_esignatureClientCopy
_esignatureClientCopy
_esignatureClientCopy
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Submission Identification Number (SID)
Taxpayer’s name Social security number
ALBERTO J ALMEIDA LANZ 002-15-5880
Spouse’s name Spouse’s social security number
Part I Tax Return Information — Tax Year Ending December 31, 2019 (Whole dollars only)
1 Adjusted gross income (Form 1040 or 1040-SR, line 8b; Form 1040-NR, line 35) . . . . . . . 1 -2,029.
2 Total tax (Form 1040 or 1040-SR, line 16; Form 1040-NR, line 61) . . . . . . . . . . . . 2 0.
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3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040 or 1040-SR, line 17; Form 1040-NR,
line 62a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Refund (Form 1040 or 1040-SR, line 21a; Form 1040-NR, line 73a; Form 1040-SS, Part I, line 13a) . 4 1,060.
5 Amount you owe (Form 1040 or 1040-SR, line 23; Form 1040-NR, line 75) . . . . . . . . . 5
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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 my electronic individual income tax return and accompanying schedules and
statements for the tax year ending December 31, 2019, and to the best of my knowledge and belief, they are true, correct, and complete. I further
declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider,
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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 my electronic income tax return
and, if applicable, my Electronic Funds Withdrawal Consent.
Taxpayer’s PIN: check one box only
I authorize Zunay Rabelo
T to enter or generate my PIN 5 5 8 8 0 as my
ERO firm name Enter five digits, but
don’t enter all zeros
signature on my tax year 2019 electronically filed income tax return.
NO
I will enter my PIN as my signature on my tax year 2019 electronically filed income tax return. 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.
I will enter my PIN as my signature on my tax year 2019 electronically filed income tax return. 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.
ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. 6 5 5 4 2 0 1 2 3 4 5
Don’t enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the tax year 2019 electronically filed income tax return 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.
Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying person is
one box.
a child but not your dependent. a
Your first name and middle initial Last name Your social security number
ALBERTO J ALMEIDA LANZ 002-15-5880
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
Check here if you, or your spouse if filing
12400 VISTA ISLES DR 1422
jointly, want $3 to go to this fund.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your
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FORT LAUDERDALE FL 33325 tax or refund. You Spouse
Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see instructions and here a
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Deduction Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness You: Were born before January 2, 1955 Are blind Spouse: Was born before January 2, 1955 Is blind
Dependents (see instructions): (2) Social security number (3) Relationship to you (4) if qualifies for (see instructions):
(1) First name Last name Child tax credit Credit for other dependents
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1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . 1
2a Tax-exempt interest . . . . 2a b Taxable interest. Attach Sch. B if required 2b
3a Qualified dividends . . . . 3a b Ordinary dividends. Attach Sch. B if required 3b
Standard
Deduction for—
• Single or Married
filing separately,
4a
c
IRA distributions . .
Pensions and annuities .
. .
.
.
.
4a
4c
T b Taxable amount
d Taxable amount
.
.
.
.
.
.
.
.
.
.
.
.
4b
4d
$12,200 5a Social security benefits . . . 5a b Taxable amount . . . . . . 5b
• Married filing
6 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . a 6
NO
jointly or Qualifying
widow(er), 7a Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . 7a -2,029.
$24,400
• Head of b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income . . . . . . . . . . . a 7b -2,029.
household,
$18,350
8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . 8a
• If you checked b Subtract line 8a from line 7b. This is your adjusted gross income . . . . . . . . . . . a 8b -2,029.
any box under
Standard 9 Standard deduction or itemized deductions (from Schedule A) . . . . . 9 12,200.
Deduction, 10 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . 10
see instructions.
11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11a 12,200.
b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . . . 11b 0.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
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DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
Form 1040 (2019) Page 2
12a Tax (see inst.) Check if any from Form(s): 1 8814 2 4972 3 12a 0.
b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . a 12b 0.
13a Child tax credit or credit for other dependents . . . . . . . . . . 13a
b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . a 13b 0.
14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . 14 0.
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . . . . . 15 0.
16 Add lines 14 and 15. This is your total tax . . . . . . . . . . . . . . . . . . a 16 0.
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . 17
• If you have a
18 Other payments and refundable credits:
qualifying child, a Earned income credit (EIC) . . . . . . . . . . . . No
. . . 18a
attach Sch. EIC.
• If you have b Additional child tax credit. Attach Schedule 8812 . . . . . . . . . 18b
nontaxable c American opportunity credit from Form 8863, line 8 . . . . . . . . 18c 1,000.
combat pay, see
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instructions. d Schedule 3, line 14 . . . . . . . . . . . . . . . . . 18d 60.
e Add lines 18a through 18d. These are your total other payments and refundable credits . . . . . a 18e 1,060.
19 Add lines 17 and 18e. These are your total payments . . . . . . . . . . . . . . . a 19 1,060.
Refund 20 If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid . . . . . . 20 1,060.
21a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here . . . . . . a 21a 1,060.
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Direct deposit? a b Routing number 0 6 3 1 0 0 2 7 7 a c Type: Checking Savings
See instructions.
a d Account number 8 9 8 0 8 3 2 6 3 9 8 2
22 Amount of line 20 you want applied to your 2020 estimated tax . . . . a 22
Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions . . . . . a
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23
You Owe 24 Estimated tax penalty (see instructions) . . . . . . . . . . . a 24
Third Party Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes. Complete below.
Designee No
(Other than Designee’s Phone Personal identification
paid preparer) name a no. a number (PIN) a
Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true,
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here If the IRS sent you an Identity
Your signature Date
T Your occupation
Protection PIN, enter it here
F
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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
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8 Other income. List type and amount a
8
9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a . . . . . . . . 9 -2,029.
Part II Adjustments to Income
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10 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach
Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . . . 12
13 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . . 13
14 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . 14
15 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . 15
16
17
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Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . .
Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . .
16
17
18a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18a
b Recipient’s SSN . . . . . . . . . . . . . . . . . . . . . a
NO
c Date of original divorce or separation agreement (see instructions) a
19 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . 20
21 Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . 21
22 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040 or
1040-SR, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
For Paperwork Reduction Act Notice, see your tax return instructions. REV 03/16/20 PRO Schedule 1 (Form 1040 or 1040-SR) 2019
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DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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7 Add lines 1 through 6. Enter here and include on Form 1040 or 1040-SR, line 13b . . . . . . . 7 0.
Part II Other Payments and Refundable Credits
8 2019 estimated tax payments and amount applied from 2018 return . . . . . . . . . . . 8
9 Net premium tax credit. Attach Form 8962 . . . . . . . . . . . . . . . . . . . . 9 60.
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10 Amount paid with request for extension to file (see instructions) . . . . . . . . . . . . . 10
11 Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . . . . . . . . 11
12 Credit for federal tax on fuels. Attach Form 4136 . . . . . . . . . . . . . . . . . . 12
13 Credits from Form: a 2439 b Reserved c 8885 d 13
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14 Add lines 8 through 13. Enter here and on Form 1040 or 1040-SR, line 18d . . . . . . . . . 14 60.
For Paperwork Reduction Act Notice, see your tax return instructions. REV 03/16/20 PRO Schedule 3 (Form 1040 or 1040-SR) 2019
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NO
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DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
2019
(Form 1040 or 1040-SR) (Sole Proprietorship)
a Go to www.irs.gov/ScheduleC for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
ALBERTO J ALMEIDA LANZ 002-15-5880
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
DRIVER a 4 8 5 3 0 0
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
E Business address (including suite or room no.) a 12400 VISTA ISLES DR, Apt. 1422
City, town or post office, state, and ZIP code FORT LAUDERDALE, FL 33325
Other (specify) a
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F Accounting method: (1) Cash (2) Accrual (3)
G Did you “materially participate” in the operation of this business during 2019? If “No,” see instructions for limit on losses . Yes No
H If you started or acquired this business during 2019, check here . . . . . . . . . . . . . . . . . a
I Did you make any payments in 2019 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No
J If “Yes,” did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes No
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Part I Income
1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . a 1 67,639.
2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2
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3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 67,639.
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4
5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 67,639.
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . a 7 67,639.
Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . 8 18 Office expense (see instructions) 18
9 Car and truck expenses (see
instructions) . . . . . 9 56,360.
T 19
20
Pension and profit-sharing plans .
Rent or lease (see instructions):
19
28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28 69,668.
29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 -2,029.
30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method (see instructions).
Simplified method filers only: enter the total square footage of: (a) your home:
and (b) the part of your home used for business: . Use the Simplified
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30
31 Net profit or (loss). Subtract line 30 from line 29.
}
• If a profit, enter on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or Form 1040-NR, line
13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and 31 -2,029.
trusts, enter on Form 1041, line 3.
• If a loss, you must go to line 32.
}
32 If you have a loss, check the box that describes your investment in this activity (see instructions).
• If you checked 32a, enter the loss on both Schedule 1 (Form 1040 or 1040-SR), line 3 (or
Form 1040-NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see the line 32a All investment is at risk.
31 instructions). Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not
at risk.
• If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 03/16/20 PRO Schedule C (Form 1040 or 1040-SR) 2019
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
33 Method(s) used to
value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35
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37 Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . 37
39 Other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
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40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40
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42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9
and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must
file Form 4562.
43 When did you place your vehicle in service for business purposes? (month, day, year) a 12/01/2017
44
T
Of the total number of miles you drove your vehicle during 2019, enter the number of miles you used your vehicle for:
46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No
TELEPHONE 360.
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!
CAUTION
Complete a separate Part III on page 2 for each student for whom you’re claiming either credit before
you complete Parts I and II.
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2 Enter: $180,000 if married filing jointly; $90,000 if single, head of household,
or qualifying widow(er) . . . . . . . . . . . . . . . . . . 2 90,000.
3 Enter the amount from Form 1040 or 1040-SR, line 8b. If you’re filing Form
2555 or 4563, or you’re excluding income from Puerto Rico, see Pub. 970 for
the amount to enter . . . . . . . . . . . . . . . . . . . 3 -2,029.
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4 Subtract line 3 from line 2. If zero or less, stop; you can’t take any education
credit . . . . . . . . . . . . . . . . . . . . . . . . 4 92,029.
5 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or
qualifying widow(er) . . . . . . . . . . . . . . . . . . . 5 10,000.
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6 If line 4 is:
• Equal to or more than line 5, enter 1.000 on line 6 . . . . . . . . . . . . .
• Less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to
at least three places) . . . . . . . . . . . . . . . . . . . . . .
} . . . 6 1.000
7 Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet the
conditions described in the instructions, you can’t take the refundable American opportunity credit;
skip line 8, enter the amount from line 7 on line 9, and check this box . . . . . . . . a 7 2,500.
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Refundable American opportunity credit. Multiply line 7 by 40% (0.40). Enter the amount here and
on Form 1040 or 1040-SR, line 18c. Then go to line 9 below . . . . . . . . . . . . . . 8 1,000.
Part II Nonrefundable Education Credits
9 Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions) . 9 1,500.
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10 After completing Part III for each student, enter the total of all amounts from all Parts III, line 31. If
zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19 . . . . . . . . . . . 10
11 Enter the smaller of line 10 or $10,000 . . . . . . . . . . . . . . . . . . . . . 11
12 Multiply line 11 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Enter: $136,000 if married filing jointly; $68,000 if single, head of household, or
qualifying widow(er) . . . . . . . . . . . . . . . . . . . 13
14 Enter the amount from Form 1040 or 1040-SR, line 8b. If you're filing Form
2555 or 4563, or you’re excluding income from Puerto Rico, see Pub. 970 for
the amount to enter . . . . . . . . . . . . . . . . . . . 14
15 Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0- on
line 18, and go to line 19 . . . . . . . . . . . . . . . . . 15
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!
CAUTION
Complete Part III for each student for whom you’re claiming either the American
opportunity credit or lifetime learning credit. Use additional copies of page 2 as needed for
each student.
Part III Student and Educational Institution Information. See instructions.
20 Student name (as shown on page 1 of your tax return) 21 Student social security number (as shown on page 1 of
ALBERTO J your tax return)
ALMEIDA LANZ 002-15-5880
22 Educational institution information (see instructions)
a. Name of first educational institution b. Name of second educational institution (if any)
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BROWARD COLLEGE
(1) Address. Number and street (or P.O. box). City, town or (1) Address. Number and street (or P.O. box). City, town or
post office, state, and ZIP code. If a foreign address, see post office, state, and ZIP code. If a foreign address, see
instructions. instructions.
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225 EAST LAS OLAS BLVD
FORT LAUDERDALE FL 33301
(2) Did the student receive Form 1098-T (2) Did the student receive Form 1098-T
Yes No Yes No
from this institution for 2019? from this institution for 2019?
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(3) Did the student receive Form 1098-T (3) Did the student receive Form 1098-T
from this institution for 2018 with box Yes No from this institution for 2018 with box Yes No
7 checked? 7 checked?
(4) Enter the institution’s employer identification number (EIN) (4) Enter the institution’s employer identification number
if you’re claiming the American opportunity credit or if you (EIN) if you’re claiming the American opportunity credit or
checked “Yes” in (2) or (3). You can get the EIN from Form if you checked “Yes” in (2) or (3). You can get the EIN
1098-T or from the institution. from Form 1098-T or from the institution.
23-7181959
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23 Has the Hope Scholarship Credit or American opportunity
Yes — Stop!
credit been claimed for this student for any 4 tax years Go to line 31 for this student. No — Go to line 24.
NO
before 2019?
24 Was the student enrolled at least half-time for at least one
academic period that began or is treated as having begun in
2019 at an eligible educational institution in a program
Yes — Go to line 25. No — Stop! Go to line 31
leading towards a postsecondary degree, certificate, or
for this student.
other recognized postsecondary educational credential?
See instructions.
25 Did the student complete the first 4 years of postsecondary Yes — Stop!
education before 2019? See instructions. Go to line 31 for this No — Go to line 26.
student.
26 Was the student convicted, before the end of 2019, of a Yes — Stop!
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No — Complete lines 27
felony for possession or distribution of a controlled Go to line 31 for this through 30 for this student.
substance? student.
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!
CAUTION
You can't take the American opportunity credit and the lifetime learning credit for the same student in the same year. If
you complete lines 27 through 30 for this student, don’t complete line 31.
2019
Form Earned Income Credit (EIC), American Opportunity Tax Credit (AOTC), Child Tax Credit (CTC) (including the Additional
Child Tax Credit (ACTC) and Credit for Other Dependents (ODC)), and Head of Household (HOH) Filing Status
Department of the Treasury a To be completed by preparer and filed with Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS. Attachment
Internal Revenue Service a Go to www.irs.gov/Form8867 for instructions and the latest information. Sequence No. 70
Taxpayer name(s) shown on return Taxpayer identification number
ALBERTO J ALMEIDA LANZ 002-15-5880
Enter preparer’s name and PTIN
Zunay Rabelo, EA P01785647
Part I Due Diligence Requirements
Please check the appropriate box for the credit(s) and/or HOH filing status claimed on the return and complete the related Parts I–V
for the benefit(s) claimed (check all that apply). EIC CTC/ACTC/ODC AOTC HOH
1 Did you complete the return based on information for tax year 2019 provided by the taxpayer or Yes No N/A
reasonably obtained by you? . . . . . . . . . . . . . . . . . . . . . . . .
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2 If credits are claimed on the return, did you complete the applicable EIC and/or CTC/ACTC/ODC
worksheets found in the Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS instructions, and/or the
AOTC worksheet found in the Form 8863 instructions, or your own worksheet(s) that provides the same
information, and all related forms and schedules for each credit claimed? . . . . . . . . .
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3 Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both of
the following.
• Interview the taxpayer, ask questions, and contemporaneously document the taxpayer’s responses to
determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing status.
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• Review information to determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing
status and to compute the amount(s) of any credit(s) . . . . . . . . . . . . . . . .
4 Did any information provided by the taxpayer or a third party for use in preparing the return, or
information reasonably known to you, appear to be incorrect, incomplete, or inconsistent? (If “Yes,”
answer questions 4a and 4b. If “No,” go to question 5.) . . . . . . . . . . . . . . .
a Did you make reasonable inquiries to determine the correct, complete, and consistent information? .
b Did you contemporaneously document your inquiries? (Documentation should include the questions
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you asked, whom you asked, when you asked, the information that was provided, and the impact the
information had on your preparation of the return.) . . . . . . . . . . . . . . . . .
5 Did you satisfy the record retention requirement? To meet the record retention requirement, you must
keep a copy of your documentation referenced in 4b, a copy of this Form 8867, a copy of any
NO
applicable worksheet(s), a record of how, when, and from whom the information used to prepare Form
8867 and any applicable worksheet(s) was obtained, and a copy of any document(s) provided by the
taxpayer that you relied on to determine eligibility for the credit(s) and/or HOH filing status or to
compute the amount(s) of the credit(s) . . . . . . . . . . . . . . . . . . . . .
List those documents, if any, that you relied on.
6 Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for the
credit(s) and/or HOH filing status and the amount(s) of any credit(s) claimed on the return if his/her
DO
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with the child for over half of the year, even if the taxpayer has supported the child, unless the child’s
custodial parent has released a claim to exemption for the child? . . . . . . . . . . . .
12 Did you explain to the taxpayer the rules about claiming the CTC/ACTC/ODC for a child of divorced or
separated parents (or parents who live apart), including any requirement to attach a Form 8332 or similar
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statement to the return? . . . . . . . . . . . . . . . . . . . . . . . . . .
Part IV Due Diligence Questions for Returns Claiming AOTC (If the return does not claim AOTC, go to Part V.)
13 Did the taxpayer provide substantiation for the credit, such as a Form 1098-T and/or receipts for the qualified Yes No
tuition and related expenses for the claimed AOTC? . . . . . . . . . . . . . . . . . . . .
FI
Part V Due Diligence Questions for Claiming HOH (If the return does not claim HOH filing status, go to Part VI.)
14 Have you determined that the taxpayer was unmarried or considered unmarried on the last day of the tax year Yes No
and provided more than half of the cost of keeping up a home for the year for a qualifying person? . . . .
Part VI Eligibility Certification
a You will have complied with all due diligence requirements for claiming the applicable credit(s) and/or HOH filing
status on the return of the taxpayer identified above if you:
A. Interview the taxpayer, ask adequate questions, contemporaneously document the taxpayer’s responses on the return or
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in your notes, review adequate information to determine if the taxpayer is eligible to claim the credit(s) and/or HOH filing
status and to compute the amount(s) of the credit(s);
B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for any applicable
credit(s) claimed and HOH filing status, if claimed;
NO
C. Submit Form 8867 in the manner required; and
D. Keep all five of the following records for 3 years from the latest of the dates specified in the Form 8867 instructions under
Document Retention.
1. A copy of this Form 8867.
2. The applicable worksheet(s) or your own worksheet(s) for any credit(s) claimed.
3. Copies of any documents provided by the taxpayer on which you relied to determine the taxpayer’s eligibility for the
credit(s) and/or HOH filing status and to compute the amount(s) of the credit(s).
4. A record of how, when, and from whom the information used to prepare this form and the applicable worksheet(s) was
obtained.
5. A record of any additional information you relied upon, including questions you asked and the taxpayer’s responses, to
determine the taxpayer’s eligibility for the credit(s) and/or HOH filing status and to compute the amount(s) of the credit(s).
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a Ifyou have not complied with all due diligence requirements, you may have to pay a $530 penalty for each failure to
comply related to a claim of an applicable credit or HOH filing status.
15 Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and Yes No
complete? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
REV 03/16/20 PRO Form 8867 (2019)
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
2019
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
ALBERTO J ALMEIDA LANZ 002-15-5880
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
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3 Household income. Add the amounts on lines 2a and 2b (see instructions) . . . . . . . . . . . . 3
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 12,140.
5 Household income as a percentage of federal poverty line (see instructions) . . . . . . . . . . . . 5 0 %
6 Did you enter 401% on line 5? (See instructions if you entered less than 100%.)
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No. Continue to line 7.
Yes. You are not eligible to take the PTC. If advance payment of the PTC was made, see the instructions for
how to report your excess advance PTC repayment amount.
7 Applicable Figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions . . 7 0.0208
FI
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.
(a) Annual enrollment (b) Annual applicable
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(c) Annual
your monthly PTC and continue to line 24.
(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-)
NO
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)
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Allocation percentage (g) Advance Payment of the PTC
(e) Premium Percentage (f) SLCSP Percentage
applied to monthly Percentage
amounts
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Allocation 3
32 (a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month
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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
applied to monthly
amounts
(e) Premium Percentage
T (f) SLCSP Percentage
(g) Advance Payment of the PTC
Percentage
(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 03/16/20 PR Form 8962 (2019)
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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Adjustments to income 673.
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Tax expense 0.
Interest expense
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Contributions
Misc. deductions
Total itemized/
standard deduction
T 24,000. 12,200.
Exemption amount 0. 0.
NO
QBI deduction
Taxable income 0. 0.
Tax
Total credits 0. 0.
Amount owed
Applied to next
year’s estimated tax
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in Part VIII, Qualified Tuition Program (Section 529 Plan) below.
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1 Did the student complete the first 4 years of postsecondary education
as of 1/1/2019? Yes X No NA
2 Was this student enrolled at an eligible education institution during
2019? X Yes No NA
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3 Was this student enrolled in a program that leads to a degree,
certificate, or credential? X Yes No NA
4 Was this student taking courses as part of a postsecondary degree
program or to acquire or improve job skills? X Yes No NA
5 Did this student take at least one-half the normal full-time workload for
one academic period? X Yes No NA
6 Has this student been convicted of a felony for possessing or distributing
a controlled substance? Yes X No NA
7 Is this student an eligible dependent of the taxpayer? Yes No X NA
8
9
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In how many prior years has an American Opportunity Credit been claimed for this student?
In how many prior years has a Hope Credit been claimed for this student
Part III ' Education Credit Qualifications (Determined based entries in Part II)
NO
1 Is this student qualified for the American Opportunity Credit? X Yes No
3 Is this student qualified for the Tuition and Fees Deduction? X Yes No
Totals
Are all School Employer Identifification Numbers (EIN) known? (School EIN’s must be
entered in the program to claim the American Opportunity Credit) X Yes No
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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c Total
3 Scholarship reported in 2019 not allocable to 2019 expense
4 Amount required to be used for other than qualified education expenses
5 Subtract line 3 and 4 from line 2c
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6 Total qualified education expenses from Part VI below 4,775.
7 If student is a candidate for a degree, enter the amount used for
qualified education expenses, otherwise, enter -0-.
8 Subtract line 7 from line 5
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9 Taxable part. Add lines 4 and 8.
10 Tax-free educational assistance. Add lines 1d and 7
Expenses:
1 Tuition paid from Part IV and
qualified elementary and
secondary tuition
Paid to institution as a
condition of enrollment:
2
DO
13 Total qualified expenses 4,775. 4,775. 4,775. 4,775. 4,775. 4,775. 1,750.
Adjustments:
14 Refunds
15 Tax-free assistance
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
16 Deducted on Sched A
17 Used for credit or deduction
18 Used for exclusion 0. 0. 0.
See tax help
19 Total adjustments. 0. 0. 0.
20 Adjusted qualified expenses 4,775. 4,775. 4,775. 4,775. 4,775. 4,775. 1,750. 0.
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3 Elect the Lifetime Learning Credit
4 Elect the tuition and fees deduction
4 Not applicable
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For Purposes For Purposes
of of 10%
Regular Additional
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Tax Tax
Regular Additional
Tax Tax
Part X ' Series EE and I U.S. Savings Bonds Issued After 1989
1 Total proceeds from U.S. Savings Bonds cashed during 2019 for this student
2 Adjusted Qualified Higher Education Expenses
3 Qualified Higher Education Expenses applied to exclusion of U.S. bond interest
4 Interest included in line 1
5 Name and address of eligible educational institution(s) attended:
Institution Name Institution Name
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
L E
FI
T
NO
DO
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
Note: Providing identification numbers helps the IRS and states verify taxpayer identity which can prevent
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unnecessary delays in tax return processing.
All identity verification information should be entered here and will automatically flow to the
state return.
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Taxpayer/Spouse does not have a driver’s license or state id
Taxpayer Note: Alabama does not allow this option
Spouse
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Taxpayer/Spouse did not provide driver’s license or state id information
Taxpayer Note: Alabama, New York and Ohio do not allow this option
Spouse
Check to confirm transferred driver’s license or state id information (which appears in green) is correct X
Note: Transfer not available for returns with Alabama, Iowa, or New York state taxes. See tax help for
more information.
Taxpayer: Spouse:
Issuing state Issuing state
DO
* Enter the first 3 characters of the NY document number, which is the 8 or 10 number/letter combination
found at the bottom of the NY license (or NY state ID) or on the back if it was issued after January 28, 2014.
Client Status:
New client
Returning client to same preparer and firm
Returning client to same firm
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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Documents Used to Verify Spouse Identity (If you file joint return):
X Driver’s license (complete detail above)
State issued identification card (complete detail above)
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FI
fdiv7101.SCR 12/18/19
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NO
DO
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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FL 74145813 AMBETTER FROM SUNSHINE HEALTH
4 Recipient’s name 5 Recipient’s SSN 6 Recipient’s DOB
ALBERTO ALMEIDA LANZ 002-15-5880 01/29/81
7 Recipient’s spouse’s name 8 Spouse’s SSN 9 Spouse’s DOB
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10 Policy start date 11 Policy termination date 12 Street address (including apartment no.)
01/01/19 12/31/19 12400 VISTA ISLES DR, Apt. 1422
13 City or town 14 State or province 15 Country and ZIP or foreign postal code
FI
FORT LAUDERDALE FL 33325
Check this box to populate the Name, SSN, and DOB for everyone listed on the return in Part II.
Note: Checking this box again will repopulate the information below and overwrite existing entries.
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A. Covered individual name B. Covered C. Covered D. Coverage E. Coverage
First individual SSN individual start date termination
Last date of birth date
16 ALBERTO J
NO
ALMEIDA LANZ 002-15-5880 01/29/81 01/01/19 12/31/19
17
18
19
20
Month Copy Feature A. Monthly enrollment B. Monthly second lowest C. Monthly advance payment
See help for premiums cost silver plan (SLCSP) of premium tax credit
more info. premium
21 JANUARY 1,099.70 1,127.73 1,086.00
22 FEBRUARY 1,099.70 1,127.73 1,086.00
23 MARCH 1,099.70 1,127.73 1,086.00
24 APRIL 1,099.70 1,127.73 1,086.00
25 MAY 1,099.70 1,127.73 1,086.00
26 JUNE 1,099.70 1,127.73 1,086.00
27 JULY 1,099.70 1,127.73 1,086.00
28 AUGUST 1,099.70 1,127.73 1,086.00
29 SEPTEMBER 1,099.70 1,127.73 1,086.00
30 OCTOBER 1,099.70 1,127.73 1,086.00
31 NOVEMBER 1,099.70 1,127.73 1,086.00
32 DECEMBER 1,099.70 1,127.73 1,086.00
33 Annual Totals 13,196. 13,533. 13,032.
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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A Schedule C 67,505. 67,505.
A Schedule E
A Schedule F
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A Other Income
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8 State tax withheld - total
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NO
DO
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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Box 1 Gross amount of payment card/third party network transactions 26,472.
Required: double-click to select the form on which to report this income:
Schedule C DRIVER
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Schedule E
Schedule F
Other Income
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Box 4 Federal income tax withheld
First State
Box 6 State FL Box 7 State identification number
Box 8 State income tax withheld
Second State
Box 6
Box 8
State
State income tax withheld
Box 7
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State identification number
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Box 1 Gross amount of payment card/third party network transactions 41,033.
Required: double-click to select the form on which to report this income:
Schedule C DRIVER
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Schedule E
Schedule F
Other Income
FI
Box 4 Federal income tax withheld
First State
Box 6 State Box 7 State identification number
Box 8 State income tax withheld
Second State
Box 6
Box 8
State
State income tax withheld
Box 7
T
State identification number
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B Approved Form 4029. Exempt from SE tax on all income
C Chapter 11 bankruptcy net profit or loss for Schedule SE, line 3
D QuickZoom to the Explanation statement for any adjustment to
SE income/loss shown on a partnership K-1. (See Help)
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Part I Farm Profit or (Loss) Schedule SE, line 1
1 Total Schedules F
2 Farm partnerships, Schedules K-1
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3 Other SE farm profit or (loss) (See Help)
4 Less SE exempt farm profit or (loss) (See Help)
5 Total for Schedule SE, line 1
6 Conservation Reserve Program payments not subject to self-
employment tax reported on:
a Schedule F, line 4b
b Schedule K-1 (Form 1065), box 20, code AH
c Total CRP payments not subject to SE tax
T
Part II Nonfarm Profit or (Loss) Schedule SE, line 2
1a Total Schedules C -2,029.
NO
b Less SE exempt Schedules C (approved Form 4361)
2 Nonfarm partnerships, Schedules K-1
3 Forms 6781
4 Other SE income reported as income on Form 1040, line 7
5a Clergy Form W-2 wages
b Clergy housing allowance
c Less clergy business deductions
d QuickZoom to the Explanation statement for entry on line 5c
6 Other SE nonfarm profit or (loss) (See Help)
7 Less other SE exempt nonfarm profit or (loss) (See Help)
8 Total for Schedule SE, line 2 -2,029.
DO
9 Exempt Notary Public income for Schedule SE, line 3 (See Help)
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Social Security Number if if
Yes No manual automatic
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ALMEIDA LANZ 4,775. Lifetime Cr X
002-15-5880 4,775. Tuition Ded X
4,775. Total Qualified Expenses
Amer Opp Cr
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Lifetime Cr
Tuition Ded
Total Qualified Expenses
Amer Opp Cr
Lifetime Cr
Tuition Ded
Total Qualified Expenses
Automatic
1 Launch OPTIMIZER - Check to launch Automatic Education Expense Optimizer now
2 Automatic - Check to use the choices calculated in Part I, column (e) above X
or
3 Manual - Check to use the choices you entered in Part I, column (d) above
DO
1 Subtract Form 1040, Line 9 from line 8b, or Form 1040NR, line
37 from line 35 and enter here 1 $ -14,229.
2 Nonbusiness capital losses before limitation. Enter as a positive number. 2
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3 Nonbusiness capital gains (without regard to section 1202 exclusion) 3
4 If line 2 is more than line 3, enter difference; otherwise enter -0- 4 0.
5 If line 3 is more than line 2, enter difference; otherwise enter -0- 5 0.
6 Nonbusiness deductions 6 12,200.
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7 Nonbusiness income other than capital gains 7
8 Add lines 5 and 7 8 0.
9 If line 6 is more than line 8, enter difference; otherwise enter -0- 9 12,200.
10 If line 8 is more than line 6, enter difference; otherwise enter -0-.
FI
Don’t enter more than line 5 10 0.
11 Business capital losses before limitation. Enter as a positive number 11
12 Business capital gains (without regard to any section 1202 exclusion) 12
13 Add lines 10 and 12 13 0.
14 Subtract line 13 from line 11. If zero or less, enter -0- 14 0.
15 Add lines 4 and 14 15 0.
16 Enter the loss, if any, from line 16 of Schedule D (enter as positive).
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If none, and if there is no Section 1202 exclusion, skip lines 16
through 21 and enter on line 22 the amount from line 15 16
17 Section 1202 exclusion. Enter as a positive number 17
18 Subtract line 17 from line 16. If zero or less, enter -0- 18
NO
19 Enter the loss, if any, from line 21 of Schedule D (enter as positive) 19
20 If line 18 is more than line 19, enter difference; otherwise enter -0- 20
21 If line 19 is more than line 18, enter difference; otherwise enter -0- 21
22 Subtract line 20 from line 15. If zero or less, enter -0- 22 0.
23 Domestic production activities deduction from your 2019 return 23
24 Net Operating Loss deduction for losses from other years (enter as positive) 24
25 Net Operating Loss. Combine lines 1, 9, 17, and 21 through 24 25 -2,029.
If line 25 is zero or more, you don’t have a Net Operating Loss.
DO
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
1 Current year Net Operating Loss - regular tax (line 25 above) 1 -2,029.
2a Depletion (regular tax - AMT) 2a
b Exercise of ISO (excess of AMT over regular tax) b
c Estates & trusts (1041 Sch K-1, box 12, code A) c
d Dispositions (AMT - regular tax) d
e Depreciation (regular tax - AMT) e
f Passive activities (AMT - regular tax) f
g Loss limitations (AMT - regular tax) g
h Circulation costs (regular tax - AMT) h
i Long-term contracts (AMT - regular tax) i
j Mining costs (regular tax - AMT) j
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k Research and experimental costs (reg tax - AMT) k
l Income from certain pre-1987 installment sales l
m Intangible drilling costs preference m
n Other adjustments from 6251 line 27 n
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o Other
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Subtotal - adjustments and preferences 2
3 a Itemized deductions allowed for regular NOL 3a
Less allowable AMT itemized deductions
(cannot exceed nonbusiness income):
b Other T b
Subtotal - net itemized deductions addback (cannot be less than zero) 3
4 AMT NOL deduction for losses from other years (enter as positive) 4
5 Net Operating Loss for AMT - combine lines 1 through 4 5 -2,029.
NO
If line 5 is zero or more, you don’t have a Net Operating Loss for AMT.
(A) (B)
Item Amount Business Nonbusiness
Income (Loss)
1 Wages, salaries, tips, etc
2 Business income -2,029. -2,029.
3 Other gains
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4 Rents
5 Royalties
6 Partnerships and S corporations
7 Estates and trusts
8 REMICs
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9 Farm income
10 Unemployment compensation
11 Interest income
12 Dividend income
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13 State tax refund
14 Alimony received
15 IRA distributions
16 Pensions
17 Taxable social security
18 Other income
19 Reallocation
20 Income (Loss) Totals
Capital Gains (Losses)
T -2,029.
21 Capital gains
22 Capital losses
NO
23 Capital loss carryover
24 Capital gain distributions
25 Capital Gains Total
26 Capital Losses Total
Deductions
27 Educator expenses
28 Certain business expenses
29 Health Savings Account
30 Moving expenses
31 Self employed tax deduction
32 Keogh, SEP and SIMPLE
33 Self employed health insurance
DO
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Totals
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2018 State Extension Information 2018 Locality Extension Information
FI
State Paid With Extension Locality Paid With Extension
(a)
State
(c)
Estimates Paid After 12/31
T (a)
Locality
(c)
Estimates Paid After 12/31
NO
2018 State Taxes Due Information 2018 Locality Taxes Due Information
2018 State Refund Applied Information 2018 Locality Refund Applied Information
DO
2018 State Tax Refund Information 2018 Locality Tax Refund Information
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7 Alternative minimum tax 7
8 Federal overpayment applied to next year estimated tax 8
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Excess Contributions 2018 2019
FI
b Spouse’s excess Archer MSA contributions as of 12/31 b
10 a Taxpayer’s excess Coverdell ESA contributions as of 12/31 10 a
b Spouse’s excess Coverdell ESA contributions as of 12/31 b
11 a Taxpayer’s excess HSA contributions as of 12/31 11 a
b Spouse’s excess HSA contributions as of 12/31 b
f 2014 f
17 AMT Nonrecap’d net Sec 1231 losses from: a 2019 17 a
b 2018 b
c 2017 c
d 2016 d
e 2015 e
f 2014 f
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
Sch C DRIVER
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3 Date placed in service 12/01/2017
4 Type of vehicle A1 - Auto
5a Ending mileage reading
b Beginning mileage reading
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c Total miles for the year 99,083
6 Business miles for the year 95,167
7 Commuting miles for the year
8 Other personal miles for the year 3,916
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9 Percent of business use % 96.05 % %
10 Months for special allocation. See Tax Help
11 Is another vehicle available for personal use? Yes No Yes X No Yes No
12 Was the vehicle available for personal use
during off-duty hours? Yes No X Yes No Yes No
13 Was the vehicle used primarily by a more
than 5% owner or related person? Yes No Yes X No Yes No
Actual Expenses
18 Expenses:
a Gasoline, oil, repairs, insurance, etc
b Vehicle registration, license (excluding
property taxes)
c Vehicle lease or rental fees:
DO
1 30 days or more
2 29 days or less
3 Total vehicle lease/rental fees
d Leased vehicle inclusion amount:
1 Year lease began
2 FMV of leased vehicle
3 Number of lease days in year
4 Inclusion amount
19 Expenses subtotal
20 Expenses applicable to business
21 Vehicle depreciation and Sec 179 (from page 2)
22 Total actual expenses
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c Less personal portion of property taxes
d Interest on vehicle
e Less personal portion of vehicle interest
27 Total expenses 56,360.
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28 Less business portion of lease or rental fees
less inclusion amount (if actual expenses)
29 Less business portion of depreciation
(if actual expenses)
FI
30 Total car and truck expenses 56,360.
31 Cost or basis
32 Section 179 expense elected
33 Depreciation and Sec 179 limit for automobiles
34 a Economic Stimulus - Qualified Property
1 If yes, and if placed in service after 9/27/17,
TYes
Yes
No N/A
No
Yes
Yes
No N/A
No
Yes
Yes
No N/A
No
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i State asset class
j State depreciation method
k State MACRS convention
l State recovery period
m State depreciable basis
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n State prior depreciation
o State depreciation deduction
p If this asset represents entire basis of replacement property, enter excess basis
q Form 8824: If luxury auto, enter depreciation at 100% business use
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r State gain/loss basis, if different from state cost
o Include vehicle in state return Yes No
65 Eligible for Sec 179 (current yr assets only)? Yes No Yes No Yes No
66 Use IRS tables for MACRS property? Yes No Yes No Yes No
67 Qualified Indian reservation property? Yes X No Yes X No Yes No
68 Used Property? Yes No Yes No Yes No
69 Depreciation type
70 Asset class
71 Depreciation method
72 Convention (HY assumed for MACRS property)
73 QZ to set 2019 convention
74 Recovery period
75 Year of depreciation
76 Depreciable basis
77 Alternative minimum tax basis, if diff from ln 30
78 Alternative minimum tax depreciation method
79 Alternative minimum tax recovery period
80 Alternative minimum tax depreciable basis
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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NO
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DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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Pensions and annuities
Rents and royalties
Partnerships, S Corps, etc
Farm income (loss)
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Social security benefits
Income other than the above
Total Income 11,384. -2,029. -13,413. -117.82
Adjustments to Income 673. -673. -100.00
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Adjusted Gross Income 10,711. -2,029. -12,740. -118.94
Itemized Deductions
Medical and dental
Income or sales tax
Real estate taxes
Personal property and other taxes
Interest paid
Gifts to charity
T
Casualty and theft losses
Miscellaneous
NO
Total Itemized Deductions 0. 0. 0.
Standard or Itemized Deduction 24,000. 12,200. -11,800. -49.17
Qualified Business Income Deduction
Taxable Income 0. 0. 0.
Income tax 0. 0. 0.
Additional income taxes
Alternative minimum tax
Total Income Taxes 0. 0. 0.
Nonbusiness credits 0. 0. 0.
Business credits
DO
Total Credits 0. 0. 0.
Self-employment tax 1,346. -1,346. -100.00
Other taxes
Total Tax After Credits 1,346. 0. -1,346. -100.00
Withholding 153. -153. -100.00
Estimated and extension payments
Earned income credit 3,461. -3,461. -100.00
Additional child tax credit 1,232. -1,232. -100.00
Other payments 1,060. 1,060.
Total Payments 4,846. 1,060. -3,786. -78.13
Form 2210 penalty
Applied to next year’s estimated tax
Refund 3,500. 1,060. -2,440. -69.71
Balance Due
Note: Transferred data will not be displayed in the prior year column unless you have entered
current year data on the Schedule C.
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Income:
1 Gross receipts or sales 70,979. 100.00 67,639. 100.00 -3340.00
2 Returns & allowances
3 Net receipts or sales 70,979. 100.00 67,639. 100.00 -3340.00
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Cost of goods sold:
4 a Beginning inventory
b Purchases
c Cost of labor
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d Materials & supplies
e Other costs
f Ending inventory
5 Cost of goods sold
6 Gross profit 70,979. 100.00 67,639. 100.00 -3340.00
7 Other income
8 Gross income 70,979. 100.00 67,639. 100.00 -3340.00
Expenses:
9
10
Advertising
Car & truck expenses 46,664.
T 65.74 56,360. 83.32 9696.00
11 Commissions and fees
12 Contract labor
NO
13 Depletion
14 Depreciation & Sec 179
15 Employee benefits
16 Insurance
17 a Mortgage interest
b Other interest
18 Legal and professional
19 Office expense
20 Pension & profit-sharing
21 Rent or lease:
a Vehicle/machinery/equip
b Other business property
DO
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Or, foreign country information:
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SMART WORKSHEET FOR: Schedule C (DRIVER): Profit or Loss from Business
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Activity Summary Smart Worksheet
Supporting information provided by program. NO ENTRIES ARE NEEDED.
A
B
Ownership
At risk status
T Taxpayer
All
C Passive status Nonpassive
NO
Schedule C
D Tentative profit (loss) -2,029. -2,029.
E Other adjustments
F At risk disallowed loss
G Passive carryover loss
H Passive disallowed loss
I Net profit (loss) allowed -2,029. -2,029.
Related Dispositions
J Tentative profit (loss)
K At risk disallowed loss
L Passive carryover loss
M Passive disallowed loss
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2018 0.00 0.00 0.00
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Prior Year Carryovers by Year Regular Tax QBI
Before 2018
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A Section 179 carryover
2018
B Section 179 carryover
Before 2018
A Section 179 carryforward
2018
B Section 179 carryforward
2019
C Section 179 carryforward
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At-Risk Limits
Before 2018
A Operating loss
B Form 4797 ordinary loss
C Form 4797 long-term loss
2018
D Operating loss
E Form 4797 ordinary loss
F Form 4797 long-term loss
DocuSign Envelope ID: 0D2948DF-0C16-4A58-A57F-416B87C0EAA7
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7 Enter the smaller of line 3 or line 6 here and on Form 8863, line 19 7 0.
SMART WORKSHEET FOR: Form 8867: Paid Preparer's Due Diligence Checklist
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Paid Preparer Smart Worksheet
If different from the preparer who will sign the return, select the paid preparer who determined
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the taxpayer’s eligibility for, and amount of, the Earned Income Credit (EIC), Child Tax Credit
(CTC), American Opportunity Tax Credit (AOTC), or Additional Child Tax Credit (ACTC).
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NO
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