CO.
FILE
DEPT.
TZL
011374
795500
AMAZON
CLOCK
749
DEVELOPMENT
ATTN: AMAZON
PAYROLL
202 WESTLAKE
AVE N
SEATTLE,
VCHR. NO.
0000180026
CENTER
Earnings Statement
1
Period Beginning: Period Ending: Pay Date:
U.S., INC
WA 98109
ZIPING LIU 109 SPANISH OAK CIRCLE LAKE JACKSON TX 77566
Filing Status: Single/Married filing separately Exemptions/Allowances: Federal: Standard Withholding Table
rate
Regular Personal Time Shrt Term Dis Sick Time Vacation Pay Holiday Pay On Sign Bonus
04/01/2022 04/30/2022 04/29/2022
salary/hours
this period
53 8472 53 8472
-113 00 59 00
53 8472 53 8472
30 00 24 00
-6 084 73 3 176 98 65 22 1 615 42 1 292 33
Gross Pay
$65 22
Statutory Social Security Tax Medicare Tax WA Paid Family Leave Ins WA Paid Medical Leave Ins Federal Income Tax Pre-Tax Medical Accident Ins Critic Illness Grp Legal Plan Pre-Tax Dental Pre-Tax Vision Supp Ad/D 401K Net Pay
-0 -0 -0 -0
71 16 20 09
-64 06*
year to date
21 484 51 3 176 98 65 22 1 615 42 1 292 33 430 78 4 139 81 32 205 05
1 973 461 99 42 4 835
75 60 15 34 46
337 11 16 45 27 48 31 1 680
06 31 92 30 00 00 41 00
$0 00
Net Check
$0 00
Excluded from federal taxable wages Your federal taxable wages this period are $1 16 Other Benefits and this period
Groupterm Life Tot Work Hours
total to date
10 44 -113 00
41 76
Paid Pers Time Sick Time Vacation Bal
2 00 0 00 23 36
YOUR COMPANY PHONE NUMBER IS 888-892-7180 BASIS OF PAY: SALARY IF YOU HAVE PAY RELATED QUESTIONS, HTTPS://ATOZ.AMAZON.WORK
VISIT
AND CLICK RESOURCES.
Taxable Marital Status: TX: Single WA: Single Exemptions/Allowances: TX: No State Income Tax WA: No State Income Tax
2000 A DP, LLC
AMAZON DEVELOPMENT CENTER U S ATTN: AMAZON PAYROLL 202 WESTLAKE AVE N SEATTLE WA 98109 Deposited
to the account of
INC
Advice number: Pay date:
account number
00000180026 04/29/2022
transit
ABA
ZIPING LIU
NON-NEGOTIABLE
amount
2021 W-2 and EARNINGS SUMMARY Employee Reference Wage and Tax Statement
Copy
W-2
2021
OMB No. 1545-0008
Copy C for employee’s records.
d
013299 c
Dept.
Control number
LOS2/JTU
This blue section is your Earnings Summary which provides more detailed information on the generation of your W-2 statement. The reverse side includes instructions and other general information.
Corp.
Employer use only
795500
Employer’s name, address, and ZIP code
A 8416 602-619-95
AMAZON WEB SERVICES INC PO BOX 80726 SEATTLE WA 98108 1. Your Gross Pay was adjusted as follows to produce your W-2 Statement.
Batch #02984
Wages, Tips, other Compensation Box 1 of W-2
e/f Employee’s name, address, and ZIP code
ZIPING LIU 109 SPANISH OAK CIRCLE LAKE JACKSON TX 77566 b
Employer’s FED ID number
a Employee’s SSA number
20-4938068 1
Gross Pay
XXX-XX-0494
Wages, tips, other comp.
2 Federal income tax withheld
101920.33 3
109,105.50
Plus GTL (C-Box 12) Less 401(k) (D-Box 12) Less Other Cafe 125 Reported W-2 Wages
Social Security Wages Box 3 of W-2
Medicare Wages Box 5 of W-2
109,105.50
109,105.50
125.28
125.28
5,945.45
125.28
N/A
N/A
1,365.00
1,365.00
1,365.00
101,920.33
107,865.78
107,865.78
16341.86 4 Social security tax withheld
Social security wages
107865.78 5
Medicare wages and tips
7
Social security tips
6687.68 6 Medicare tax withheld
107865.78
1564.05 8 Allocated tips
9
10 Dependent care benefits
11 Nonqualified plans
12a See instructions for box 12
C
14 Other 6863.04 RSU
2. Employee Name and Address.
ZIPING LIU 109 SPANISH OAK CIRCLE LAKE JACKSON TX 77566
125.28
12b D 5945.45 12c DD 8374.47 12d 13 Stat emp. Ret. plan 3rd party sick pay
X
15 State Employer’s state ID no. 16 State wages, tips, etc.
TX 17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
1
Wages, tips, other comp.
2 Federal income tax withheld
101920.33 3
Social security wages
5
Medicare wages and tips
d
Control number
107865.78 107865.78
013299 c
LOS2/JTU
Dept.
¤
1
2021 ADP, Inc.
Wages, tips, other comp.
16341.86 4 Social security tax withheld
3
Social security wages
6 Medicare tax withheld
5
Medicare wages and tips
d
Control number
6687.68 1564.05
Corp.
Employer use only
795500
Employer’s name, address, and ZIP code
A 8416 602-619-95
107865.78 107865.78
013299 c
LOS2/JTU
a Employee’s SSA number
Social security tips
8 Allocated tips
7
9
10 Dependent care benefits
11 Nonqualified plans
12a See instructions for box 12
14 Other
12b
14 Other
7
6863.04 RSU
b
12c
125.28 5945.45 8374.47
16341.86
3
Social security wages
4 Social security tax withheld
6 Medicare tax withheld
5
Medicare wages and tips
6 Medicare tax withheld
d
Control number
6687.68 1564.05
Corp.
Employer use only
A 8416 602-619-95
a Employee’s SSA number
20-4938068 Social security tips
2 Federal income tax withheld
101920.33
4 Social security tax withheld
795500
Employer’s FED ID number
XXX-XX-0494
C D DD
Wages, tips, other comp.
107865.78 107865.78
013299 c
LOS2/JTU
6687.68 1564.05
Dept.
Corp.
Employer use only
795500
Employer’s name, address, and ZIP code
AMAZON WEB SERVICES INC PO BOX 80726 SEATTLE WA 98108
Employer’s FED ID number
20-4938068
Dept.
1
16341.86
Employer’s name, address, and ZIP code
AMAZON WEB SERVICES INC PO BOX 80726 SEATTLE WA 98108
b
2 Federal income tax withheld
101920.33
A 8416 602-619-95
AMAZON WEB SERVICES INC PO BOX 80726 SEATTLE WA 98108
b
Employer’s FED ID number
XXX-XX-0494
a Employee’s SSA number
20-4938068 Social security tips
XXX-XX-0494 8 Allocated tips
8 Allocated tips
7
9
10 Dependent care benefits
9
10 Dependent care benefits
11 Nonqualified plans
12a 12
11 Nonqualified plans
12a
14 Other
12b
6863.04 RSU
C 12b D 12c DD
125.28 5945.45 8374.47
12d
12d
13 Stat emp. Ret. plan 3rd party sick pay
13 Stat emp. Ret. plan 3rd party sick pay
X
6863.04 RSU
C D 12c DD
125.28 5945.45 8374.47
12d 13 Stat emp. Ret. plan 3rd party sick pay
X
X
e/f Employee’s name, address and ZIP code
e/f Employee’s name, address and ZIP code
e/f Employee’s name, address and ZIP code
ZIPING LIU 109 SPANISH OAK CIRCLE LAKE JACKSON TX 77566
ZIPING LIU 109 SPANISH OAK CIRCLE LAKE JACKSON TX 77566
ZIPING LIU 109 SPANISH OAK CIRCLE LAKE JACKSON TX 77566
15 State Employer’s state ID no. 16 State wages, tips, etc.
15 State Employer’s state ID no. 16 State wages, tips, etc.
15 State Employer’s state ID no. 16 State wages, tips, etc.
TX
TX
TX
17 State income tax
18 Local wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
19 Local income tax
20 Locality name
19 Local income tax
20 Locality name
W-2
Federal Filing Copy Wage and Tax Statement OMB
Copy B to be filed with employee’s
2021
No. 1545-0008 Federal Income Tax Return.
W-2
State Reference Copy Wage and Tax Statement OMB No.
City
2021
Copy 2 to be filed with employee’s State Income Tax Return.
1545-0008
W-2
or Local Reference Wage and Tax Statement
Copy
2021
OMB No. 1545-0008 Copy 2 to be filed with employee’s City or Local Income Tax Return.
Instructions for Employee Box 1. Enter this amount on the wages line of your tax return. Box 2. Enter this amount on the federal income tax withheld line of your tax return. Box 5. You may be required to report this amount on Form 8959, Additional Medicare Tax. See the Instructions for Forms 1040 and 1040-SR to determine if you are required to complete Form 8959. Box 6. This amount includes the 1.45% Medicare Tax withheld on all Medicare wages and tips shown in box 5, as well as the 0.9% Additional Medicare Tax on any of those Medicare wages and tips above $200,000. Box 8. This amount is not included in box 1, 3, 5, or 7. For information on how to report tips on your tax return, see the Instructions for Forms 1040 and 1040-SR. You must file Form 4137, Social Security and Medicare Tax on Unreported Tip Income, with your income tax return to report at least the allocated tip amount unless you can prove with adequate records that you received a smaller amount. If you have records that show the actual amount of tips you received, report that amount even if it is more or less than the allocated tips. Use Form 4137 to figure the social security and Medicare tax owed on tips you didn’t report to your employer. Enter this amount on the wages line of your tax return. By filing Form 4137, your social security tips will be credited to your social security record (used to figure your benefits). Box 10. This amount includes the total dependent care benefits that your employer paid to you or incurred on your behalf (including amounts from a section 125 (cafeteria) plan). Any amount over your employer’s plan limit is also included in box 1. See Form 2441. Box 11. This amount is (a) reported in box 1 if it is a distribution made to you from a nonqualified deferred compensation or nongovernmental section 457(b) plan, or (b) included in box 3 and/or box 5 if it is a prior year deferral under a nonqualified or section 457(b) plan that became taxable for social security and Medicare taxes this year because there is no longer a substantial risk of forfeiture of your right to the deferred amount. This box shouldn’t be used if you had a deferral and a distribution in the same calendar year. If you made a deferral and received a distribution in the same calendar year, and you are or will be age 62 by the end of the calendar year, your employer should file Form SSA-131, Employer Report of Special Wage Payments, with the Social Security Administration and give you a copy. Box 12. The following list explains the codes shown in box 12. You may need this information to complete your tax return. Elective deferrals (codes D, E, F, and S) and designated Roth contributions (codes AA, BB, and EE) under all plans are generally limited to a total of $19,500 ($13,500 if you only have SIMPLE plans; $22,500 for section 403(b) plans if you qualify for the 15-year rule explained in Pub. 571). Deferrals under code G are limited to $19,500. Deferrals under code H are limited to $7,000.
However, if you were at least age 50 in 2021, your employer may have allowed an additional deferral of up to $6,500 ($3,000 for section 401(k)(11) and 408(p) SIMPLE plans). This additional deferral amount is not subject to the overall limit on elective deferrals. For code G, the limit on elective deferrals may be higher for the last 3 years before you reach retirement age. Contact your plan administrator for more information. Amounts in excess of the overall elective deferral limit must be included in income. See the Instructions for Forms 1040 and 1040-SR. Note: If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-up pension contribution for a prior year(s) when you were in military service. To figure whether you made excess deferrals, consider these amounts for the year shown, not the current year. If no year is shown, the contributions are for the current year. A—Uncollected social security or RRTA tax on tips. Include this tax on Form 1040 or 1040-SR. See the Instructions for Forms 1040 and 1040-SR. B—Uncollected Medicare tax on tips. Include this tax on Form 1040 or 1040-SR. See the Instructions for Forms 1040 and 1040-SR. C—Taxable cost of group-term life insurance over $50,000 (included in boxes 1, 3 (up to the social security wage base), and 5) D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also includes deferrals under a SIMPLE retirement account that is part of a section 401(k) arrangement. E—Elective deferrals under a section 403(b) salary reduction agreement F—Elective deferrals under a section 408(k)(6) salary reduction SEP G—Elective deferrals and employer contributions (including nonelective deferrals) to a section 457(b) deferred compensation plan H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. See the Instructions for Forms 1040 and 1040-SR for how to deduct. J—Nontaxable sick pay (information only, not included in box 1, 3, or 5) K—20% excise tax on excess golden parachute payments. See the Instructions for Forms 1040 and 1040-SR. L—Substantiated employee business expense reimbursements (nontaxable) M—Uncollected social security or RRTA tax on taxable cost of group-term life insurance over $50,000 (former employees only). See the Instructions for Forms 1040 and 1040-SR. N—Uncollected Medicare tax on taxable cost of group-term life insurance over $50,000 (former employees only). See the Instructions for Forms 1040 and 1040-SR. P—Excludable moving expense reimbursements paid directly to a member of the U.S. Armed Forces (not included in box 1, 3, or 5) Q—Nontaxable combat pay. See the Instructions for Forms 1040 and 1040-SR for details on reporting this amount. R—Employer contributions to your Archer MSA. Report on Form 8853, Archer MSAs and Long-Term Care Insurance Contracts.
S—Employee salary reduction contributions under a section 408(p) SIMPLE plan (not included in box 1) T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified Adoption Expenses, to figure any taxable and nontaxable amounts. V—Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3 (up to the social security wage base), and 5). See Pub. 525, Taxable and Nontaxable Income, for reporting requirements. W—Employer contributions (including amounts the employee elected to contribute using a section 125 (cafeteria) plan) to your health savings account. Report on Form 8889, Health Savings Accounts (HSAs). Y—Deferrals under a section 409A nonqualified deferred compensation plan Z—Income under a nonqualified deferred compensation plan that fails to satisfy section 409A. This amount is also included in box 1. It is subject to an additional 20% tax plus interest. See the Instructions for Forms 1040 and 1040-SR. AA—Designated Roth contributions under a section 401(k) plan BB—Designated Roth contributions under a section 403(b) plan DD—Cost of employer-sponsored health coverage. The amount reported with code DD is not taxable. EE—Designated Roth contributions under a governmental section 457(b) plan. This amount does not apply to contributions under a tax-exempt organization section 457(b) plan. FF—Permitted benefits under a qualified small employer health reimbursement arrangement GG—Income from qualified equity grants under section 83(i) HH—Aggregate deferrals under section 83(i) elections as of the close of the calendar year Box 13. If the “Retirement plan” box is checked, special limits may apply to the amount of traditional IRA contributions you may deduct. See Pub. 590-A, Contributions to Individual Retirement Arrangements (IRAs). Box 14. Employers may use this box to report information such as state disability insurance taxes withheld, union dues, uniform payments, health insurance premiums deducted, nontaxable income, educational assistance payments, or a member of the clergy’s parsonage allowance and utilities. Railroad employers use this box to report railroad retirement (RRTA) compensation, Tier 1 tax, Tier 2 tax, Medicare tax, and Additional Medicare Tax. Include tips reported by the employee to the employer in railroad retirement (RRTA) compensation. Note: Keep Copy C of Form W-2 for at least 3 years after the due date for filing your income tax return. However, to help protect your social security benefits, keep Copy C until you begin receiving social security benefits, just in case there is a question about your work record and/or earnings in a particular year.
Department of the Treasury - Internal Revenue Service
NOTE: THESE ARE SUBSTITUTE WAGE AND TAX STATEMENTS AND ARE ACCEPTABLE FOR FILING WITH YOUR FEDERAL, STATE AND LOCAL/CITY INCOME TAX RETURNS. This information is being furnished to the Internal Revenue Service. If you are required to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it. IMPORTANT NOTE: In order to insure efficient processing, attach this W-2 to your tax return like this (following agency instructions):
TAX RETURN
THIS FORM W-2
OTHER W-2’S
Notice to Employee Do you have to file? Refer to the Instructions for Forms 1040 and 1040-SR to determine if you are required to file a tax return. Even if you don’t have to file a tax return, you may be eligible for a refund if box 2 shows an amount or if you are eligible for any credit. Earned income credit (EIC). You may be able to take the EIC for 2021 if your adjusted gross income (AGI) is less than a certain amount. The amount of the credit is based on income and family size. Workers without children could qualify for a smaller credit. You and any qualifying children must have valid social security numbers (SSNs). You can’t take the EIC if your investment income is more than the specified amount for 2021 or if income is earned for services provided while you were an inmate at a penal institution. For 2021 income limits and more information, visit www.irs.gov/EITC. See also Pub. 596, Earned Income Credit. Any EIC that is more than your tax liability is refunded to you, but only if you file a tax return. Employee’s social security number (SSN). For your protection, this form may show only the last four digits of your SSN. However, your employer has reported your complete SSN to the IRS and SSA. Clergy and religious workers. If you aren’t subject to social security and Medicare taxes, see Pub. 517, Social Security and Other Information for Members of the Clergy and Religious Workers. Corrections. If your name, SSN, or address is incorrect, correct Copies B, C, and 2 and ask your employer to correct
Department of the Treasury - Internal Revenue Service
Department of the Treasury - Internal Revenue Service
your employment record. Be sure to ask the employer to file Form W-2c, Corrected Wage and Tax Statement, with the Social Security Administration (SSA) to correct any name, SSN, or money amount error reported to the SSA on Form W-2. Be sure to get your copies of Form W-2c from your employer for all corrections made so you may file them with your tax return. If your name and SSN are correct but aren’t the same as shown on your social security card, you should ask for a new card that displays your correct name at any SSA office or by calling 800-772-1213. You may also visit the SSA website at www.SSA.gov. Cost of employer-sponsored health coverage (if such cost is provided by the employer). The reporting in box 12, using code DD, of the cost of employer-sponsored health coverage is for your information only. The amount reported with code DD is not taxable. Credit for excess taxes. If you had more than one employer in 2021 and more than $8,853.60 in social security and/or Tier 1 railroad retirement (RRTA) taxes were withheld, you may be able to claim a credit for the excess against your federal income tax. If you had more than one railroad employer and more than $5,203.80 in Tier 2 RRTA tax was withheld, you may also be able to claim a credit. See the Instructions for Forms 1040 and 1040-SR and Pub. 505, Tax Withholding and Estimated Tax.
Department of the Treasury - Internal Revenue Service
Form 1040 Filing Status
Check one box.
1 2 3
Department of the Treasury--IRS
US INDIVIDUAL INCOME TAX RETURN
Single Married filing jointly (even if only one had income) Married filing separately (MFS) Spouse name 1st Name, MI
Your Name: Spouse Name: Street, No: City,ST,ZIP:
Foreign Address
Ziping
Foreign country name:
Last Name
2021
Not for Filing
OMB No.1545-0074 4 Head of hshld. If qual person a child but not your dependent, child's name: Qual widow(er) (QW)
5 Jr
Liu
***-**-0494 Make sure SSNs correct
WA 98105 Foreign province/county:
Foreign postal code:
At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Someone can claim you as a dependent. You born before Jan 2, 1957 Blind . . . 0 Someone can claim your spouse as a dependent. Sp born before Jan 2, 1957 Blind
MINI-WORKSHEET FOR MFS/DUAL-STATUS ALIEN a. Married, filing separately and spouse itemizes . . . . . . . . . . . . . . . . . . b. Are you a dual-status alien . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sp itemizes on sep rtn/dual-status alien
Presidential Note: Checking a box below won't change your tax or refund. Elec Campaign Check if you/spouse want $3 to go to fund . . . . . . . . . . . You Spouse c Dependents: (3) Rela(4) (1) First Last Name (2) SSN tionship CTC CFOD
If > 4 dependents, check here
MINI-WORKSHEET FOR LINE 1, WAGES a. Wages not on W-2 . . . . . . . . Self: 0 Spouse: b. Total from line a . . . . . . . . . . . . . . Note: Line b includes spouse amounts only if you are
0 0
married filing a joint return.
c. Wages from W-2's . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. Total for line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Income
copy B
101,920 101,920
1
Wages, etc.
2a 3a 3b 4a 5a
.. 1 Exempt interest 2a 2b 0 b Taxable interest Qual divs . . . . . . . . . . . . 3a 0 Ordinary dividends . . . . . . . . . . . . . . . . . . . . 3b IRA distributions a b Taxable 4b Pensions and annuities a b Taxable 5b
101,920 1 0 0 0
STATE-ONLY TAXABLE RETIREMENT DISTRIBUTIONS MINI-WORKSHEET
a. Taxable IRA . . . . . . . . . . . . . .Self: b. Taxable pension
6a 7 8 9 10 11
0 Spouse:
and annuities . . . . . . . . . . . . Self: 0 Spouse: Soc Sec benefits . . . . . 6a b Taxable . . Capital gain/loss . . . . . . . . . . . . . . . . . Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . . . . Total income. Lns 1, 2b, 3b, 4b, 5b, 6b, 7, and 8 . . . . . . . . . . . . . . Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . Adjusted gross income. Line 9 - line 10 . . . . . . . . . . . . . . . . . . . . .
MINI-WORKSHEET FOR LINE 12a, STANDARD VS ITEMIZED DEDUCTION
a. b. c. d. e. f.
0 0
6b 7 8 9 10 11
15,996 14,472 132,389 0 132,389
Your standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,550 Itemized deductions (from Schedule A) . . . . . . . . . . . . . . . 1,992 You are required to itemize . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . You want to itemize, even if lower deduction . . . . . . . . . . . . . . . . . . You are married filing separately and claiming the standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Line a or line b. To line 12a . . . . . . . . . . . . . . . . . . . . . . . . . . 12,550 Note: Line f is line b when lines c or d are checked. Line f is line a when line e is checked. Note: We take line 12b into account when we compare the standard deduction to the itemized deduction.
12a Itemized deductions or standard deduction . . . . . . . . . . . . . . . . . . . . . 12a b Charitable contributions if you take the standard deduction. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12b
12,550
the standard deduction to the itemized deduction.
12a Itemized deductions or standard deduction . . . . . . . . . . . . . . . . . . . . . 12a b Charitable contributions if you take the standard deduction. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12b c Sum of lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c
12,550
12,550
Check here if you itemized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
KIA
13 14 15
Qualified business income deduction (see instr.) . . . . . . . . . . . . . 13 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Taxable income. Ln 11 - 14. (not less than 0) . . . . . . . . . . . . . . . . . . 15 END OF PAGE 1
0 12,550 119,839
Not for Filing
KIA
Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Taxable income. Ln 11 - 14. (not less than 0) . . . . . . . . . . . . . . . . . . 15
14 15
Form 1040 (2021) Ziping
SSN:
Liu
FOREIGN EARNED INCOME TAX WORKSHEET a. Form 1040 or 1040-SR, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Form 2555, line 45 and 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Total amount of itemized deductions or exclusions
12,550 119,839
Page 2 376-29-0494
you couldn't claim because they are related to excluded income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. Line b minus line c. If zero or less, enter 0 . . . . . . . . . . . . . . . . . . . e. Combine lines a and d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f. Tax on line e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g. Tax on line d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h. Line f minus line g. If zero or less, enter 0 . . . . . . . . . . . . . . . . . . .
16 17 18 19 20 21 22 23 24
Tax. See instr. Check if total includes tax from 1 8814 2 4972 3
16
22,390
Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . Sum of lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nonrefundable child tax credit/cr for other deps . . . . . . . . . . . . . Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . Sum of lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Line 18 - line 21. If zero or less enter -0- . . . . . . . . . . . . . . . . . . . . Other taxes, incl SE tax, from Schedule 2, ln 21 . . . . . . . . . . . . . . Total tax. Sum of lines 22 and 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 18 19 20 21 22 23 24
0 22,390
MINI-WORKSHEET FOR LINE 25, FEDERAL TAX WITHHELD
0 0 22,390 0 22,390
a. Backup withholding (Bkgd Wks, 1099-DIV, 1099-INT/OID,
1099-MISC, 1099-NEC, 1099-B, 1099-K, K-1) . . . . . . . . . . . . . . . .
0
b. Oth fed inc tax w/h (W-2, W-2G, 1099-G, 1099-R,
SSA-1099, RRB-1099) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Add'l Medicare tax withholding from Form 8959 . . . . . . . . . . . . d. Total federal tax withheld (to line 25) . . . . . . . . . . . . . . . . . . . . . . Federal income tax withheld from: Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a 16,342 Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b 0 Other forms (see instructions) . . . . . . . . . . . . 25c 0 Federal income tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2021 est tax pmts + amount from 2020 return . . . . . . . . . . . . . . . EIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Check here if you were born after 1/1/1998, and before 1/2/2004, and you satisfy all the other requirements for taxpayers who are at least age 18, to claim the EIC. See instructions . . . . . . . . . . . . . . . . . . . . . 27b Nontaxable combat pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27c Prior year (2019) earned income . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Schedule 8812 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Form 8863 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25 a b c d 26 27a
MINI-WORKSHEET FOR LINE 30, RECOVERY REBATE CREDIT
25d 26 27a
27b 27c 28 29
a. Can you be claimed as a dependent on another's 2021 return? If you're married filing jointly, go to line b. No. Go to line b. Yes. Stop. You can't take the credit. b. Does your 2021 tax return include an SSN issued on/before the due date of your 2021 return (including extensions) for you (and your spouse if married filing jointly)? Yes. Go to line g. No. Go to line c. c. Are you filing a joint return for 2021? Yes. Go to line d. No. Go to line f. d1. Were you and/or your spouse a member of the U.S. Armed Forces at any time during 2021?
Yes. No.
d2. Were you and/or your spouse a member of the U.S. Armed
e.
f.
Forces at any time during 2021 and does at least one of you have an SSN issued on/before the due date of your 2021 return (including extensions)? Yes. Your credit is not limited. Go to line g. No. Go to line e. Does one of you have an SSN issued on/before the due date of your 2021 return (including extensions)? Yes. Your credit is limited. Go to line g. No. Go to line f. Do you have any dependents listed on Form 1040/1040-SR with an SSN that was issued on/before the due date of your 2021 return (including extensions) or an adoption taxpayer identification number?
16,342 0 16,342
16,342 0
0
Not for Filing
f.
g.
h. i. j. k.
l. m.
n. o.
p. q. r.
s.
Refund Direct
deposit? See instr.
Amount
Do you have any dependents listed on Form 1040/1040-SR with an SSN that was issued on/before the due date of your 2021 return (including extensions) or an adoption taxpayer identification number? Yes. Enter zero on line g and go to line h. No. Stop. You can't take the credit. Enter: $1,400 if single, head of household, MFS, or QW $1,400 if MFJ and you answered Yes to question e $2,800 if MFJ and you answered Yes to question b or d2 valid SSN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,400 $1400 x number of qualifying children . . . . . . . . . . . . . . . . . . . . 0 Sum of lines g and h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,400 Amount from line 11 of Form 1040/1040-SR . . . . . . . . . . . . . . . . 132,389 Enter: $150,000 if married filing jointly or qualifying widow(er) $112,500 if head of household $75,000 if single or married filing separately . . . . . . . . . . . . . 75,000 Is the amount on line j more than the amount on line k? No. Enter the line i amount on line q. Yes. Enter the amount from line j . . . . . . . . . . . . . . . . . . . . . 132,389 Enter: $160,000 if married filing jointly or qualifying widow(er) $120,000 if head of household $80,000 if single or married filing separately . . . . . . . . . . . . . 80,000 Is the amount on line j more than the amount on line m? Yes. Stop. You can't take the credit. No. Line m minus line l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter: $10,000 if married filing jointly or qualifying widow(er) $7,500 if head of household $5,000 if single or married filing separately . . . . . . . . . . . . . . Divide line n by line o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Line i multipled by line p . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Was an EIP 3 stimulus payment issued to you?
Yes. Enter an amount on line o. No. Leave the line o amount blank.
Amount, if any, of the economic stimulus payment you received (before offset) as shown on Notice 1444-C. If you're filing a joint return, include your spouse's payment as shown on your spouse's Notice 1444-C . . . . . . . . . . . . . . . . . Recovery rebate credit. Line q minus line r. If zero or less, enter -0-. To line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Check if you (and/or your spouse if married filing jointly) were residents of American Samoa, Guam, Puerto Rico, the U.S. Virgin Islands, or the Northern Mariana Islands in 2021. Note: If the box is checked you won't receive the rebate on your federal return. We blank out the line 30 amount.
Recovery rebate credit. See instructions . . . . . . . . . . . . . . . . . . . . Amount from Schedule 3, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . Lns 27 - 31. Total other pmts/refundable crdts . . . . . . . . . . . . . . . . . . Sum of lines 25d, 26, and 32. Total payments . . . . . . . . . . . . . . . . . If line 33 is larger than line 24, amt overpaid . . . . . . . . . . . . . . . . Amount of line 34 you want refunded to you. Check if Form 8888 is attached: b Routing number XXXXXXXXX c Type: Checking d Account number XXXXXXXXXXXXXXXXX 36 Amt to apply to 2022 estimated tax . . . . . . . . . . 36 37 Amount you owe (including Form 2210 penalty) . . . . . . . . . . . . . . . Note: Schedule H and Schedule SE filers, line 37 may not represent all of the taxes you owe for 2020. See Schedule 3, line 12e, and its instructions for details.
30 31 32 33 34 35a
30 31 32 33 34 35a
Savings
37
You Owe 38 Amount of penalty on Form 2210 . . . . . . . . . 38 50 Third Do you want to allow another person to discuss this return with the Party IRS (see instructions)? Yes. Complete below. No Designee Designee name Phone Note: If you are signing for your child, sign his or her name, and write "By" and then your name, and then, "parent for minor child."
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 accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Signature: Date Your occupation IP PIN Sign software engineer here Spouse's sig (if jt.) Date Spouse's occupation IP PIN Phone No. (domestic) 979-319-2471 (foreign) Email yuliu6699@gmail.com Keep copy Preparer name Preparer signature Date
for your records.
Firm's name
PTIN Firm's
0 0 16,342
Ph
6,098
PIN
Not for Filing
Keep copy for your records. KIA
979-319-2471 yuliu6699@gmail.com Preparer name Preparer signature Firm's name Firm's address Check if:
Date
PTIN Firm's
Self-employed END OF PAGE 2
Ph EIN
Not for Filing
KIA
Firm's address Check if:
SCHEDULE 1 (Form 1040 or Form 1040-SR) Ziping
Part I
Self-employed
ADDITIONAL INCOME AND ADJUSTMENTS TO INCOME
EIN
2021*01 OMB No. 1545-0074 SSN:
Liu
376-29-0494
Additional Income MINI-WORKSHEET FOR LINE 1, TAXABLE REFUNDS OF STATE AND LOCAL INCOME TAXES
Note: This mini-worksheet requires certain information
from your 2020 income tax return. If you did not create this tax return using last year's tax data, complete the Last Year's Data Worksheet before continuing. a. Sum of "special case" amounts from Forms 1099-G (based on Pub. 525) . . . . . . . . . . . . . . . . . . .a. 0 (If so, see IRS Pub. 525 and enter your taxable refunds manually on line 1.) b. Amount of refunds (up to diff betw deds): i. Refunds received (Form 1099-G) . . . . . . . . . . . . 0 Check to use amount on line i . . . . . . . . . . . . . . . . . . . . . . . . . . . . Check to calculate limit on taxable amt . . . . . . . . . . . . . . . . . . . .
Limitation on Taxable Amount H&R Block load last year users who calculated (but did not use) sales tax deduction in 2020: 1. Sales tax you could have
deducted in 2020 . . . . . . . . . . . . . . . . . . . . . Line 1 comes from the Last Year's Data Worksheet. We blank out lines 2 - 9 if line 1 is calculated.
Others: 2. 2020 family size . . . . . . . . . . . . . . . . . . . . . . . . . 3. 2020 adjusted gross income . . . . . . . . . . . . . . 4. 2020 nontaxable income . . . . . . . . . . . . . . . . . 5. 2020 total available income . . . . . . . . . . . . . . 6. 2020 states of residence: (1) 2020 state at year-end . . . . . . . . . . . . .
1 2a
2020 locality . . . . . 2020 state general sales tax rate . . . . . . . . . CA and NV: Enter your 2020 combined state and local general sales tax rate on the following line. 2020 local general sales tax rate . . . . . . . . . (2) 2020 other state . . . . . . . . . . . . . . . . . . . 2020 dates of residence in other state: From to 2020 locality . . . . . 2020 state general sales tax rate . . . . . . . . . CA and NV: Enter your 2020 combined state and local general sales tax rate on the following line. 2020 Local general sales tax rate . . . . . . . . . 7. 2020 total from tables . . . . . . . . . . . . . . . . . . . 8. 2020 sales tax for major purchases . . . . . . . . 9. 2020 state and local sales tax (line 7 + line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . 10. 2020 state and local income tax . . . . . . . . . . . 11. Ln 10 minus ln 9 (or line 1, if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Smaller of lines b(i) and 11 . . . . . . . . . . . . . . . ii. Line b(i) or 12 . . . . . . . . . . . . . . . . . . . . . . . . . .b. Note: We carry line 12 to line b if you indicate that you want to calculate the difference between your 2020 income and sales tax deductions. Otherwise we carry line b(i) to line b. c. 2020 total state tax - limit (not < 0) . . . . . . . . . . . . .c. d. Line b minus line c . . . . . . . . . . . . . . . . . . . . . . . . . . .d. Note: If line b is not more than line c, none of your refund is taxable. We blank line m. e. Itemized deductions allowed in 2020 . . . . . . . . . . .e. f. 2020 filing status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .f. If line f is "3", "X" if itemizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g. 2020 minimum standard deduction . . . . . . . . . . . .g. h. Number of boxes x'd near the top of page 1 of 2020 Form 1040 or 1040-SR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h. i. Ln h x $1300 ($1650 if ln f is 1 or 4) . . . . . . . . . . . . i. j. 2020 standard deduction (ln g + ln i) . . . . . . . . . . . j. Note: We blank line j if line f is X'd. k. Carry from line j . . . . . . . . . . . . . . . . . . . . . . . . . . . . .k. l. Line e - line k (not < 0) . . . . . . . . . . . . . . . . . . . . . . . .l. m. Smaller of line d or line l . . . . . . . . . . . . . . . . . . . . . .m. n. Sum of lines a and m (to line 1) . . . . . . . . . . . . . . . .n. 0 Taxable refunds of state and local income taxes . . . . . . . . . . . . . 1 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
%
%
%
%
0
Not for Filing
m. Smaller of line d or line l . . . . . . . . . . . . . . . . . . . . . .m. n. Sum of lines a and m (to line 1) . . . . . . . . . . . . . . . .n. 1 2a b
0
Not for Filing
Orig divorce/separation agreement date . . . . . . . . 2nd divorce/separation agreement date. . . . . . . . . 3rd divorce/separation agreement date. . . . . . . . . .
Business income or loss. Attach Sched C . . . . . . . . . . . . . . . . . . . . Other gains or losses. Attach Form 4797 . . . . . . . . . Rent, royalty, partnership, S corp, trust (Sch E) . . . . . . . . . . . . . . . Farm income or loss. Attach Schedule F . . . . . . . . . . . . . . . . . . . . Unemploy compensation . . . . . . . . . . . . . Other income: a Net operating loss (enter as negative) . . . . . . . . . . . . . . . . . . . . . . b Gambling income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Cancellation of debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Foreign earned income exclusion (enter as neg) . . . . . . . . . . . . . e Taxable health savings account distribution (and/or MSA distribution) . . . . . . . . . . . . . f Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . . . . . . . . g Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h Prizes and awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i Activity not engaged in for profit income . . . . . . . . . . . . . . . . . . . j Stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k Income from the rental of personal property if you engaged in the rental for profit but were not in the business of renting such property . . . . . . . . . . . . . . . . . . . . . . l Olympic/Paralympic medals and USOC prize money . . . . . . . . . . m Section 951(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . n Section 951A(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . o Section 461(l) excess business loss adjustment . . . . . . . . . . . . . . p Taxable distributions from an ABLE account . . . . . . . . . . . . . . . . . z Other income (type and amt) . . . . . . SEE ATTACHED 9 Total other income. Sum of lines 8a - 8z . . . . . . . . . . . . . . . . . . . . 10 Lines 1 - 7, plus line 9. To 1040/1040-SR, line 8 . . . . . . . . . . . . . . . END OF PAGE 3
3 4 5 6 7 8
0
Taxable refunds of state and local income taxes . . . . . . . . . . . . . 1 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a Alimony received under a post-2018 agreement . . . . . . . . . . . . .
3 4 5 6 7
0
8a 8b 8c 8d
0 0
8e 8f 8g 8h 8i 8j
0
8k 8l 8m 8n 8o 8p 8z 9 10
0
0
0
0
0 14,472 14,472 14,472
z 9 10 Part II
Other income (type and amt) . . . . . . SEE ATTACHED 8z Total other income. Sum of lines 8a - 8z . . . . . . . . . . . . . . . . . . . . 9 Lines 1 - 7, plus line 9. To 1040/1040-SR, line 8 . . . . . . . . . . . . . . . 10
Adjustments to Income 11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . 12 Certain bus expenses of reservists, 13 14 15 16 17 18 19a b c
11
artists, fee-basis gov't officials . . . . . . . . . . . . 12 Health savings acct ded (Fm 8889) . . . . . . . . 13 Moving exps (Form 3903) . . . . . . . . 14 Deductible self-empl tax (Sch SE) . . . . . . . . . . 15 SE SEP/SIMPLE/qualified plans. . . 16 Self-employed health ins deduction . . . . . . . 17 Penalty on early w/drawal of svgs . . . . . . . . . 18 Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . 19a Recip SSN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Orig divorce/separation agreement date . . . . . . . .
Not for Filing
0 0 0 0 0 0 0
MINI-WORKSHEET FOR LINE 20, IRA DEDUCTION
a. Your IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Your spouse's IRA deduction . . . . . . . . . . . . . . . . . . . . . . . c. Total (to line 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
14,472 14,472 14,472
IRA deduction (see instr) . . . . . . . . . . . . . . .
20 MINI-WORKSHEET FOR LINE 21, STUDENT LOAN INTEREST DEDUCTION
0 0
0
Note: If you are claimed as a dependent on someone a. b. c. d. e. f. g. h. i. j. k. l. 21 22 23 24 a b c d e f g h i j k z 25 26 KIA
else's return, or if you are married filing a separate return, you are not eligible for this deduction. Qualifying interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Maximum interest deduction . . . . . . . . . . . . . . . . . . . . . . . Eligible interest. Smaller line a or b . . . . . . . . . . . . . . . . . . Total income (Form 1040/1040-SR, line 9) . . . . . . . . . . . . Adjustments (Form 1040/1040-SR, line 10) . . . . . . . . . . . Foreign earned income and housing deduction . . . . . . . Income excluded from Puerto Rico, Guam, American Samoa, or N. Mariana Islands . . . . . . . . . . . . . . Modified AGI. Ln d - ln e + lns f and g . . . . . . . . . . . . . . . . Phaseout threshold ($70,000; $140,000 jnt) . . . . . . . . . . . Line h - line i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reduction amount (line c times line j divided by $15,000 if not joint, $30,000 joint) . . . . . . . . . . . . . . . . Deduction (line c - line k). To line 21 . . . . . . . . . . . . . . . . .
Student loan interest deduction . . . . . . . . . . . 21 Reserved for future use . . . . . . . . . . . . . . . . . . 22 Archer MSA deduction . . . . . . . . . . . . . . . . . . . 23 0 Other adjustments: Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deductible expenses related to income reported on line 8k from pers prop rental engaged in for profit . . . . . . . . . . . . . . Nontaxable amount of value of Olympic/Paralympic medals and USOC prize money reported on ln 8l . . . . . . . . . . . . Reforestation amortization and expenses . . . . . . . . . . . . . . . . . . . Repayment of supplemental unemployment benefits under the Trade Act of 1974 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contributions to sec 501(c)(18)(D) pension plans . . . . . . . . . . . . . Contribs by certain chaplains to sec 403(b) plans . . . . . . . . . . . . . Attorney fees and court costs for actions involving certain unlawful discrimination claims (see inst) . . . . . . . . . . . . . Attorney fees and court costs you paid in connection with award from IRS for info you provided . . . . . . . . . . . . . . . . . . Housing deduction from Form 2555 . . . . . . . . . . . . . . . . . . . . . . . Excess deductions of section 67(e) expenses from Schedule K-1 (Form 1041) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other adjs (type and amt). Total other adjustments. Sum of lines 24a - 24z . . . . . . . . . . . . . . Sum of lines 11 - 23, plus line 25. Adjustments to income. To 1040/1040-SR, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . END OF PAGE 4
24a 24b 24c 24d 24e 24f 24g
0
24h 24i 24j
0
24k 24z 25
0
26
0
0
26 KIA
Sum of lines 11 - 23, plus line 25. Adjustments to income. To 1040/1040-SR, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
SCHEDULE 2 (Form 1040 or Form 1040-SR) Ziping
Part I
Part II
ADDITIONAL TAXES
Liu
0
2021*02 OMB No. 1545-0074 SSN:
376-29-0494
Tax 1 Alternative minimum tax. (Form 6251) . . . . . . . . . . . . . . . . . . . . . . 2 Excess adv prem tax cr repmt. Attach Form 8962 . . . . . . . . . . . . 3 Sum of lines 1 and 2. To F1040/1040-SR, ln 17 . . . . . . . . . . . . . . . Other Taxes 4 Self-employment tax. (Sched SE) . . . . . . . 5 Soc sec/medicare tax on unreported tip income . . . . . . . . . . . . . 6 Uncollected soc sec/Medicare tax on wages . . . . . . . . . . . . . . . . . 7 Total add'l soc sec/Medicare tax. Line 5 + line 6 . . . . . . . . . . . . . . 8 Tax on IRAs, qualified plans, etc. (Form 5329) . . . . . . . . . . . . 9 Household employment taxes from Schedule H . . . . . . . . . . . . . 10 First-time homebuyer credit repayment. Form 5405 . . . . . . . . . . 11 Additional Medicare Tax. Form 8959 . . . . . . . . . . . . . . . . . . . . . . . 12 Net investment income tax. Form 8960 . . . . . . . . . . . . . . . . . . . . . 13 Uncollected social security and Medicare/RRTA tax 14 15 16
on tips/group-term life ins from W-2, box 12 . . . . . . . . . . . . . . . . Interest on tax due on installment income from sale of certain residential lots and timeshares . . . . . . . . . . . . . . . Interest on deferred tax on gain from certain installment sales with sales price over $150,000 . . . . . . . . . . . . . Low-income housing credit recapture. Form 8611 . . . . . . . . . . . . END OF PAGE 5
1 2 3
0
4 5 6 7 8 9 10 11 12
0 0
13
0
14 15 16
0
0 0 0 0 0 0
Not for Filing
15 16 KIA
Interest on deferred tax on gain from certain installment sales with sales price over $150,000 . . . . . . . . . . . . . 15 Low-income housing credit recapture. Form 8611 . . . . . . . . . . . . 16
Other additional taxes: Recapture of other credits . . . . . . . . . . . . . Fed mortgage subsidy recap. 2021 sales, see inst . . . . . . . . . . . . Additional tax on HSA distributions. Form 8889 . . . . . . . . . . . . . . Addl HSA tax bc you didn't remain elig indiv . . . . . . . . . . . . . . . . . Addl tax on Archer MSA distributions. Form 8853 . . . . . . . . . . . . Additional tax on Medicare Advantage MSA distributions. Form 8853 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g Recap of charitable contrib deduction related to fractional interest in tangible personal prop . . . . . . . . . . . . . . . . . h Income received from noqualified deferred comp plan that fails to meet section 409A requirements . . . . . . . . . . . i Compensation received from noqualified deferred comp plan described in section 457A . . . . . . . . . . . . . . . . . . . . . . . j Section 72(m)(5) excess benefits tax . . . . . . . . . . . . . . . . . . . . . . . . k Golden parachute payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l Tax on accumulation distribution of trusts . . . . . . . . . . . . . . . . . . m Excise tax on insider stock compensation from an expatriated corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n Look-back interest under section 167(g) or 460(b) from Form 8697 or 8866 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o Tax on non-effectively connected inc for part of year you were nonresident alien from Form 1040-NR . . . . . . . . . p Interest from F8621, ln 16f, relating to distribs from, and dispositions of, stock of sec 1291 fund . . . . . . . . . . . . q Any interest from Form 8621, line 24 . . . . . . . . . . . . . . . . . . . . . . . z Any other taxes. Type and amount . . . . . . . 18 Total additional taxes. Sum of lines 17a - 17z . . . . . . . . . . . . . . . . 19 Additional tax from Schedule 8812 . . . . . . . . . . . . . . . . . . . . . . . . . 20 Sec 965 net tax liability installment from F965-A . . . . . . . . . . . . . 21 Sum of lines 4, 7-16, 18, and 19. These are your total other taxes. To Form 1040 or 1040-SR, ln 23 . . . . . . . . . . . . . . END OF PAGE 6
17 a b c d e f
17a 17b 17c 17d 17e
0
17f
0
0 0 0
17g 17h 17i 17j 17k 17l
0
17m 17n 17o 17p 17q 17z 18 19 20 21
0
0
Not for Filing
20 21
Sec 965 net tax liability installment from F965-A . . . . . . . . . . . . . 20 Sum of lines 4, 7-16, 18, and 19. These are your total other taxes. To Form 1040 or 1040-SR, ln 23 . . . . . . . . . . . . . . 21
SCHEDULE 3 (Form 1040 or Form 1040-SR) Ziping
Part I
ADDITIONAL CREDITS AND PAYMENTS
2021*03 OMB No. 1545-0074 SSN:
Liu
0
376-29-0494
Nonrefundable Credits MINI-WORKSHEET FOR LINE 1, FOREIGN TAX CREDIT
a. Foreign tax credit from Form(s) 1099-DIV, 1099-INT, 1099-
MISC, and Schedule(s) K-1 (partnerships/S corps) . . . . . . . . . . . Note: We blank line a if you use Form(s) 1116. b. Smaller of line a or 1040 or 1040-SR, line 16 plus Schedule 2, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Foreign tax credit from Form(s) 1116 . . . . . . . . . . . . . . . . . . . . . . d. Line b + line c. To line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 2 3 4 5 6 a b c d e f g h i j k l z 7 8
Foreign tax credit (1116 if req'd) . . . . . . . . . . . . . . . . . . . . . . . . . . . Child care credit (Form 2441) . . . . . . . . . . Education credits from Form 8863, line 19 . . . . . . . . . . . . . . . . . . Retirement savings credit (Fm 8880) . . . . . . . . . . . . . . . . . . . . . . . Residential energy credit (Form 5695) . . . . . . . . . . . . . . . . . . . . . . Other nonrefundable credits: General business credit. Form 3800 . . . . . . . . . . . . . . . . . . . . . . . . Credit for prior year minimum tax. Form 8801 . . . . . . . . . . . . . . . Adoption credit. Form 8839 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit for elderly or disabled. Schedule R . . . . . . . . . . . . . . . . . . . Alternative motor vehicle credit. Form 8910 . . . . . . . . . . . . . . . . . Qualified plug-in motor vehicle credit. Form 8936 . . . . . . . . . . . . Mortgage interest credit. Form 8396 . . . . . . . . . . . . . . . . . . . . . . . DC first-time homebuyer credit. Form 8859 . . . . . . . . . . . . . . . . . Qualified electric vehicle credit. Form 8834 . . . . . . . . . . . . . . . . . . Alt fuel vehicle refueling prop credit. Form 8911 . . . . . . . . . . . . . Credit to holders of tax credit bonds. Form 8912 . . . . . . . . . . . . . Amount on Form 8978, line 14. See instructions . . . . . . . . . . . . . Other nonrefundable credits . . . . . . . . . . . . Total other nonrefundable credits. Sum of 6a-6z . . . . . . . . . . . . . Lns 1 - 5 plus 7. To 1040 or 1040-SR, ln 20 . . . . . . . . . . . . . . END OF PAGE 7
0
0 0 0
1 2 3 4 5
0
6a 6b 6c 6d 6e 6f 6g 6h 6i 6j 6k 6l 6z 7 8
0 0 0 0 0 0 0 0
0 0
0 0
Not for Filing
z 7 8 Part II
Other nonrefundable credits . . . . . . . . . . . . 6z Total other nonrefundable credits. Sum of 6a-6z . . . . . . . . . . . . . 7 Lns 1 - 5 plus 7. To 1040 or 1040-SR, ln 20 . . . . . . . . . . . . . . 8
0 0
Other Payments and Refundable Credits 9 Net premium tax credit. Attach Form 8962 . . . . . . . . . . . 9 10 Amt paid with extension request (see instr) . . . . . . . . . . . 10 MINI-WORKSHEET FOR LINE 11, EXCESS SOC SEC AND RRTA (Fill in W-2's first; leave blank unless 2 or more employers.) a. "X" if more than 1 employer. Self: Spouse: b. Eligible Soc Sec tax paid. Self: Spouse: c. Eligible RRTA tax paid. Self: Spouse: d. Uncollected SS/RRTA on tips or group term life insurance. Self: Spouse: e. Sum of lines b, c, and d. Self: 0 Spouse: f. If a="X", amount on line e minus $8,853.60 . . . . . . . . . . . . . . . . . . . . . . Self: 0 Spouse: g. Total on line f. Carry to ln 11 . . . . . . . . . . . . . . . . . . . . TOTAL:
11 12 13
Excess Soc Sec & tier 1 tax withheld . . . . . . . . . . . . . . . . . Credit for fed tax on fuels (Form 4136) . . . . . . . . . . . . . . . Other payments or refundable credits: a Form 2439 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Qualified sick/family leave credits from Sch H/Form 7202 for leave taken before 4/1/21 . . . . . . . . . . . c Health coverage tax credit from Form F8885 . . . . . . . . . .
MINI-WORKSHEET FOR LINE 13d, MISCELLANEOUS CREDITS
Not for Filing
0
11 12
0
13a
0
13b 13c
0 0
Credit for repayment of amounts you included in income in an earlier year because it appeared you had a right to the income . . . . . . . . . . . . . . . . . . . . . . . . . . .
d Credit for repayment of amounts included in
KIA
income from earlier years . . . . . . . . . . . . . . . . . . . . . . . . . . 13d e Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13e f Deferred amt of net 965 tax liab (see inst) . . . . . . . . . . . . 13f g Credit for child and dependent care expenses from Form 2441, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13g h Qualified sick/family leave credits from Sch H/Form 7202 for leave taken after 3/31/21 . . . . . . . . . . . 13h z Other payments/refundable credits . . . . . . . . . . . . . 13z 14 Sum of lines 13a through 13z . . . . . . . . . . . . . . . . . . . . . . . 14 15 Sum of lns 9 - 12 plus 14. To Form 1040 or 1040-SR, line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 END OF FORM
0 0 0 0