Oscar Velazquez Ortega 2021 - TaxReturn

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The Form 1040 is used to file individual US income taxes. It collects information about a filer's income, deductions, credits, and tax owed or refund amount. Standard information includes names, addresses, dependents, income sources, adjustments, deductions, credits and amount of tax.

The Form 1040 collects a filer's name, address, filing status, dependents, income from various sources like wages, interest, dividends, retirement distributions, social security benefits, capital gains or losses, and other income. It also includes adjustments to income and the standard or itemized deductions.

To calculate adjusted gross income (AGI), you start with total income by adding all income sources reported on the form. Then you subtract any adjustments to income, such as IRA contributions or student loan interest, to arrive at the AGI amount.

1040 U.S.

Individual Income Tax Return 2021 (99)


Form Department of the Treasury—Internal Revenue Service

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 your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying
one box.
person is a child but not your dependent a
Your first name and middle initial Last name Your social security number
Oscar J Velazquez-Ortega 002-65-4071
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
Maria E Rivera-Martinez 882-52-3927
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
20956 SW 124th Avenue Rd Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
Miami FL 331775750 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes No

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, 1957 Are blind Spouse: Was born before January 2, 1957 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4)  if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four Onice C Velazquez-Rivera 056-49-3614 Daughter
dependents,
see instructions
and check
here a
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . 1 18,000.
Attach 2a Tax-exempt interest . . . 2a 2b
b Taxable interest . . . . .
Sch. B if
3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
required.
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Standard 6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
Deduction for— a
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . 7
• Single or
Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8 -8,450.
separately,
$12,550 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . a 9 9,550.
• Married filing 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
jointly or
11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . a 11 9,550.
Qualifying
widow(er),
$25,100
12a Standard deduction or itemized deductions (from Schedule A) . . 12a 25,100.
• Head of b Charitable contributions if you take the standard deduction (see instructions) 12b 600.
household,
$18,800 c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . 12c 25,700.
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13 0.
any box under
Standard 14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . 14 25,700.
Deduction,
see instructions.
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . 15 0.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2021)
Form 1040 (2021) Page 2
16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 0.
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 0.
19 Nonrefundable 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 0.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 0.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . a 24 0.
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 80.
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 80.
26 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . . 26
If you have a
qualifying child, 27a Earned income credit (EIC) . . . . . . . . . . . . . . 27a 3,618.
attach Sch. EIC.
Check here if you were born after January 1, 1998, and before
January 2, 2004, and you satisfy all the other requirements for
taxpayers who are at least age 18, to claim the EIC. See instructions a
b Nontaxable combat pay election . . . . 27b
c Prior year (2019) earned income . . . . 27c
28 Refundable child tax credit or additional child tax credit from Schedule 8812 28 1,500.
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Recovery rebate credit. See instructions . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits a 32 5,118.
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . a 33 5,198.
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 5,198.
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . a 35a 5,198.
Direct deposit? ab Routing number 0 6 3 1 0 7 5 1 3 a c Type: Checking Savings
See instructions. a
d Account number 6 7 9 4 7 5 0 7 7 5
36 Amount of line 34 you want applied to your 2022 estimated tax . . a 36
Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions . a 37
You Owe 38 Estimated tax penalty (see instructions) . . . . . . . . . a 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . a Yes. Complete below. No
Designee’s Phone Personal identification
name a no. a number (PIN) a
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
Sign 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? Construction Worker (see inst.) a


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.) a
Homemaker
Phone no. (305)333-4869 Email address
Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name a Self-Prepared Phone no.
Use Only a a
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 03/12/22 Intuit.cg.cfp.sp Form 1040 (2021)
SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
(Form 1040)
Department of the Treasury
a Attach to Form 1040, 1040-SR, or 1040-NR. 2021
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, 1040-SR, or 1040-NR Your social security number
Oscar J Velazquez-Ortega & Maria E Rivera-Martinez 002-65-4071
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
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:
a Net operating loss . . . . . . . . . . . . . . . . . . 8a ( 8,450. )
b Gambling income . . . . . . . . . . . . . . . . . . . 8b
c Cancellation of debt . . . . . . . . . . . . . . . . . . 8c
d Foreign earned income exclusion from Form 2555 . . . . . 8d ( )
e Taxable Health Savings Account distribution . . . . . . . . 8e
f Alaska Permanent Fund dividends . . . . . . . . . . . . 8f
g Jury duty pay . . . . . . . . . . . . . . . . . . . . 8g
h Prizes and awards . . . . . . . . . . . . . . . . . . 8h
i Activity not engaged in for profit income . . . . . . . . . 8i
j Stock options . . . . . . . . . . . . . . . . . . . . 8j
k 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 . . . . . . . . . . . . . . . . . . . . . . 8k
l Olympic and Paralympic medals and USOC prize money (see
instructions) . . . . . . . . . . . . . . . . . . . . . 8l
m Section 951(a) inclusion (see instructions) . . . . . . . . . 8m
n Section 951A(a) inclusion (see instructions) . . . . . . . . 8n
o Section 461(l) excess business loss adjustment . . . . . . . 8o
p Taxable distributions from an ABLE account (see instructions) . 8p
z Other income. List type and amount a
8z 0.
9 Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . 9 -8,450.
10 Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or
1040-NR, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 -8,450.
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040) 2021
Schedule 1 (Form 1040) 2021 Page 2

Part II Adjustments to Income


11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Certain business expenses of reservists, performing artists, and fee-basis government
officials. Attach Form 2106 . . . . . . . . . . . . . . . . . . . . . . . 12
13 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . 13
14 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . 14
15 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . 15
16 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . 16
17 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . 17
18 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . 18
19a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19a
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . a
c Date of original divorce or separation agreement (see instructions) a
20 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . 21
22 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Archer MSA deduction . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Other adjustments:
a Jury duty pay (see instructions) . . . . . . . . . . . . . 24a
b Deductible expenses related to income reported on line 8k from
the rental of personal property engaged in for profit . . . . . 24b
c Nontaxable amount of the value of Olympic and Paralympic
medals and USOC prize money reported on line 8l . . . . . 24c
d Reforestation amortization and expenses . . . . . . . . . 24d
e Repayment of supplemental unemployment benefits under the
Trade Act of 1974 . . . . . . . . . . . . . . . . . . . 24e
f Contributions to section 501(c)(18)(D) pension plans . . . . . 24f
g Contributions by certain chaplains to section 403(b) plans . . 24g
h Attorney fees and court costs for actions involving certain
unlawful discrimination claims (see instructions) . . . . . . 24h
i Attorney fees and court costs you paid in connection with an
award from the IRS for information you provided that helped the
IRS detect tax law violations . . . . . . . . . . . . . . 24i
j Housing deduction from Form 2555 . . . . . . . . . . . 24j
k Excess deductions of section 67(e) expenses from Schedule K-1
(Form 1041) . . . . . . . . . . . . . . . . . . . . . 24k
z Other adjustments. List type and amount a
24z
25 Total other adjustments. Add lines 24a through 24z . . . . . . . . . . . . . 25
26 Add lines 11 through 23 and 25. These are your adjustments to income. Enter
here and on Form 1040 or 1040-SR, line 10, or Form 1040-NR, line 10a . . . . . 26
BAA REV 03/12/22 Intuit.cg.cfp.sp Schedule 1 (Form 1040) 2021
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040) 1040 `
2021
Qualifying Child Information .........

a
1040-SR
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
Oscar J Velazquez-Ortega & Maria E Rivera-Martinez 002-65-4071
If you are separated from your spouse, filing a separate return and meet the requirements to claim the EIC (see instructions), check here

Before you begin: • See the instructions for Form 1040, lines 27a, 27b, and 27c, to make sure that (a) you can take the EIC, and
(b) you have a qualifying child.
• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social
security card. Otherwise, at the time we process your return, we may reduce your EIC. If the name or SSN on
the child’s social security card is not correct, call the Social Security Administration at 800-772-1213.
• If you have a child who meets the conditions to be your qualifying child for purposes of claiming the EIC, but that
child doesn’t have an SSN as defined in the instructions for Form 1040, lines 27a, 27b, and 27c, see the instructions.

F
• You can’t claim the EIC for a child who didn’t live with you for more than half of the year.
!
CAUTION
• If your child doesn’t have an SSN as defined in the instructions for Form 1040, lines 27a, 27b, and 27c, see the instructions.
• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.
• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.

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. Onice C Velazquez-Rivera
2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040, lines 27a,
27b, and 27c, unless the child was born
and died in 2021 or you are claiming the
self-only EIC (see instructions). If your
child was born and died in 2021 and did
not have an SSN, enter “Died” on this line
and attach a copy of the child’s birth
certificate, death certificate, or hospital
medical records showing a live birth. 056-49-3614
3 Child’s year of birth Year 2 0 0 7 Year Year
If born after 2002 and the child is If born after 2002 and the child is If born after 2002 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


2021, 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 2021? 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.) Daughter
6 Number of months child lived
with you in the United States
during 2021
• If the child lived with you for more than
half of 2021 but less than 7 months,
enter “7.”
• If the child was born or died in 2021 and 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 2021, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax BAA REV 03/12/22 Intuit.cg.cfp.sp Schedule EIC (Form 1040) 2021
return instructions.
SCHEDULE 8812 Credits for Qualifying Children `
OMB No. 1545-0074
(Form 1040) . .1040
and Other Dependents .......

a Attach to Form 1040, 1040-SR, or 1040-NR.


1040-SR
.........
1040-NR 2021
Department of the Treasury 8812 Attachment
Internal Revenue Service (99) a Go to www.irs.gov/Schedule8812 for instructions and the latest information. Sequence No. 47

Name(s) shown on return Your social security number


Oscar J Velazquez-Ortega & Maria E Rivera-Martinez 002-65-4071
Part I-A Child Tax Credit and Credit for Other Dependents
1 Enter the amount from line 11 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . 1 9,550.
2a Enter income from Puerto Rico that you excluded . . . . . . . . . . . 2a
b Enter the amounts from lines 45 and 50 of your Form 2555 . . . . . . . . 2b 0.
c Enter the amount from line 15 of your Form 4563 . . . . . . . . . . . 2c
d Add lines 2a through 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d 0.
3 Add lines 1 and 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9,550.
4a Number of qualifying children under age 18 with the required social security number 4a 1.
b Number of children included on line 4a who were under age 6 at the end of 2021 . . 4b 0.
c Subtract line 4b from line 4a . . . . . . . . . . . . . . . . . 4c 1.
5 If line 4a is more than zero, enter the amount from the Line 5 Worksheet; otherwise, enter -0- . . . . . . 5 3,000.
6 Number of other dependents, including any qualifying children who are not under age
18 or who do not have the required social security number . . . . . . . . 6 0.
Caution: Do not include yourself, your spouse, or anyone who is not a U.S. citizen, U.S. national, or U.S. resident
alien. Also, do not include anyone you included on line 4a.
7 Multiply line 6 by $500 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Add lines 5 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 3,000.
9 Enter the amount shown below for your filing status.
• Married filing jointly—$400,000
• All other filing statuses—$200,000 }
. . . . . . . . . . . . . . . . . . . . . . 9 400,000.
10 Subtract line 9 from line 3.

}
• If zero or less, enter -0-.
• If more than zero and not a multiple of $1,000, enter the next multiple of $1,000. For
example, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc. . . . . . . . 10 0.
11 Multiply line 10 by 5% (0.05) . . . . . . . . . . . . . . . . . . . . . . . . . 11 0.
12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 12 3,000.
13 Check all the boxes that apply to you (or your spouse if married filing jointly).
A Check here if you (or your spouse if married filing jointly) had a principal place of abode in the United States
for more than half of 2021 . . . . . . . . . . . . . . . . . . . . . . . .
B Check here if you (or your spouse if married filing jointly) were a bona fide resident of Puerto Rico for 2021
Part I-B Filers Who Check a Box on Line 13
Caution: If you did not check a box on line 13, do not complete Part I-B; instead, skip to Part I-C.
14a Enter the smaller of line 7 or line 12 . . . . . . . . . . . . . . . . . . . . . . . 14a 0.
b Subtract line 14a from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . 14b 3,000.
c If line 14a is zero, enter -0-; otherwise, enter the amount from the Credit Limit Worksheet A . . . . . . 14c 0.
d Enter the smaller of line 14a or line 14c . . . . . . . . . . . . . . . . . . . . . . 14d 0.
e Add lines 14b and 14d . . . . . . . . . . . . . . . . . . . . . . . . . . . 14e 3,000.
f Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received
for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the
instructions before entering an amount on this line. If you didn’t receive any advance child tax credit payments
for 2021, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14f 1,500.
Caution: If the amount on this line doesn’t match the aggregate amounts reported to you (and your spouse if
filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
g Subtract line 14f from line 14e. If zero or less, enter -0- on lines 14g through 14i and go to Part III . . . . 14g 1,500.
h Enter the smaller of line 14d or line 14g. This is your credit for other dependents. Enter this amount on line
19 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . 14h 0.
i Subtract line 14h from line 14g. This is your refundable child tax credit. Enter this amount on line 28 of
your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . 14i 1,500.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 03/12/22 Intuit.cg.cfp.sp Schedule 8812 (Form 1040) 2021
Schedule 8812 (Form 1040) 2021 Page 2
Part I-C Filers Who Do Not Check a Box on Line 13
Caution: If you checked a box on line 13, do not complete Part I-C.
15a Enter the amount from the Credit Limit Worksheet A . . . . . . . . . . . . . . . . . 15a
b Enter the smaller of line 12 or line 15a . . . . . . . . . . . . . . . . . . . . . . 15b
Additional child tax credit. Complete Parts II-A through II-C if you meet each of the following items.
1. You are not filing Form 2555.
2. Line 4a is more than zero.
3. Line 12 is more than line 15a.
c If you completed Parts II-A through II-C, enter the amount from line 27; otherwise, enter -0- . . . . . . 15c
d Add lines 15b and 15c . . . . . . . . . . . . . . . . . . . . . . . . . . . 15d
e Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received
for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the
instructions before entering an amount on this line. If you didn’t receive any advance child tax credit payments
for 2021, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15e
Caution: If the amount on this line doesn’t match the aggregate amounts reported to you (and your spouse if
filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
f Subtract line 15e from line 15d. If zero or less, enter -0- on lines 15f through 15h and go to Part III . . . . 15f
g Enter the smaller of line 15b or line 15f. This is your nonrefundable child tax credit and credit for other
dependents. Enter this amount on line 19 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . 15g
h Subtract line 15g from line 15f. This is your additional child tax credit. Enter this amount on line 28 of your
Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . 15h
Part II-A Additional Child Tax Credit (use only if completing Part I-C)
Caution: If you file Form 2555, do not complete Parts II-A through II-C; you cannot claim the additional child tax credit.
Caution: If you checked a box on line 13, do not complete Parts II-A through II-C; you cannot claim the additional child tax credit.
16a Subtract line 15b from line 12. If zero, skip Parts II-A and II-B and enter -0- on line 27 . . . . . . . . 16a
b Number of qualifying children under 18 with the required social security number: x $1,400.
Enter the result. If zero, skip Parts II-A and II-B and enter -0- on line 27 . . . . . . . . . . . . 16b
TIP: The number of children you use for this line is the same as the number of children you used for line 4a.
17 Enter the smaller of line 16a or line 16b . . . . . . . . . . . . . . . . . . . . . . 17
18a Earned income (see instructions) . . . . . . . . . . . . . . . . 18a
b Nontaxable combat pay (see instructions) . . . . . . 18b
19 Is the amount on line 18a more than $2,500?
No. Leave line 19 blank and enter -0- on line 20.
Yes. Subtract $2,500 from the amount on line 18a. Enter the result . . . . 19
20 Multiply the amount on line 19 by 15% (0.15) and enter the result . . . . . . . . . . . . . . 20
Next. On line 16b, is the amount $4,200 or more?
No. If line 20 is zero, enter -0- on line 15c. Otherwise, skip Part II-B and enter the smaller of line 17 or line
20 on line 27.
Yes. If line 20 is equal to or more than line 17, skip Part II-B and enter the amount from line 17 on line 27.
Otherwise, go to line 21.
Part II-B Certain Filers Who Have Three or More Qualifying Children
21 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 . . . . . . . . . . . . . . . . . . . . . . 21
22 Enter the total of the amounts from Schedule 1 (Form 1040), line 15; Schedule 2 (Form
1040), line 5; Schedule 2 (Form 1040), line 6; and Schedule 2 (Form 1040), line 13 . 22
23 Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . . 23
24 1040 and

}
1040-SR filers: Enter the total of the amounts from Form 1040 or 1040-SR, line 27a,
and Schedule 3 (Form 1040), line 11.
1040-NR filers: Enter the amount from Schedule 3 (Form 1040), line 11. 24
25 Subtract line 24 from line 23. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 25
26 Enter the larger of line 20 or line 25 . . . . . . . . . . . . . . . . . . . . . . . 26
Next, enter the smaller of line 17 or line 26 on line 27.
Part II-C Additional Child Tax Credit
27 Enter this amount on line 15c . . . . . . . . . . . . . . . . . . . . . . . . . 27
REV 03/12/22 Intuit.cg.cfp.sp Schedule 8812 (Form 1040) 2021
BAA
Schedule 8812 (Form 1040) 2021 Page 3
Part III Additional Tax (use only if line 14g or line 15f, whichever applies, is zero)
28a Enter the amount from line 14f or line 15e, whichever applies . . . . . . . . . . . . . . . 28a
b Enter the amount from line 14e or line 15d, whichever applies . . . . . . . . . . . . . . . 28b
29 Excess advance child tax credit payments. Subtract line 28b from line 28a. If zero, stop; you do not owe the
additional tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
30 Enter the number of qualifying children taken into account in determining the annual advance amount you
received for 2021. See your Letter 6419 for this number. If you are missing your Letter 6419, you are filing a joint
return, or you received more than one Letter 6419, see the instructions before entering a number on this line . . 30
Caution: If the amount on this line doesn’t match the number of qualifying children reported to you (and your
spouse if filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
31 Enter the smaller of line 4a or line 30 . . . . . . . . . . . . . . . . . . . . . . . 31
32 Subtract line 31 from line 30. If zero, skip to line 40 and enter the amount from line 29; otherwise, continue to
line 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 Enter the amount shown below for your filing status.

}
• Married filing jointly or Qualifying widow(er)—$60,000
• Head of household—$50,000
• All other filing statuses—$40,000 . . . . . . . . . . . . . . . 33
34 Subtract line 33 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 34
35 Enter the amount from line 33 . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Divide line 34 by line 35. Enter the result as a decimal (rounded to at least three places). If the result is 1.000 or
more, enter 1.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
37 Multiply line 32 by $2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . 37
38 Multiply line 37 by line 36 . . . . . . . . . . . . . . . . . . . . . . . . . . 38
39 Subtract line 38 from line 37 . . . . . . . . . . . . . . . . . . . . . . . . . 39
40 Subtract line 39 from line 29. If zero or less, enter -0-. This is your additional tax. If more than zero, enter
this amount on Schedule 2 (Form 1040), line 19 . . . . . . . . . . . . . . . . . . . 40
BAA REV 03/12/22 Intuit.cg.cfp.sp Schedule 8812 (Form 1040) 2021
Form 8995 Qualified Business Income Deduction OMB No. 1545-2294

Simplified Computation
a Attach
to your tax return.
2021
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
Oscar J Velazquez-Ortega & Maria E Rivera-Martinez 002-65-4071
Note. You can claim the qualified business income deduction only if you have qualified business income from a qualified trade or
business, real estate investment trust dividends, publicly traded partnership income, or a domestic production activities deduction
passed through from an agricultural or horticultural cooperative. See instructions.
Use this form if your taxable income, before your qualified business income deduction, is at or below $164,900 ($164,925 if married
filing separately; $329,800 if married filing jointly), and you aren’t a patron of an agricultural or horticultural cooperative.

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

ii

iii

iv

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


column (c) . . . . . . . . . . . . . . . . . . . . . . 2
3 Qualified business net (loss) carryforward from the prior year . . . . . . . 3 ( 46,225. )
4 Total qualified business income. Combine lines 2 and 3. If zero or less, enter -0- 4 0.
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . 5 0.
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 0.
11 Taxable income before qualified business income deduction (see instructions) 11 0.
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . 12 0.
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . 13 0.
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . 14 0.
15 Qualified business income deduction. Enter the smaller of line 10 or line 14. Also enter this amount on
the applicable line of your return (see instructions) . . . . . . . . . . . . . . . . a 15 0.
16 Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . . 16 ( 46,225. )
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 03/12/22 Intuit.cg.cfp.sp Form 8995 (2021)
Form 8962 Premium Tax Credit (PTC)
OMB No. 1545-0074

2021
a Attach to Form 1040, 1040-SR, or 1040-NR.
Department of the Treasury Attachment
Internal Revenue Service a Go to www.irs.gov/Form8962 for instructions and the latest information. Sequence No. 73
Name shown on your return Your social security number
Oscar J Velazquez-Ortega & Maria E Rivera 002-65-4071
A. If you, or your spouse (if filing a joint return), received, or were approved to receive, unemployment compensation for any week beginning during 2021,
check the box. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a
B. You cannot take the PTC if your filing status is married filing separately unless you qualify for an exception. See instructions. If you qualify, check the box a

Part I Annual and Monthly Contribution Amount


1 Tax family size. Enter your tax family size. See instructions . . . . . . . . . . . . . . . . . 1 3
2a Modified AGI. Enter your modified AGI. See instructions . . . . . . . . . 2a 9,550.
b Enter the total of your dependents’ modified AGI. See instructions . . . . . . 2b
3 Household income. Add the amounts on lines 2a and 2b. See instructions . . . . . . . . . . . . 3 9,550.
4 Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3. See instructions. Check the
appropriate box for the federal poverty table used. a Alaska b Hawaii c Other 48 states and DC 4 21,720.
5 Household income as a percentage of federal poverty line (see instructions) . . . . . . . . . . . . 5 43 %
6 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Applicable figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions . . 7 0.0000
8a Annual contribution amount. Multiply line 3 by b Monthly contribution amount. Divide line 8a
line 7. Round to nearest whole dollar amount
8a 0. by 12. Round to nearest whole dollar amount
8b 0.
Part II Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit
9 Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage? See instructions.
Yes. Skip to Part IV, Allocation of Policy Amounts, or Part V, Alternative Calculation for Year of Marriage. No. Continue to line 10.
10 See the instructions to determine if you can use line 11 or must complete lines 12 through 23.
Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12–23 No. Continue to lines 12–23. Compute
and continue to line 24. your monthly PTC and continue to line 24.
(a) Annual enrollment (b) Annual applicable (c) Annual (d) Annual maximum (e) Annual premium tax (f) Annual advance
Annual SLCSP premium premium assistance
premiums (Form(s) contribution amount credit allowed payment of PTC (Form(s)
Calculation (Form(s) 1095-A, (subtract (c) from (b); if
1095-A, line 33A) (line 8a) (smaller of (a) or (d)) 1095-A, line 33C)
line 33B) zero or less, enter -0-)

11 Annual Totals
(c) Monthly
(a) Monthly enrollment (b) Monthly applicable (d) Monthly maximum (f) Monthly advance
contribution amount (e) Monthly premium tax
Monthly premiums (Form(s) SLCSP premium premium assistance payment of PTC (Form(s)
(amount from line 8b credit allowed
Calculation 1095-A, lines 21–32, (Form(s) 1095-A, lines (subtract (c) from (b); if 1095-A, lines 21–32,
or alternative marriage (smaller of (a) or (d))
column A) 21–32, column B) zero or less, enter -0-) column C)
monthly calculation)

12 January 1,200. 1,374. 0. 1,374. 1,200. 1,200.


13 February 1,200. 1,374. 0. 1,374. 1,200. 1,200.
14 March
15 April
16 May
17 June
18 July
19 August
20 September
21 October
22 November
23 December
24 Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here 24 2,400.
25 Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here 25 2,400.
26 Net premium tax credit. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and
on Schedule 3 (Form 1040), line 9. If line 24 equals line 25, enter -0-. Stop here. If line 25 is greater than line 24,
leave this line blank and continue to line 27 . . . . . . . . . . . . . . . . . . . . . 26 0.
Part III Repayment of Excess Advance Payment of the Premium Tax Credit
27 Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here 27
28 Repayment limitation (see instructions) . . . . . . . . . . . . . . . . . . . . . . 28
29 Excess advance premium tax credit repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2
(Form 1040), line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
For Paperwork Reduction Act Notice, see your tax return instructions. BA REV 03/12/22 Intui Form 8962 (2021)
Form 8962 (2021) Page 2
Part IV Allocation of Policy Amounts
Complete the following information for up to four policy amount allocations. See instructions for allocation details.
Allocation 1
30 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC


(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 2
31 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC


(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 3
32 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC


(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

Allocation 4
33 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month

Allocation percentage (g) Advance Payment of the PTC


(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts

34 Have you completed all policy amount allocations?


Yes. Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and non-
allocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on
lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24.
No. See the instructions to report additional policy amount allocations.

Part V Alternative Calculation for Year of Marriage


Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9.
To complete line(s) 35 and/or 36 and compute the amounts for lines 12–23, see the instructions for this Part V.
(a) Alternative family size (b) Alternative monthly (c) Alternative start month (d) Alternative stop month
35 Alternative entries contribution amount
for your SSN

(a) Alternative family size (b) Alternative monthly (c) Alternative start month (d) Alternative stop month
36 Alternative entries contribution amount
for your spouse’s
SSN
REV 03/12/22 Intui Form 8962 (2021)
Oscar J Velazquez-Ortega & Maria E Rivera-Martinez 002-65-4071 1

Additional information from your 2021 Federal Tax Return

Schedule 1: Additional Income and Adjustments to Income


Line 8a Explanation Statement
Net Operating Loss Carryforward
NOL profit and loss line #31 tax return 2020

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