NONE

,
808-216-2328

October 27, 2022

TSATE KONGAI
212 QUIVIRA ROAD
OVERLAND PARK, KS 66210

Dear Tsate,

Your 2021 Federal Individual Income Tax return will be electronically

filed with the Internal Revenue Service upon receipt of a signed Form
8879 - IRS e-file Signature Authorization. No tax is payable with the
filing of this return. You will receive a refund of $318.

Enclosed is your 2021 Kansas Individual Income Tax Return. The original
should be signed and dated at the bottom of page 2 of Form K-40. There
is a balance due of $1,514.

Mail your Kansas return on or before April 18, 2022 and make the check
payable to:

KANSAS INCOME TAX

KANSAS DEPARTMENT OF REVENUE
PO BOX 750260
TOPEKA, KS 66699-0260

Your 2022 estimated tax payment schedule is listed below. If not paying
electronically, mail your payments to the address shown on your
estimated tax payment vouchers.

Due Date Kansas

4/18/22 $ 371
6/15/22 371
9/15/22 371
1/17/23 371
----------
$ 1,484

Please be sure to call if you have any questions.

Sincerely,

Kathy Young
2021 Federal Income Tax Summary Page 1
TSATE KONGAI 467-98-9784

INCOME
Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57,100
Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,451
Dividend income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,120
Capital gain or loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -3,000
Total income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,671
ADJUSTMENTS TO INCOME
Total adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,671

ITEMIZED DEDUCTIONS
Taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,200
Total itemized deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,200

TAX COMPUTATION
Standard deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,250
Charitable contr. if taking standard ded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Larger of itemized or standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,550
Taxable income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47,121
Tax before credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,832
CREDITS
Total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Tax after credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,832

OTHER TAXES
Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,832

PAYMENTS & REFUNDABLE CREDITS

Federal income tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,150
Total payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,150

REFUND OR AMOUNT DUE

Amount overpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Amount refunded to you. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Amount you owe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

TAX RATES
Marginal tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.0%
Effective tax rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.4%
2021 Kansas Income Tax Summary Page 1
TSATE KONGAI 467-98-9784

FEDERAL ADJUSTED GROSS INCOME

Federal adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,671

ADJUSTED GROSS INCOME

Kansas adjusted gross income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,671
DEDUCTIONS
Standard/Itemized deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,350
Exemption allowance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,250
Total deductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,600
Taxable income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,071

TAX COMPUTATION
Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,682
Total Income tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,682

CREDITS
Tax balance after credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,682
TAX
Total tax balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,682

PAYMENTS AND REFUNDABLE CREDITS

Kansas income tax withheld. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,200
Estimated tax paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Total payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,200

REFUND OR AMOUNT DUE

Estimated tax penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Amount you owe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,514

TAX RATES
Marginal tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7%
Effective tax rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.9%
2021 General Information Page 1
TSATE KONGAI 467-98-9784

Forms needed for this return

Federal: 1040, Sch B, Sch D, 6252, 8879

Kansas: K-40, K-40ES, Sch K-210, K-40V

Tax Rates

Marginal Effective
Federal 22.0% 12.4%
Kansas 5.7% 4.9%

Underpayment Penalty

Kansas 32.

Carryovers to 2022

Federal Carryovers
Short-Term Capital Loss 549.
Deductible State and Local Taxes 1,482.

Estimates

Kansas Estimates
Estimate Overpayment Balance
4/18/22 371. 0. 371.
6/15/22 371. 0. 371.
9/15/22 371. 0. 371.
1/17/23 371. 0. 371.
Total $ 1,484. $ 0. $ 1,484.
2021 Agency Disclosure Statements Page 1
Client TSATE KONGAI 467-98-9784

Kansas Disclosure Statements

Statement:
The state of Kansas is requesting additional information in an effort to combat
stolen-identity tax fraud to ensure that your hard-earned tax refund goes to you.
Please provide the requested information from your driver's license or state-issued
identification card. This information has been requested in prior years on
electronically filed Kansas returns but is not required to be provided. Your return
will not be rejected if you do not have a driver's license or identification card,
or choose not to enter the information.

Statement:
Taxpayers expecting refunds that filed electronically can expect a deposit in 10 to
14 business days. Taxpayers expecting a refund that filed using a paper form should
allow at least 16 to 20 weeks to receive a refund back by mail. To check your
current year tax refund go to our website or call 785-368-8222 for automated refund
information. You will need your Social Security number(s) and the expected amount of
your refund. Any errors, inaccurate forms or information, photocopied forms, or
incomplete information will delay the processing of a return and can extend the
timeframe for you to expect your refund. URL:
http//www.kdor.ks.gov/apps/kcsc/increfundstatus.aspx - taxpayers can use this link
to check status of refund.

Statement:
At the request of Kansas Department of Revenue the following information has been
provided to you. 1. Make a direct payment using your banking information allows you
to 'file now, pay later' by choosing the date you would like your bank account
debited. Go to the Kansas Department of Revenue Customer Service Center at
https://www.kdor.ks.gov/Apps/kcsc/login.aspx to create a login and make an
electronic payment. To create a login you will need access to your email and an
access code that is assigned by the department or your prior year's tax information.
To avoid any penalties or interest you must have the balance due paid in full no
later than the April 15th due date. Payments can created on the due date no later
than 11:59pm to be considered timely submitted. If you need the access code or
assistance please call 1-785-368-8222 or send an email to: [email protected] 2. Make
a credit card payment for your Kansas tax can be done online through third-party
vendors. Services and fees vary, but all vendors accept major credit cards. Go to
https://ksrevenue.org/faqs-credit.html for a list of vendors authorized to accept
payments for Kansas. To make sure your payment is timely you can create the payment
on the due date of April 15th no later than 11:59pm. 3. If you are unable to pay
the full amount due, you should file your Kansas income tax return then pay as much
as you can before the filing due date by making smaller payments to Kansas using our
Customer Service Center for bank account withdraws at
https://www.kdor.ks.gov/Apps/kcsc/login.aspx or our credit card payment options at
https://ksrevenue.org/faqs-credit.html. Penalties and interest will accrue on any
unpaid balance due after the due date until fully paid. If you cannot get the tax
debit paid by the due date there is an option to set up a payment plan once the
debit is considered past due. For the payment plan request information go to
https://ksrevenue.org/payplan.html or call 1-785-296-6121 for payment plan
assistance.
Form 8879 IRS e-file Signature Authorization
OMB No. 1545-0074
(Rev. January 2021) G ERO must obtain and retain completed Form 8879.
Department of the Treasury
Internal Revenue Service G Go to www.irs.gov/Form8879 for the latest information.

Submission Identification Number (SID) A

Taxpayer's name Social security number

TSATE KONGAI 467-98-9784

Spouse's name Spouse's social security number

Part I Tax Return Information ' Tax Year Ending December 31, 2021 (Enter year you are authorizing.)
Enter whole dollars only on lines 1 through 5.
Note: Form 1040-SS filers use line 4 only. Leave lines 1, 2, 3, and 5 blank.
1 Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 61,671.
2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5,832.
3 Federal income tax withheld from Form(s) W-2 and Form(s) 1099. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6,150.
4 Amount you want refunded to you. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 318.
5 Amount you owe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
Under penalties of perjury, I declare that I have examined a copy of the income tax return (original or amended) I am now authorizing, and to
the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from
the income tax return (original or amended) I am now authorizing. I consent to allow my intermediate service provider, transmitter, or electronic
return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of
the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the
U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution
account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and
the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury
Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at
1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also
authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to
answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my
signature for the income tax return (original or amended) I am now authorizing and, if applicable, my Electronic Funds Withdrawal Consent.

Taxpayer's PIN: check one box only

X I authorize None to enter or generate my PIN 57293 as my
ERO firm name Enter five digits, but
don't enter all zeros
signature on the income tax return (original or amended) I am now authorizing.
I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Your signature G Date G

Spouse's PIN: check one box only

I authorize to enter or generate my PIN as my
ERO firm name Enter five digits, but
don't enter all zeros
signature on the income tax return (original or amended) I am now authorizing.
I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.

Spouse's signature G Date G

Practitioner PIN Method Returns Only ' continue below

Part III Certification and Authentication ' Practitioner PIN Method Only

ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.
Don't enter all zeros

I certify that the above numeric entry is my PIN, which is my signature for the electronic individual income tax return (original or amended)
I am now authorized to file for tax year indicated above for the taxpayer(s) indicated above. I confirm that I am submitting this return in
accordance with the requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual
Income Tax Returns.

ERO's signature G Kathy Young Date G

ERO Must Retain This Form ' See Instructions

Don't Submit This Form to the IRS Unless Requested To Do So
BAA For Paperwork Reduction Act Notice, see your tax return instructions. Form 8879 (Rev. 01-2021)

FDIA1701L 01/22/21
 Department of the Treasury ' Internal Revenue Service (99)
Form 1040 U.S. Individual Income Tax Return 2021 OMB No. 1545-0074 IRS Use Only ' Do not write or staple in this space.
Filing Status X 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 G
Your first name and middle initial Last name Your social security number

TSATE KONGAI 467-98-9784

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

212 QUIVIRA ROAD Check here if you, or your spouse

if filing jointly, want $3 to go to this
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
fund. Checking a box below will
OVERLAND PARK, KS 66210 not change your tax or refund.

Foreign country name Foreign province/state/county Foreign postal code

You Spouse

At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes X 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: X 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) b if qualifies for (see instructions):
number to you
If more (1) First name Last name Child tax credit Credit for other dependents
than four
dependents,
see instructions
and check
here G

1 Wages, salaries, tips, etc. Attach Form(s) W-2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 57,100.

Attach 2 a Tax-exempt interest. . . . . . . . . . 2 a b Taxable interest . . . . . . . . . . . . . . . 2b 3,451.
Sch. B if
required. 3 a Qualified dividends. . . . . . . . . . . 3 a 4,120. b Ordinary dividends. . . . . . . . . . . . . 3b 4,120.
4 a IRA distributions. . . . . . . . . . . . . 4 a b Taxable amount . . . . . . . . . . . . . . . 4b
5 a Pensions and annuities . . . . . . 5 a b Taxable amount . . . . . . . . . . . . . . . 5b
6 a Social security benefits . . . . . . . . . . . 6 a b Taxable amount . . . . . . . . . . . . . . . 6b
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here. . . . . . . . . . . . . . . . . . . . . . . G 7 -3,000.
8 Other income from Schedule 1, line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Standard 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income. . . . . . . . . . . . . . . . . . . . . G 9 61,671.
Deduction for '
? Single or
10 Adjustments to income from Schedule 1, line 26. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Married filing
separately, $12,550 11 Subtract line 10 from line 9. This is your adjusted gross income. . . . . . . . . . . . . . . . . . . . . . . G 11 61,671.
?Married filing
12 a Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . . . . 12a 14,250.
jointly or Qualifying
widow(er), $25,100 b Charitable contributions if you take the standard deduction (see instructions). . . 12b 300.
?Head of c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c 14,550.
household, $18,800
? If you checked any 13 Qualified business income deduction from Form 8995 or Form 8995-A. . . . . . . . . . . . . . . . . . . . 13
box under Standard
Deduction, 14 Add lines 12c and 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 14,550.
see instructions.
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 15 47,121.

BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2021)

FDIA0112L 12/10/21
Form 1040 (2021) TSATE KONGAI 467-98-9784 Page 2
16 Tax (see instructions). Check if any from Form(s): 1 8814
2 4972 3 ............................................. 16 5,832.
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 5,832.
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 0.
22 Subtract line 21 from line 18. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 5,832.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . . . . . . . . . . . . 23
24 Add lines 22 and 23. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 24 5,832.
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a 6,150.
b Form(s) 1099. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25c
d Add lines 25a through 25c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d 6,150.
26 2021 estimated tax payments and amount applied from 2020 return. . . . . . . . . . . . . . . . . . . . . . 26
If you have a
qualifying child, 27 a Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27a
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G
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
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 32
33 Add lines 25d, 26, and 32. These are your total payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 33 6,150.
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . . . . . . . . . . . . . 34 318.
35 a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . G 35a 318.
Direct deposit? G b Routing number . . . . . . . . XXXXXXXXXX G c Type: Checking Savings
See instructions.
G d Account number. . . . . . . . XXXXXXXXXXXXXXXXXXXXXXXX
36 Amount of line 34 you want applied to your 2022 estimated tax . . G 36
Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions . . . . . . . . . . . . . G 37
You Owe 38 Estimated tax penalty (see instructions). . . . . . . . . . . . . . . . . . . G 38

Third Party Do you want to allow another person to discuss this return with the IRS?
Designee See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .G X Yes. Complete below. No
Designee's Phone Personal identification
G G G
name Kathy Young no. (808) 216-2328 number (PIN)

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

Phone no. Email address

Preparer's name Preparer's signature Date PTIN Check if:

Paid Kathy Young Kathy Young Self-employed

Preparer Firm's name G None Phone no. 808-216-2328

Use Only
Firm's address G Firm's EIN G
,
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2021)

FDIA0112L 12/10/21
SCHEDULE B Interest and Ordinary Dividends OMB No. 1545-0074

(Form 1040)
Department of the Treasury G Go to www.irs.gov/ScheduleB for instructions and the latest information.
2021
Attachment
Internal Revenue Service (99) G Attach to Form 1040 or 1040-SR. Sequence No. 08
Name(s) shown on return Your social security number

TSATE KONGAI 467-98-9784

Part I 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used Amount
the property as a personal residence, see the instructions and list this interest first. Also,
Interest show that buyer's social security number and address G

(See instructions INTEREST ON INSTALLMENT SALE 3,250.

and the 467-98-9784
Instructions for
Form 1040, 212 QUIVIRA ROAD
line 2b.) OVERLAND PARK, KS 66210
OLANTHE NATIONAL BANK 201.
Note: If you
received a Form 1
1099-INT, Form
1099-OID, or
substitute statement
from a brokerage
firm, list the firm's
name as the payer
and enter the total
interest shown on
that form.

2 Add the amounts on line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3,451.

3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach
Form 8815 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b. . . G 4 3,451.
Note: If line 4 is over $1,500, you must complete Part III. Amount
Part II 5 List name of payer G
JOHNSON CORPORATION 4,120.
Ordinary
Dividends
(See instructions
and the
Instructions for
Form 1040,
line 3b.)

Note: If you 5
received a Form
1099-DIV or
substitute statement
from a brokerage
firm, list the firm's
name as the payer
and enter the
ordinary dividends
shown on that form.

6 Add the amounts on line 5. Enter the total here and on Form 1040 or 1040-SR, line 3b. . . . G 6 4,120.
Note: If line 6 is over $1,500, you must complete Part III.
Part III You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a
Yes No
foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.
Foreign 7a At any time during 2021, did you have a financial interest in or signature authority over a financial
Accounts account (such as a bank account, securities account, or brokerage account) located in a foreign country?
and Trusts See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
If 'Yes,' are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR),
Caution: If required, to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing
failure to file FinCEN requirements and exceptions to those requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 114 may b If you are required to file FinCEN Form 114, enter the name of the foreign country where the financial
result in
substantial account is located G
penalties. See
8
During 2021, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust?
instructions.
If 'Yes,' you may have to file Form 3520. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA0401L 11/05/21 Schedule B (Form 1040) 2021
SCHEDULE D OMB No. 1545-0074

(Form 1040) Capital Gains and Losses

G Attach to Form 1040, 1040-SR, or 1040-NR. 2021
Department of the Treasury G Go to www.irs.gov/ScheduleD for instructions and the latest information.
Attachment
Internal Revenue Service (99) G Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10. Sequence No. 12
Name(s) shown on return Your social security number

TSATE KONGAI 467-98-9784

Did you dispose of any investment(s) in a qualified opportunity fund during the tax year? Yes X No
If "Yes," attach Form 8949 and see its instructions for additional requirements for reporting your gain or loss.

Part I Short-Term Capital Gains and Losses ' Generally Assets Held One Year or Less (see instructions)
See instructions for how to figure the amounts to (g) (h) Gain or (loss)
enter on the lines below. (d) (e) Adjustments Subtract column (e)
Proceeds Cost to gain or loss from from column (d) and
This form may be easier to complete if you round (sales price) (or other basis) Form(s) 8949, Part I, combine the result
off cents to whole dollars. line 2, column (g) with column (g)
1a Totals for all short-term transactions reported
on Form 1099-B for which basis was reported
to the IRS and for which you have no
adjustments (see instructions).
However, if you choose to report all these
transactions on Form 8949, leave this line
blank and go to line 1b . . . . . . . . . . . . . . . . . . . . . 14,500. 35,550. -21,050.
1b Totals for all transactions reported on
Form(s) 8949 with Box A checked . . . . . . . . . . .
2 Totals for all transactions reported on
Form(s) 8949 with Box B checked . . . . . . . . . . .
3 Totals for all transactions reported on
Form(s) 8949 with Box C checked . . . . . . . . . . .

4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . . . . . . . . . . . . 4

5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 . . . . 5
6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover
Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ( )

7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any long-term
capital gains or losses, go to Part II below. Otherwise, go to Part III on the back. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 -21,050.
Part II Long-Term Capital Gains and Losses ' Generally Assets Held More Than One Year (see instructions)
See instructions for how to figure the amounts to (g) (h) Gain or (loss)
enter on the lines below. (d) (e) Adjustments Subtract column (e)
Proceeds Cost to gain or loss from from column (d) and
This form may be easier to complete if you round (sales price) (or other basis) Form(s) 8949, Part II, combine the result
off cents to whole dollars. line 2, column (g) with column (g)
8a Totals for all long-term transactions reported
on Form 1099-B for which basis was reported
to the IRS and for which you have no
adjustments (see instructions). However,
if you choose to report all these transactions
on Form 8949, leave this line blank and go
to line 8b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8b Totals for all transactions reported on
Form(s) 8949 with Box D checked. . . . . . . . . . .
9 Totals for all transactions reported on
Form(s) 8949 with Box E checked. . . . . . . . . . .
10 Totals for all transactions reported on
Form(s) 8949 with Box F checked. . . . . . . . . . .
11 Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from
Forms 4684, 6781, and 8824. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 17,501.

12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 . . . . 12

13 Capital gain distributions. See the instrs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover
Worksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 ( )

15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then, go to Part III on
the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 17,501.
BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA0612L 08/20/21 Schedule D (Form 1040) 2021
Schedule D (Form 1040) 2021 TSATE KONGAI 467-98-9784 Page 2

Part III Summary

16 Combine lines 7 and 15 and enter the result. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 -3,549.

? If line 16 is a gain, enter the amount from line 16 on Form 1040, 1040-SR, or 1040-NR, line 7.
Then, go to line 17 below.
? If line 16 is a loss, skip lines 17 through 20 below. Then, go to line 21. Also be sure to complete
line 22.
? If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, 1040-SR, or
1040-NR, line 7. Then, go to line 22.
17 Are lines 15 and 16 both gains?
Yes. Go to line 18.

No. Skip lines 18 through 21, and go to line 22.

18 If you are required to complete the 28% Rate Gain Worksheet (see instructions), enter the
amount, if any, from line 7 of that worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 18

19 If you are required to complete the Unrecaptured Section 1250 Gain Worksheet (see
instructions), enter the amount, if any, from line 18 of that worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G 19

20 Are lines 18 and 19 both zero or blank and are you not filing Form 4952?

Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions
for Forms 1040 and 1040-SR, line 16. Don't complete lines 21 and 22 below.

No. Complete the Schedule D Tax Worksheet in the instructions. Don't complete lines 21
and 22 below.

21 If line 16 is a loss, enter here and on Form 1040, 1040-SR, or 1040-NR, line 7, the smaller of:
? The loss on line 16; or
................................................ 21 ( 3,000.)
? ($3,000), or if married filing separately, ($1,500)

Note: When figuring which amount is smaller, treat both amounts as positive numbers.

22 Do you have qualified dividends on Form 1040, 1040-SR, or 1040-NR, line 3a?
X Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions
for Forms 1040 and 1040-SR, line 16.

No. Complete the rest of Form 1040, 1040-SR, or 1040-NR.

Schedule D (Form 1040) 2021

FDIA0612L 08/20/21
Form 6252 Installment Sale Income OMB No. 1545-0228

G Attach to your tax return.

G Use a separate form for each sale or other disposition of property on the installment method.
2021
Department of the Treasury Attachment
Internal Revenue Service G Go to www.irs.gov/Form6252 for the latest information. Sequence No. 67
Name(s) shown on return Identifying number

TSATE KONGAI 467-98-9784

1 Description of property G Code:4 - LAND
2a Date acquired (mm/dd/yyyy) G 1/28/2015 b Date sold (mm/dd/yyyy) G 1/28/2021
3 Was the property sold to a related party (see instructions) after May 14, 1980? If 'No,' skip line 4 . . . . . . . . . . . . . . . . . . Yes X No
4 Was the property you sold to a related party a marketable security? If 'Yes,' complete Part III. If 'No,'
complete Part III for the year of sale and the 2 years after the year of sale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Gross Profit and Contract Price. Complete this part for all years of the installment agreement.
5 Selling price including mortgages and other debts. Don't include interest, whether stated or unstated. . . . . . . . 5 180,000.
6 Mortgages, debts, and other liabilities the buyer assumed or took the property
subject to (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Subtract line 6 from line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 180,000.
8 Cost or other basis of property sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 130,000.
9 Depreciation allowed or allowable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Adjusted basis. Subtract line 9 from line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 130,000.
11 Commissions and other expenses of sale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Income recapture from Form 4797, Part III (see instructions). . . . . . . . . . . . . . . . . . . 12
13 Add lines 10, 11, and 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 130,000.
14 Subtract line 13 from line 5. If zero or less, don't complete the rest of this form. See instructions . . . . . . . . . . . 14 50,000.
15 If the property described on line 1 above was your main home, enter the amount of your excluded gain.
See instructions. Otherwise, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 0.
16 Gross profit. Subtract line 15 from line 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 50,000.
17 Subtract line 13 from line 6. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 0.
18 Contract price. Add line 7 and line 17. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 180,000.
Part II Installment Sale Income. Complete this part for all years of the installment agreement.
19 Gross profit percentage (expressed as a decimal amount). Divide line 16 by line 18. (For years after the year
of sale, see instructions.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 0.2778
20 If this is the year of sale, enter the amount from line 17. Otherwise, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 0.
21 Payments received during year (see instructions). Don't include interest, whether stated or unstated . . . . . . . . 21 63,000.
22 Add lines 20 and 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 63,000.
23 Payments received in prior years (see instructions). Don't include interest,
whether stated or unstated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Installment sale income. Multiply line 22 by line 19. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 17,501.
25 Enter the part of line 24 that is ordinary income under the recapture rules. See instructions. . . . . . . . . . . . . . . . . 25
26 Subtract line 25 from line 24. Enter here and on Schedule D or Form 4797. See instructions. . . . . . . . . . . . . . . . 26 17,501.
Part III Related Party Installment Sale Income. Don't complete if you received the final payment this tax year.
27 Name, address, and taxpayer identifying number of related party

28 Did the related party resell or dispose of the property ("second disposition") during this tax year? . . . . . . . . . . . . . . . . . Yes No
29 If the answer to question 28 is "Yes," complete lines 30 through 37 below unless one of the following conditions is met.
Check the box that applies.
a The second disposition was more than 2 years after the first disposition (other than dispositions of
marketable securities). If this box is checked, enter the date of disposition (mm/dd/yyyy). . . . . . . . . . . . . . . . . . . . G
b The first disposition was a sale or exchange of stock to the issuing corporation.
c The second disposition was an involuntary conversion and the threat of conversion occurred after the first disposition.
d The second disposition occurred after the death of the original seller or buyer.
e It can be established to the satisfaction of the IRS that tax avoidance wasn't a principal purpose for either
of the dispositions. If this box is checked, attach an explanation. See instructions.
30 Selling price of property sold by related party (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
31 Enter contract price from line 18 for year of first sale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
32 Enter the smaller of line 30 or line 31. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 Total payments received by the end of your 2021 tax year (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
34 Subtract line 33 from line 32. If zero or less, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
35 Multiply line 34 by the gross profit percentage on line 19 for year of first sale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Enter the part of line 35 that is ordinary income under the recapture rules. See instructions. . . . . . . . . . . . . . . . . 36
37 Subtract line 36 from line 35. Enter here and on Schedule D or Form 4797. See instructions. . . . . . . . . . . . . . . . 37
BAA For Paperwork Reduction Act Notice, see separate instructions. FDIZ1501L 08/23/21 Form 6252 (2021)
2021 Federal Worksheets Page 1
TSATE KONGAI 467-98-9784

Wage Schedule

Federal Medi- State Local

Taxpayer - Employer Wages W/H FICA care W/H W/H
SHAWNEE MISSION SCHOOL DISTRICT
57,100. 6,150. 3,726. 871. 1,200.
Grand Total 57,100. 6,150. 3,726. 871. 1,200. 0.

Form 1040, 1040-SR, or 1040-NR, Line 3a

Qualified Dividends

JOHNSON CORPORATION 4,120.

Total 4,120.

Qualified Dividends and Capital Gain Tax Worksheet (Form 1040, 1040-SR, or 1040-NR, Line 16)

1. Enter the amount from Form 1040, 1040-SR, or 1040-NR, line 15 47,121.
2. Enter amount from Form 1040, 1040-SR,
or 1040-NR, line 3a 4,120.
3. Are you filing Schedule D?
[X] Yes. Enter the smaller of line 15 or 16 of
Schedule D, but do not enter less than zero
[ ] No. Enter amount from Form 1040, 1040-SR,
or 1040-NR, line 7 0.
4. Add lines 2 and 3 4,120.
5. Subtract line 4 from line 1. If 0 or less, enter 0. 43,001.
6. Enter:
$40,400 if single or married filing separately,
$80,800 if married filing jointly or qualifying
widow(er), $54,100 if head of household 40,400.
7. Enter the smaller of line 1 or line 6 40,400.
8. Enter the smaller of line 5 or line 7 40,400.
9. Subtract line 8 from line 7. This amount is taxed at 0% 0.
10. Enter the smaller of line 1 or line 4 4,120.
11. Enter the amount from line 9 0.
12. Subtract line 11 from line 10 4,120.
13. Enter:
$445,850 if single, $250,800 if married filing
separately, $501,600 if married filing jointly
or qualifying widow(er), $473,750 if head
of household. 445,850.
14. Enter the smaller of line 1 or line 13 47,121.
15. Add lines 5 and 9 43,001.
16. Subtract line 15 from line 14. If 0 or less, enter 0. 4,120.
17. Enter the smaller of line 12 or line 16 4,120.
18. Multiply line 17 by 15% (.15) 618.
19. Add lines 9 and 17 4,120.
20. Subtract line 19 from line 10 0.
21. Multiply line 20 by 20% (.20) 0.
22. Figure the tax on the amount on line 5.
(Use the Tax Table or Tax Computation Worksheet) 5,214.
23. Add lines 18, 21, and 22 5,832.
24. Figure the tax on the amount on line 1.
(Use the Tax Table or Tax Computation Worksheet) 6,116.
2021 Federal Worksheets Page 2
TSATE KONGAI 467-98-9784

Qualified Dividends and Capital Gain Tax Worksheet (Form 1040, 1040-SR, or 1040-NR, Line 16) (continued)

25. Tax on all taxable income (including

capital gain distributions). Enter the
smaller of line 23 or line 24 here and on
Form 1040, 1040-SR, or 1040-NR, line 16 5,832.

Federal Income Tax Withheld

SHAWNEE MISSION SCHOOL DISTRICT 6,150.

Total 6,150.

Capital Loss Carryover Worksheet

(IRS Publication 550)

1. Enter the amount from Form 1040, 1040-SR,

or 1040NR, line 15 47,121.
2. Enter the loss from Schedule D, line 21 3,000.
3. Combine lines 1 and 2 (but not less than zero) 50,121.
4. Enter the smaller of line 2 or line 3 3,000.
- Note: If line 7 of Schedule D is a loss, go to line
5; otherwise, enter zero on line 5 and go to line 9.
5. Enter the loss from Schedule D, line 7 21,050.
6. Enter gain from Schedule D, line 15 17,501.
7. Add lines 4 and 6 20,501.
8. Short-term capital loss carryover to 2022.
Subtract line 7 from line 5 549.
- Note: If line 15 of Schedule D is a loss, go to
line 9; otherwise, skip lines 9 through 13
9. Enter the loss from Schedule D, line 15
10. Enter gain from Schedule D, line 7
11. Subtract line 5 from line 4
12. Add lines 10 and 11
13. Long-term capital loss carryover to 2022.
Subtract line 12 from line 9
2021 Federal Worksheets Page 3
TSATE KONGAI 467-98-9784

Installment Sale - Schedule of Principal Payments

Description of Property: Code:4 - LAND

Year Principal Payment Total Gain Ordinary Income Unrecaptured 1250

2021 63,000. 17,501. 63,000.
Total 63,000. 17,501. 0. 63,000.

Total from year of sale: 0. 0. 0.

Balance Remaining: 0. 0. 0.

Form 1040 or 1040-SR, Line 30

Recovery Rebate Credit

1. Can you be claimed as a dependent on another person's 2021

return? If filing a joint return, go to line 2.
- No. Go to line 2.
2. Does your 2021 return include a valid social security number that
was issued on or before the due date of the return (including
extensions) for you and, if filing a joint return, your spouse?
- Yes. Go to line 6.
3. Was at least one of you a member of the U.S. Armed Forces at any
time during 2021, and does at least one of you have a valid SSN
that was issued on or before the due date of the return (including
extensions)?
4. Does one of you have a valid SSN?
5. Do you have any dependents listed on Form 1040 or 1040-SR, page 1
with a valid SSN/ATIN issued on or before the due date of the
return (including extensions)?
6. Enter $1,400 if single, HOH, MFS, or qualifying widow(er)
Enter $1,400 if MFJ and answered "yes" to question 4, or
Enter $2,800 if MFJ and answered "yes" to questions 2 or 3. . . . . . . . . . . . . . . 1,400.
7. Multiply $1,400 by the number of dependents listed in the Dependents
section on page 1 of Form 1040 or 1040-SR who had a SSN/ATIN that
was issued on or before the due date of the return (including
extensions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.
8. Add lines 6 and 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,400.
9. Is the amount on line 11 of Form 1040 or 1040-SR more than the
amount shown below for your filing status?
Single or Married filing separately: $75,000
- No. Enter the amount from line 8 on line 12 and skip lines 10 and 11
10. Is line 9 more than the amount shown below for your filing status?
Single of Married filing separately: $80,000
11. Divide line 10 by the amount shown below for your filing status.
Enter the result as a decimal (rounded to at least 2 places) . . . . . . . . . .
Single or Married filing separately: $5,000
12. Multiply line 8 by line 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,400.
13. Enter the amount, if any, of EIP 3 that was issued to you. If
filing a joint return, include the amount, if any, of your
spouse's EIP3. You may refer to Notice 1444-C or your tax account
information at IRS.gov/Account for the amount to enter here. . . . . . . . . . . . 0.
14. Recovery rebate credit. Subtract line 13 from line 12. If zero or
less, enter 0. If line 13 is more than line 12, you don't have to
pay back the difference. Enter the result here and, if more than
zero, on line 30 of Form 1040 or 1040-SR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,400.
* NOTE: The credit will not carry to Form 1040 or 1040-SR until an
2021 Federal Worksheets Page 4
TSATE KONGAI 467-98-9784

Form 1040 or 1040-SR, Line 30 (continued)

Recovery Rebate Credit

entry is made in economic impact payment 3 received

in the Recovery Rebate Credit input screen.
 005 122821
K-40
(Rev. 7-21)
2021 KANSAS INDIVIDUAL INCOME TAX
TSATE KONGAI KONG 467989784

212 QUIVIRA ROAD 00 000

OVERLAND PARK KS 66210
Name or address has changed? Taxpayer or (spouse if filing joint) died during this tax year Taxpayer was engaged in commercial farming/fishing in 2021

Amended Return: Amended affects Kansas only Amended Federal tax return Adjustment by the IRS

Head of Household (Do not

Filing Status: X Single Married Filing Joint (Even if only one had income) Married Filing Separate check if filing joint return)

Residency Status: X Resident NonResident (Complete Sch S, Part B) KS State of Legal Residence

Part-Year Resident (Complete Sch S, Part B) From To

Exemptions: 1 Enter the total exemptions for you, your spouse (if applicable),
and each person you claim as a dependent.
If filing status above is Head of
Household, add one exemption.
1 Total Kansas exemptions

KSIA0301L 09/24/21

In the following spaces, provide the requested information for all persons you claimed as dependents. DO NOT include you or your spouse.
If additional space is needed, enclose a separate sheet, only after completing all nine lines below.
Dependent Name ' First, Middle and Last Date of Birth ' MMDDYYYY Relationship SSN

Food Sales Tax Credit: You must have been a Kansas resident for ALL of 2021. Complete this section to determine your qualifications and credit.

A Had a dependent child who lived with you all year and
E Number of exemptions claimed
was under the age of 18 all of 2021?

B Were you (or spouse) 55 years of age or older all of 2021 F Number of dependents that are 18 years of age or older
(born prior to January 1, 1966)? (born on or before January 1, 2004)

C Were you (or spouse) totally and permanently disabled

or blind all of 2021, regardless of age? G Total qualifying exemptions (subtract line F from line E)
If you answered NO to A, B, and C, STOP HERE, you do
not qualify for this credit.
D If you answered YES to A, B, or C, enter your FAGI from H Food Sales Tax Credit (multiply line G by $125).Enter
line 1 of this return. result here and on line 18 of this form.
If Line D is more than $30,615 STOP HERE, you do not
qualify for this credit.

Page 1 of 2 For Office Use Only

 005 122921
K-40
(Rev. 7-21)
2021KANSAS INDIVIDUAL INCOME TAX
TSATE KONGAI KONG 467989784
1 Federal adjusted gross income 61671 23 Estimated tax paid 0
24 Amount paid with Kansas
2 Modifications 0 extension 0

61671
25 Refundable portion of earned
3 Kansas adjusted gross income
income tax credit 0

4350 0
4 Standard or itemized deductions.
26 Refundable portion of tax credits
(If itemizing, complete KS Sch A)

5 Exemption allowance
2250 27 Payments remitted with original
return 0

6600 0
28 Overpayment from original return.
6 Total deductions This figure is a subtraction

7 Taxable income 55071 29 Total refundable credits 1200

8 Tax 2682 30 Underpayment
1482
9 Nonresident percentage 0 31 Interest 0
10 Nonresident tax 0 32 Penalty 0
11 KS tax on lump sum distributions 0 33 Estimated tax penalty
32
12 TOTAL INCOME TAX 2682 34 AMOUNT YOU OWE 1514
13 Credit for taxes paid to other
states 0 35 Overpayment 0
14 Credit for child and dependent
care expenses 0 36 CREDIT FORWARD
0
15 Other credits
0 37 Chickadee Checkoff 0

2682 0
38 Senior Citizens Meals On Wheels
16 Subtotal
Contribution Program

17 Earned Income Credit 0 39 Breast Cancer Research Fund 0

18 Food Sales Tax Credit 0 40 Military Emergency Relief Fund 0
19 Tax balance after credits 2682 41 Kansas Hometown Heroes Fund 0
20 Use Tax Due (out of state and
internet purchases) 0 42 Kansas Creative Arts Industry
Fund 0

2682
43 Local School District Contribution
21 Total Tax Balance
Fund. School District Number 0 0

1200 0
22 KS income tax withheld from W-2,
44 REFUND
1099 or K-19

X I authorize the Director of Taxation or the Director's designee to discuss my K-40 and any enclosures with my preparer.
KSIA0301L 09/24/21

I declare under the penalties of perjury that to the best of my knowledge and belief this is a true, correct, and complete return.

Taxpayer Spouse
Signature Signature
(Required) Date (Required) Date

Preparer
Signature
(Required) Kathy Young Preparer
Phone Number
8082162328 Preparer PTIN, EIN, or SSN

INDIVIDUAL INCOME TAX

PO Box 750260
Page 2 of 2 TOPEKA KS 66699-0260
 2021
KANSAS UNDERPAYMENT OF ESTIMATED TAX 180018
K-210 (INDIVIDUAL INCOME TAX)
(Rev. (7-21)
Name as shown on Form K-40 Social Security Number

TSATE KONGAI 467-98-9784

CURRENT AND PRIOR YEAR INFORMATION

1 Amount from line 19, 2021 Form K-40. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2,682.

2 Multiply line 1 by 90% (farmers and fishers multiply by 66 2/3%). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2,414.

3 Prior year's tax liability (from line 19, 2020 Form K-40) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 0.

4 Enter the total amount of your 2021 Kansas income tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1,200.

NOTE: If any due date falls on a Saturday, Sunday, or legal holiday, substitute the next regular work day.

PART I ' EXCEPTIONS TO THE PENALTY 1/1/21 ' 4/15/21 1/1/21 ' 6/15/21 1/1/21 ' 9/15/21 1/1/21 ' 1/15/22
25% of line 4 50% of line 4 75% of line 4 100% of line 4

5 Cumulative total of your 2021 withholding. . . . . . . . 5 300. 600. 900. 1,200.

6 Cumulative timely paid estimated tax
payments from January through each
payment due date . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 0. 0. 0. 0.
7 Total amount withheld and timely paid
estimated payments (add lines 5 and 6). . . . . . . . . 7 300. 600. 900. 1,200.
25% of line 2 or 3 50% of line 2 or 3 75% of line 2 or 3 100% of line 2 or 3
8 Exception 1 ' Cumulative amount from
either line 2 or line 3, whichever is less. . . . . . . . . . 8 604. 1,207. 1,811. 2,414.
22.5% of tax 45% of tax 67.5% of tax 90% of tax
9 Exception 2 ' Tax on annualized 2021
income; enclose computation. (Farmers/fishers
use line 9b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a
66.66% of tax

9b

PART II ' FIGURING THE PENALTY

10 Amount of underpayment. Enter the sum of

line 8 less line 7; line 9a less line 7; or, line 9b
less line 7, whichever is applicable. . . . . . . . . . . . . . 10 304. 607. 911. 1,214.

11 Due date of each installment. . . . . . . . . . . . . . . . . . 11 4/15/21 6/15/21 9/15/21 1/15/22

12 Number of days from the due date of the Lines 12-15 See Attached Worksheet
installment to the due date of the next
installment or 12/31/21, whichever is earlier.
If paid late, see instructions. . . . . . . . . . . . . . . . . . . . 12 61 92 107

13 Number of days from 1/15/22 to date paid

or 4/15/22, whichever is earlier. If paid late,
see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 15

14 Line 12
365 X 4% X amount on line 10 . . . . . . . . . . . 14

15 Line 13
365 X 4% X amount on line 10 . . . . . . . . . . . 15

16 Penalty (add lines 14 and 15) . . . . . . . . . . . . . . . . . . 16 2.03 6.12 12.18 11.97

17 Total penalty. Add amounts on line 16 and enter the total here and on line 33, Estimated
Tax Penalty, on page 2 of Form K-40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 32.

KSIA0101 10/25/21
 2021 Underpayment Penalty Worksheet
TSATE KONGAI 467-98-9784
Required Payment Penalty
Installment

Date Type * Amount Underpayment Days Rate Amount of Penalty per

Late Penalty ** Period
First Qtr
604. 4/15/21 2 300. 304. 61 0.040 2.03
Total 2.03
Second Qtr
603. 6/15/21 2 300. 607. 92 0.040 6.12

Total 6.12
Third Qtr
604. 9/15/21 2 300. 911. 107 0.040 10.68
Rate Change 12/31/21 911. 15 0.040 1.50

Total 12.18
Fourth Qtr
603. 1/15/22 2 300. 1,214. 90 0.040 11.97

Total 11.97

TOTAL UNDERPAYMENT PENALTY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.

* 1 = Overpayment ** Days Late

2 = Withholding Underpayment x x Rate
365
3 = Estimate
4 = Extension
5 = Paid with return

FDIL1601L 06/24/21
 NOTE: If any due date falls on a Saturday, Sunday, or legal holiday, substitute the next regular work day.

Mail K-40V payments to:

Kansas Income Tax

Kansas Department of Revenue
PO BOX 750260
Topeka, KS 66699-0260

KSIA1201 08/12/21

K-40V 2021 Kansas

Rev. 7-21
INDIVIDUAL INCOME
PAYMENT VOUCHER
005

TSATE KONGAI KONG

212 QUIVIRA ROAD 467989784

OVERLAND PARK KS 66210 Name or Address
Daytime Phone Number: Change

- If married filing a joint return, include both names and Social Security numbers

- Make check or money order payable to: Kansas Income Tax

Amended Extension
Return Payment

$ 1514.00
Payment
Amount

112221KONG467989784XXXX000000000
2021 Kansas Estimated Tax Worksheet Page 1
TSATE KONGAI 467-98-9784

Estimated Tax Worksheet

1. Federal AGI expected in 2022 (ES Wrksht line 1) $ 61,671.

2. Adjustments expected in 2022
2a. Additions to income 0.
2b. Subtractions from income 0.
3. Total adjustments (line 2a less line 2b) 0.
4. AGI expected in 2022 61,671.
5. Deductions/exemptions expected in 2022 6,600.
6. Expected taxable income 55,071.
7. Estimated tax expected in 2022 2,682.
(Based on 2021 tax rates)
8. Additional taxes 0.
9. Credits expected in 2022 0.
10. Total estimated tax expected in 2022 2,682.
(line 7 plus line 8 less line 9)
11. Total required estimated tax 2,682.
(Based on 100% of 2022 tax)
12. Income tax withholding expected in 2022 1,200.
13. Net required estimated tax(ln 11 less ln 12) 1,482.
14. Rounded balance 1,484.
15. 2021 overpayment applied to 2022 0.
16. Estimated tax due(line 14 less line 15) $ 1,484.
 NOTE: If any due date falls on a Saturday, Sunday, or legal holiday,
substitute the next regular workday.

DO NOT SEND A PHOTOCOPY OF THIS VOUCHER

or risk the chance of our automated system not capturing your data correctly.

SEND THE ORIGINAL

Mail to:
KDOR - Individual Estimated Income Tax
Kansas Department of Revenue
PO Box 3506
Topeka, KS 66625-3506

KSIA0401L 08/30/21

K-40ES
Rev. 7-21
2022 Kansas
INDIVIDUAL ESTIMATED
INCOME TAX VOUCHER
005

TSATE KONGAI KONG XXXX

212 QUIVIRA ROAD 467989784

OVERLAND PARK KS 66210 Name or Address
Daytime Phone Number: Change 000000000
- If married filing a joint return, include both names and Social Security numbers

- Make check or money order payable to: Kansas Individual Estimated Tax
1
1ST QUARTER PAYMENT DUE BY APRIL 15, 2022
Payment Amount $ 371.00

182522KONG467989784XXXX000000000
 NOTE: If any due date falls on a Saturday, Sunday, or legal holiday,
substitute the next regular workday.

DO NOT SEND A PHOTOCOPY OF THIS VOUCHER

or risk the chance of our automated system not capturing your data correctly.

SEND THE ORIGINAL

Mail to:
KDOR - Individual Estimated Income Tax
Kansas Department of Revenue
PO Box 3506
Topeka, KS 66625-3506

KSIA0402L 08/12/21

K-40ES 2022 Kansas

Rev. 7-21
INDIVIDUAL ESTIMATED
INCOME TAX VOUCHER
005

TSATE KONGAI KONG XXXX

212 QUIVIRA ROAD 467989784

OVERLAND PARK KS 66210 Name or Address
Daytime Phone Number: Change 000000000
- If married filing a joint return, include both names and Social Security numbers
- Make check or money order payable to: Kansas Individual Estimated Tax
2
2ND QUARTER PAYMENT DUE BY JUNE 15, 2022
Payment Amount $ 371.00

182522KONG467989784XXXX000000000
 NOTE: If any due date falls on a Saturday, Sunday, or legal holiday,
substitute the next regular workday.

DO NOT SEND A PHOTOCOPY OF THIS VOUCHER

or risk the chance of our automated system not capturing your data correctly.

SEND THE ORIGINAL

Mail to:
KDOR - Individual Estimated Income Tax
Kansas Department of Revenue
PO Box 3506
Topeka, KS 66625-3506

KSIA0403L 08/12/21

K-40ES 2022 Kansas

Rev. 7-21
INDIVIDUAL ESTIMATED
INCOME TAX VOUCHER
005

TSATE KONGAI KONG XXXX

212 QUIVIRA ROAD 467989784

OVERLAND PARK KS 66210 Name or Address
Daytime Phone Number: Change 000000000
- If married filing a joint return, include both names and Social Security numbers
- Make check or money order payable to: Kansas Individual Estimated Tax
3
3RD QUARTER PAYMENT DUE BY SEPTEMBER 15, 2022
Payment Amount $ 371.00

182522KONG467989784XXXX000000000
 NOTE: If any due date falls on a Saturday, Sunday, or legal holiday,
substitute the next regular workday.

DO NOT SEND A PHOTOCOPY OF THIS VOUCHER

or risk the chance of our automated system not capturing your data correctly.

SEND THE ORIGINAL

Mail to:
KDOR - Individual Estimated Income Tax
Kansas Department of Revenue
PO Box 3506
Topeka, KS 66625-3506

KSIA0404L 08/30/21

K-40ES 2022 Kansas

Rev. 7-21
INDIVIDUAL ESTIMATED
INCOME TAX VOUCHER
005

TSATE KONGAI KONG XXXX

212 QUIVIRA ROAD 467989784

OVERLAND PARK KS 66210 Name or Address
Daytime Phone Number: Change 000000000
- If married filing a joint return, include both names and Social Security numbers

- Make check or money order payable to: Kansas Individual Estimated Tax
4
4TH QUARTER PAYMENT DUE BY JANUARY 15, 2023
Payment Amount $ 371 .00

182522KONG467989784XXXX000000000