1040 U.S.

Individual Income Tax Return 2019

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

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying person is
one box.
a child but not your dependent. a
Your first name and middle initial Last name Your social security number
Jose Rivera Rivera 582-93-4508
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
Check here if you, or your spouse if filing
8767 Turkey Ridge Rd
jointly, want $3 to go to this fund.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your
Breinigsville PA 18031-2040 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and  here a

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

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

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

Kylie S Caraballo Martinez 384-83-1003 Niece

Sindy Martinez 040-70-3466 Sister

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

2a Tax-exempt interest . . . . 2a b Taxable interest. Attach Sch. B if required 2b
3a Qualified dividends . . . . 3a b Ordinary dividends. Attach Sch. B if required 3b
Standard
Deduction for— 4a IRA distributions . . . . . 4a b Taxable amount . . . . . . 4b
• Single or Married
filing separately,
c Pensions and annuities . . . 4c d Taxable amount . . . . . . 4d
$12,200 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b
• Married filing
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . a 6
jointly or Qualifying
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 7a 25,748.
$24,400
• Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . a 7b 25,748.
household, 1,819.
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a
• If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . a 8b 23,929.
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 18,350.
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10 1,116.
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 19,466.
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 4,463.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
 Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 448.
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b 448.
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a 448.
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b 448.
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 0.
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 3,638.
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . a 16 3,638.
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17

• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . . . . 18a 2,744.
attach Sch. EIC.
• If you have b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b 1,400.
nontaxable c American opportunity credit from Form 8863, line 8 . . . . . . . . 18c
combat pay, see
instructions. d Schedule 3, line 14 . . . . . . . . . . . . . . . . . 18d
e Add lines 18a through 18d. These are your total other payments and refundable credits . . . . . a 18e 4,144.
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19 4,144.
Refund 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 506.
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a 506.
Direct deposit? a b Routing number 0 3 1 2 0 2 0 8 4 a c Type: Checking Savings
See instructions.
a d Account number 3 8 3 0 1 3 8 1 3 7 2 3
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . a 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . a 23
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . . a 24
Third Party Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes. Complete below.
Designee No
(Other than Designee’s Phone Personal identification
paid preparer) name a no. a number (PIN) a

Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true,
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
F

Joint return? Barbero (see inst.)

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

Phone no. Email address

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

Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 04/05/20 Intuit.cg.cfp.sp Form 1040 (2019)
SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 01
Name(s) shown on Form 1040 or 1040-SR Your social security number
Jose Rivera Rivera 582-93-4508
At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any
virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . 1
2a Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Date of original divorce or separation agreement (see instructions) a
3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . 3 25,748.
4 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . 4
5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . 5
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . 6
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income. List type and amount a
8
9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a . . . . . . . . 9 25,748.
Part II Adjustments to Income
10 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach
Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . . . 12
13 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . . 13
14 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . 14 1,819.
15 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . 15
16 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . 16
17 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . 17
18a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18a
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . . a
c Date of original divorce or separation agreement (see instructions) a
19 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . 20
21 Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . 21
22 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040 or
1040-SR, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 1,819.
For Paperwork Reduction Act Notice, see your tax return instructions. REV 04/05/20 Intuit.cg.cfp.sp Schedule 1 (Form 1040 or 1040-SR) 2019
SCHEDULE 2 OMB No. 1545-0074
Additional Taxes
2019
(Form 1040 or 1040-SR)
a Attach to Form 1040 or 1040-SR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 02
Name(s) shown on Form 1040 or 1040-SR Your social security number
Jose Rivera Rivera 582-93-4508
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . . . . 1
2 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . 2
3 Add lines 1 and 2. Enter here and include on Form 1040 or 1040-SR, line 12b . . . . . . . . 3
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . 4 3,638.
5 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . . . . 5
6 Additional tax on IRAs, other qualified retirement plans, and other tax-favored accounts. Attach Form
5329 if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7a Household employment taxes. Attach Schedule H . . . . . . . . . . . . . . . . . 7a
b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required . . . . 7b
8 Taxes from: a Form 8959 b Form 8960
c Instructions; enter code(s) 8
9 Section 965 net tax liability installment from Form 965-A . . . . . . . 9
10 Add lines 4 through 8. These are your total other taxes. Enter here and on Form 1040 or 1040-SR,
line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 3,638.
For Paperwork Reduction Act Notice, see your tax return instructions. REV 04/05/20 Intuit.cg.cfp.sp Schedule 2 (Form 1040 or 1040-SR) 2019
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074

2019
(Form 1040 or 1040-SR) (Sole Proprietorship)
a Go to www.irs.gov/ScheduleC for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
Jose Rivera Rivera 582-93-4508
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
Barbero a 9 9 9 9 9 9
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)

E Business address (including suite or room no.) a 8767 Turkey Ridge Rd

City, town or post office, state, and ZIP code Breinigsville, PA 18031-2040
F Accounting method: (1) Cash (2) Accrual (3) Other (specify) a
G Did you “materially participate” in the operation of this business during 2019? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . a

I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No
J If “Yes,” did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . a 1 33,313.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 33,313.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 33,313.
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . a 7 33,313.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 18 Office expense (see instructions) 18
9 Car and truck expenses (see 19 Pension and profit-sharing plans . 19
instructions) . . . . . 9 3,480. 20 Rent or lease (see instructions):
10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a
11 Contract labor (see instructions) 11 b Other business property . . . 20b
12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21
13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 1,800.
expense deduction (not
included in Part III) (see 23 Taxes and licenses . . . . . 23
instructions) . . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . 24a
(other than on line 19) . . 14 b Deductible meals (see
15 Insurance (other than health) 15 instructions) . . . . . . . 24b 1,260.
16 Interest (see instructions): 25 Utilities . . . . . . . . 25
a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) . 26
b Other . . . . . . 16b 27a Other expenses (from line 48) . . 27a 1,025.
17 Legal and professional services
17 b Reserved for future use . . . 27b
28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28 7,565.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 25,748.
30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method (see instructions).
Simplified method filers only: enter the total square footage of: (a) your home:
and (b) the part of your home used for business: . Use the Simplified
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30
31 Net profit or (loss). Subtract line 30 from line 29.

}
• If a profit, enter on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or Form 1040-NR, line
13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and 31 25,748.
trusts, enter on Form 1041, line 3.
• If a loss, you must go to line 32.

}
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or
Form 1040-NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see the line 32a All investment is at risk.
31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
• If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 04/05/20 Intuit.cg.cfp.sp Schedule C (Form 1040 or 1040-SR) 2019
Schedule C (Form 1040 or 1040-SR) 2019 Page 2
Part III Cost of Goods Sold (see instructions)

33 Method(s) used to
value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35

36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36

37 Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . 37

38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38

39 Other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40

41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9
and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must
file Form 4562.

43 When did you place your vehicle in service for business purposes? (month, day, year) a 05/20/2019

44 Of the total number of miles you drove your vehicle during 2019, enter the number of miles you used your vehicle for:

a Business 6,000 b Commuting (see instructions) c Other 92,000

45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . Yes No

46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No

47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part V Other Expenses. List below business expenses not included on lines 8–26 or line 30.

Uniforme y zapatos 1,025.

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48 1,025.

REV 04/05/20 Intuit.cg.cfp.sp Schedule C (Form 1040 or 1040-SR) 2019
SCHEDULE SE OMB No. 1545-0074
(Form 1040 or 1040-SR) Self-Employment Tax
2019
a Go to www.irs.gov/ScheduleSE for instructions and the latest information. Attachment
Department of the Treasury
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, or 1040-NR. Sequence No. 17

Name of person with self-employment income (as shown on Form 1040, 1040-SR, or 1040-NR) Social security number of person
Jose Rivera Rivera with self-employment income a 582-93-4508
Before you begin: To determine if you must file Schedule SE, see the instructions.

May I Use Short Schedule SE or Must I Use Long Schedule SE?

Note: Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions.

Did you receive wages or tips in 2019?

No Yes
d d d
Are you a minister, member of a religious order, or Christian
Yes Was the total of your wages and tips subject to social security Yes
Science practitioner who received IRS approval not to be taxed a or railroad retirement (tier 1) tax plus your net earnings from a
on earnings from these sources, but you owe self-employment
self-employment more than $132,900?
tax on other earnings?

No
No
d d

Are you using one of the optional methods to figure your net Did you receive tips subject to social security or Medicare tax Yes
Yes a
earnings (see instructions)? a that you didn't report to your employer?

No
No d
d
No Did you report any wages on Form 8919, Uncollected Social Yes
Did you receive church employee income (see instructions) Yes ` Security and Medicare Tax on Wages? a
reported on Form W-2 of $108.28 or more? a

No
d d
You may use Short Schedule SE below a You must use Long Schedule SE on page 2

Section A—Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE.

1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065),
box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a
b If you received social security retirement or disability benefits, enter the amount of Conservation
Reserve Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065),
box 20, code AH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b ( )
2 Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other
than farming). Ministers and members of religious orders, see instructions for types of income to
report on this line. See instructions for other income to report . . . . . . . . . . . . . 2 25,748.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . 3 25,748.
4 Multiply line 3 by 92.35% (0.9235). If less than $400, you don't owe self-employment tax; don't file
this schedule unless you have an amount on line 1b . . . . . . . . . . . . . . . . a 4 23,778.
Note: If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see
instructions.
5 Self-employment tax. If the amount on line 4 is:
• $132,900 or less, multiply line 4 by 15.3% (0.153). Enter the result here and on Schedule 2 (Form
1040 or 1040-SR), line 4, or Form 1040-NR, line 55.
• More than $132,900, multiply line 4 by 2.9% (0.029). Then, add $16,479.60 to the result.
Enter the total here and on Schedule 2 (Form 1040 or 1040-SR), line 4, or Form 1040-NR, line 55 . 5 3,638.
6 Deduction for one-half of self-employment tax.
Multiply line 5 by 50% (0.50). Enter the result here and on Schedule 1 (Form
1040 or 1040-SR), line 14, or Form 1040-NR, line 27 . . . . . . . . 6 1,819.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 04/05/20 Intuit.cg.cfp.sp Schedule SE (Form 1040 or 1040-SR) 2019
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040 or 1040-SR) 1040 `
Qualifying Child Information
2019
.........
1040-SR
a Complete and attach to Form 1040 or 1040-SR only if you have a
Department of the Treasury qualifying child. EIC Attachment
Internal Revenue Service (99) a Go to www.irs.gov/ScheduleEIC for the latest information. Sequence No. 43
Name(s) shown on return Your social security number
Jose Rivera Rivera 582-93-4508
• See the instructions for Form 1040 or 1040-SR, line 18a, to make sure that (a) you can take the EIC, and (b)
Before you begin: you have a qualifying child.
• 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 or disallow your EIC. If the name or SSN on the child’s
social security card is not correct, call the Social Security Administration at 1-800-772-1213.

F
!
CAUTION
• You can't claim the EIC for a child who didn't live with you for more than half of the year.
• 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.

Qualifying Child Information Child 1 Child 2 Child 3

1 Child’s name First name Last name First name Last name First name Last name

If you have more than three qualifying

children, you have to list only three to get
the maximum credit. Kylie S Caraballo Martinez
2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040 or
1040-SR, line 18a, unless the child was
born and died in 2019. If your child was
born and died in 2019 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. 384-83-1003
3 Child’s year of birth
Year 2 0 1 4 Year Year
If born after 2000 and the child is If born after 2000 and the child is If born after 2000 and the child is
younger than you (or your spouse, if younger than you (or your spouse, if younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b;
go to line 5. go to line 5. go to line 5.

4 a Was the child under age 24 at the end of

2019, a student, and younger than you (or Yes. No. Yes. No. Yes. No.
your spouse, if filing jointly)?
Go to Go to line 4b. Go to Go to line 4b. Go to Go to line 4b.
line 5. line 5. line 5.

b Was the child permanently and totally

disabled during any part of 2019? Yes. No. Yes. No. Yes. No.
Go to The child is not a Go to The child is not a Go to The child is not a
line 5. qualifying child. line 5. qualifying child. line 5. qualifying child.

5 Child’s relationship to you

(for example, son, daughter, grandchild,
niece, nephew, eligible foster child, etc.) Niece
6 Number of months child lived
with you in the United States
during 2019

• If the child lived with you for more than

half of 2019 but less than 7 months,
enter “7.”
• If the child was born or died in 2019 and 12 months months months
your home was the child’s home for more
than half the time he or she was alive Do not enter more than 12 Do not enter more than 12 Do not enter more than 12
during 2019, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax REV 04/05/20 Intuit.cg.cfp.sp Schedule EIC (Form 1040 or 1040-SR) 2019
BAA
return instructions.
SCHEDULE 8812 OMB No. 1545-0074
Additional Child Tax Credit . . 1040
.......
`
2019
(Form 1040 or 1040-SR) 1040-SR
.........
a
Attach to Form 1040, 1040-SR, or 1040-NR. 1040-NR
Department of the Treasury
a Go to www.irs.gov/Schedule8812 for instructions and the latest 8812 Attachment
Internal Revenue Service (99) information. Sequence No. 47

Name(s) shown on return Your social security number

Jose Rivera Rivera 582-93-4508
Part I All Filers
Caution: If you file Form 2555, stop here; you cannot claim the additional child tax credit.
1 If you are required to use the worksheet in Pub. 972, enter the amount from line 10 of the Child Tax Credit
and Credit for Other Dependents Worksheet in the publication. Otherwise:
1040 and Enter the amount from line 8 of your Child Tax Credit and Credit for Other Dependents
1040-SR filers: Worksheet (see the instructions for Forms 1040 and 1040-SR, line 13a).
1040-NR filers: Enter the amount from line 8 of your Child Tax Credit and Credit for Other Dependents
Worksheet (see the instructions for Form 1040-NR, line 49).
} 1 2,500.

2 Enter the amount from Form 1040, line 13a; Form 1040-SR, line 13a; or Form 1040-NR, line 49 . . . . . 2 448.
3 Subtract line 2 from line 1. If zero, stop here; you cannot claim this credit . . . . . . . . . . . . 3 2,052.
4 Number of qualifying children under 17 with the required social security number: 1 x $1,400.
Enter the result. If zero, stop here; you cannot claim this credit . . . . . . . . . . . . . . . 4 1,400.
TIP: The number of children you use for this line is the same as the number of children you used for line 1 of the
Child Tax Credit and Credit for Other Dependents Worksheet.
5 Enter the smaller of line 3 or line 4 . . . . . . . . . . . . . . . . . . . . . . . 5 1,400.
6a Earned income (see instructions) . . . . . . . . . . . . . . . . 6a 23,929.
b Nontaxable combat pay (see instructions) . . . . . . 6b
7 Is the amount on line 6a more than $2,500?
No. Leave line 7 blank and enter -0- on line 8.
Yes. Subtract $2,500 from the amount on line 6a. Enter the result . . . . . 7 21,429.
8 Multiply the amount on line 7 by 15% (0.15) and enter the result . . . . . . . . . . . . . . . 8 3,214.
Next. On line 4, is the amount $4,200 or more?
No. If line 8 is zero, stop here; you cannot claim this credit. Otherwise, skip Part II and enter the smaller
of line 5 or line 8 on line 15.
Yes. If line 8 is equal to or more than line 5, skip Part II and enter the amount from line 5 on line 15.
Otherwise, go to line 9.
Part II Certain Filers Who Have Three or More Qualifying Children
9 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 . . . . . . . . . . . . . . . . . 9

}
10 1040 and Enter the total of the amounts from Schedule 1 (Form 1040 or 1040-SR),
1040-SR filers: line 14, and Schedule 2 (Form 1040 or 1040-SR), line 5, plus any taxes
that you identified using code “UT” and entered on Schedule 2 (Form
1040 or 1040-SR), line 8. 10
1040-NR filers: Enter the total of the amounts from Form 1040-NR, lines 27 and
56, plus any taxes that you identified using code “UT” and
entered on line 60.
11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . 11
12 1040 and Enter the total of the amounts from Form 1040 or 1040-SR, line
1040-SR filers: 18a, and Schedule 3 (Form 1040 or 1040-SR), line 11.
1040-NR filers: Enter the amount from Form 1040-NR, line 67.
} 12
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 13
14 Enter the larger of line 8 or line 13 . . . . . . . . . . . . . . . . . . . . . . . 14
Next, enter the smaller of line 5 or line 14 on line 15.
Part III Additional Child Tax Credit
15 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . . . . 15 1,400.
Enter this amount on
Form 1040, line 18b;
Form 1040-SR, line 18b; or
. . 1040
.......
Form 1040-NR, line 64.
1040-SR
.........
1040-NR `

For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 04/05/20 Intuit.cg.cfp.sp Schedule 8812 (Form 1040 or 1040-SR) 2019
Form 8995 Qualified Business Income Deduction OMB No. 1545-0123

Simplified Computation
a Attach
to your tax return.
2019
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form8995 for instructions and the latest information. Sequence No. 55
Name(s) shown on return Your taxpayer identification number
Jose Rivera Rivera 582-93-4508

1 (a) Trade, business, or aggregation name (b) Taxpayer (c) Qualified business
identification number income or (loss)

i Jose Rivera Rivera 582934508 23,929.

ii

iii

iv

2 Total qualified business income or (loss). Combine lines 1i through 1v,

column (c) . . . . . . . . . . . . . . . . . . . . . . 2 23,929.
3 Qualified business net (loss) carryforward from the prior year . . . . . . . 3 ( )
4 Total qualified business income. Combine lines 2 and 3. If zero or less, enter -0- 4 23,929.
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . 5 4,786.
6 Qualified REIT dividends and publicly traded partnership (PTP) income or (loss)
(see instructions) . . . . . . . . . . . . . . . . . . . . 6
7 Qualified REIT dividends and qualified PTP (loss) carryforward from the prior
year . . . . . . . . . . . . . . . . . . . . . . . . . 7 ( )
8 Total qualified REIT dividends and PTP income. Combine lines 6 and 7. If zero
or less, enter -0- . . . . . . . . . . . . . . . . . . . . 8
9 REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . . 9
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . 10 4,786.
11 Taxable income before qualified business income deduction . . . . . . 11 5,579.
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . 12 0.
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . 13 5,579.
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . 14 1,116.
15 Qualified business income deduction. Enter the lesser of line 10 or line 14. Also enter this amount on
the applicable line of your return . . . . . . . . . . . . . . . . . . . . . . a 15 1,116.
16 Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . . 16 ( 0. )
17 Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 6 and 7. If greater than
zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 ( 0. )
For Privacy Act and Paperwork Reduction Act Notice, see instructions. REV 04/05/20 Intuit.cg.cfp.sp Form 8995 (2019)
 1900116342

PA-40 - 2019
Pennsylvania Income Tax Return
ENTER ONE LETTER OR NUMBER IN EACH BOX (07-19)

N Extension. N Amended Return.

582934508
R Residency Status.
RIVERA RIVERA PA Resident/Nonresident/Part-Year Resident
from to
JOSE Occupation BARBERO S Single, Married/Filing Jointly,
Married/Filing Separately, Final Return
Occupation
N Deceased

N Taxpayer Date of Death

N Spouse Date of Death

8767 TURKEY RIDGE RD
N Farmers.
BREINIGSVILLE PA 18031 School District Name LITTLESTOWN A
________________________

787-528-0850 01520

1a Gross Compensation. Do not include exempt income, such as combat zone pay and 1a 0
qualifying retirement benefits. See the instructions.

1b Unreimbursed Employee Business Expenses. 1b 0

1c Net Compensation. Subtract Line 1b from Line 1a. 1c 0

2 Interest Income. Complete PA Schedule A if required. 2 0

3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. 3 0
4 Net Income or Loss from the Operation of a Business, Profession or Farm. 4 0

5 Net Gain or Loss from the Sale, Exchange or Disposition of Property. 5 0

6 Net Income or Loss from Rents, Royalties, Patents or Copyrights. 6 0
7 Estate or Trust Income. Complete and submit PA Schedule J. 7 0
8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 8 0
9 Total PA Taxable Income. Add only the positive income amounts from Lines 1c, 9 0
2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6.

10 Other Deductions. Enter the appropriate code for the type of deduction. N 10 0
See the instructions for additional information.
11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9. 11 0

1555 REV 03/27/20 INTUIT.CG.CFP.SP

Page 1 of 2
EC OFFICIAL USE ONLY FC

1900116342
 1900216357
PA-40 - 2019
Social Security Number

582934508 Name(s) JOSE RIVERA RIVERA

12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307). 12 0

13 Total PA Tax Withheld. See the instructions. 13 0

14 Credit from your 2018 PA Income Tax return. 14 0

15 2019 Estimated Installment Payments. REV-459B included. N 15 0
16 2019 Extension Payment. 16 0
17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) 17 0
18 Total Estimated Payments and Credits. Add Lines 14, 15, 16 and 17. 18 0
Tax Forgiveness Credit. Submit PA Schedule SP.
19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased 19a 00
19b Dependents, Section II, Line 2, PA Schedule SP 19b 00
20 Total Eligibility Income from Section III, Line 11, PA Schedule SP. 20 0
21 Tax Forgiveness Credit from Section IV, Line 16, PA Schedule SP. 21 0

22 Resident Credit. Submit your PA Schedule(s) G-L and/or RK-1. 22 0

23 Total Other Credits. Submit your PA Schedule OC. 23 0
24 TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22 and 23. 24 0
25 USE TAX. Due on internet, mail order or out-of-state purchases. See instructions. 25 0
26 TAX DUE. If the total of Line 12 and Line 25 is more than line 24, enter the difference here. 26 0
27 Penalties and Interest. See the instructions. Enter Code: 27 0
If including form REV-1630/REV-1630A, mark the box. N
28 TOTAL PAYMENT DUE. See the instructions. 28 0
29 OVERPAYMENT. If Line 24 is more than the total of Line 12, Line 25 and Line 27, enter 29 0
the difference here.
The total of Lines 30 through 36 must equal Line 29.
30 Refund – Amount of Line 29 you want as a check mailed to you. REFUND 30 0
31 Credit – Amount of Line 29 you want as a credit to your 2020 estimated account. 31 0

32 Refund donation line. Enter the organization code and donation amount. See instructions. 32
33 Refund donation line. Enter the organization code and donation amount. See instructions. 33
34 Refund donation line. Enter the organization code and donation amount. See instructions. 34
35 Refund donation line. Enter the organization code and donation amount. See instructions. 35
36 Refund donation line. Enter the organization code and donation amount. See instructions. 36

Signature(s). Under penalties of perjury, I (we) declare that I (we) have examined this return, including all
accompanying schedules and statements, and to the best of my (our) belief, they are true, correct, and complete.
Your Signature Spouse’s Signature, if filing jointly

Preparer’s Name and Telephone Number Date E-File Opt Out N

SELF-PREPARED
Firm FEIN
Preparer’s PTIN
1555 REV 03/27/20 INTUIT.CG.CFP.SP
Page 2 of 2

1900216357 1900216357