Acct214.docx
Donna and Chris Hoser have been married for three years. Donna works as a nurse at Tarleton Memorial Hospital. Chris is a full-time student at Southwest Texas State University (STSU) and also works part-time during the summer at Tarleton Hospital. Chris' birthdate is January 12, 1996, and Donna's birthdate is November 4, 1998. Donna and Chris each received a W-2 form from Tarleton Memorial Hospital Corp. (see separate tab).
Donna and Chris received Forms 1099-INT, 1099-OID, and 1099-DIV (see separate tab).
Chris is an excellent student at STSU. He was given a $1,750 scholarship by the university to help pay educational expenses. The scholarship funds were used by Chris for tuition and books.
Chris entered the Compositors Expanse Residence (CER) sweepstakes and ended up winning $10,000. Chris took advantage of the no-purchase-required option and paid nothing to join the sweepstakes. He received a 1099-MISC (not shown) reporting the prize.
Donna is a valued employee at the hospital. Her supervisor gave her two tickets to a single game of the nearby professional football team that were worth $100 each. The hospital also sent Donna flowers valued at $40 when her mother passed away during 2022.
Chris has a 4-year-old son, Robert R. Hoser, from a prior marriage that ended in divorce in 2019. During 2022, he paid his ex-wife $300 per month in child support. Robert is claimed as a dependent by Chris's ex-wife.
During 2022, Chris' aunt died. The aunt, in her will, left Chris $15,000 in cash. Chris deposited this money in the Lone Star State Bank savings account.
Required:Complete the Hoser's federal tax return for 2022 on Form 1040, Schedule 1, and the Qualified Dividends and Capital Gain Tax Worksheet. The Hoser's had health coverage for the entire year. They do not want to make any contribution to the presidential election campaign. Make any other realistic assumptions about any missing data. If an amount box does not require an entry or if an amount is zero, enter "0". Enter amounts as positive numbers. If required, round amounts to the nearest dollar.
Donna and Chris' earnings and income tax withholdings are reported on the following W-2 forms from Tarleton Memorial Hospital Corp.:
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a Employee's social security number 465-74-3322
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OMB No. 1545-0008
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Safe, accurate,FAST! Use
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IRS e ~ file
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Visit the IRS website at www.irs.gov/efile
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b
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Employer identification number (EIN) 31-1238977
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1
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Wages, tips, other compensation 50,198.00
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2
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Federal income tax withheld 4,020.30
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c
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Employer's name, address, and ZIP code Tarleton Memorial Hospital Corp.412 N. Belknap StreetStephenville, TX 76401
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3
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Social security wages 50,198.00
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Social security tax withheld 3,112.28
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5
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Medicare wages and tips 50,198.00
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Medicare tax withheld 727.87
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7
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Social security tips
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8
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Allocated tips
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d
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Control number
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9
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10
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Dependent care benefits
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e
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Employee's first name and initial Donna Hoser1313 W. Washington StStephenville, TX 76401
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Last name
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Suff.
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11
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Nonqualified plans
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12a
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See instructions for box 12
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Code C
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48.00
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13
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Statutory employee
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Retirement plan
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Third-party sick pay
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12b
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Code DD
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5,700.00
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14
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Other FSA $2,850
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12c
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Code
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12d
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Code
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f
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Employee's address and ZIP code
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15 State TX
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Employer's state ID number
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16
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State wages, tips, etc.
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17
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State income tax
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Local wages, tips, etc.
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19
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Local income tax
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Locality name
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Form W-2
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Wage and TaxStatement
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2022
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Department of the Treasury—Internal Revenue Service
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Copy B–To Be Filed With Employee's FEDERAL Tax Return.
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This information is being furnished to the Internal Revenue Service.
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a Employee's social security number 465-57-9935
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OMB No. 1545-0008
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Safe, accurate,FAST! Use
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IRS e ~ file
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Visit the IRS website at www.irs.gov/efile
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b
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Employer identification number (EIN) 31-1238977
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1
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Wages, tips, other compensation 3,200.00
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2
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Federal income tax withheld 150.00
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Employer's name, address, and ZIP code Tarleton Memorial Hospital Corp.412 N. Belknap StreetStephenville, TX 76401
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Social security wages 3,200.00
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Social security tax withheld 198.40
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Medicare wages and tips 3,200.00
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Medicare tax withheld 46.40
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Social security tips
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Allocated tips
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Control number
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9
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Dependent care benefits
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Employee's first name and initial Chris Hoser1313 W. Washington StStephenville, TX 76401
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Last name
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Suff.
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11
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Nonqualified plans
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12a
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See instructions for box 12
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Code
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13
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Statutory employee
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Retirement plan
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Third-party sick pay
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12b
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Code
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14
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Other
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12c
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Code
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12d
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Code
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Employee's address and ZIP code
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15 State TX
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Employer's state ID number
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16
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State wages, tips, etc.
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State income tax
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Local wages, tips, etc.
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Local income tax
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Locality name
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Form W-2
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Wage and TaxStatement
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2022
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Department of the Treasury—Internal Revenue Service
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Copy B–To Be Filed With Employee's FEDERAL Tax Return.
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This information is being furnished to the Internal Revenue Service.
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Donna and Chris received the following Form 1099-INT, Form 1099-OID and Form 1099-DIV:
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◻ CORRECTED (if checked)
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PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Lone Star State Bank1000 N. Wolfe Nursery Rd.Stephenville, TX 76401
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Payer's RTN (optional)
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OMB No. 1545-0112 2022Form 1099-INT
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InterestIncome
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1 Interest income $ 623.63
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2 Early withdrawal penalty
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Copy B For RecipientThis is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
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PAYER'S TIN
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RECIPIENT'S TIN
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$
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3 Interest on U.S. Savings Bonds and Treas. obligations
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33-1234556
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465-74-3322
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$
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RECIPIENT'S name
Donna and Chris Hoser
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4 Federal income tax withheld $
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5 Investment expenses $
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Street address (including apt. no.)
1313 W. Washington Street
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6 Foreign tax paid $
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7 Foreign country or U.S. possession
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City or town, state or province, country, and ZIP or foreign postal code
Stephenville, TX 76401
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8 Tax-exempt interest $
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9 Specified private activity bond interest $
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10 Market discount
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11 Bond premium
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FATCA filing requirement
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$
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$
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12 Bond premium on Treasury obligations $
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13 Bond premium on tax-exempt bond $
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Account number (see instructions)
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14 Tax-exempt and tax credit bond CUSIP no.
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15 State
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16 State identification no.
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17 State tax withheld $
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$
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Form 1099-INT
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(keep for your records)
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Department of the Treasury – Internal Revenue Service
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◻ CORRECTED (if checked)
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PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Stephenville Indep. School District2655 West Overhill DriveStephenville, Texas 76401
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1 Original issue discout for the year* $
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OMB No. 1545-0110 2022 Form 1099-OID
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Original Issue Disount
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* This may not be the correct figure to report on your income tax return. See instructions on the back.
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2 Other periodic interest $
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Copy B For RecipientThis is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
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PAYER'S TIN
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RECIPIENT'S TIN
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3 Early withdrawal penalty $
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4 Federal income tax withheld $
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13-3229985
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465-74-3322
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5 Market discount $
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6 Acquisition premium $
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RECIPIENT'S name
Donna Hoser
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7. Description
STEPHENVILLE TEX INDPTSCUSIP 859128HW30% DUE 02/15/23
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Street address (including apt. no.)
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1313 W. Washington Street
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City or town, state or province, country, and ZIP or foreign postal code
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Stephenville, TX 76401
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8 Original issue discount on U.S Treasury Obligations* $
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9 Investment expenses $
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FATCA filing requirement
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10 Bond premium $
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11 Tax-exempt OID $ 122.00
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Account number (see instructions)
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12 State
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13 State identification no
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14 State tax withheld $
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$
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Form 1099-OID Rev (10-2019)
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(keep for your records)
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Department of the Treasury – Internal Revenue Service
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◻ CORRECTED (if checked)
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PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Ozark Corporation900 South Orange Ave.Springfield, MO 62126
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1a Total ordinary dividends $ 320.00
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OMB No. 1545-0110 2022Form 1099-DIV
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Dividends andDistributions
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1b Qualified dividends $ 320.00
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2a Total capital gain distr. $
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2b Unrecap. Sec. 1250 gain $
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Copy B For RecipientThis is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
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PAYER'S TIN
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RECIPIENT'S TIN
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2c Section 1202 gain $
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2d Collectibles (28%) gain $
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33-1122335
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465-57-9935
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2e Section 897 ordinary dividends $
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2f Section 897 capital gain $
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RECIPIENT'S name
Chris Hoser
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3 Nondividend distributions $
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4 Federal income tax withheld $
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5 Section 199A dividends
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6 Investment expenses
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Street address (including apt. no.)
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$
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1313 W. Washington Street
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7 Foreign tax paid
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8 Foreign country or U.S. possession
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City or town, state or province, country, and ZIP or foreign postal code
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$
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Stephenville, TX 76401
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9 Cash liquidation distributions $
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10 Noncash liquidation distributions $
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11 FATCA filing requirement
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12 Exempt-interest dividends $
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13 Specified private activity bond interest dividends $
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Account number (see instructions)
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14 State
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15 State identification no
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16 State tax withheld $
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$
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Form 1099-DIV
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(keep for your records)
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Department of the Treasury – Internal Revenue Service
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1.
for instructions and the latest information.
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OMB No. 1545-0074
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2022
AttachmentSequence No. 01
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Name(s) shown on Form 1040, 1040-SR, or 1040-NR Donna and Chris Hoser
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Your social security number
465-74-3322
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1
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Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1
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2a
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Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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2a
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b
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Date of original divorce or separation agreement (see instructions) ►
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3
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Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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3
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4
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Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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4
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5
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Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . . . . . . . . . . .
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5
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6
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Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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6
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7
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Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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7
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8
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Other income:
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a
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Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8a
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()
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b
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Gambling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8b
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c
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Cancellation of debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8c
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d
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Foreign earned income exclusion from Form 2555 . . . . . . . . . . . . . . . . . . . . . . .
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8d
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()
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Income from Form 8853 . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8e
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Income from Form 8889 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8f
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Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8g
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h
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Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8h
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Prizes and awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8i
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fill in the blank c4f5eaf99005069_1
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Activity not engaged in for profit income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8j
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k
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Stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8k
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Income from the rental of personal property if you engaged in the rental for profit but were not in the business of renting such property . . . . . . . . . . . . . . . . . . . . .
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8l
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m
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Olympic and Paralympic medals and USOC prize money (see instructions) . . . . . .
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8m
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n
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Section 951(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8n
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Section 951A(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8o
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p
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Section 461(l) excess business loss adjustment . . . . . . . . . . . . . . . . . . . . . . . . .
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8p
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q
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Taxable distributions from an ABLE account (see instructions) . . . . . . . . . . . . . . .
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8q
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r
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Scholarship and fellowship grants not reported on Form W-2 . . . . . . . . . . . . . . .
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8r
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s
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Nontaxable amount of Medicaid waiver payments included on Form 1040, line 1a or 1d . . . . . . . . . . . . . . . . . . .
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8s
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()
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Pension or annuity from a nonqualifed deferred compensation plan or a nongovernmental section 457 plan . . . . . . . . . . . .
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8t
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Wages earned while incarcerated . . . . . . . . . . . . .
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8u
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z
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Other income. List type and amount: ►
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8z
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9
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Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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9
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fill in the blank c4f5eaf99005069_2
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10
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Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8 . . . . . . . . . . .
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10
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fill in the blank c4f5eaf99005069_3
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For Paperwork Reduction Act Notice, see your tax return instructions.
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Cat. No. 71479F
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Schedule 1 (Form 1040) 2022
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Complete the Hoser's Form 1040.
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Form
1040
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Department of the Treasury—Internal Revenue Service (99) U.S. Individual Income Tax Return
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2022
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OMB No. 1545-0074
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IRS Use Only
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Filing Status
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Your first name and middle initial Donna
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Last name Hoser
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Your social security number465-74-3322
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If joint return, spouse's first name and middle initial Chris
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Last name Hoser
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Spouse's social security number 465-57-9935
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Home address (number and street). If you have a P.O. box, see instructions. 1313 W. Washington Street
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Apt. no.
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Presidential Election CampaignCheck 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.
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City, town, or post office. If you have a foreign address, also complete spaces below. Stephenville
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State TX
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ZIP code 76401
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Foreign country name
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Foreign province/state/country
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Foreign postal code
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At any time during 2022, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency?
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Standard Deduction
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Someone can claim:
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Age/Blindness
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You:
Spouse:
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DependentsIf more than four dependents, see instructions and check here ► ◻
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(see instructions):
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(2) Social securitynumber
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(3) Relationshipto you
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(4) ✓ if qualifies for (see instructions):
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(1) First name
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Last name
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Child tax credit
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Credit for other dependents
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IncomeAttach Form(s)W-2 here. Alsoattach FormsW-2G and1099-R if taxwas withheld.If you did notget a FormW-2, seeinstructions.
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1a
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Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . . . . . . . . .
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1a
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fill in the blank f1a4f3fcd014fbb_7
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b
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Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . . . . . . .
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1b
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c
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Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . . . . . . . . . .
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1c
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d
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Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . .
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1d
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e
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Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . . . . .
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1e
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f
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Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . . . . . . .
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1f
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g
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Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1g
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h
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Other earned income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1h
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i
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Nontaxable combat pay election (see instructions) . . . .
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i
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z
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Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1z
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fill in the blank f1a4f3fcd014fbb_8
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AttachSch. B ifrequired.
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2a
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Tax-exempt interest . .
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2a
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fill in the blank f1a4f3fcd014fbb_9
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b
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Taxable interest . . . . . . . . . .
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2b
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fill in the blank f1a4f3fcd014fbb_10
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3a
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Qualified dividends . .
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3a
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fill in the blank f1a4f3fcd014fbb_11
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b
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Ordinary dividends . . . . .
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3b
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fill in the blank f1a4f3fcd014fbb_12
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4a
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IRA distributions . .
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4a
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b
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Taxable amount . . . . . . . . . .
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4b
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5a
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Pensions and annuities
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5a
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b
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Taxable amount . . . . . . . . . .
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5b
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Standard Deduction for–
· Single or Married filing separately, $12,950
· Married filing jointly or Qualifying widow(er), $25,900
· Head of household, $19,400
· If you checked any box under Standard Deduction, see instructions.
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6a
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Social security benefits
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6a
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b
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Taxable amount . . . . . . . . . .
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6b
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c
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If you elect to use the lump-sum election method, check here (see instructions) . ◻
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7
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Capital gain or (loss). Attach Schedule D if required. If not required, check here . ► ◻
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7
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8
|
Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8
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fill in the blank f1a4f3fcd014fbb_13
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9
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Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . ►
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9
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fill in the blank f1a4f3fcd014fbb_14
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10
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Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . . . . . . . . . . .
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10
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|
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11
|
Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . . . . . ►
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11
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fill in the blank f1a4f3fcd014fbb_15
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|
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12
|
Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . . . . . . . . .
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12
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fill in the blank f1a4f3fcd014fbb_16
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13
|
Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . . . . .
|
13
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14
|
Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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14
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fill in the blank f1a4f3fcd014fbb_17
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15
|
Subtract line 14 from line 11. This is your taxable income . . . . .
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15
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fill in the blank f1a4f3fcd014fbb_18
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For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
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Cat. No. 11320B
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Form 1040 (2022)
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Tax andCredits
|
16
|
Tax (see instructions). Check if any from Form(s): 1 ◻ 8814 2 ◻ 4972 3 ◻ . .
|
16
|
fill in the blank f1a4f3fcd014fbb_19
|
|
|
17
|
Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
17
|
|
|
|
18
|
Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
18
|
fill in the blank f1a4f3fcd014fbb_20
|
|
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19
|
Child tax credit or credit for other dependents from Schedule 8812 . . . .
|
19
|
|
|
|
20
|
Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
20
|
|
|
|
21
|
Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
21
|
|
|
|
22
|
Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . .
|
22
|
fill in the blank f1a4f3fcd014fbb_21
|
|
|
23
|
Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . . . . . .
|
23
|
|
|
|
24
|
Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ►
|
24
|
fill in the blank f1a4f3fcd014fbb_22
|
|
Payments
|
25
|
Federal income tax withheld from: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
|
|
|
|
a
|
Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
25a
|
fill in the blank f1a4f3fcd014fbb_23
|
|
|
|
|
b
|
Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
25b
|
|
|
|
|
|
c
|
Other forms (see instructions) . . . . . . . . . . . . . . . . . . . . . .
|
25c
|
|
|
|
|
|
d
|
Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
25d
|
fill in the blank f1a4f3fcd014fbb_24
|
|
If you have a qualifying child, attach Sch. EIC.
|
26
|
2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . . . . .
|
26
|
|
|
|
27
|
Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . . .
|
27
|
|
|
|
|
|
28
|
Additional child tax credit from Schedule 8812 . . . . . . . . . . . . . . . . .
|
28
|
|
|
|
|
|
29
|
American opportunity credit from Form 8863, line 8 . . . . . . . .
|
29
|
|
|
|
|
|
30
|
Reserved for future use . . . . . . . . . . . . . . . .
|
30
|
|
|
|
|
|
31
|
Amount from Schedule 3, line 15 . . . . . . . . . . . . . . . . . . . . .
|
31
|
|
|
|
|
|
32
|
Add lines 27, 28, 29 and 31. These are your total other payments and refundable credits . . ►
|
32
|
|
|
|
33
|
Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . . . . . . . . ►
|
33
|
fill in the blank f1a4f3fcd014fbb_25
|
|
Refund
|
34
|
If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . .
|
34
|
fill in the blank f1a4f3fcd014fbb_26
|
|
|
35a
|
Amount of line 34 you want refunded to you. If Form 8888 is attached, check here ► ◻
|
35a
|
fill in the blank f1a4f3fcd014fbb_27
|
|
Direct deposit?
|
► b
|
|
Routing number
|
|
|
|
|
|
|
|
|
|
► c Type: ◻ Checking ◻ Savings
|
|
|
|
|
See instructions.
|
► d
|
|
|
|
|
|
36
|
Amount of line 34 you want applied to your 2023 estimated tax . . ►
|
36
|
|
|
|
|
AmountYou Owe
|
37
|
Subtract line 33 from line 24. This is the amount you owe. For details on how to pay, go to or see instructions . . . . . . . . . . . . . . . . . . . . . . . ►
|
37
|
|
|
|
38
|
Estimated tax penalty (see instructions) . . . . . . . . . . . . . . ►
|
38
|
|
|
|
|
Third Party Designee
|
Do you want to allow another person to discuss this return with the IRS? See instructions. ►
|
▢ Yes. Complete below.▢ No
|
|
|
Designee'sname ►
|
|
Phoneno. ►
|
|
Personal identificationnumber (PIN) ►
|
|
|
|
|
|
|
|
|
|
|
SignHereJoint return? See instructions. Keep a copy for your records.
|
|
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
|
|
|
►
|
Your signature
|
Date
|
Your occupation Nurse
|
|
If the IRS sent you an Identity Protection PIN, enter it here
|
|
(see inst.) ►
|
|
|
|
|
|
|
|
|
|
|
Spouse's signature. If a joint return, both must sign.
|
Date
|
Spouse's occupation Student
|
|
If the IRS sent your spouse an Identity Protection PIN, enter it here
|
|
(see inst.) ►
|
|
|
|
|
|
|
|
|
|
Phone no.
|
Email address
|
|
Paid Preparer Use Only
|
|
Preparer's name
|
Preparer's signature
|
Date
|
PTIN
|
Check if:◻ Self-employed
|
|
|
|
Firm's name ►
|
Phone no.
|
|
|
|
Firm's address ►
|
Firm's EIN ►
|
|
Go to for instructions and the latest information.
|
|
Form 1040 (2022)
|
|
|
|
|
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