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Your first name and middle initial |
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Last name |
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Your social security number |
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If joint return, spouse’s first name and middle initial |
Last name |
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Spouse’s social security number |
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Home address (number and street). If you have a P.O. box, see instructions. |
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Apt. no. |
Presidential Election Campaign |
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Check here if you, or your |
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spouse if filing jointly, want $3 |
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City, town, or post office. If you have a foreign address, also complete spaces below. |
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State |
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ZIP code |
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to go to this fund. Checking a |
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box below will not change |
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Foreign country name |
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Foreign province/state/county |
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Foreign postal code |
your tax or refund. |
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You |
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Spouse |
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At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? |
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Yes |
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No |
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Standard |
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Someone can claim: |
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You as a dependent |
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Your spouse as a dependent |
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Deduction |
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Spouse itemizes on a separate return or you were a dual-status alien |
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Age/Blindness You: |
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Were born before January 2, 1957 |
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Are blind |
Spouse: |
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Was born before January 2, 1957 |
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Is blind |
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Dependents (see instructions): |
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(2) Social security |
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(3) Relationship |
(4) ✔ if qualifies for (see instructions): |
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If more |
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(1) First name |
Last name |
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number |
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to you |
Child tax credit |
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Credit for other dependents |
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than four |
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dependents, |
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see instructions |
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and check |
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here ▶ |
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Attach |
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1 |
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Wages, salaries, tips, etc. Attach Form(s) W-2 |
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1 |
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2 |
a |
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Tax-exempt interest . . . |
2a |
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b Taxable interest |
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2b |
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Sch. B if |
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3 |
a |
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Qualified dividends . . . |
3a |
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b Ordinary dividends . . . . |
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3b |
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required. |
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4a |
IRA distributions . . . . |
4a |
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b Taxable amount |
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4b |
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5a |
Pensions and annuities . . |
5a |
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b Taxable amount |
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5b |
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Standard |
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6a |
Social security benefits . . |
6a |
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b Taxable amount |
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6b |
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Deduction for— |
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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• Single or |
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8 |
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Other income from Schedule 1, line 10 |
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8 |
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Married filing |
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separately, |
9 |
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Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income |
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9 |
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$12,550 |
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• Married filing |
10 |
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Adjustments to income from Schedule 1, line 26 |
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10 |
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jointly or |
11 |
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Subtract line 10 from line 9. This is your adjusted gross income |
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▶ |
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11 |
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Qualifying |
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widow(er), |
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12 |
a |
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Standard deduction or itemized deductions (from Schedule A) |
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12a |
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$25,100 |
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b |
Charitable contributions if you take the standard deduction (see instructions) |
12b |
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• Head of |
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household, |
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c |
Add lines 12a and 12b |
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12c |
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$18,800 |
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• If you checked |
13 |
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Qualified business income deduction from Form 8995 or Form 8995-A |
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13 |
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any box under |
14 |
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Add lines 12c and 13 |
. . . . . . . . . . . . . . . . . . . . . . |
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14 |
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Standard |
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Deduction, |
15 |
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Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- |
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15 |
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see instructions. |
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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 (2021) |