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1040 U.S. Individual Income Tax Return 2021
Department of the Treasury—Internal Revenue Service (99)
Form
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
Filing Status Single ✓ Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying
one box.
person is a child but not your dependent
Your first name and middle initial Last name Your social security number
Zachary L. Mao 123 45 6789
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number
Cici K. Mao 987 65 4321
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
520 Chestnut St. Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
Philadelphia PA 19106 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse
At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes ✓ No
Standard Someone can claim: You as a dependent Your spouse as a dependent
Deduction Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness You: Were born before January 2, 1957 Are blind Spouse: Was born before January 2, 1957 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) ✔ if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four Oliver Mao 111 22 3333 Son ✓
dependents,
see instructions
and check
here
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . 1 85,000
Attach 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b 200
Sch. B if
3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
required.
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Standard 6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
Deduction for—
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . 7
• Single or
Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8
separately,
$12,550 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . 9 85,200
• Married filing 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
jointly or
Qualifying 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . 11 85,200
widow(er),
$25,100
12a Standard deduction or itemized deductions (from Schedule A) . . 12a 25,100
• Head of b Charitable contributions if you take the standard deduction (see instructions) 12b
household,
$18,800 c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . 12c 25,100
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
any box under
Standard 14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . 14 25,100
Deduction,
see instructions.
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . 15 60,100
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2021)
Notes to Instructor:
For 2021, many taxpayers received advance payments for a portion of their child tax credit. This problem specifies
that the taxpayers did not receive any such payments. Although advance payments applied only for 2021 (and not for 2022),
some instructors may want to specify its amount (e.g., $1,800), which would reduce the amount on line 28.
The American Rescue Plan Act of 2021 provided for rebate payments that typically were $1,400 for each taxpayer
and each dependent. Most taxpayers received these payments directly from the government. An eligible taxpayer
who did not receive a rebate payment from the government can claim it as a credit on the 2021 tax return.
This problem does not specify whether the taxpayers received a rebate payment. The solution here assumes that they
received the full amount to which they were entitled, so they cannot claim a credit. If they received less than such
full amount, they could claim the unreceived amount as a credit on line 30.
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Form 1040 (2021) Page 2
16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 6,817*
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 6,817
19 Nonrefundable child tax credit or credit for other dependents from Schedule 8812 . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 6,817
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . 24 6,817
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 5,600
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 5,600
26 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . . 26
If you have a
qualifying child, 27a Earned income credit (EIC) . . . . . . . . . . . . . . 27a
attach Sch. EIC.
Check here if you were born after January 1, 1998, and before
January 2, 2004, and you satisfy all the other requirements for
taxpayers who are at least age 18, to claim the EIC. See instructions
b Nontaxable combat pay election . . . . 27b
c Prior year (2019) earned income . . . . 27c
28 Refundable child tax credit or additional child tax credit from Schedule 8812 28 3,600
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Recovery rebate credit. See instructions . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits 32 3,600
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . 33 9,200
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 2,383
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . 35a 2,383
Direct deposit? b Routing number c Type: Checking Savings
See instructions.
d Account number
36 Amount of line 34 you want applied to your 2022 estimated tax . . 36
Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions . 37
You Owe 38 Estimated tax penalty (see instructions) . . . . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)
Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
Joint return?
Manager (see inst.)
See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. Teacher (see inst.)
Phone no. Email address
Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name Phone no.
Use Only
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2021)
*From 2021 Tax Table.
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1040-SR U.S. Tax Return for Seniors
Department of the Treasury—Internal Revenue Service (99)
2021
Form
OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
Filing ✓ Single
Status* Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s
one box. name if the qualifying person is a child but not your dependent ▶
Last name Your social security number
John R. Lane 111 44 6666
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
1010 lpsen St. Check here if you, or your
State ZIP code
$3 to go to this fund.
Yorba Linda CA 90102 Checking a box below will
Foreign country name Foreign province/state/county Foreign postal code not change your tax or
refund. ✓ You Spouse
At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any
. . . . . . . . . . . . . . . . . . . . ▶ Yes ✓ No
Standard Someone can claim: You as a dependent Your spouse as a dependent
Deduction Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness { You:
Spouse:
✓ Were born before January 2, 1957
Was born before January 2, 1957
Are blind
Is blind
Dependents* (2) Social security number (3) Relationship to (4) ✔
(see instructions): (1) First name Last name you Child tax credit Credit for other dependents
If more than four
dependents, see
instructions and
check here ▶
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . 1 50,000
Attach
Schedule B
2a Tax-exempt interest . 2a b Taxable interest . . 2b 240
if required. 3a . . 3a b Ordinary dividends . 3b
4a IRA distributions . . . 4a b Taxable amount . . 4b
5a Pensions and annuities 5a 41,000 b Taxable amount . . 5b 41,000
6a . 6a b Taxable amount . . 6b
7 Capital gain or (loss). Attach Schedule D if required. If not required,
check here . . . . . . . . . . . . . . . . . . . . . . . ▶ 7
8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . 8
9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . ▶ 9 91,240
10 Adjustments to income from Schedule 1, line 26 ▶ 10 6,000
11 Subtract line 10 from line 9. This is your adjusted gross income . . ▶ 11 85,240
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 71930F Form 1040-SR (2021)
*John does not qualify as a head of household because his cousin is not his dependent (his cousin fails the relationship
test for a qualifying child, as well as the relationship test for a qualifying individual).
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Form 1040-SR (2021) Page 2
Standard 12a Standard deduction or itemized deductions (from
Deduction Schedule A) . . . . . . . . . . . . . . . . . 12a 14,250*
See Standard
Deduction Chart b Charitable contributions if you take the standard
on the last page
deduction (see instructions) . . . . . . . . . . 12b
of this form.
c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . 12c 14,250
13 deduction from Form 8995 or Form 8995-A 13
14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . 14 14,250
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . 15 70,990
16 Tax (see instructions). Check if any from:
1 Form(s) 8814 2 Form 4972 3 . . . . . . . 16 11,363**
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . 18 11,363
19 Nonrefundable child tax credit or credit for other dependants from 19
Schedule 8812 . . . . . . . . . . . . . . . . . . . . . . . .
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . 22 11,363
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . 23
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . ▶ 24 11,363
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . 25a 12,100
b Form(s) 1099 . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . 25d 12,100
26 2021 estimated tax payments and amount applied from 2020 return . . 26
If you have
a qualifying 27a Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . 27a
child, attach Check here if you were born after January 1, 1998,
Sch. EIC.
and before January 2, 2004, and you satisfy all the
other requirements for taxpayers who are at least
age 18 to claim the EIC. See instructions . . . . . . . . . . .
b Nontaxable combat pay election . . . . . . . . 27b
c Prior year (2019) earned income . . . . . . . . 27c
28 Refundable child tax credit or additional child tax
credit from Schedule 8812 . . . . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . 29
30 Recovery rebate credit. See instructions . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . 31
32 Add line 27a and 28 through 31. These are your total other payments
and refundable credits . . . . . . . . . . . . . . . . . . . ▶ 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . ▶ 33 12,100
Go to www.irs.gov/Form1040SR for instructions and the latest information. Form 1040-SR (2021)
* From Standard Deduction Chart on page 4 of Form 1040-SR.
** From 2021 Tax Table.
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