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Explanation & Answer
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ZIFENGXIE
,
904-343-3711
December 4, 2018
John and Mary Mrs Jacobs
C/O Mary Jacobs
303 SECOND AVENUE SOUTH, JACKSONVILLE BE #303
JACKSONVILLE, FL 32250
US
Dear John and Mary,
Your 2017 Federal Individual Income Tax return will be electronically
filed with the Internal Revenue Service upon receipt of a signed Form
8879 - IRS e-file Signature Authorization. No tax is payable with the
filing of this return. The refund of $9,875 will be directly deposited
into your bank account.
Under the Affordable Care Act, either you or another member of your
household did not have health coverage or an exemption for one or more
months during 2017. There is an individual shared responsibility payment
of $2,126, which reduced the refund on your tax return.
Your 2017 Ohio Individual Income Tax Return will be electronically filed
with the State of Ohio. No tax is payable with the filing of this
return.
Please be sure to call if you have any questions.
Sincerely,
zifeng xie
2017
Tax Reform Impact Summary
Page 1
John and Mary Mrs Jacobs
The Tax Reform
it had been in
tax return, or
the tax law to
380-78-9645
Impact Summary shows the impact of the Tax Cuts and Jobs Act as if
effect this tax year. It does not attempt to forecast next year's
account for expiring provisions. Specific limitations in applying
this return, if any, are noted on continuing pages.
2017 Tax Law
2018 Tax Law
INCOME
Total income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
105,842
105,842
ADJUSTMENTS TO INCOME
Total adjustments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adjusted gross income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
105,842
0
105,842
ITEMIZED DEDUCTIONS
Taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total itemized deductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1,134
1,134
1,134
1,134
TAX COMPUTATIONS
Standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Larger of itemized or standard deduction. . . . . . . . . . . . . . . . . . .
Income prior to exemption deduction. . . . . . . . . . . . . . . . . . . . . . . . . . .
Exemption deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Taxable income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax before credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12,700
12,700
93,142
20,250
72,892
9,999
24,000
24,000
81,842
0
81,842
9,884
NONREFUNDABLE CREDITS
Child tax credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Family tax credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total nonrefundable credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax after credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2,000
0
2,000
7,999
4,000
500
4,500
5,384
OTHER TAXES
Other taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2,126
10,125
2,126
7,510
REFUNDABLE CREDITS
Total refundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total tax after refundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
10,125
0
7,510
2017
Tax Reform Impact Summary
John and Mary Mrs Jacobs
Page 2
380-78-9645
TAX COMPUTATION
The Tax Cuts and Jobs Act increases the standard deduction on this return from
$12,700 to $24,000 in 2018.
The Tax Cuts and Jobs Act eliminates the deduction for personal exemptions in
2018.
OTHER TAXES
The Tax Cuts and Jobs Act removes the penalty for failure to purchase health
insurance starting in 2019.
2017
Federal Income Tax Summary
John and Mary Mrs Jacobs
Page 1
380-78-9645
INCOME
Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rent, royalty, partnership, SCorp, trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
100,000
42
5,800
105,842
ADJUSTMENTS TO INCOME
Total adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
105,842
ITEMIZED DEDUCTIONS
Taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total itemized deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1,134
1,134
TAX COMPUTATION
Standard deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Larger of itemized or standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Income prior to exemption deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Exemption deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Taxable income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax before credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12,700
12,700
93,142
20,250
72,892
9,999
CREDITS
Child tax credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax after credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2,000
2,000
7,999
OTHER TAXES
Health care: individual responsibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2,126
10,125
PAYMENTS
Federal income tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20,000
20,000
REFUND OR AMOUNT DUE
Amount overpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount refunded to you. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount you owe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9,875
9,875
0
TAX RATES
Marginal tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Effective tax rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15.0%
13.9%
2017
Ohio Income Tax Summary
John and Mary Mrs Jacobs
Page 1
380-78-9645
FEDERAL ADJUSTED GROSS INCOME
Federal adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
105,842
OHIO ADJUSTMENTS
Deductions from federal AGI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5,800
ADJUSTED GROSS INCOME
Ohio adjusted gross income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Personal & dependent exemption ded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ohio income tax base. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
100,042
9,000
91,042
TAX
Tax liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Business income tax liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax before credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ohio nonrefundable credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ohio income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2,654
0
2,654
2,654
0
PAYMENTS
Total payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
REFUND OR AMOUNT OWED
Amount you owe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
TAX RATES
Marginal tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.0%
Record of Authorization to
Electronically File FBARs
Form 114a
Department of the Treasury
Financial Crimes Enforcement
Network (FinCEN)
Do not send to FinCEN. Retain this form for your records.
The form 114a may be digitally signed.
May 2015
Part I
(See instructions below for completion)
Persons who have an obligation to file a Report of Foreign Bank and Financial Account(s)
1. Owner last name or entity’s legal name
2. Owner first name
Jacobs
Mary
4. Spouse last name (if jointly filing FBAR - see instructions below)
5. Spouse first name
3. Owner M. I.
6. Spouse M. I.
1
I/we declare that I/we have provided information concerning _______
(enter number of accounts) foreign bank and financial account(s) for the
2017 to the preparer listed in Part II; that this information is to the best of my/our knowledge true, correct,
filing year ending December 31, ________
and complete; that I/we authorize the preparer listed in Part II to complete and submit to the Financial Crimes Enforcement Network (FinCEN) a
Report of Foreign Bank and Financial Accounts (FBAR) based on the information that I/we have provided; and that I/we authorize the preparer
listed in Part II to receive information from FinCEN, answer inquiries and resolve issues relating to this submission. I/we acknowledge that,
notwithstanding this declaration, it is my/our legal responsibility, not that of the preparer listed in Part II, to timely file an FBAR if required by law
to do so.
7. Owner signature (Authorized representative if entity)
8 Date
9 Owner or entity TIN
10 TIN
a
type
b
X SSN/ITIN
c
Foreign
a
EIN
b
SSN/ITIN
c
Foreign
368-74-5462
MM / DD / YYYY
13 Spouse TIN
12 Date
11. Spouse signature
14 TIN
type
MM / DD / YYYY
Part II
Individual or Entity Authorized to File FBAR on behalf of Persons who have an obligation to file.
15. Preparer last name
16. Preparer first name
xie
zifeng
19 Address
20 City
23 Country
code
EIN
24 Preparer’s (item 15) employer’s (Entity) name
US
17. Preparer M.I.
21 State
25. Employer EIN
18. Preparer PTIN
22 ZIP/postal code
26. Preparer’s signature
59-4181732
Instructions for completing the FBAR Signature Authorization Record
This record may be completed by the individual or entity granting such authorization (Part I) OR the individual/entity authorized to perform such
services. The completed record must be signed by the individual(s)/entity granting the authorization (Part I) and the individual/entity that will file the
FBAR. The Preparer/filing entity must be registered with FinCEN BSA E-File system. (See http://bsaefiling.fincen.treas.gov/main.html for registration).
Read and complete the account owner statement in Part I.
To authorize a third party to file the Foreign Bank and Financial Accounts Report (FBAR), the account owner should complete Part I, items 1 through
3 (as required), sign and date the document in Part I, Items 7/8 and complete items 9 and 10. Item 7 may be digitally signed.
Accounts Jointly Owned by Spouses (see exceptions in the FBAR instructions)
If the account owner is filing an FBAR jointly with his/her spouse, the spouse must also complete Part I, items 4 through 6. The spouse must also
sign and date the report in items 11/12, (item 11 may be digitally signed) and complete items 13 and 14. A third party preparer may be one of the
spouses of the jointly owned foreign account. In this case, both spouses must complete Part I of form 114a in its entirety. The third party preparer
(spouse) that will file the FBAR on behalf of both spouses will complete Part II in its entirety (do not use such terms as see above, or same as item
number x ).
Complete Part II, items 15 through 18 with the preparer’s information. The address, items 19 through 23, is that of the preparer or the preparer’s
employer if the preparer is an employee. Record the employer’s information (if any) in items 24 and 25. If the preparer does not have a PTIN, leave
item 18 blank. The third party preparer must sign in item 26 (digital signature acceptable) of Part II indicating that the FBAR will be filed as directed
by the authorizing authority.
The person(s) listed in Part I, and the person listed in Part II as authorized to file on behalf of the person(s) listed in Part I, should retain copies
of this record of authorization and the filing itself, both for a period of 5 years. See 31 CFR 1010. 430(d).
DO NOT SEND THIS RECORD TO FinCEN UNLESS REQUESTED TO DO SO.
BAA
FBAA0301L
05/27/15
Rev. 10.7 May 21, 2015
Form
8879
OMB No. 1545-0074
IRS e-file Signature Authorization
2017
G Return completed Form 8879 to your ERO. (Do not send to IRS.)
Department of the Treasury
Internal Revenue Service
GGo to www.irs.gov/Form8879 for the latest information.
Submission Identification Number (SID)
A
Taxpayer's name
Social security number
John Jacobs
380-78-9645
Spouse's name
Spouse's social security number
Mary Jacobs Mrs
368-74-5462
Tax Return Information ' Tax Year Ending December 31, 2017 (Whole dollars only)
Part I
1
Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4; Form 1040NR,
line 37). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
Total tax (Form 1040, line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61). . . . . . . . . . .
2
105,842.
10,125.
3
Federal income tax withheld from Forms W-2 and 1099 (Form 1040, line 64; Form 1040A, line 40;
Form 1040EZ, line 7; Form 1040NR, line 62a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
20,000.
4
Refund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 13a; Form 1040-SS, Part I, line 13a;
Form 1040NR, line 73a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
9,875.
5
Amount you owe (Form 1040, line 78; Form 1040A, line 50; Form 1040EZ, line 14; Form 1040NR, line 75). . .
5
Part II
Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements for the tax year ending
December 31, 2017, and to the best of my knowledge and belief, it is true, correct, and accurately lists all amounts and sources of income I received during the tax year. 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 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
X I authorize
zifengxie
to enter or generate my PIN
ERO firm name
57254
Enter five digits, but
don't enter all zeros
as my signature on my tax year 2017 electronically filed income tax return.
I will enter my PIN as my signature on my tax year 2017 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.
Your signature
Date G
G
Spouse's PIN: check one box only
X I authorize
zifengxie
to enter or generate my PIN
ERO firm name
69599
Enter five digits, but
don't enter all zeros
as my signature on my tax year 2017 electronically filed income tax return.
I will enter my PIN as my signature on my tax year 2017 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.
Spouse's signature
Date G
G
Practitioner PIN Method Returns Only ' continue below
Part III
Certification and Authentication ' Practitioner PIN Method Only
ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.
Don't enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the tax year 2017 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.
ERO's signature
G
zifeng xie
Date G
ERO Must Retain This Form ' See Instructions
Don't Submit This Form to the IRS Unless Requested To Do So
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA1701L
07/28/17
Form 8879 (2017)
Form
1040
Department of the Treasury
' Internal Revenue Service
(99)
U.S. Individual Income Tax Return
For the year Jan. 1 - Dec. 31, 2017, or other tax year beginning
2017
, 2017, ending
Your first name and initial
OMB No. 1545-0074 IRS Use Only
, 20
See separate instructions.
Last name
Your social security number
John Jacobs
380-78-9645
If a joint return, spouse's first name and initial
Last name
Spouse's social security number
Mary Jacobs Mrs
368-74-5462
Home address (number and street). If you have a P.O. box, see instructions.
Apt. no.
303 SECOND AVENUE SOUTH, JACKSONVILLE BE #303
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
JACKSONVILLE, FL 32250
Foreign country name
Foreign province/state/county
US
Filing Status
Check only
one box.
Exemptions
1
2
3
Single
4
X Married filing jointly (even if only one had income)
Married filing separately. Enter spouse's SSN above & full
name here. . G
5
Foreign postal code
J
Make sure the SSN(s) above
and on line 6c are correct.
Presidential Election Campaign
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.
You
Spouse
Head of household (with qualifying person). (See
instructions.) If the qualifying person is a child
but not your dependent, enter this child's
name here. . G
Qualifying widow(er) (see instructions)
6a X Yourself. If someone can claim you as a dependent, do not check box 6a. . . . . . . . . . .
b X Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Dependents:
(1) First name
If more than four
dependents, see
instructions and
check here. . . G
' Do not write or staple in this space.
Seth Jacobs
Joe Jacobs
Sarah Jacobs
Boxes checked
on 6a and 6b. . .
No. of children
on 6c who:
2
(4) b if
child under ? lived
with you. . . . . .
age 17
qualifying for
child tax credit ? did not
Last name
(see instructions) live with you
due to divorce
or separation
(see instructions). .
Dependents
on 6c not
entered above. .
Add numbers
on lines
claimed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . above. . . . . . G
(2) Dependent's
social security
number
(3) Dependent's
relationship
to you
234-53-1246 Child
524-36-1243 Child
314-51-4231 Daughter
3
X
X
d Total number of exemptions
7 Wages, salaries, tips, etc. Attach Form(s) W-2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
Income
8 a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8a
b Tax-exempt interest. Do not include on line 8a. . . . . . . . . . . . . .
8b
9 a Ordinary dividends. Attach Schedule B if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9a
Attach Form(s)
b Qualified dividends. . . . . . . . ...