 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. Your electronic funds withdrawal payment request was accepted for processing. 5. Your electronic funds withdrawal payment request was not accepted for processing. Refer to the "If You Owe Tax" section. 6. 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 . SOF TW 2. AL 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 TRI 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 returns for your area. The address is available at www.irs.gov, or you can call the IRS toll-free at-. 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 return 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-, 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-. EEA www.irs.gov Form 9325 (Rev. 1-2017) The IRS uses refunds to cover overdue taxes and notifies you when this occurs. The Fiscal Service 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-, if you have additional questions. If You Owe Tax ARE 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 needed. 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 www.irs.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 www.irs.gov. You may also order Form 9465 by calling 1-800-TAX-FORM -). If approved, the IRS charges a user fee to set up an installment agreement. TW If You Need to Inquire About Your Electronic Funds Withdrawal Payment You may call- 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. SOF 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 AL 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 PIN," "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. Individual Income Tax Transmittal for an IRS e-file Return, to send required paper forms or supporting documentation listed next to the form check boxes (do not send Forms W-2, W-2G, or 1099R). TRI 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 still 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. PONDEROSA PINE EEA www.irs.gov Form 9325 (Rev. 1-2017) (99) Department of the Treasury-Internal Revenue Service Form 1040 U.S. Individual Income Tax Return Filing Status Check only one box. 2021 OMB No- IRS Use Only-Do not write or staple in this space. Single Married filing jointly Married filing separately (MFS) X Head of household (HOH) Qualifying widow(er) (QW) If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child's name if the qualifying person is a child but not your dependent Your first name and middle initial Last name PONDEROSA If joint return, spouse's first name and middle initial Your social security number PINE XXX-XX-XXXX Last name Spouse's social security number Apt. no. City, town, or post office. If you have a foreign address, also complete spaces below. State Atlanta ZIP code GA Foreign country name Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund. ARE Home address (number and street). If you have a P.O. box, see instructions. 100 EVERGREEN LANE 30302 Foreign province/state/county Foreign postal code You At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Someone can claim: You as a dependent Your spouse as a dependent Standard Deduction Spouse itemizes on a separate return or you were a dual-status alien Were born before January 2, 1957 Dependents (see instructions): Standard Deduction for- For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. EEA Was born before January 2, 1957 (3) Relationship to you Son X No Is blind (4) Check if qualifies for (see instructions): Child tax credit Credit for other dependents X Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . Tax-exempt interest . . . . 2a b Taxable interest . . . . . . . . . Qualified dividends . . . . . 3a b Ordinary dividends . . . . . . . . IRA distributions . . . . . . 4a b Taxable amount . . . . . . . . . Pensions and annuities . . . 5a b Taxable amount . . . . . . . . . Social security benefits . . . 6a b Taxable amount . . . . . . . . . Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . . Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . . . . . . . Adjustments to income from Schedule 1, line 26 ......................... Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . . . . . . . Standard deduction or itemized deductions (from Schedule A). . . . . 12a 18,800 Charitable contributions if you take the standard deduction (see instructions) 12b Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Qualified business income deduction from Form 8995 or Form 8995-A .............. Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taxable income. Subtract line 14 from line 11. If zero or less, enter -0-. . . . . . . . . . . . . . . TRI Single or Married filing separately, $12,550 Married filing jointly or Qualifying widow(er), $25,100 Head of household, $18,800 If you checked any box under Standard Deduction, see instructions. 1 2a 3a 4a 5a 6a-a b c 13 14 15 XXX-XX-XXXX AL Attach Sch. B if required. Last name PINE Spouse: (2) Social security number SOF (1) First name If more than four SPRUCE dependents, see instructions and check here Are blind TW Age/Blindness You: Yes Spouse 1 2b 3b 4b 5b 6b- 21,500 12c 13 14 15 18,800 21,500 21,500 18,800 2,700 Form 1040 (2021) Form 1040 (2021) PONDEROSA PINE Page 2 XXX-XX-XXXX Tax (see instructions). Check if any from Form(s):- ... 16 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Nonrefundable child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . 22 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . . . . . . . . 23 Add lines 22 and 23. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Federal income tax withheld from: Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a 2,100 Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b Other forms (see instructions) . . . . . . . . . . . . . . . . . . . . . 25c Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . . . . . . . . 26 If you have a qualifying child, Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . 27a 3,297 attach Sch. EIC. Check here if you were born after January 1, 1998, and before January 2, 2004, and you satisfy all the other requirements for taxpayers who are at least age 18, to claim the EIC. See instructions b Nontaxable combat pay election . . . . . . . . 27b c Prior year (2019) earned income . . . . . . . 27c 28 Refundable child tax credit or additional child tax credit from Schedule-,500 29 American opportunity credit from Form 8863, line 8 . . . . . . . . . . . 29 30 Recovery rebate credit. See instructions . . . . . . . . . . . . . . . . 30 0 31 Amount from Schedule 3, line 15 . . . . . . . . . . . . . . . . . . . . 31 1,800 Add lines 27a and 28 through 31. These are your total other payments and refundable credits . 32 .. 32 33 Add lines 25d, 26, and 32. These are your total payments. . . . . . . . . . . . . . . . . . . . 33 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . . . . 34 Refund 35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here ....... 35a Direct deposit? b Routing number X X X X X X X X X c Type: Checking Savings See instructions. d Account number X X X X X X X X X X X X X X X X X 36 Amount of line 34 you want applied to your 2022 estimated tax. . . . 36 Amount ..... 37 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions You Owe 38 Estimated tax penalty (see instructions) . . . . . . . . . . . . . . . . 38 Third Party Do you want to allow another person to discuss this return with the IRS? See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. Designee 271 271 - ARE - a b c d 26 27a SOF TW 2,100 Sign Here Your signature 46213 - Preparer's signature Preparer's name Firm's name Firm's address John Doe Firm Name 123 Main St Franklin, NC 28734 Go to www.irs.gov/Form1040 for instructions and the latest information. EEA Date X No Personal identification number (PIN) If the IRS sent you an Identity Protection PIN, enter it here (see inst.) Your occupation - BOTANIST Spouse's signature. If a joint return, both must sign. Date Phone no. Paid Preparer Use Only Phone no. 0 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. TRI Joint return? See instructions. Keep a copy for your records. AL Designee's name 6,597 8,697 8,426 8,426 Email address If the IRS sent your spouse an Identity Protection PIN, enter it here (see inst.) Spouse's occupation -Date PTIN - XXXXXXXXX Check if: Self-employed Phone no. Firm's EIN Form 1040 (2021) SCHEDULE 3 Department of the Treasury Internal Revenue Service 2021 Attach to Form 1040, 1040-SR, or 1040-NR. Go to www.irs.gov/Form1040 for instructions and the latest information. Name(s) shown on Form 1040, 1040-SR, or 1040-NR PONDEROSA PINE Part I OMB No- Additional Credits and Payments (Form 1040) Attachment Sequence No. 03 Your social security number XXX-XX-XXXX Nonrefundable Credits Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Credit for child and dependent care expenses from Form 2441, line 11. Attach Form 2441 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ARE 1 3 Education credits from Form 8863, line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Retirement savings contributions credit. Attach Form 8880 . . . . . . . . . . . . . . . . . . . . . 4 5 Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Other nonrefundable credits: a General business credit. Attach Form 3800 . . . . . . . . . . . . . . . . . . 6a TW b Credit for prior year minimum tax. Attach Form 8801 . . . . . . . . . . . . 6b c Adoption credit. Attach Form 8839 . . . . . . . . . . . . . . . . . . . . . . . 6c d Credit for the elderly or disabled. Attach Schedule R . . . . . . . . . . . . 6d e Alternative motor vehicle credit. Attach Form 8910 . . . . . . . . . . . . . 6e Qualified plug-in motor vehicle credit. Attach Form 8936 . . . . . . . . . . 6f SOF f g Mortgage interest credit. Attach Form 8396 . . . . . . . . . . . . . . . . . . 6g h District of Columbia first-time homebuyer credit. Attach Form 8859 . . . 6h i Qualified electric vehicle credit. Attach Form 8834. . . . . . . . . . . . . . 6i j Alternative fuel vehicle refueling property credit. Attach Form 8911 . . . 6j k Credit to holders of tax credit bonds. Attach Form 8912 . . . . . . . . . . 6k l Amount on Form 8978, line 14. See instructions . . . . . . . . . . . . . . . 6l AL z Other nonrefundable credits. List type and amount 6z Total other nonrefundable credits. Add lines 6a through 6z . . . . . . . . . . . . . . . . . . . . . 7 8 Add lines 1 through 5 and 7. Enter here and on Form 1040,1040-SR, or 1040-NR, line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 TRI 7 For Paperwork Reduction Act Notice, see your tax return instructions. EEA 0 (continued on page 2) Schedule 3 (Form- Page 2 Schedule 3 (Form- Part II 9 Other Payments and Refundable Credits Net premium tax credit. Attach Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 Amount paid with request for extension to file (see instructions) . . . . . . . . . . . . . . . . . . 10 11 Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Credit for federal tax on fuels. Attach Form 4136. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Other payments or refundable credits: ARE a Form 2439 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13a b Qualified sick and family leave credits from Schedule(s) H and Form(s) 7202 for leave taken before April 1, 2021 . . . . . . . . . . . . . . 13b c Health coverage tax credit from Form 8885 . . . . . . . . . . . . . . . . . . 13c d Credit for repayment of amounts included in income from earlier years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13d e Reserved for future use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13e Deferred amount of net 965 tax liability (see instructions) . . . . . . . . . 13f TW f g Credit for child and dependent care expenses from Form 2441, line 10. Attach Form 2441 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13g 1,800 h Qualified sick and family leave credits from Schedule(s) H and Form(s) 7202 for leave taken after March 31, 2021 . . . . . . . . . . . . . 13h SOF z Other payments or refundable credits. List type and amount 13z 14 Total other payments or refundable credits. Add lines 13a through 13z . . . . . . . . . . . . . . 14 1,800 15 Add lines 9 through 12 and 14. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1,800 TRI AL EEA Schedule 3 (Form- Form 2441 OMB No- Child and Dependent Care Expenses 2021 Attach to Form 1040, 1040-SR, or 1040-NR. Attachment Sequence No. Go to www.irs.gov/Form2441 for instructions and the latest information. Department of the Treasury Internal Revenue Service (99) Name(s) shown on return 21 Your social security number PONDEROSA PINE XXX-XX-XXXX A You can't claim a credit for child and dependent care expenses if your filing status is married filing separately unless you meet the requirements listed in the instructions under "Married Persons Filing Separately." If you meet these requirements, check this box B For 2021, your credit for child and dependent care expenses is refundable if you, or your spouse if married filing jointly, had a principal place of abode in the United States for more than half of 2021. If you meet these requirements, check this box . . . . . . X (a) Care provider's name (b) Address (number, street, apt. no., city, state, and ZIP code) 100 EVERGREEN LANE Atlanta, GA 30302 KIDS ZONE Did you receive dependent care benefits? (d) Check here if the care provider is your (e) Amount paid household employee. (see instructions) (see instructions ARE 1 Persons or Organizations Who Provided the Care - You must complete this part. If you have more than three care providers, see the instructions and check this box . . . . . . . . . . . . . . . . . . . (c) Identifying number (SSN or EIN) - 3,600 TW Part I No Yes Complete only Part II below. Complete Part III on page 2 next. Part II 2 SOF Caution: If the care was provided in your home, you may owe employment taxes. For details, see the instructions for Schedule H (Form 1040). If you incurred care expenses in 2021 but didn't pay them until 2022, or if you prepaid in 2021 for care to be provided in 2022, don't include these expenses in column (c) of line 2 for 2021. See the instructions. Credit for Child and Dependent Care Expenses Information about your qualifying person(s). If you have more than three qualifying persons, see the instructions and check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a) Qualifying person's name First SPRUCE security number AL For Paperwork Reduction Act Notice, see your tax return instructions. EEA (c) Qualified expenses you incurred and paid in 2021 for the person listed in column (a) XXX-XX-XXXX Add the amounts in column (c) of line 2. Don't enter more than $8,000 if you had one qualifying person or $16,000 if you had two or more persons. If you completed Part III, enter the amount from line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Enter your earned income. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 If married filing jointly, enter your spouse's earned income (if you or your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4 . . . . . . . . . . . 6 Enter the smallest of line 3, 4, or 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Enter the amount from Form 1040, 1040-SR, or 1040-NR, line 11 . . 7 21,500 8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7. If line 7 is $125,000 or less, enter .50 on line 8. If line 7 is over $125,000 and no more than $438,000, see instructions for line 8 for the amount to enter. If line 7 is over $438,000, don't complete line 8. Enter zero on line 9a. You may be able to claim a credit on line 9b. 9a Multiply line 6 by the decimal amount on line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b If you paid 2020 expenses in 2021, complete Worksheet A in the instructions. Enter the amount from line 13 of the worksheet here. Otherwise, go to line 10 . . . . . . . . . . . . . . . . . . . . . 10 Add lines 9a and 9b and enter result. If you checked the box on line B above, this is your refundable credit for child and dependent care expenses; enter the amount from this line on Schedule 3 (Form 1040), line 13g, and don't complete line 11. If you didn't check the box on line B above, go to line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Nonrefundable credit for child and dependent care expenses. If you didn't check the box on line B above, your credit is nonrefundable and limited by the amount of your tax; see the instructions to figure the portion of line 10 that you can claim and enter that amount here and on Schedule 3 (Form 1040), line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TRI 3 Last PINE (b) Qualifying person's social 3,600 3 4 3,600 21,500 5 6 21,500 3,600 8 9a X . 50 1,800 9b 10 1,800 11 Form 2441 (2021) Earned Income Credit SCHEDULE EIC (Form 1040) OMB No- Qualifying Child Information Department of the Treasury Internal Revenue Service (99) 2021 Complete and attach to Form 1040 or 1040-SR only if you have a qualifying child. Go to www.irs.gov/ScheduleEIC for the latest information. Attachment Sequence No. 43 Name(s) shown on return Your social security number PONDEROSA PINE XXX-XX-XXXX If you are separated from your spouse, filing a separate return and meet the requirements to claim the EIC (see instructions), check here Before you begin: See the instructions for Form 1040, lines 27a, 27b, and 27c, to make sure that (a) you can take the EIC, and (b) you have a qualifying child. ARE Be sure the child's name on line 1 and social security number (SSN) on line 2 agree with the child's social security card. Otherwise, at the time we process your return, we may reduce your EIC. If the name or SSN on the child's social security card is not correct, call the Social Security Administration at-. If you have a child who meets the conditions to be your qualifying child for purposes of claiming the EIC, but that child doesn't have an SSN as defined in the instructions for Form 1040, lines 27a, 27b, and 27c, see the instructions. Qualifying Child Information Child 1 First name 1 Child's name Last name 2 Child's SSN SOF The child must have an SSN as defined in the instructions for Form 1040, lines 27a, 27b, and 27c, unless the child was born and died in 2021 or you are claiming the self-only EIC (see instructions). If your child was born and died in 2021 and did not have an SSN, enter "Died" on this line and attach a copy of the child's birth certificate, death certificate, or hospital medical records showing a live birth. Year 2015 AL Was the child under age 24 at the end of 2021, a student, and younger than you (or your spouse, if filing jointly)? TRI b Last name First name Last name XXX-XX-XXXX If born after 2002 and the child is younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5. 4a First name Child 3 SPRUCE PINE If you have more than three qualifying children, you have to list only three to get the maximum credit. 3 Child's year of birth Child 2 TW ! CAUTION! You can't claim the EIC for a child who didn't live with you for more than half of the year. If your child doesn't have an SSN as defined in the instructions for Form 1040, lines 27a, 27b, and 27c, see the instructions. If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details. It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child. Yes. Go to line 5. Was the child permanently and totally disabled during any part of 2021? Yes. Go to line 5. No. Go to line 4b. No. The child is not a qualifying child. Year Year If born after 2002 and the child is younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5. Yes. Go to line 5. Yes. Go to line 5. No. Go to line 4b. No. The child is not a qualifying child. If born after 2002 and the child is younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5. Yes. Go to line 5. Yes. Go to line 5. No. Go to line 4b. No. The child is not a qualifying child. 5 Child's relationship to you (for example, son, daughter, grandchild, niece, nephew, eligible foster child, etc.) SON 6 Number of months child lived with you in the United States during 2021 If the child lived with you for more than half of 2021 but less than 7 months, enter "7." If the child was born or died in 2021 and your home was the child's home for more than half the time he or she was alive during 2021, enter "12." months 12 Do not enter more than 12 months. For Paperwork Reduction Act Notice, see your tax return instructions. EEA months Do not enter more than 12 months. months Do not enter more than 12 months. Schedule EIC (Form- Credits for Qualifying Children and Other Dependents SCHEDULE 8812 (Form 1040) OMB No- 2021 Attach to Form 1040, 1040-SR, or 1040-NR. Department of the Treasury Internal Revenue Service (99) Attachment Sequence No. 47 Go to www.irs.gov/Schedule8812 for instructions and the latest information. Name(s) shown on return Your social security number PONDEROSA PINE XXX-XX-XXXX Part I-A 1 21,500 2d 3 21,500 5 3,000 Multiply line 6 by $500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Add lines 5 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the amount shown below for your filing status. • Married filing jointly-$400,000 7 8 3,000 • All other filing statuses-$200,000 .................................... Subtract line 9 from line 3. • If zero or less, enter -0-. • If more than zero and not a multiple of $1,000, enter the next multiple of $1,000. For example, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc. ........... 9 200,000 10 11 12 0 ARE 1 2a b c d 3 4a b c 5 6 Child Tax Credit and Credit for Other Dependents Enter the amount from line 11 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . Enter income from Puerto Rico that you excluded .................. 2a Enter the amounts from lines 45 and 50 of your Form 2555 .............. 2b Enter the amount from line 15 of your Form 4563 . . . . . . . . . . . . . . . . . . . 2c Add lines 2a through 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Add lines 1 and 2d .............................................. Number of qualifying children under age 18 with the required social security number . . 4a 1 Number of children included on line 4a who were under age 6 at the end of 2021 . . . . 4b Subtract line 4b from line 4a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4c 1 If line 4a is more than zero, enter the amount from the Line 5 Worksheet; otherwise, enter -0- . . . . . . . . . . Number of other dependents, including any qualifying children who are not under age 18 or who do not have the required social security number . . . . . . . . . . . . . . 7 8 9 } Multiply line 10 by 5% (0.05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Subtract line 11 from line 8. If zero or less, enter -0.............................. Check all the boxes that apply to you (or your spouse if married filing jointly). A Check here if you (or your spouse if married filing jointly) have a principal place of abode in the United States for more than half of 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X B Check here if you (or your spouse if married filing jointly) are a bona fide resident of Puerto Rico for 2021 . . Part I-B AL 11 12 13 SOF } 10 TW 6 Caution: Do not include yourself, your spouse, or anyone who is not a U.S. citizen, U.S. national, or U.S. resident alien. Also, do not include anyone you included on line 4a. 3,000 Filers Who Check a Box on Line 13 TRI Caution: If you did not check a box on line 13, do not complete Part I-B; instead, skip to Part I-C. 14a Enter the smaller of line 7 or line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a 0 b Subtract line 14a from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b 3,000 c If line 14a is zero, enter -0-; otherwise, enter the amount from the Credit Limit Worksheet A . . . . . . . . . . 14c 0 d Enter the smaller of line 14a or line 14c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14d 0 e Add lines 14b and 14d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14e 3,000 f Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the instructions before entering an amount on this line. If you didn't receive any advance child tax credit payments for 2021, enter -0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14f 1,500 Caution: If the amount on this line doesn't match the aggregate amounts reported to you (and your spouse if filing jointly) on your Letter(s) 6419, the processing of your return will be delayed. g Subtract line 14f from line 14e. If zero or less, enter -0- on lines 14g through 14i and go to Part III . . . . . . . . . 14g 1,500 h Enter the smaller of line 14d or line 14g. This is your credit for other dependents. Enter this amount on line 19 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14h 0 i Subtract line 14h from line 14g. This is your refundable child tax credit. Enter this amount on line 28 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14i 1,500 For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 8812 (Form- EEA Schedule 8812 (Form- Part I-C PONDEROSA PINE XXX-XX-XXXX Caution: If you checked a box on line 13, do not complete Part I-C. 15a Enter the amount from the Credit Limit Worksheet A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Enter the smaller of line 12 or line 15a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional child tax credit. Complete Parts II-A through II-C if you meet each of the following items. 1. You are not filing Form 2555. 2. Line 4a is more than zero. 3. Line 12 is more than line 15a. c If you completed Parts II-A through II-C, enter the amount from line 27; otherwise, enter -0- . . . . . . . . . . . . d Add lines 15b and 15c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h ARE f g Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the instructions before entering an amount on this line. If you didn't receive any advance child tax credit payments for 2021, enter -0.............................................. Caution: If the amount on this line doesn't match the aggregate amounts reported to you (and your spouse if filing jointly) on your Letter(s) 6419, the processing of your return will be delayed. Subtract line 15e from line 15d. If zero or less, enter -0- on lines 15f through 15h and go to Part III . . . . . . . . . Enter the smaller of line 15b or line 15f. This is your nonrefundable child tax credit and credit for other dependents. Enter this amount on line 19 of your Form 1040, 1040-SR, or 1040-NR ............. Subtract line 15g from line 15f. This is your additional child tax credit. Enter this amount on line 28 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part II-A TW e Page 2 Filers Who Do Not Check a Box on Line 13 15a 15b 15c 15d 15e 15f 15g 15h Additional Child Tax Credit (use only if completing Part I-C) AL SOF Caution: If you file Form 2555, do not complete Parts II-A through II-C; you cannot claim the additional child tax credit. Caution: If you checked a box on line 13, do not complete Parts II-A through II-C; you cannot claim the additional child tax credit. 16a Subtract line 15b from line 12. If zero, skip Parts II-A and II-B and enter -0- on line 27 . . . . . . . . . . . . . . 16a b Number of qualifying children under 18 with the required social security number: x $1,400. Enter the result. If zero, skip Parts II-A and II-B and enter -0- on line 27 . . . . . . . . . . . . . . . . . . . . . 16b TIP: The number of children you use for this line is the same as the number of children you used for line 4a. 17 Enter the smaller of line 16a or line 16b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 18a Earned income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 18a b Nontaxable combat pay (see instructions) . . . . . . . . . 18b 19 Is the amount on line 18a more than $2,500? No. Leave line 19 blank and enter -0- on line 20. Yes. Subtract $2,500 from the amount on line 18a. Enter the result ....... 19 20 Multiply the amount on line 19 by 15% (0.15) and enter the result . . . . . . . . . . . . . . . . . . . . . . . . 20 Next. On line 16b, is the amount $4,200 or more? No. If line 20 is zero, enter -0- on line 15c. Otherwise, skip Part II-B and enter the smaller of line 17 or line 20 on line 27. Yes. If line 20 is equal to or more than line 17, skip Part II-B and enter the amount from line 17 on line 27. Otherwise, go to line 21. Part II-B Certain Filers Who Have Three or More Qualifying Children Withheld social security, Medicare, and Additional Medicare taxes from Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse’s amounts with yours. If your employer withheld or you paid Additional Medicare Tax or tier 1 RRTA taxes, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the total of the amounts from Schedule 1 (Form 1040), line 15; Schedule 2 (Form 1040), line 5; Schedule 2 (Form 1040), line 6; and Schedule 2 (Form 1040), line 13 . . . Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TRI 21 22 23 24 21 22 23 1040 and 1040-SR filers: Enter the total of the amounts from Form 1040 or 1040-SR, line 27a, and Schedule 3 (Form 1040), line 11. 1040-NR filers: Enter the amount from Schedule 3 (Form 1040), line 11. 24 Subtract line 24 from line 23. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the larger of line 20 or line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Next, enter the smaller of line 17 or line 26 on line 27. } 25 26 Part II-C 27 EEA Additional Child Tax Credit .......................................... Enter this amount on line 15c 25 26 27 Schedule 8812 (Form- Schedule 8812 (Form- PONDEROSA PINE XXX-XX-XXXX 30 31 32 33 Excess advance child tax credit payments. Subtract line 28b from line 28a. If zero, stop; you do not owe the additional tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the number of qualifying children taken into account in determining the annual advance amount you received for 2021. See your Letter 6419 for this number. If you are missing your Letter 6419, you are filing a joint return, or you received more than one Letter 6419, see the instructions before entering a number on this line ... Caution: If the amount on this line doesn’t match the number of qualifying children reported to you (and your spouse if filing jointly) on your Letter(s) 6419, the processing of your return will be delayed. Enter the smaller of line 4a or line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Subtract line 31 from line 30. If zero, skip to line 40 and enter the amount from line 29; otherwise, continue to line 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the amount shown below for your filing status. • Married filing jointly or Qualifying widow(er)—$60,000 • Head of household—$50,000 • All other filing statuses—$40,000 ........................... Subtract line 33 from line 3. If zero or less, enter -0.............................. Enter the amount from line 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divide line 34 by line 35. Enter the result as a decimal (rounded to at least three places). If the result is 1.000 or more, enter 1.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Multiply line 32 by $2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Multiply line 37 by line 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Subtract line 38 from line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Subtract line 39 from line 29. If zero or less, enter -0-. This is your additional tax. If more than zero, enter this amount on Schedule 2 (Form 1040), line 19 .............................. - TRI AL EEA SOF 34 35 36 TW } ARE 28a b 29 Additional Tax (use only if line 14g or line 15f, whichever applies, is zero) Enter the amount from line 14f or line 15e, whichever applies .......................... Enter the amount from line 14e or line 15d, whichever applies . . . . . . . . . . . . . . . . . . . . . . . . . . Page 3 Part III 28a 28b 29 30 31 32 - Schedule 8812 (Form- Form 8867 (Rev. December 2021) Department of the Treasury Internal Revenue Service Paid Preparer's Due Diligence Checklist OMB No- Earned Income Credit (EIC), American Opportunity Tax Credit (AOTC), Child Tax Credit (CTC) (including the Additional Child Tax Credit (ACTC) and Credit for Other Dependents (ODC)), and Head of Household (HOH) Filing Status To be completed by preparer and filed with Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS. Attachment Sequence No. 70 Go to www.irs.gov/Form8867 for instructions and the latest information. Taxpayer name(s) shown on return Taxpayer identification number PONDEROSA PINE XXX-XX-XXXX Enter preparer's name and PTIN John Doe Part I XXXXXXXXX Due Diligence Requirements TW ARE Please check the appropriate box for the credit(s) and/or HOH filing status claimed on the return and complete the related Parts I–V for the benefit(s) claimed (check all that apply). AOTC X EIC X CTC/ ACTC/ODC X HOH 1 Did you complete the return based on information for the applicable tax year provided by the taxpayer Yes No N/A or reasonably obtained by you? (See instructions if relying on prior year earned income.) . . . . . . . . X 2 If credits are claimed on the return, did you complete the applicable EIC and/or CTC/ACTC/ODC worksheets found in the Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS, or Schedule 8812 (Form 1040) instructions, and/or the AOTC worksheet found in the Form 8863 instructions, or your own worksheet(s) that provides the same information, and all related forms and schedules for each credit claimed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 3 Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both of the following. • Interview the taxpayer, ask questions, and contemporaneously document the taxpayer's responses to determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing status. X TRI AL SOF • Review information to determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing status and to figure the amount(s) of any credit(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Did any information provided by the taxpayer or a third party for use in preparing the return, or information reasonably known to you, appear to be incorrect, incomplete, or inconsistent? (If "Yes," answer questions 4a and 4b. If "No," go to question 5.) . . . . . . . . . . . . . . . . . . . . . . . . . . a Did you make reasonable inquiries to determine the correct, complete, and consistent information? . . b Did you contemporaneously document your inquiries? (Documentation should include the questions you asked, whom you asked, when you asked, the information that was provided, and the impact the information had on your preparation of the return.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Did you satisfy the record retention requirement? To meet the record retention requirement, you must keep a copy of your documentation referenced in question 4b, a copy of this Form 8867, a copy of any applicable worksheet(s), a record of how, when, and from whom the information used to prepare Form 8867 and any applicable worksheet(s) was obtained, and a copy of any document(s) provided by the taxpayer that you relied on to determine eligibility for the credit(s) and/or HOH filing status or to figure the amount(s) of the credit(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . List those documents provided by the taxpayer, if any, that you relied on: Childcare Records Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for the credit(s) and/or HOH filing status and the amount(s) of any credit(s) claimed on the return if his/her return is selected for audit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year? . . . . (If credits were disallowed or reduced, go to question 7a; if not, go to question 8.) a Did you complete the required recertification Form 8862? . . . . . . . . . . . . . . . . . . . . . . . . . 8 If the taxpayer is reporting self-employment income, did you ask questions to prepare a complete and correct Schedule C (Form 1040)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X X 6 For Paperwork Reduction Act Notice, see separate instructions. EEA X X X Form 8867 (Rev. 12-2021) Form 8867 (Rev. 12-2021) Part II PONDEROSA PINE 9a Have you determined that the taxpayer is eligible to claim the EIC for the number of qualifying children claimed, or is eligible to claim the EIC without a qualifying child? (If the taxpayer is claiming the EIC and does not have a qualifying child, go to question 10.) . . . . . . . . . . . . . . . . . . . . . . . . b Did you ask the taxpayer if the child lived with the taxpayer for over half of the year, even if the taxpayer has supported the child the entire year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Did you explain to the taxpayer the rules about claiming the EIC when a child is the qualifying child of more than one person (tiebreaker rules)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part III 11 Did you explain to the taxpayer that he/she may not claim the CTC/ACTC if the child has not lived with the taxpayer for over half of the year, even if the taxpayer has supported the child, unless the child's custodial parent has released a claim to exemption for the child? . . . . . . . . . . . . . . . . . . . . . Did you explain to the taxpayer the rules about claiming the CTC/ACTC/ODC for a child of divorced or separated parents (or parents who live apart), including any requirement to attach a Form 8332 or similar statement to the return? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X Yes X No N/A X X Due Diligence Questions for Returns Claiming AOTC (If the return does not claim AOTC, go to Part V.) Yes No Due Diligence Questions for Claiming HOH (If the return does not claim HOH filing status, go to Part VI.) Have you determined that the taxpayer was unmarried or considered unmarried on the last day of the tax year and provided more than half of the cost of keeping up a home for the year for a qualifying person? . . . . . . . Part VI N/A X Did the taxpayer provide substantiation for the credit, such as a Form 1098-T and/or receipts for the qualified tuition and related expenses for the claimed AOTC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part V No X TW 13 ARE Have you determined that each qualifying person for the CTC/ACTC/ODC is the taxpayer's dependent who is a citizen, national, or resident of the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part IV Yes Due Diligence Questions for Returns Claiming CTC/ACTC/ODC (If the return does not claim CTC, ACTC, or ODC, go to Part IV.) 10 12 Page 2 XXX-XX-XXXX Due Diligence Questions for Returns Claiming EIC (If the return does not claim EIC, go to Part III.) Eligibility Certification Yes X No TRI AL SOF You will have complied with all due diligence requirements for claiming the applicable credit(s) and/or HOH filing status on the return of the taxpayer identified above if you: A. Interview the taxpayer, ask adequate questions, contemporaneously document the taxpayer’s responses on the return or in your notes, review adequate information to determine if the taxpayer is eligible to claim the credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s); B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for any applicable credit(s) claimed and HOH filing status, if claimed; C. Submit Form 8867 in the manner required; and D. Keep all five of the following records for 3 years from the latest of the dates specified in the Form 8867 instructions under Document Retention. 1. A copy of this Form 8867. 2. The applicable worksheet(s) or your own worksheet(s) for any credit(s) claimed. 3. Copies of any documents provided by the taxpayer on which you relied to determine the taxpayer's eligibility for the credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s). 4. A record of how, when, and from whom the information used to prepare this form and the applicable worksheet(s) was obtained. 5. A record of any additional information you relied upon, including questions you asked and the taxpayer's responses, to determine the taxpayer's eligibility for the credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s). If you have not complied with all due diligence requirements, you may have to pay a penalty for each failure to comply related to a claim of an applicable credit or HOH filing status (see instructions for more information). 15 EEA Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and complete? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No Form 8867 (Rev. 12-2021) EIC Due Diligence Assistant (This page is not filed with the return. It is for your records only.) 2021 Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Part I All Taxpayers 1 Enter preparer's name and PTIN 2 Is the taxpayer's filing status married filing separately? John Doe XXXXXXXXX ............................ Yes X No 2a Does the taxpayer have a qualifying child? ARE If you checked "No" on line 2, go to line 3. Otherwise, go to line 2a. ................................... Yes No Yes No Yes No If you checked "No" on line 2a, stop; the taxpayer cannot take the EIC. Otherwise, continue. 2b Did the taxpayer either live apart from his or her spouse for the last six months of the year, or live apart from his or her spouse at the end of the year and have a decree of separate maintenance, written separation agreement, or decree requiring one spouse to make payments for support or maintenance of the other? .... 3 TW If you checked "No" on line 2b, stop; the taxpayer cannot take the EIC. Otherwise, continue. Does the taxpayer (and the taxpayer's spouse if filing jointly) have a social security number (SSN) that allows him or her to work and is valid for EIC purposes? See the instructions before answering ................................................. X 4 SOF If you checked "No" on line 3, stop; the taxpayer cannot take the EIC. Otherwise, continue. Is the taxpayer (or the taxpayer's spouse if filing jointly) filing Form 2555 (relating to the exclusion of foreign earned income)? .................................... Yes X No Yes X No If you checked "Yes" on line 4, stop; the taxpayer cannot take the EIC. Otherwise, continue. 5a Was the taxpayer (or the taxpayer's spouse) a nonresident alien for any part of 2021? ............. b AL If you checked "Yes" on line 5a, go to line 5b. Otherwise, skip line 5b and go to line 6. Is the taxpayer's filing status married filing jointly? ............................... Yes No TRI If you checked "Yes" on line 5a and "No'' on line 5b, stop; the taxpayer cannot take the EIC. Otherwise, continue. 6 Is the taxpayer's investment income more than $10,000? .......................... Yes X No Yes X No If you checked "Yes" on line 6, stop; the taxpayer cannot take the EIC. Otherwise, continue. 7 Could the taxpayer be a qualifying child of another person for 2021? If the taxpayer's filing status is married filing jointly, check "No." . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you checked "Yes" on line 7, stop; the taxpayer cannot take the EIC. Otherwise, go to Part II or Part III, whichever applies. Your signature Paid preparer's signature Date Date - DDASSIST.LD Spouse's signature. If joint return, BOTH must sign. Date EIC Due Diligence Assistant 2021 (This page is not filed with the return. It is for your records only.) Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Part II Taxpayers With a Child Child 1 Child 2 X Yes No Yes Yes No No No Yes Yes No No Yes Yes No No X Yes No Yes No Yes No X No Yes No Yes No TW AL TRI 16 No X Yes X Yes Yes Yes No Don't know SOF b Enter the child's relationship to the other person(s) . . . . . . . . . . . . . . . c Under the tiebreaker rules, is the child treated as the taxpayer's qualifying child? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you checked "Yes" on line 13c, go to line 14. If you checked "No," the taxpayer cannot take the EIC based on this child and cannot take the EIC for taxpayers who do not have a qualifying child. If you checked "Don't know," explain to the taxpayer that, under the tiebreaker rules, the taxpayer's EIC and other tax benefits may be disallowed. Then, if the taxpayer wants to take the EIC based on this child, complete lines 14 and 15. If not, and there are no other qualifying children, the taxpayer cannot take the EIC, including the EIC for taxpayers without a qualifying child; do not complete Part III. 14 Does the qualifying child have an SSN that allows him or her to work and is valid for EIC purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you checked "No" on line 14, the taxpayer cannot take the EIC based on this child and cannot take the EIC available to taxpayers without a qualifying child. If there is more than one child, complete lines 8 through 14 for the other child(ren) (but for no more than three qualifying children). If you checked "Yes" on line 14, continue. 15 If the qualifying child was not the taxpayer's son or daughter, do you know or did you ask why the parents were not claiming the child? . . . . . . . . . . . . . . Child 3 SPRUCE PINE ARE Caution: If there is more than one child, complete lines 8 through 14 for one child before going to the next column. 8 Child's name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Is the child the taxpayer's son, daughter, stepchild, foster child, brother, sister, stepbrother, stepsister, half brother, half sister, or a descendant of any of them? . . 10 Was the child unmarried at the end of 2021? If "No" and the child filed a return for any reason other than to claim a refund, the child is not the taxpayer's qualifying child. 11 Did the child live with the taxpayer in the United States for over half of 2021? . . . 12 Was the child (at the end of 2021) Under age 19 and younger than the taxpayer (or the taxpayer's spouse, if the taxpayer files jointly), Under age 24, a student (defined in the instructions), and younger than the taxpayer (or the taxpayer's spouse, if the taxpayer files jointly), or Any age and permanently and totally disabled? . . . . . . . . . . . . . . . If you checked "Yes" on lines 9, 10, 11, and 12, the child is the taxpayer's qualifying child; go to line 13a. If you checked "No" on line 9, 10, 11, or 12, the child is not the taxpayer's qualifying child. 13a Do you or the taxpayer know of another person who could check "Yes" on lines 9, 10, 11, and 12 for the child? . . . . . . . . . . . . . . . . . . . . . If you checked "No" on line 13a, go to line 14. Otherwise, go to line 13b. Yes No Don't know Yes No Don't know Yes X Yes No Yes No Yes No Yes No X Does not apply Does not apply Are the taxpayer's earned income and adjusted gross income each less than the limit that applies to the taxpayer for 2021? . . . . . . . . . . . . . . . If you checked "No" on line 16, stop; the taxpayer cannot take the EIC. If you checked "Yes" on line 16, the taxpayer can take the EIC. Complete Schedule EIC and attach it to the taxpayer's return. If there are two or three qualifying children with valid SSNs, list them on Schedule EIC in the same order as they are listed here. If the taxpayer's EIC was reduced or disallowed for a year after 1996, see Pub. 596 to see if Form 8862 must be filed. Your signature Paid preparer's signature Date Date - DDASSIST.LD2 Spouse's signature. If joint return, BOTH must sign. Yes No Does not apply X Yes Date No No EIC Due Diligence Assistant (This page is not filed with the return. It is for your records only.) 2021 Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Part III 17 Taxpayers Without a Qualifying Child Was the taxpayer's main home, and the main home of the taxpayer's spouse if filing jointly, in the United States for more than half the year? (Military personnel on extended active duty outside the United States are considered to be living in the United States during that duty period.) Yes No Yes No Yes No Yes No If you checked "No" on line 17, stop; the taxpayer cannot take the EIC. Otherwise, continue. Has the taxpayer, or the taxpayer's spouse if filing jointly, reached the applicable minimum age at the end of 2021? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ARE 18 If you checked "No" on line 18, stop; the taxpayer cannot take the EIC. Otherwise, continue. 19 Is the taxpayer eligible to be claimed as a dependent on anyone else's federal income tax return for 2021? If the taxpayer's filing status is married filing jointly, check "No" ....................... If you checked "Yes" on line 19, stop; the taxpayer cannot take the EIC. Otherwise, continue. Are the taxpayer's earned income and adjusted gross income each less than the limit that applies to the taxpayer for 2021? ....................................... TW 20 If you checked "No" on line 20, stop; the taxpayer cannot take the EIC. If you checked "Yes" on line 20, the taxpayer can take the EIC. If the taxpayer's EIC was reduced or disallowed for a year after 1996, see Pub. 596 to find out if Form 8862 must be filed. Part IV Documents Provided to You Identify below any document that the taxpayer provided to you and that you relied on to determine the taxpayer's EIC eligibility. Check all that apply. Keep a copy of any documents you relied on. See the instructions before answering. If there is no qualifying child, check box a. If there is no disabled child, check box o. SOF 21 Residency of Qualifying Child(ren) No qualifying child School records or statement Landlord or property management statement Healthcare provider statement Medical records Childcare provider records Placement agency statement Social services records or statement o p q r No disabled child Doctor statement Other healthcare provider statement Social services agency or program statement AL X a b c d e f g h i j k l Place of worship statement Indian tribal official statement Employer statement Other (specify) m Did not rely on any documents, but made notes in file n Did not rely on any documents Disability of Qualifying Child(ren) TRI X Your signature Paid preparer's signature Date Date - DDASSIST.LD3 s Other (specify) t u Did not rely on any documents, but made notes in file Did not rely on any documents Spouse's signature. If joint return, BOTH must sign. Date Due Diligence 2021 (This page is not filed with the return. It is for your records only.) Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Age - Qualifying Child (complete only if qualifying child is over age 18) For children over age 18 who are students or permanently and totally disabled, the following Child 1 additional information and documentation should be available: 1. Children who are students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Not a student a. What school does the child attend? Child 2 Child 3 Not a student Not a student Yes No Not disabled Yes No Not disabled Yes No Not disabled Yes No Yes No Yes No Yes No Yes No Yes No No Yes No Yes No . . . . . . . . . . Child 1 TW ARE Child 2 Child 3 b. Can you provide documentation showing that the child was a full-time student for at least 5 months? The school records need to show the dates of attendance. The months don't have to be consecutive . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Children with a permanent and total disability . . . . . . . . . . . . . . . . . . . . . . . . . . . a. What type of disability does the child have? . . . . . . Child 1 Child 2 Child 3 b. Does the child receive SSI or other disability payments? . . . . . . . . . . . . . . . . . . . . c. Do you have a letter from the child's doctor, other healthcare provider, or any social service program or agency verifying that the child is permanently and totally disabled? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Relationship - Qualifying Child Child 2 Child 3 No Yes No Yes No No Yes No Yes No No Yes No Yes No No Yes No Yes No TRI AL SOF 1. If the biological parent is NOT living with the child, where is the parent? Did he or she provide support? Child 1 Child 2 Child 3 Mother Yes Father Child 1 2. Adopted children: a. Is the adoption final or pending? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. If the adoption is pending, do you have a letter from an authorized adoption agency? . . . . . Yes 3. Foster children: a. Do you have a letter from the authorized placement agency or applicable court document? . . . Yes 4. Brother, sister, niece, nephew, grandchild, great-grandchild: a. Can you provide a birth certificate that verifies your relationship to the child? . . . . . . . . . . Yes 5. Stepchildren or descendent of them, step-grandchildren, step-great-grandchildren: a. Can you provide a birth certificate & marriage certificate verifying the relationship to the child? ... Yes Residency - Qualifying Child Can you provide any of the following documentation to prove that your child lived with you for more than half of the year? More than one type of documentation may be required by the IRS. Child 1 Child 2 Child 3 School records School records School records Medical records Medical records Medical records Letter* Letter* Letter* Social service records Social service records Social service records Daycare records Daycare records Daycare records Daycare provider Daycare provider Daycare provider *The letter must be on official letterhead from one of the following: school, medical provider, social service agency, place of worship, or other acceptable entity. The letter must include the name of the child, name of the child's parent or guardian, child's address, and dates during the year child lived with taxpayer. Adjusted Gross Income - Qualifying Child For tax years beginning after December 31, 2020 a taxpayer other than the parents of a qualifying Child 1 child can claim the child, but only if the adjusted gross income (AGI) of the taxpayer is higher than the AGI of any parent of the child. If you are not a parent of the qualifying child, is your AGI higher than any parent of the child? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes Your signature Paid preparer's signature Date Date - DD_QC.LD Spouse's signature. If joint return, BOTH must sign. Child 2 No Yes Date Child 3 No Yes No Income Due Diligence (This page is not filed with the return. It is for your records only.) 2021 Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Does the income appear to be sufficient to support the taxpayer and qualifying children? If "No," some additional inquiries might be needed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X Yes No Taxpayers with self-employment income: ARE Not applicable 1. How long have you owned your business? ..... Brief description of business ............ Where do you conduct business? .......... 2. What services do you perform? . . . . . . . . . . . How much do you charge for these services? .... 3. Approximately how many clients do you have? . . . . How often do you provide services for each client? . . 5. Do you travel for business? Yes No When and where do you have to travel for business? TW 4. What types of items do you need to operate? . . . . . How often are these items replenished? . . . . . . . How do you keep track of mileage? .. SOF 6. Can you provide any documentation to substantiate your business? Business cards Business/occupational license (if required) Business stationary Other tax returns (sales/excise, employment, etc.) Receipts or receipt book (with company header) Advertisements (newspaper, flyer, yellow pages, etc.) Other (list any other documentation you can provide to substantiate your business): 7. Who maintains the business records? .......... .................... AL 8. Do you maintain separate banking accounts for personal and business transactions? a. If "Yes," what form of records were provided? Yes No Yes No Yes Yes No No b. If "No," how do you differentiate between personal and business transactions and monetary assets? TRI 9. Were satisfactory records of income and expense provided? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a. If "Yes," in what form were these records provided? Accounting records Log books Paid invoices/receipts Ledgers Computer records Business bank accounts Car/truck expenses Other (list any other forms of documentation you can provide to support your business): b. If "No," how did you determine: The amount of income? The amount of expense? 10. Form 1099-NEC: a. Do you have any Forms 1099-NEC to support the income? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. If not, is it reasonable that the business type would not receive Form 1099-NEC? .................... DD_INC.LD Income Due Diligence (This page is not filed with the return. It is for your records only.) 2021 Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Yes No 12. Are the amounts of expense reasonable? .................................... Yes No ....................... Yes No 13. Are any expenses that are typical for this type of business missing? 14. If no (or low) expenses, why are they so low? 15. If high expenses or a loss, why are they so high? ARE ............................ 11. Are the expenses consistent with the type of business? 16. If high expenses or a loss, how are you able to pay these expenses and keep this business open? TW 17. List any other information you can provide related to your business: Date Paid preparer's signature Date Spouse's signature. If joint return, BOTH must sign. SOF Your signature TRI AL - DD_INC.LD2 Date Head of Household Due Diligence (This page is not filed with the return. It is for your records only.) 2021 Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX SOF TW ARE Filing Status - Head of Household The IRS could require additional information/documentation if you are divorced, legally separated, or married and did not reside with your spouse the last 6 months of the year to determine if you qualify for the head of household filing status. 1. Marital status: Married but lived apart from spouse during the last 6 months of the year X Never married Spouse deceased Separation agreement Divorced, separated or spouse deceased 2. If you are divorced or legally separated, can you provide the IRS with any of the following documents? Divorce decree Separate maintenance agreement or separation agreement 3. If you are married but did not reside with your spouse for the last 6 months of the tax year, can you provide the IRS with any of the supporting documents verifying that your spouse did not live with you? Not applicable Lease agreement Utility bills Letter for a clergy member Letter from social services Other supporting documentation If so, what type of documentation? 4. Can you provide the IRS with receipts and bills substantiating the cost of maintaining more than half of the cost of the home? Documentation that the IRS requires to substantiate the cost of maintaining the home includes: Utility bills Rent receipts or mortgage interest statement Property tax bills Maintenance and repair bills Grocery receipts Other household bills 5. Did you receive any non-taxable support/income? Family support Childcare assistance Food stamps Other Housing assistance 6. If anyone else lives in the home: Name Relationship Do they provide any financial support? Yes No AL * This worksheet can be used to substantiate the costs of maintaining the home. Publication 17, Worksheet 2-1. Cost of Keeping Up a Home Amount You Paid TRI Property taxes Mortgage interest expense Rent Utility charges Repairs/Maintenance Property insurance Food eaten in the home Other household expenses Totals Minus total amount you paid Amount others paid Total Cost $ $ $ $ ( $ ) If the total amount you paid is more than the amount others paid, you meet the requirement of paying more than half of the cost of keeping up the home. Your signature Paid preparer's signature Date Date - DD_HOH.LD Spouse's signature. If joint return, BOTH must sign. Date Form 8879 IRS e-file Signature Authorization OMB No- (Rev. January 2021) 2021 ERO must obtain and retain completed Form 8879. Go to www.irs.gov/Form8879 for the latest information. Department of the Treasury Internal Revenue Service Submission Identification Number (SID) Taxpayer's name Social security number PONDEROSA PINE XXX-XX-XXXX Spouse's name Part I Spouse's social security number Tax Return Information - Tax Year Ending December 31, 2021 (Enter year you are authorizing.) Part II ARE Enter whole dollars only on lines 1 through 5. Note: Form 1040-SS filers use line 4 only. Leave lines 1, 2, 3, and 5 blank. 1 Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . . . . . . . . . 4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 3 4 5 21,-,100 8,426 Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return) SOF TW Under penalties of perjury, I declare that I have examined a copy of the income tax return (original or amended) I am now authorizing, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from the income tax return (original or amended) I am now authorizing. 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-. 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 the income tax return (original or amended) I am now authorizing and, if applicable, my Electronic Funds Withdrawal Consent. Taxpayer's PIN: check one box only X I authorize Firm Name to enter or generate my PIN 46213 ERO firm name as my Enter five digits, but don't enter all zeros signature on the income tax return (original or amended) I am now authorizing. Your signature AL I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. 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 PIN: check one box only I authorize Date as my to enter or generate my PIN ERO firm name Enter five digits, but don't enter all zeros TRI signature on the income tax return (original or amended) I am now authorizing. I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. 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 Part III Date Practitioner PIN Method Returns Only - continue below Certification and Authentication - Practitioner PIN Method Only ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. -12233 Don't enter all zeros I certify that the above numeric entry is my PIN, which is my signature for the electronic individual income tax return (original or amended) I am now authorized to file for tax year indicated above 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. EEA Form 8879 (Rev. 01-2021) Computation of Regular Tax 2021 (This page is not filed with the return. It is for your records only.) Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Statement for line 16 of Form 1040 Tax per Tax Table 271 Tax computed using only available method TRI AL SOF TW ARE $ $ TAX_COMP.LD 271 Credit Limit Worksheet 2021 (This page is not filed with the return. It is for your records only.) Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX 271 3. 271 5. 271 13. 0 14. 271 16. 271 TRI AL SOF TW ARE 1. Amount from line 18 of Form 1040, 1040-SR, or 1040-NR minus Schedule 3, line 6l . . . . . 1. 2. Foreign tax credit amount from Schedule 3 (Form 1040), line 1 . . . . . . . . . . . . . . . 2. 3. Subtract line 2 from line 1. If zero or less, enter -0-. This amount is used to calculate Form 2441, line 11 .............................. 4. Amount from Form 2441, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Subtract line 4 from line 3. If zero or less, enter -0-. Enter this amount on Schedule R, line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Amount from Schedule R, line 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 7. Enter amount from Form 8863, line 18 . . . . . . . . . . . . . . . . 7. 8. Subtract line 6 from line 5. If zero or less, enter -0. . . . . . . . . 8. 271 9. Enter the smaller of line 7 or line 8. Nonrefundable lifetime learning credit . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. 10. Enter amount from Form 8863, line 9 . . . . . . . . . . . . . . . . 10. 11. Subtract line 9 from line 8. If zero or less, enter -0- . . . . . . . . . -. Enter the smaller of line 10 or line 11. Nonrefundable American Opportunity credit . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Add line 9 and line 12. Enter this amount on Form 8863, line 19 . . . . . . . . . . . . 14. Subtract line 13 from line 8. If zero or less, enter -0-. Enter this amount on Form 8880, line 11 ..................................... 15. Amount from Form 8880, line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 16. Subtract line 15 from line 14. If zero or less, enter -0-. Enter this amount on Form 5695, line 29 ..................................... 17. Amount from Form 5695, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. 18. Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. Subtract line 17 from line 16. If zero or less, enter -0-. Enter this amount on Form 8910, line 14 ..................................... 21. Amount from Form 8910, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. 22. Subtract line 21 from line 20. If zero or less, enter -0-. Enter this amount on Form 8936, line 22 ..................................... 23. Amount from Form 8936, line 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. 24. Amount from line 19 of Form 1040, 1040-SR or 1040-NR, or amount from line 14 of Credit Limit Worksheet B (Form 8812), if present in the return . . . . . . . . . . . . . . . . . . 24. 25. Subtract lines 23 and 24 from line 22. If zero or less, enter -0-. Enter this amount on Form 8396, line 8 ................................. 26. Amount from Form 8396, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26. 27. Subtract line 26 from line 25. If zero or less, enter -0. . . . . . . . . . . . . . . . . . 27. 28. Amount from Form 8839, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28. 29. Enter the smaller of line 27 or line 28. Enter this amount on Form 8839, lines 15 and 16 . . 29. 30. Subtract line 29 from line 27. If zero or less, enter -0-. Enter this amount on Form 8859, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31. Amount from Form 8859, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31. 32. Subtract line 31 from line 30. If zero of less, enter -0-. Enter this amount on Form Form 5695, line 14 .................................. CRED_LMT.LD 18. 20. 271 22. 271 25. 271 271 30. 271 32. 271 Earned Income Credit Worksheet - Form 1040 or 1040-SR, line 27 2021 (Keep for your records) Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX 1. 2. If you received a taxable scholarship or fellowship grant that was not reported on a W-2 form, enter that amount here; plus any amounts received for work performed while an inmate in a penal institution; plus any amounts received as a pension or annuity from a nonqualified deferred compensation plan or a nongovernmental section 457 plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. .......................................... 3. 4. If you were self-employed or used Schedule C as a statutory employee, enter the amount from Worksheet B, line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. ............................................... 5. 21,500 6. Look up the amount on line 5 above in the EIC Table right after Worksheet B in the instructions to find your credit. Enter the credit here. If line 6 is zero, stop. You cannot take the credit. Enter "No" directly to the left of Form 1040 or 1040-SR, line 27 . . . . . . . . . . . . . . . . . . . . . . . . 6. 3,297 ............................. 7. 21,500 8. Is line 7 less than • $11,650 if you do not have a qualifying child? ($17,600 if married filing joint) • $19,550 if you have at least one qualifying child? ($25,500 if married filing joint) Yes. Go to line 9 now. X No. Look up the amount on line 7 above in the EIC Table to find your credit. Enter the credit here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3,297 9. Earned income credit. • If you checked "Yes" on line 8, enter the amount from line 6. • If you checked "No" on line 8, enter the smaller of line 6 or line 8. . . . . . . . . . . . . . . . . . . . . . . 9. 3,297 5. Add lines 3 and 4 SOF 7. Enter your AGI from Form 1040 or 1040-SR, line 11 TW 3. Subtract line 2 from line 1 ARE 1. Enter the amount from Form 1040 or 1040-SR, line 1 plus any nontaxable combat pay elected to be included in earned income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TRI AL For additional information on the EIC calculation see the form instructions or IRS Publication 596. WK_EIC.LD 21,500 21,500 Recovery Rebate Credit Worksheet (This page is not filed with the return. It is for your records only.) Name(s) as shown on return Tax ID Number PONDEROSA PINE 1. 2021 XXX-XX-XXXX Can you be claimed as a dependent on another person's 2021 return? If filing a joint return, go to line 2. Go to line 2. Yes. STOP You can't take the credit. Don’t complete the rest of this worksheet and don’t enter any amount on line 30. Does your 2021 return include a social security number that was issued on or before the due date of your 2021 return (including extensions) for you and, if filing a joint return, your spouse? X Yes. Go to line 6. No. If you are filing a joint return, go to line 3. If you aren't filing a joint return, go to line 5. Was at least one of you a member of the U.S. Armed Forces at any time during 2021, and does at least one of you have a social security number that was issued on or before the due date of your 2021 return (including extensions)? Yes. Your credit is not limited. Go to line 6. No. Go to line 4. 5. 6. 7. 8. 9. Does one of you have a social security number that was issued on or before the due date of your 2021 return (including extensions)? Yes. Your credit is limited. Go to line 6. No. Go to line 5. Do you have any dependents listed in the Dependents section on page 1 of Form 1040 or 1040-SR for whom you entered a social security number that was issued on or before the due date of your 2021 return (including extensions) or an adoption taxpayer identification number? Yes. Enter zero on line 6 and go to line 7. No. STOP You can’t take the credit. Don’t complete the rest of this worksheet and don’t enter any amount on line 30. Enter: • $1,400 if single, head of household, married filing separately, or qualifying widow(er), • $1,400 if married filing jointly and you answered “Yes” to question 4, or • $2,800 if married filing jointly and you answered “Yes” to question 2 or 3 . . . . . . . . . . . . . . . . . . . . 6. TW 4. SOF 3. Multiply $1,400 by the number of dependents listed in the Dependents section on page 1 of Form 1040 or 1040-SR for whom you entered a social security number that was issued on or before the due date of your 2021 return (including extensions) or an adoption taxpayer identification number . . . . . . . . . . . . . . . . . . . . . 7. Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. Is the amount on line 11 of Form 1040 or 1040-SR more than the amount shown below for your filing status? • Single or Married filing separately—$75,000 • Married filing jointly or qualifying widow(er)—$150,000 • Head of household—$112,500 Yes. Enter the amount from line 11 of Form 1040 or 1040-SR and go to line 10 Enter the amount from line 8 on line 12 and skip lines 10 and 11. Is line 9 more than the amount shown below for your filing status? • Single or married filing separately—$80,000 • Married filing jointly or qualifying widow(er)—$160,000 • Head of household—$120,000 X No. TRI 10. AL 2. ARE X No. Yes. No. 11. 12. 13. 14. STOP 1,400 2,800 . . . . . . . . . . . . . . . . . . 9. You can’t take the credit. Don’t complete the rest of this worksheet and don’t enter any amount on line 30. Subtract line 9 from the amount shown above for your filing status .................... Divide line 10 by the amount shown below for your filing status. Enter the result as a decimal (rounded to at least 2 places). • Single or married filing separately—$5,000 • Married filing jointly or qualifying widow(er)—$10,000 • Head of household—$7,500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Multiply line 8 by line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the amount, if any, of EIP 3 that was issued to you. If filing a joint return, include the amount, if any, of your spouse’s EIP 3. You may refer to Notice 1444-C or your tax account information at IRS.gov/Account for the amount to enter here .............................................. Recovery rebate credit. Subtract line 13 from line 12. If zero or less, enter -0-. If line 13 is more than line 12, you don’t have to pay back the difference. Enter the result here and, if more than zero, on line 30 of Form 1040 or 1040-SR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WK_RRC.LD 1,400 10. 11. 12. 2,800 13. 2,800 14. 0 Worksheet for Schedule 8812, Line 5 Schedule 8812 2021 (Keep for your records) Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Multiply Schedule 8812, line 4b, by $3,600 ................................... 1. 2. Multiply Schedule 8812, line 4c, by $3,000 ................................... 2. 3,000 3. Add line 1 and line 2 .............................................. 3. 3,000 4. Multiply Schedule 8812, line 4a, by $2,000 ................................... 4. 2,000 5. Subtract line 4 from line 3 ........................................... 5. 1,000 6. Enter the amount shown below for your filing status • Married filing jointly - $12,500 • Qualifying widow(er) - $2,500 • Head of household - $4,375 • All other filing statuses - $6,250 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 4,375 TW ARE 1. ....................................... Enter the smaller of line 5 or line 6 7. 1,000 8. Enter the amount shown below for your filing status • Married filing jointly or Qualifying widow(er) - $150,000 • Head of household - $112,500 • All other filing statuses - $75,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 112,500 9. SOF 7. Subtract line 8 from Schedule 8812, line 3 • If zero or less, enter -0• If more than zero and not a multiple of $1,000, enter the next multiple of $1,000 For example, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc 9. 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 3,000 Multiply line 9 by 5% (0.05) 11. Enter the smaller of line 7 or line 10 12. Subtract line 11 from line 3. Enter on Schedule 8812, line 5 TRI AL 10. WK_8812.LD5 .............. Carryover Worksheet List of items that will carryover to the 2022 tax return (This page is not filed with the return. It is for your records only.) 2021 Name(s) as shown on return Tax ID Number PONDEROSA PINE XXX-XX-XXXX Itemized Deductions Carryover Amount ARE Contributions subject to 100% of AGI limitations ................................... Contributions subject to 60% of AGI limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contributions subject to 30% of AGI limitations (50% capital gains appreciated property) . . . . . . . . . . . . . . . . . Contributions subject to 30% of AGI limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contributions subject to 20% of AGI limitations (30% capital gains appreciated property) . . . . . . . . . . . . . . . . . Taxable state and local refunds to Schedule 1 (Form 1040) line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . State/local taxes paid in 2022 to flow to the Schedule A ............................... State donations and contributions carryover ..................................... State overpayment applied to next year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expenses TW Office in home operating expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Office in home excess casualty losses and depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disallowed investment interest expense . . . . . . . . . . . . . . . . AMT Reg. Tax Section 179 expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Operating expenses, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use . . . . . . . Excess depreciation, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use . . . . . . . Losses SOF Short-term capital loss . . . . . . . . . . . . . . . . . . . . . . . . . AMT Reg. Tax Long-term capital loss . . . . . . . . . . . . . . . . . . . . . . . . . AMT Reg. Tax Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . . AMT Reg. Tax Excess business loss from Form 461 (becomes part of NOL next year) AMT Reg. Tax Qualified REIT and PTP loss carryover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . QBI loss carryover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nonrecaptured net section 1231 losses from WK_1231C . . . . . . . . AMT Reg. Tax Credits Other AL Mortgage interest credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit for prior year minimum tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Foreign Tax credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMT Reg. Tax District of Columbia first time home owner's credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Res. energy efficient property credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TRI Preparer Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overpayment applied to next year's estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Estimated Tax Payment 1 Estimated Tax Payment 2 Estimated Tax Payment 3 Estimated Tax Payment 4 Federal tax liability for 2210 calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State tax liability for state 2210 calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IRA basis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taxpayer Spouse Disaster distributions taxable in 2022 . . . . . . . . . . . . . . . . Taxpayer Spouse Disaster distributions taxable in 2023 . . . . . . . . . . . . . . . . Taxpayer Spouse Excess repayments from 8915-F . . . . . . . . . . . . . . . . . . Taxpayer Spouse Deferred SE tax to be repaid by 12/31/2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Passive Activity At Risk Limitations WK_CARRY.LD 0 ARE FOR TAX YEAR 2021 TRI AL SOF TW PONDEROSA PINE Firm Name 123 Main St Franklin, NC 28734 TAX RETURN COMPARISON 2019 / 2020 / 2021 2021 (This page is not filed with the return. It is for your records only.) Name(s) as shown on return Identifying number PONDEROSA PINE XXX-XX-XXXX 2019 2020 Filing Status . . . . . . . . . . . . . . Number of Dependents . . . . . . . . . AL TRI Difference- 1 21,500 TW ARE 21,500 SOF Income Wages, salaries, tips, etc. . . . . . . . Taxable interest and dividends . . . . Taxable state and local refunds . . . . Alimony. . . . . . . . . . . . . . . . Business income (loss) . . . . . . . . Gains (losses) . . . . . . . . . . . . Pensions and IRA distributions . . . . Rent and royalty income (loss) . . . . Part, S-corps, trusts income (loss) . . . Farm income (loss) . . . . . . . . . . Unemployment compensation . . . . . Total SS benefits received. . . . . . . Taxable SS benefits. . . . . . . . . . Other income (loss) . . . . . . . . . . Total Income . . . . . . . . . . . . . Adjusted Gross Income Half of self-employment tax . . . . . . IRA deduction. . . . . . . . . . . . . Other adjustments . . . . . . . . . . Total Adjusted Gross Income . . . . Deductions Medical deductions . . . . . . . . . . State and local taxes . . . . . . . . . Interest . . . . . . . . . . . . . . . . Contributions . . . . . . . . . . . . . Employee business expenses . . . . . Standard or other deductions . . . . . Total deductions claimed . . . . . . Qualified Business Income Deduction . Tax and Credits Taxable Income . . . . . . . . . . . Tax. . . . . . . . . . . . . . . . . . Credits . . . . . . . . . . . . . . . . Self-employment tax . . . . . . . . . Other taxes . . . . . . . . . . . . . . Total Tax . . . . . . . . . . . . . . . Payments Withholdings . . . . . . . . . . . . . Estimated tax payments . . . . . . . . Earned income credit . . . . . . . . . Other payments and credits . . . . . . Estimated tax penalty . . . . . . . . Overpayment ............ Overpayment Applied . . . . . . . . . Refund . . . . . . . . . . . . . . . . Balance Due . . . . . . . . . . . . . . Marginal tax rate . . . . . . . . . . . . . Effective tax rate . . . . . . . . . . . . . 2021 Head of House 1 21,500 21,500 21,500 21,500 18,800 18,800 18,800 18,800 2,700 271 2,700 271 271 271 2,100 2,100 3,297 3,300 3,297 3,300 8,426 8,426 8,426 8,426 - -