Tommie chamberlain



Download 234.15 Kb.
View original pdf
Date18.05.2020
Size234.15 Kb.
Return Printed on 01/11/2020 at 02:53:24 PM
__________________________________________________________________________
TOMMIE CHAMBERLAIN
2033 KNOLL CREST DR
ARLINGTON TX 76104
39712
Page 01
Prepared for
Preparer’s Review Copy
2019
9USBDR1
This Page was Printed on 01/11/20 at 02:53:24 PM
UNLIMITED TAXES AND MORE X - Tax Refund - Refund Advance X - Tax Refund - Refund Transfer X - Audit Protection TOMMIE CHAMBERLAIN
39712 Page 02 9USCON1
This form is provided to you by (Tax Preparer). Federal law requires this consent form be provided to you. Unless authorized bylaw, we, as your Tax
Preparer, cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature. If you would like us to use your tax return information to determine your eligibility for the following products, please choose the particular product and check the appropriate box below Printed Name of Taxpayer Printed Name of Joint Taxpayer Taxpayer Signature Joint Taxpayer Signature
Date:
Date: If you believe your tax return information has been disclosed or used improperly in a manner unauthorized bylaw or without your permission, you may contact the Treasury Inspector General for
Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.
Consent to Use of Tax Return Information
2019 Tax Year
TOMMIE CHAMBERLAIN KNOLL CREST DR
ARLINGTON, TX Dear Client,
Please find enclosed your 2019 Federal individual income tax return. We prepared your return based on the information provided. Please review the return carefully to ensure that there are no omissions. You should retain a copy of your return, along with any supporting documents,
for a minimum of three years from the filing date.
Your Federal return was filed electronically. The IRS was instructed to deposit your refund of directly into an account at TPG. Once this direct deposit is received by the bank, you will receive notification when your TPG payment is available. The payment will be available based on the time and date that the IRS processes your refund.
As your Electronic Return Originator, we will forward your required supporting documents to the IRS.
If you have any questions about your return, please feel free to contact our office. Remember that we are here throughout the year to assist you with all of your financial and tax consulting needs.
Sincerely,
January 11, 2020
UNLIMITED TAXES & MORE
1670 N HAMPTON RD 109
DESOTO, TX 75115
214-782-9045
TOMMIE CHAMBERLAIN
317-94-3147 85,556 12,200 65,800
.................. 10,340 2,000
(7,556)
8,340 22.000 15.714
.............. 78,000 15,205
......... 78,000 15,205 6,865 Filing Status Single
...................... 909 909 39712 Page 04 39712 Page Wages, Salaries and Tips
(
Itemized / Standard Deduction
(
)
Interest
Qualified Business Income Deduction
Dividends
Taxable Income
Taxable IRA Distributions
Tentative Tax
Taxable Pension Distributions
Alternative Minimum Tax
Social Security Benefits
Excess Advance Premium Tax Credit Repayment
(
)
Capital Gain / (Loss)
Child Tax Credit/Credit for Other Dependents
State Tax Refund
(
)
Other Credits
Alimony Received
Self-Employment Tax
Business Income / (Loss)
Other Taxes
Other Gain / (Loss)
Total Tax
Rents, Royalties, Part
Farm Income / (Loss)
Unemployment Compensation
Other Income
Total Income
Withholding
Estimated Payments
Adjustments to Income
(
)
Earned Income Credit
Adjusted Gross Income
Additional Child Tax Credit
Other Payments
Total Payments
Amount Overpaid
Amount Applied to Your 2020 Estimated Tax
Form 2210 / F Penalty
Total Medical
Medical less 7.5%
12,200 1,650
Single
Taxes
24,400 1,300
MFJ/QW
Interest
12,200 1,300
MFS
Contributions
H of H Casualty Loss
Other Miscellaneous
TOTAL ITEMIZED DEDUCTIONS
9USTS1
1.
19.
2.
20.
3.
21.
4.
22.
5.
23.
6.
24.
7.
25.
8.
26.
9.
27.
10.
28.
11.
29.
12.
13.
Marginal Tax Rate
14.
Effective Tax Rate
15.
16.
30.
31.
17.
32.
18.
33.
34.
35.
36.
37.
38.
Refunded to You
39.
40.
Amount Due
ITEMIZED DEDUCTIONS
STANDARD DEDUCTION
Filing Status
Standard Deduction
+ Age / Blind
State
Total Income
Total Tax
Balance Due
Refund
Withholdings
Visit the IRS website at http://www.irs.gov to find out about your refund.
2019 TAX SUMMARY
TOMMIE CHAMBERLAIN
317-94-3147 78,000 8,340 15,205 6,865
X
UNLIMITED TAXES AND MORE
03147 75156619712 39712 Page Department of the Treasury Internal Revenue Service
OMB No. Form Taxpayers name
Spouse's name
Form
(2019)
1037 CPTS 9USPA1
Social security number
Spouse’s social security number
ERO firm name
Enter five digits, but
don’t enter all zeros
Enter five digits, but
ERO firm name
don’t enter all zeros
Don’t enter all zeros
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, 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 US. 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 US. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the US. Treasury Financial Agent at. 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.
1-888-353-4537
ERO must obtain and retain completed Form 8879.
Go to www.irs.gov/Form8879 for the latest information.
SPA For Paperwork Reduction Act Notice, see your tax return instructions.
Submission Identification Number (SID)
Adjusted gross income (Form 1040 or SR, line b Form NR, line Total tax (Form 1040 or SR, line 16; Form NR, line 61) Federal income tax withheld from Forms Wand (Form 1040 or SR, line 17; Form NR, line 62a)
Refund (Form 1040 or SR, line a Form NR, line a Form SS, Part I, line 13a)
Amount you owe (Form 1040 or SR, line 23; Form NR, line I authorize to enter or generate my PIN as my signature on my tax year 2019 electronically filed income tax return.
I will enter my PIN as my signature on my tax year 2019 electronically filed income tax return. Check this box if you are entering your own PIN your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Your signature Date to enter or generate my PIN I authorize as my signature on my tax year 2019 electronically filed income tax return.
I will enter my PIN as my signature on my tax year 2019 electronically filed income tax return. Check this box if you are entering your own PIN your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Spouse's signature Date Enter your six-digit EFIN followed by your five-digit self-selected PIN.
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 taxpayers) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and
Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
ERO's signature Date
1
1
2
2
3
3
4
4
5
5
Taxpayer’s PIN check one box only
only
and
Spouse’s PIN check one box only
only
and
ERO’s EFIN/PIN.
Pub. 1345,
(Whole dollars only)
Part I
Tax Return Information - Tax Year Ending December 31, 2019
Part II
Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
Practitioner PIN Method Returns Only - continue below
Part III Certification and Authentication - Practitioner PIN Method Only
ERO Must Retain This Form - See Instructions
Don’t Submit This Form to the IRS Unless Requested To Do So
8879
IRS e-file Signature Authorization
2019
8879

39712 Page 06 9USAD41
The UNLIMITED TAX AUDIT PROTECT Protection Plan is a service warranty program that provides you with professional support in the event your tax return is subjected to an IRS audit. UNLIMITED TAX AUDIT PROTECT provides you with one-on-one support from a licensed CPA. or Enrolled Agent who will work directly with you and the IRS throughout every phase of the open audit. Our agents work to defend your rights and privileges under the Federal Tax Code and utilize extensive means to protect your assets within the confines of the current tax laws. The objective of our support team is to satisfactorily resolve all targeted areas of your audit and eliminate or minimize any increases in your tax obligation. This plan also provides reimbursement of assessed interest, penalties and certain increases in taxes up to $3,000*, in qualified cases (please see below for qualification criteria. Your enrollment fee is refundable if at any point during the preparation for your audit, you become dissatisfied with the level of support you receive.
Provisions for UNLIMITED TAX AUDIT PROTECT subscribers include. Assistance from a dedicated CPA or Enrolled Agent throughout all phases of the open audit. Our representatives provide. evaluation of all related IRS correspondence. explanation of claim requirements and the available options expert consultation and strategic planning
1.1.3.
1.1.4. aid with document organization and review for presentation
1.1.5. drafting of letters and necessary communication as needed to resolve the issue and. telephone correspondence with the IRS agent for explanations and discussions during the open audit. A cash reimbursement up to $3,000* of assessed penalties, interest and certain increases in tax liability (limitations apply.
1.3. A full 36 months of coverage on each tax year fora onetime payment. Coverage for returns with all major forms including schedules ACE and F. 100% reimbursement of paid enrollment fees in lieu of further assistance for any subscriber dissatisfied with their audit support.
(Requests for reimbursement must be made in writing prior to the commencement of any audit sessions).
The following defines our service limitations
2.1. Coverage is ONLY applicable to the tax year of purchases and does not extend to any other tax year or previously filed returns.
2.2. UNLIMITED TAX AUDIT PROTECT does not provide assistance for IRS collection notices or bills resulting from audits that were not defended through the subscriber's coverage.
Coverage does not include physical appearance of a representative during the audit session or face to face consultation. However,
2.3.
the assigned representative is made available for telephone correspondence throughout the audit session as needed.
2.4. Coverage ends 36 months after the purchase date. The return must be filed timely or within a valid extension period granted by the IRS. This agreement shall be rendered null and void if it has been determined that the audit assessment is a result of:
incomplete, false or otherwise fraudulent information knowingly provided to Return Preparer by the subscriber for the
2.6.1.
preparation of the return. fraudulent information intentionally filed by the Return Preparer with or without the subscriber’s knowledge or consent. the subscriber’s failure to provide the relevant records to either UNLIMITED TAX AUDIT PROTECT or the IRS within the prescribed forty-five (45) day period following the claim or. the subscriber taking a position on the return that challenges current tax laws and IRS guidelines or interpretations which results in increased tax liability.
2.7. If the payment for coverage is not received via the initial method attempted, it will become the taxpayer’s responsibility to pay all fees to UNLIMITED TAX AUDIT PROTECT within 45 days of the return completion to ensure that coverage remains in effect. UNLIMITED TAX AUDIT PROTECT does not guarantee favorable actions taken or decisions made by the IRS. UNLIMITED TAX AUDIT PROTECT does NOT provide legal representation or advice as apart of its audit support function. UNLIMITED TAX AUDIT PROTECT Protection Plan is NOT AN INSURANCE POLICY and UNLIMITED TAX AUDIT PROTECT is
NOT AN INSURANCE COMPANY, and does not operate under the guidelines of any state or federal insurance regulations. Subscription does not provide face-to-face audit representations or appeals in Federal or Tax Court. Support service does not include compilation of receipts, reconciliation of checkbooks or bank statements, record keeping,
bookkeeping or other clerical tasks.
UNLIMITED TAX AUDIT PROTECT does not cover returns NOT accepted by the IRS and reserves the right to accept or deny
2.13.
any application for coverage or cancel any existing coverage at its sole discretion.
1. INCLUSIONS
2. LIMITATIONS
UNLIMITED TAX AUDIT PROTECT
CLIENT COVERAGE CERTIFICATE

39712 Page 07 8
8 8
8 8
8 8
9USAD42
Some audits, tax returns, and/or audit issues maybe excluded from coverage for any of the following reasons:
Pre-existing Audit - Audits with the condition where the date of the audit notice from the IRS precedes the date of coverage.
3.1.
Coverage date is the date payment and subscription information is received by UNLIMITED TAX AUDIT PROTECT for the subscriber's plan.
Large Business - Sole-proprietorships, farm or rental property businesses filed on the 1040 return with gross receipts
3.2.
exceeding $1 million. Criminal Investigation Audits - Audits for returns that have been or become subjected to IRS criminal investigations. The following types of returns are excluded from coverage. Nonresident federal returns. State and local tax returns filed in conjunction with Federal return
3.4.3. Amended returns. Corporate or partnership returns such as 1065, S, 1120;
3.4.5. Trust, franchise, estate, and gift tax issues
3.4.6. Appeals to positions taken by the IRS following the close of an examination and. Returns containing items or issues that have been previously or currently banned by the IRS.
UNLIMITED TAX AUDIT PROTECT provides reimbursement of assessed penalties, interests and increases in tax liabilities from IRS
adjustments. Tax adjustments considered eligible for reimbursement include but are not limited to "Legitimate Preparer errors" and
"wrongfully denied" credits and deductions. Eligibility for reimbursement is determined case by case and is subject to all limitations and exclusions outlined in sections 2.0 and 3.0 of this agreement. Reimbursement on each return is assessed on an individual line item basis and applies only to disputed items for which the IRS rejects "valid and sufficient" support provided by the subscriber in a timely manner unless caused by a "Legitimate Prepare error. A Tax Preparer error is considered "Legitimate" and eligible for reimbursement only in cases where an honest mistake was made by the Preparer without general evidence of incompetence, willful and excessive repetition of the same actions, fraud or willful intent to deceive the IRS through omissions or understatement of tax liabilities. In cases for reimbursement, the assigned UNLIMITED TAX AUDIT PROTECT support professional shall determine the validity and sufficiency of supporting items prior to presentation to the IRS. Tax Bill Reimbursements are granted at the sole discretion of UNLIMITED TAX
AUDIT PROTECT and will be issued only after all the criteria outlined in this agreement are satisfied. Failure to comply with procedure and strategy actions recommended by your assigned UNLIMITED TAX AUDIT PROTECT agent or other UNLIMITED TAX AUDIT PROTECT representatives associated with your case, may result in an unfavorable outcome. Failure or refusal to comply with requests or instructions from the IRS or it agents during your audit may result in adverse actions taken by the IRS to your detriment. In either case, UNLIMITED TAX AUDIT PROTECT will not beheld responsible for the outcome and reserves the right to cease providing services where reasonably warranted. In the event you receive an IRS notification Immediately notify UNLIMITED TAX AUDIT PROTECT of any notices of examination from the IRS. Failure to act in a timely manner could result in the IRS taking irreversible actions to your detriment. Be prepared to provide UNLIMITED TAX AUDIT PROTECT with copies of all notices and other government documents relating to the auditor assessment at the time of contact. Provide UNLIMITED TAX AUDIT PROTECT with a copy via fax at (877) 328-8544 or email to audit@unlimitedtaxes.com. Immediately after fully reviewing your case and identifying targeted areas, an assigned UNLIMITED TAX AUDIT PROTECT
representative will consult with you to clearly explain the full scope and details of the examination and identify your available options for providing support as requested. We will discuss your rights as a taxpayer as it pertains to your case and formulate a strategy for presenting your best support for the most favorable outcome. Based on your consultations, your assigned representative will outline a list of required documents to be provided (if available)
along with acceptable alternatives for supporting your claims. Your representative will assist you in organizing and summarizing your documents for presentation and consult with you throughout the entire process, as well as prepare explanations regarding your return for the IRS agent on your behalf. If requested, UNLIMITED TAX AUDIT PROTECT may provide a tax professional to accompany you to the auditor attend the audit in your place. In such cases, an additional charge of $125 per hour of representation time will be assessed to you. WHEREAS, UNLIMITED TAX AUDIT PROTECT OFFERS ITS AUDIT PROTECTION PLAN FOR DISTRIBUTION AND SALE
THROUGH TAX PREPARATION SOFTWARE INDEPENDENT THIRD PARTIES. UNLIMITED TAX AUDIT PROTECT SHALL
ASSUME ALL RESPONSIBILITIES AND LIABILITIES ASSOCIATED WITH THE SALE AND PERFORMANCE OF THE AUDIT
PROTECTION PLAN. UNLIMITED TAX AUDIT PROTECT SHALL INDEMNIFY, HOLD HARMLESS AND REIMBURSE THE
MANUFACTURERS/DISTRIBUTORS OF THE SOFTWARE AND THEIR OFFICERS, DIRECTORS, AND EMPLOYEES,
(WHICHEVER MAY HAVE INCURRED THE LOSS, FOR ALL COSTS, INCLUDING WITHOUT LIMITATION, ATTORNEY'S FEES,
JUDGMENTS, PENALTIES, PAYMENTS OF OTHER DIRECT EXPENSES AND PAYMENTS IN SETTLEMENT OR OTHER
DISPOSITION OF, ORIN CONNECTION WITH, ANY CLAIMS, DISPUTES, CONTROVERSIES OR LITIGATION ARISING OUT OF
THE ACTUAL BREACH BY UNLIMITED TAX AUDIT PROTECT OF ITS DUTIES AND OBLIGATIONS UNDER THIS AGREEMENT.
3. EXCLUSIONS:
4. REIMBURSEMENT POLICY
5. DISCLAIMER:
6. CLAIMS PROCEDURES
7. INDEMNIFICATION:
TOMMIE CHAMBERLAIN
317-94-3147 UNLIMITED TAXES AND MORE
751566 214-686-8308 39712 Page 08 9USAD43
TAXPAYER NAME (PRINT)
SOCIAL SECURITY NUMBER
DATE
OFFICE EFIN
OFFICE PHONE NUMBER
OFFICE NAME
By consenting to the submission of your electronic application to UNLIMITED TAX AUDIT PROTECT, you are acknowledging that you understand and accept all terms as outlined in this agreement as well as the cost for enrollment as charged by your return preparer. This agreement becomes effective and legally binding between you and UNLIMITED TAX AUDIT PROTECT as of the date of submission with a Thirty (30) day Right of Recession immediately following. You may, without reason, cancel your subscription to this protection plan fora full refund of your cost within the first Thirty (30) calendar days subsequent to your enrollment.
8. CONSENT AND RIGHT OF RECESSION
UNLIMITED TAX AUDIT PROTECT CLIENT COVERAGE CERTIFICATE

X
TOMMIE CHAMBERLAIN
317-94-3147 2033 KNOLL CREST DR ARLINGTON TX 76104
NAHRIA CHAMBERLAIN DAUGHTER X 85,556
(7,556)
78,000 78,000 12,200 12,200 65,800 39712 Page 09 8
8 jointly or Qualifying
Check here if you, or your spouse if filing jointly, want $3 to go to this fund.
Checking a box below will not change your tax or refund. Department of the Treasury—Internal Revenue Service IRS Use Only—Do not write or staple in this space. Standard Deduction for—
Single or Married filing separately,
$12,200
Married filing widower,
$24,400
Head of household,
$18,350
If you checked any box under Standard
Deduction,
see instructions CPTS US
Spouse
You
Form
(2019
Foreign postal code If more than four dependents, see instructions and here Ordinary dividends. Attach Sch. B if required
Spouse’s social security number
Presidential Election Campaign
(99)
OMB No. 1545-0074
Single
Married filing jointly
Head of household (HOH)
Qualifying widower) (QW)
Married filing separately (MFS)
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.
Your first name and middle initial Last name If joint return, spouse’s first name and middle initial
Last name Home address (number and street. If you have a PO. box, see instructions. Apt. no. City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions. Foreign country name Foreign province/state/county You as a dependent
Your spouse as a dependent
Spouse itemizes on a separate return or you were a dual-status alien
Were born before January 2, Are blind
Was born before January 2, Is blind Social security number Relationship to you if qualifies for (see instructions)
Child tax credit
Credit for other dependents First name Last name
Wages, salaries, tips, etc. Attach Forms) W .
Tax-exempt interest . Taxable interest. Attach Sch. B if required
Qualified dividends IRA distributions Taxable amount Pensions and annuities Taxable amount Social security benefits Taxable amount Capital gain or (loss. Attach Schedule D if required. If not required, check here Other income from Schedule 1, line 9 Add lines 1, b, b, b, db, and a. This is your Adjustments to income from Schedule 1, line 22 Subtract line a from line b. This is your
(from Schedule A) Qualified business income deduction. Attach Form 8995 or Form A Add lines 9 and 10 .
Subtract line a from line b. If zero or less, enter -0- .
Your social security number
Someone can claim:
Age/Blindness
You:
Spouse:
(2)
(3)
(4)
(1)
1
1
2a
b
2b
2a
3a
b
3a
3b
4a
b
4a
4b
c
d
4c
4d
5a
b
5a
5b
6
6
7a
7a
b
total income
7b
8 a
8a
b
adjusted gross income
8b
9
Standard deduction or itemized deductions
9
10
10
11a
11a
b
Taxable income.
11b
SPA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
)
(see instructions):
Filing Status
Standard
Deduction
Dependents
1040
U.S. Individual Income Tax Return
2019
1040
JESSICA JACKSON (RTRP)
10,340 10,340 2,000 2,000 8,340 8,340 15,205 15,205 6,865 6,865
XXXXXXXXX
X
XXXXXXXXXXXXX3147
LINE WORKER
P02278548
UNLIMITED TAXES & MORE
214-782-9045 1670 N HAMPTON RD 109 DESOTO TX 75115 Page 10 8
8
If you have a qualifying child, attach Sch. EIC.
If you have nontaxable combat pay, see instructions.
Direct deposit See instructions. Other than paid preparer)
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.
Joint return See instructions. Keep a copy for your records. rd Party Designee
Form
(2019)
Check if any from Forms
Self-employed
Email address Form 1040 (Page Tax (see inst)
8814 Add Schedule 2, line 3, and line a and enter the total Child tax creditor credit for other dependents Add Schedule 3, line 7, and line a and enter the total Subtract line b from line b. If zero or less, enter -Other taxes, including self-employment tax, from Schedule 2, line 10 Add lines 14 and 15. This is your Federal income tax withheld from Forms Wand Other payments and refundable credits Earned income credit (EIC) Additional child tax credit. Attach Schedule 8812 American opportunity credit from Form 8863, line 8 Schedule 3, line 14 Add lines a through d. These are your Add lines 17 and e. These are your If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you Amount of line 20 you want
If Form 8888 is attached, check here Routing number Type Checking
Savings
Account number
Amount of line 20 you want
Subtract line 19 from line 16. For details on how to pay, see instructions Estimated tax penalty (see instructions) . Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS See instructions.
Complete below.
Designee’s Phone Personal identification name no. number (PIN) If the IRS sent you an Identity Your signature Date Your occupation Protection PIN, enter it here see inst.)
If the IRS sent your spouse an Spouses signature. If a joint return, both must sign. Date Spouses occupation
Identity Protection PIN, enter it here see inst.)
Phone no.
Preparer’s name
Preparer’s signature Date
PTIN
Check if:
Firm’s name Phone no. Firms EIN Firms address
1037 CPTS US
12a
1
2
3
12a
b
12b
13a
13a
b
13b
14
14
15
15
16
total tax
16
17
17
18
a
18a
b
18b
c
18c
d
18d
total other payments and refundable credits
e
18e
19
total payments
19
20
overpaid
20
21a
refunded to you.
21a
b
c
d
22
applied to your 2020 estimated tax
22
23
Amount you owe.
23
24
24
Yes.
No
SPA Go to www.irs.gov/Form1040 for instructions and the latest information.
1040
2
Refund
Amount
You Owe
Third Party
Designee
Paid
Preparer
Use Only
Sign
Here
TOMMIE CHAMBERLAIN Trade or Business Name:
UNNAMED ACTIVITY Taxpayer Identification Number:
Business Income. (7,556)
Qualified Business Income. (7,556)
39712 Page 11
US RET 1040
Qualified Business Income Activities
{)
2019
CPTS
Name(s)
Tax Identification Number
8us01k_1
04/03/2019
TOMMIE CHAMBERLAIN
317-94-3147
_________
_________
85,556
_________
_________
_________
_________
_________
_________
_________
_________
_________
_________
_________
___
_________
_________
_________
_________________
_________
_________
_________
___
_________
_________
_________
___
_________
_________
_________
_________
_________
_________
_____
_________
_________
_________
___
_________
_________
_________
_________
_________
_________
_________
___
_________
_________
___________________________
_________
_________
___________________________
_________
_________
_________
_________
Page 12
Taxpayer
Spouse
1.
Wages
2.
Disability and corrective distributions
3.
Excess reimbursement
4.
Taxable dependent care benefits
5.
Employer paid moving expenses
6.
Deferred compensation plan from W Box Deferred compensation plan adjustments
7.
Total
8.
Clergy Excess Rental Allowance
Total
Public Safety Officer Amount
9.
Total
10.
Household help wages MAX of $2,100 per household employer)
Total
Adoption benefit/credit
11.
12.
Taxable tips
13.
Wages reported on Federal Form 8919, Line 6
Total
14.
Scholarship income not included on Form W-2.
Total
15.
Other income from Form 1099-MISC
16.
Foreign employer compensation
Total
17.
Income from W-2PR when not excluded
18a.
18b.
19.
Total
Income entered above earned while an inmate
Total
US RET 1040
Line 1 - Income Wks
{)
2019
CPTS
Name(s)
Tax Identification Number
9us01z1
12/04/2019
TOMMIE CHAMBERLAIN
317-94-3147
__
_________
1 2,000
__
_________
_________
2,000
_________
78,000
_________
_________
78,000
_________
XXX XXX X Page 13 Number of qualifying children under 17 with required SSN
X $2,000 Number of other dependents, including qualifying children who are not under 17 or who do not have the required SSN
X $ 500 Add lines 1 and 2 Amount from Form 1040, line 8b
4.
5.
Enter the total of any exclusion of income from Puerto Rico,
and amounts from Form 2555, lines 45 and 50; and
Form 4563, line 15 Add lines 4 and 5 Amount based on filing status
7.
8.
Is line 6 more than line 7?
(
)No
(
)Yes
8.
9.
Multiply line 8 by 5% (Is the amount online more than line No. STOP. Cannot take the child tax creditor credit for other dependents
(
)Yes. Subtract line 9 from line 3 Amount from Form 1040, line 12a
11.
12.
Amounts from Form 1040, Schedule 3, lines 1 through 4; Form 5695, line Form 8910, line 15; Form 8936, line 23 and Schedule R, line 22 Subtract line 12 from line 11 Is taxpayer claiming credits from Forms 8396, 8839, 5695 (Part I) or No. Enter -Yes. Complete line 14 worksheet
14.
15.
Subtract line 14 from line 13 Is amount online more than amount online No. Enter the amount from line Yes. Enter the amount from line 15 Enter the amount from line 10 of the Child Tax Credit and Credit for Other Dependents Worksheet
1.
2.
Number of qualifying children under 17 with required SSN
X $1,400 Enter earned income
3.
4.
Is amount online more than No. Leave line 4 blank, go to line Yes. Subtract $2,500 from line 3 Multiply line 4 by 15% (Is line 2 of this worksheet $4,200 or more?
(
)No
(
)Yes
7.
Social security & Medicare taxes withheld
7.
8.
Add Form 1040, Schedule 1, line 14 and Schedule 2, line 5, and line 8 using code "UT"
8.
9.
Add lines 7 and 8 Add Form 1040, line a and Schedule 3, line 11 Subtract line 10 from line 9 Enter larger of line 5 or line 11 Enter smaller of line 2 or line 12 Is line 13 more than line No. Subtract line 13 from line Yes. Enter -Enter the total of amounts from Form 8396, line 9; Form 8839, line 16; Form 5695, line 15 and Form 8859, line 3 15.
Line 14 Worksheet
US RET 1040
Child Tax Credit and Credit for Other Dependents Worksheet
{)
2019
CPTS
Name(s)
Tax Identification Number
9us01w1
12/04/2019
TOMMIE CHAMBERLAIN X (7,556)
(7,556)
39712 Page Department of the Treasury Internal Revenue Service OMB No. Attachment Sequence No. Names) shown on Form 1040 or SR CPTS USA
Your social security number
Schedule 1 (Form 1040 or SR) 2019
(Form 1040 or SR)
Attach to Form 1040 or 1040-SR.
Go to www.irs.gov/Form1040 for instructions and the latest information.
SPA For Paperwork Reduction Act Notice, see your tax return instructions.
At anytime during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency?
Yes
No
Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . Date of original divorce or separation agreement (see instructions) Business income or (loss. Attach Schedule C . . . . . . . . . . . . . . . . . Other gains or (losses. Attach Form 4797 . . . . . . . . . . . . . . . . . . Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . Farm income or (loss. Attach Schedule F . . . . . . . . . . . . . . . . . . Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . Other income. List type and amount Combine lines 1 through 8. Enter here and on Form 1040 or SR, line a . . . . . . . . Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach
Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . .
Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . .
Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recipients SSN . . . . . . . . . . . . . . . . . . . . Date of original divorce or separation agreement (see instructions) IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student loan interest deduction Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . Add lines 10 through 21. These are your
Enter here and on Form 1040 or SR, line a . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
1
2a
2a
b
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
16
17
17
18a
18a
b
c
19
19
20
20
21
21
adjustments to income.
22
22
SCHEDULE 1
01
Part I
Additional Income
Part II
Adjustments to Income
Additional Income and Adjustments to Income
2019
TOMMIE CHAMBERLAIN UNNAMED ACTIVITY XXX Page 15 8
8 j j
j j
j j
j j
j
Department of the Treasury Internal Revenue Service (99) see instr)
Employer ID number (EIN),
Enter code from instructions
OMB No. Attachment Sequence No. Name of proprietor
1037 CPTS 9US091
Social security number (SSN)
B
D
SPA
Principal business or profession, including product or service (see instructions) Business name. If no separate business name, leave blank. Business address (including suite or room no.)
City, town or post office, state, and ZIP code Accounting method
Cash
Accrual Other (specify) Did you "materially participate" in the operation of this business during 2019? If "No" see instructions for limit on losses If you started or acquired this business during 2019, check here Did you make any payments in 2019 that would require you to file Forms) 1099? (see instructions) If "Yes" did you or will you file required Forms 1099? Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on Form Wand the "Statutory employee box on that form was checked Returns and allowances Subtract line 2 from line Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . Subtract line 4 from line 3 Other income, including federal and state gasoline or fuel tax creditor refund (see instructions) . . . Add lines 5 and 6 Office expense (see instructions)
Advertising
Pension and profit-sharing plans
Car and truck expenses (see Rent or lease (see instructions):
instructions)
Commissions and fees Vehicles, machinery, and equipment Contract labor (see instructions)
Other business property
Depletion . . . . Repairs and maintenance . . Depreciation and section 179 Supplies (not included in Part III) expense deduction (not Taxes and licenses . . . . included in Part III) (see Travel and meals:
instructions) . Travel . . . . . . . . Employee benefit programs other than online. Deductible meals (see instructions) . . . . . Insurance (other than health)
Interest: (see instructions):
Utilities . . . . . . . Wages (less employment credits) Mortgage (paid to banks, etc.)
Other
Other expenses (from line 48) . Legal and professional services before expenses for business use of home. Add lines 8 through a Tentative profit or (loss. Subtract line 28 from line 7 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829 unless using the simplified method (see instructions 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 online Subtract line 30 from line 29. If a profit, enter on both
(or Form and on If you checked the box online, see instructions. Estates and trusts, enter on If a loss, you go to line If you have a loss, check the box that describes your investment in this activity (see instructions.
If you checked a, enter the loss on both
(or All investment is at risk. and on (If you checked the box online, seethe Some investment is not line 31 instructions. Estates and trusts, enter on at risk.
If you checked b, you attach
. Your loss maybe limited.
(Form 1040 or SR)
(Sole Proprietorship)
Go to www.irs.gov/ScheduleC for instructions and the latest information.
Attach to Form 1040, SR, NR, or 1041; partnerships generally must file Form 1065.
A
C
E
(1)
(2)
(3)
F
G
Yes
No
H
I
Yes
No
J
Yes
No
1
1
2
2
3
3
4
4
5
Gross profit.
5
6
6
7
Gross income.
7
8
18
18
8
19
19
9
9
20
10
a
20a
10
11
b
20b
11
12
21
12
21
13
22
22
23
23
24
13
a
24a
14
14
b
15
24b
15
16
25
25
a
26
26
16a
b
27 a
27a
16b
17
b
Reserved for future use
17
27b
28
Total expenses
28
29
29
30
Simplified method filers only
30
31
Net profit or (loss.
Schedule 1 (Form 1040 or SR, line 3
1040-NR, line 13)
Schedule SE, line 2.
Form
31
1041, line 3.
must
32
Schedule 1 (Form 1040 or SR, line 3
32a
Form NR, line 13)
Schedule SE, line 2.
32b
Form 1041, line 3.
must
Form 6198
For Paperwork Reduction Act Notice, seethe separate instructions.
Schedule C (Form 1040 or SR) 2019
Enter expenses for business use of your home online.
only
Expenses.
SCHEDULE Cb b09bbPart I
Income
Part II
Profit or Loss From Business
2019
TOMMIE CHAMBERLAIN UNNAMED ACTIVITY
(7,556)
(7,556)
7,794 65,800 65,800 13,160 15,350 39712 Page OMB No. Form Department of the Treasury Attachment Internal Revenue Service
Sequence No. Names) shown on return Trade, business, or aggregation name
Taxpayer
Qualified business identification number income or (loss Form
(2019)
Your taxpayer identification number
(a)
(b)
(c)
1037 CPTS 9USQA1
Attach to your tax return.
Go to www.irs.gov/Form8995 for instructions and the latest information.
SPA For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Qualified business net (loss) carryforward from the prior year
Total qualified business income. Combine lines 2 and 3. If zero or less, enter -Total qualified business income or (loss. Combine lines i through v, column (c) . . . . . . . . . . . . . . . . . . . . . .
( Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . Qualified REIT dividends and publicly traded partnership (PTP) income or (loss) see instructions) . . . . . . . . . . . . . . . . . . . Qualified REIT dividends and qualified PTP (loss) carryforward from the prior
( year . . . . . . . . . . . . . . . . . . . . . . . . Total qualified REIT dividends and PTP income. Combine lines 6 and 7. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . Qualified business income deduction before the income limitation. Add lines 5 and 9 Taxable income before qualified business income deduction Net capital gain (see instructions) . . . . . . . . . . . . . . Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . Qualified business income deduction. Enter the lesser of line 10 or line 14. Also enter this amount on the applicable line of your return . . . . . . . . . . . . . . . . . . . . . . Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . .
( Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 6 and 7. If greater than
( zero, enter -0- .
1
i
ii
iii
iv
v
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
16
17
17
55
8995
Qualified Business Income Deduction
Simplified Computation
2019
8995
TOMMIE CHAMBERLAIN JESSICA JACKSON PX XXXXXHEALTH CARE PROVIDER STATEMENT NO DISABLED CHILDREN NOTES XXX Page 17 OMB No. Form Department of the Treasury Attachment Internal Revenue Service Sequence No. Taxpayer names) shown on return
Enter preparer’s name and PTIN
Form
(2019)
1037 CPTS 9USEJ1
Taxpayer identification number
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
To be completed by preparer and filed with Form 1040, SR, NR, PR, or 1040-SS.
Go to www.irs.gov/Form8867 for instructions and the latest information.
SPA For Paperwork Reduction Act Notice, see separate instructions.
Yes
No
N/A
Please check the appropriate box for the credits) and/or HOH filing status claimed on the return and complete the related Parts IV for the benefits) claimed (check all that apply.
EIC
CTC/ACTC/ODC
AOTC
HOH
Did you complete the return based on information for tax year 2019 provided by the taxpayer or reasonably obtained by you . . . . . . . . . . . . . . . . . . . . . . . If credits are claimed on the return, did you complete the applicable EIC and/or CTC/ACTC/ODC worksheets found in the Form 1040, SR, NR, PR, or SS instructions, and/or the
AOTC worksheet found in the Form 8863 instructions, or your own worksheets) that provides the same information, and all related forms and schedules for each credit claimed . . . . . . . . . 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 credits) and/or HOH filing status Review information to determine that the taxpayer is eligible to claim the credits) and/or HOH filing status and to compute the amounts) of any credits) . . . . . . . . . . . . . . . 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 a and b. If No go to question 5.) . . . . . . . . . . . . . . . Did you make reasonable inquiries to determine the correct, complete, and consistent information Did you contemporaneously document your inquiries (Documentation should include the questions 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) . . . . . . . . . . . . . . . . Did you satisfy the record retention requirement To meet the record retention requirement, you must keep a copy of your documentation referenced in b, a copy of this Form 8867, a copy of any applicable worksheets, a record of how, when, and from whom the information used to prepare Form 8867 and any applicable worksheets) was obtained, and a copy of any documents) provided by the taxpayer that you relied onto determine eligibility for the credits) and/or HOH filing status or to compute the amount(s)
of the credits) . . . . . . . . . . . . . . . . . . . . . . . . . . . . List those documents, if any, that you relied on.
Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for the credits) and/or HOH filing status and the amounts) of any credits) claimed on the return if his/her return is selected for audit . . . . . . . . . . . . . . . . . . . . . . . . Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year . If credits were disallowed or reduced, go to question a if not, go to question Did you complete the required recertification Form 8862? . . . . . . . . . . . . . . If the taxpayer is reporting self-employment income, did you ask questions to prepare a complete and correct Schedule C (Form 1040 or SR . . . . . . . . . . . . . . . . . . .
Due Diligence Requirements
1
2
3
4
a
b
5
6
7
a
8
70
Part I
8867
Paid Preparer’s Due Diligence Checklist
2019
8867
TOMMIE CHAMBERLAIN
317-94-3147
X
X
X
X
39712 Page Form 8867 (Page
1037 CPTS 9USEJ2
Form
(2019)
SPA
Yes
No
N/A
Yes
No
N/A
Yes
No
Yes
No
Yes
No
(If the return does not claim EIC, go to Part III.)
Have you determined that the taxpayer is, in fact, eligible to claim the EIC for the number of qualifying children claimed, or is eligible to claim the EIC without a qualifying child (Skip band c if the taxpayer is claiming the EIC and does not have a qualifying child) . . . . . . . . . . . . . . Did you ask the taxpayer if the child lived with the taxpayer for over half of the year, even if the taxpayer has supported the child the entire year . . . . . . . . . . . . . . . . . . . . Did you explain to the taxpayer the rules about claiming the EIC when a child is the qualifying child of more than one person (tiebreaker rules . . . . . . . . . . . . . . . . . . . If the return does not claim CTC, ACTC, or ODC, go to Part IV.)
Have you determined that each qualifying person for the CTC/ACTC/ODC is the taxpayer’s dependent who is a citizen, national, or resident of the United States . . . . . . . . . . . . . . Did you explain to the taxpayer that he/she may not claim the CTC/ACTC if the taxpayer has not lived 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 . . . . . . . . . . . Did you explain to the taxpayer the rules about claiming the CTC/ACTC/ODC fora child of divorced or separated parents (or parents who live apart, including any requirement to attach a Form 8332 or similar statement to the return . . . . . . . . . . . . . . . . . . . . . . . . . If the return does not claim AOTC, go to Part V.)
Did the taxpayer provide substantiation for the credit, such as a Form T and/or receipts for the qualified tuition and related expenses for the claimed AOTC? . . . . . . . . . . . . . . . . . . . If the return does not claim HOH filing status, go to Part VI.)
Have you determined that the taxpayer was unmarried or considered unmarried on the last day of the tax year and provided more than half of the cost of keeping up a home for the year fora qualifying person . . . A. Interview the taxpayer, ask adequate questions, contemporaneously document the taxpayer’s responses on the return or in your notes, review adequate information to determine if the taxpayer is eligible to claim the credits) and/or HOH filing status and to compute the amounts) of the credit(s);
B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for any applicable credits) claimed and HOH filing status, if claimed;
C. Submit Form 8867 in the manner required 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. A copy of this Form 8867.
2. The applicable worksheets) or your own worksheets) for any credits) claimed. Copies of any documents provided by the taxpayer on which you relied to determine the taxpayer’s eligibility for the credits) and/or HOH filing status and to compute the amounts) of the credits. A record of how, when, and from whom the information used to prepare this form and the applicable worksheets) was obtained. 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 credits) and/or HOH filing status and to compute the amounts) of the credit(s).
Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and complete . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Due Diligence Questions for Returns Claiming EIC
9a
b
c
Due Diligence Questions for Returns Claiming CTC/ACTC/ODC
10
11
12
Due Diligence Questions for Returns Claiming AOTC
13
Due Diligence Questions for Claiming HOH
14
Eligibility Certification
You will have complied with all due diligence requirements for claiming the applicable credits) and/or HOH filing
status on the return of the taxpayer identified above if you:
and
If you 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 creditor HOH filing status.
15
2
Part II
Part III
Part IV
Part V
Part VI
8867
TOMMIE CHAMBERLAIN
317-94-3147
X
X
X
NOTES XX Page 19 8USEJ3
A. Which documents below, if any, did you rely onto determine EIC/CTC/ACTC eligibility for the qualifying children) on the return Check all that apply. KEEP A COPY OF ANY DOCUMENTS YOU RELIED ON. If there is no qualifying child, check box a. If there is no disabled child, check box o.
a No qualifying child j Indian tribal official statement b School records or statement k Employer statement c Landlord or property management statement l Other d Health care provider statement e Medical records f Childcare provider records g Placement agency statement h Social service records or statement m Did not rely on documents, but made notes in file i Place of worship statement n Did not rely on any documents o No disabled child s Other p Doctor statement q Other health care provider statement r Social services agency or program statement t Did not rely on documents, but made notes in file u Did not rely on any documents
B. If a Schedule C is included with this return, which documents or other information, if any, did you rely onto confirm the existence of the business and to figure the amount of Schedule C income and expenses reported on the return Check all that apply. KEEP A COPY OF ANY DOCUMENTS YOU RELIED ON. If there is no Schedule C, check box a.
a No Schedule Ci Reconstruction of income and expenses b Business license j Other c Forms d Records of gross receipts provided by taxpayer e Taxpayer summary of income f Records of expenses provided by taxpayer k Did not rely on documents, but made notes in file g Taxpayer summary of expenses l Did not reply on any documents h Bank statements
A.
Which documents below, if any, did you rely onto determine AOTC eligibility for the qualifying education expenses Check all that apply. KEEP A COPY OF ANY DOCUMENTS YOU RELIED ON. If there is no AOTC, check box a.
a No American Opportunity Credit f Other b Form T from college or university c Form Q for distributions d College or university bursar statement e Taxpayer summary of expenses g Did not rely on documents, but made notes in file h Did not rely on any documents
Which documents below, if any, did you rely onto determine Head of Household eligibility Check all that apply.
A.
KEEP A COPY OF ANY DOCUMENTS YOU RELIED ON. If not filing Head of Household, check box a.
a Not Head of Household h Other b Divorce decree c Separation agreement d Bank statements e Property tax bills i Did not rely on documents, but made notes in file f Rent statements j Did not rely on any documents g Utility bills
Line 5 - List of Documents for EIC and CTC/ACTC
Residency of Qualifying (Child(ren)
Disability of Qualifying Child(ren)
Documents or Other Information
Line 5 - List of Documents for AOTC
Documents or Other Information
Line 5 - List of Documents for Head of Household
Documents or Other Information

Document Outline

  • Preparer's Review Copy


Share with your friends:




The database is protected by copyright ©essaydocs.org 2020
send message

    Main page