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Accountancy 503 Fall 2022
Tax Return Assignment
Marci Birx, age-59, is single and has no dependents. Marci had the following relevant transactions for 2020:
Wages as Walmart greeter
Federal income tax withheld
Interest income from local bank
Qualified dividends
Loss on sale of Tandem Diabetic stock (held from
11/10/2019 to 10/31/2021)
Federal income tax quarterly deposits (total)
Charitable contributions
Itemized deductions
RENTAL OPERATIONS
Rental income
Interest expense
Property taxes
Maintenance
Insurance
Depreciation-Building (Line 17, Form 4562)
Depreciation-Appliances (Line 17, Form 4562)
$17,000
2,260
1,450
1,155
-3,100
6,500
325
11,600
Single
Family
Home
$31,900
11,800
1,650
440
1,260
2,495
0
SALE OF RENTAL RESIDENCE
Sales price (November 27, 2021)
Land (line 2, Form 4797)
Building (line 19A, From 4797)
Cost (October 18, 2011)
Land
Building
Depreciation allowed (including 2021depreciation)
SALE OF APPLIANCES WITH RESIDENCE
Sales price (line 19B, From 4797)
Cost (October 18, 2015)
Depreciation allowed
Duplex
$29,200
11,200
6,366
560
1.465
1,491
0
$ 72,000
48,000
$ 38,000
40,000
8,898
$ 2,500
9,000
9,000
Complete a Form 1040 with the appropriate Schedules and Forms for 2021 for Marci Birx.
Minimum forms required:
Form 1040, Schedule 1, Schedule 3
Form 1040, Schedule B, Schedule D, Schedule E.
Form 4562, Form 4797, Form 8949 (Optional), Form 8995 (optional).
Hints:
Claim the QBI deduction for the rentals (i.e., the rentals qualify as a trade or business). Any depreciation
recapture and any Sec. 1231 loss is included in QBI; any Sec. 1231 gain, is not.
COVER PAGE
Filing Checklist for 2021 Tax Return Filed On Standard Forms
Prepared on: 12/07/2022 04:21:15 am
Return: /Users/nathanoestreich/Documents/Marci Birx 2021 Tax Return.T21
To file your 2021 tax return, simply follow these instructions:
Step 1. Sign and date the return
If your return is signed by a representative for you, you must have a power of attorney attached that specifically authorizes the representative to sign your return. To
do this, you can use Form 2848, Power of Attorney and Declaration of Representative.
Step 2. Assemble the return
These forms should be assembled behind Form 1040: U.S. Individual Income Tax Return
– Schedule D
– – Form 8949
– Schedule E
– Form 4797
– Form 8995
– Form 8582 – Page 1
– – Form 8582 Page 2 (Regular Tax)
Staple these documents to the front of the first page of the return:
Form W-2: Wage and Tax Statement
1st (Walmart)
Step 3. Mail the return
Mail the return to this address:
Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0002
We recommend that you use one of these IRS-approved methods to send your return. Retain the proof of mailing to avoid a late filing penalty:
– U.S. Postal Service certified mail.
– DHL Express, Express 9:00, Express 10:30, Express 12:00, Express Worldwide, Express Envelope, Import Express 10:30, Import Express 12:00, and Import Express
Worldwide.
– FedEx First Overnight, Priority Overnight, Standard Overnight, 2 Day, International Next Flight Out, International Priority, International First, or International
Economy.
– UPS Next Day Air Early A.M., Next Day Air, Next Day Air Saver, 2nd Day Air, 2nd Day Air A.M., Worldwide Express Plus, or Worldwide Express.
Step 4. Keep a copy
Print a second copy of the return for your records. We recommend that you also print and retain these supporting forms, which don’t need to be sent to the IRS:
– – Background Worksheet
– – Last Year’s Data Worksheet
– – Form 1099-INT/OID
– – Form 1099-DIV
– – Charitable Worksheet
– – Depreciation Summary
– – Depreciation Worksheet
– – Capital Gains and Losses Worksheet
– – Charitable Worksheet
– – Depreciation Summary
– – Depreciation Worksheet
– – Capital Gains and Losses Worksheet
– – Rentals and Royalties
2021 return information – Keep this for your records
Here is some additional information about your 2021 return. Keep this information with your records.
You will need your 2021 AGI to electronically sign your return next year.
Quick Summary
Income
Adjustments
$91,886

Adjusted gross income
Deductions

Taxable income
$14,250
$73,239
Tax withheld or paid already
$8,760
Actual tax due

Refund applied to next year

Refund
$0
$91,886
$8,708
$0
$52
* Your long-term capital gains and qualifying dividends are taxed at a lower rate than your other income. As a result, your total federal tax is less than the tax shown
on the IRS’s Tax Table.
F
o
r
m
1040-SR U.S. Tax Return for Seniors
Department of the Treasury—Internal Revenue Service (99)
X Single
Filing
Status
2021
OMB No. 1545-0074
Married filing jointly
Qualifying widow(er) (QW)
Head of household (HOH)
IRS Use Only—Do not write or staple in this space.
Married filing separately (MFS)
If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s
Check only
name if the qualifying person is a child but not your dependent
one box.
Your first name and middle initial
Last name
Marci
Your social security number
M
Birx
469-98-9898
If joint return, spouse’s first name and middle initial
Last name
Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions.
City, town, or post office. If you have a foreign address, also complete spaces below.
State
National City
WA
Foreign country name
Presidential Election Campaign
Check here if you, or your
spouse if filing jointly, want
ZIP code
$3 to go to this fund.
98987
Checking a box below will
Foreign postal code not change your tax or
refund.
You
Spouse
Apt. no.
4321 Ohio Street
Foreign province/state/county
At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any
financial interest in any virtual currency?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Someone can claim:
You as a dependent
Your spouse as a dependent
Standard
Spouse itemizes on a separate return or you were a dual-status alien
Deduction
Age/Blindness
X Were born before January 2, 1957
{ You:
Spouse:
Was born before January 2, 1957
Dependents
(2) Social security number
(see instructions): (1)
First name
Yes
X No
Are blind
Is blind
(3) Relationship to you
(4) Check if qualifies for (see inst.):
Child tax credit
Credit for other dependents
Last name
If more
than four
dependents,
see instructions
and check
here
1
Attach
Schedule B
if required.
Wages, salaries, tips, etc. Attach Form(s) W-2
1
17,000
b Taxable interest
. . .
2b
1,450
.
3b
1,155
2a Tax-exempt interest
. .
2a
0
3a Qualified dividends
. .
3a
1,155
. . . .
4a
b Taxable amount
. . .
4b
0
5a Pensions and annuities .
5a
b Taxable amount
. . .
5b
0
6a Social security benefits
6a
b Taxable amount
. . .
6b
4a IRA distributions
7
KIA
. . . . . . . . . . . . . . . . .
.
b Ordinary dividends
Capital gain or (loss). Attach Schedule D if required. If not required,
check here
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
47,798
8
Other income from Schedule 1, line 10
8
24,483
9
Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income
9
91,886
10
Adjustments to income from Schedule 1, line 26
10
0
11
Subtract line 10 from line 9. This is your adjusted gross income
11
91,886
. . . . . . . . . . . . . . . . . . . . .
. . . . . .
. . . . . . . . . . . . . . . . .
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
. .
Form 1040-SR (2021)
Page 2
Form 1040-SR (2021)
Standard
Deduction 12a
See Standard
Deduction Chart
b
14,250
13
Qualified business income deduction from Form 8995 or Form 8995-A
14
Add lines 12c and 13
15
Taxable income. Subtract line 14 from line 11. If zero or less, enter -0-
16
Tax (see instructions). Check if any from:
c
1
a qualifying
child, attach
Sch. EIC.
2
13
4,397
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
18,647
. . . . .
15
73,239
. . . . . . .
16
8,708
. . . . . . . . . . . . . . . . . . . . .
17
0
8,708
Form 4972
.
3
Amount from Schedule 2, line 3
18
Add lines 16 and 17
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
19
Nonrefundable child tax credit or credit for other dependents from
Schedule 8812
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
20
Amount from Schedule 3, line 8
. . . . . . . . . . . . . . . . . . . . .
20
0
21
22
23
24
Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 21 from line 18. If zero or less, enter -0. . . . . . . . . .
Other taxes, including self-employment tax, from Schedule 2, line 21
. .
Add lines 22 and 23. This is your total tax
. . . . . . . . . . . . . .
21
0
22
8,708
23
0
24
8,708
25
Federal income tax withheld from:
26
Form(s) W-2
. . . . . . . . . . . . . . . . . . . . . . . .
25a
2,260
Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . 25b
0
Other forms (see instructions)
. . . . . . . . . . . . 25c
0
Add lines 25a through 25c
. . . . . . . . . . . . . . . . . . . . . . . . 25d
2021 estimated tax payments and amount applied from 2020 return
. . 26
27a Earned income
credit (EIC)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2,260
6,500
27a
Check here if you were born after January 1, 199
and before January 2, 2004, and you satisfy all th
other requirements for taxpayers who are at leas
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 lines 27a and 28 through 31. These are your total other payments
and refundable credits
. . . . . . . . . . . . . . . . . . . . . . . .
32
0
Add lines 25d, 26, and 32. These are your total payments
33
8,760
33
KIA
Form(s) 8814
. . . . .
17
a
b
c
d
• If you have
14,250
12a
Charitable contributions if you take the standard deductio
0
(see instructions)
. . . . . . . . . . . . . . . . . . 12b
Add lines 12a and 12b
. . . . . . . . . . . . . . . . . . . . . . . . . . 12c
on the last page
of this form.
Standard deduction or itemized deductions (from
Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . .
Go to www.irs.gov/Form1040SR for instructions and the latest information.
0
. . . . . .
Form 1040-SR (2021)
Page 3
Form 1040-SR (2021)
Refund
Direct deposit?
See
instructions.
34
35a Amount of line 34 you want refunded to you. If Form 8888 is attached,
check here
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Routing number XXXXXXXXX
c Type: X Checking
Savings
34
52
35a
52
d Account number XXXXXXXXXXXXXXXXX
36
Amount
You Owe
If line 33 is more than line 24, subtract line 24 from line 33. This is the
amount you overpaid
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount of line 34 you want applied to your 2022
estimated tax
. . . . . . . . . . . . . . . . . . . . . .
0
36
37
Amount you owe. Subtract line 33 from line 24. For details on how to
pay, see instructions
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38
Estimated tax penalty (see instructions)
. . . . . . . . .
38
37
0
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS? See
instructions
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sign
Here
Designee’s
Phone
Personal identification
name
no.
number (PIN)
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of
my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information
of which preparer has any knowledge.
Joint return?
See instructions.
Keep a copy for
your records.
Paid
Preparer
Use Only
KIA
Your signature
Date
Your occupation
Spouse’s signature. If a joint return, both must sign.
Date
Spouse’s occupation
Phone no.
Email address
Wallmart Greater
Preparer’s name
Preparer’s signature
Date
Yes. Complete below.
X No
If the IRS sent you an Identity
Protection PIN, enter it here
(see inst.)
If the IRS sent your spouse an
Identity Protection PIN, enter it here
(see inst.)
PTIN
Check if:
Self-employed
Firm’s name
Phone no.
Firm’s address
Firm’s EIN
Form 1040-SR (2021)
Go to www.irs.gov/Form1040SR for instructions and the latest information.
SCHEDULE 1
2021
Attach to Form 1040, 1040-SR, or 1040-NR.
Go to www.irs.gov/Form1040 for instructions and the latest information.
Department of the Treasury
Internal Revenue Service
Name(s) shown on Form 1040, 1040-SR, or 1040-NR
Marci
Part I
OMB No. 1545-0074
Additional Income and Adjustments to Income
(Form 1040)
M
Attachment
Sequence No. 01
Your social security number
Birx
469-98-9898
Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes
. . . . . . . . . . . . . . . . . .
2a Alimony received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Date of original divorce or separation agreement (see instructions)
1
0
2a
3
4
5
Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach
Schedule E
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4
0
2,500
5
21,983
6
Farm income or (loss). Attach Schedule F
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
0
7
Unemployment compensation
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8
Other income:
a Net operating loss
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8a (
b Gambling income
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8b
c Cancellation of debt
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
8c
d Foreign earned income exclusion from Form 2555
8d (
0)
. . . . . . . . . . . . . . .
8e
0
. . . . . . . . . . . . . . . . . . . . .
8f
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8g
e Taxable Health Savings Account distribution
f Alaska Permanent Fund dividends
g Jury duty pay
. . . . . . . . . . . .
h Prizes and awards
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i Activity not engaged in for profit income
8h
. . . . . . . . . . . . . . . . . .
8i
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8j
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
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8k
l Olympic and Paralympic medals and USOC prize money (see
instructions)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8l
m Section 951(a) inclusion (see instructions)
. . . . . . . . . . . . . . . . .
8m
n Section 951A(a) inclusion (see instructions)
. . . . . . . . . . . . . . . .
8n
. . . . . . . . . . . . . .
8o
j Stock options
0)
o Section 461(l) excess business loss adjustment
p Taxable distributions from an ABLE account (see instructions)
. . . . . . .
8p
z Other income. List type and amount
8z
9
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10 Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or
1040-NR, line 8
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
KIA
Total other income. Add lines 8a through 8z
0
For Paperwork Reduction Act Notice, see your tax return instructions.
0
24,483
Schedule 1 (Form 1040) 2021
Schedule 1 (Form 1040) 2021
Part II
Page 2
Adjustments to Income
Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Certain business expenses of reservists, performing artists, and fee-basis government officials.
Attach Form 2106
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Health savings account deduction. Attach Form 8889
. . . . . . . . . . . . . . . . . . . . . . . . .
14 Moving expenses for members of the Armed Forces. Attach Form 3903
. . . . . . . . . . . . . . .
15 Deductible part of self-employment tax. Attach Schedule SE
. . . . . . . . . . . . . . . . . . . . .
16 Self-employed SEP, SIMPLE, and qualified plans
. . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Self-employed health insurance deduction
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 Penalty on early withdrawal of savings
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19a Alimony paid
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Recipient’s SSN
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Date of original divorce or separation agreement (see instructions)
20 IRA deduction
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21 Student loan interest deduction
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
22
Reserved for future use
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
23
Archer MSA deduction
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
24
Other adjustments:
11
12
a Jury duty pay (see instructions)
. . . . . . . . . . . . . . . . . . . . . .
24a
b Deductible expenses related to income reported on line 8k from
the rental of personal property engaged in for profit . . . . . . . . . . . .
24b
c Nontaxable amount of the value of Olympic and Paralympic
medals and USOC prize money reported on line 8l
. . . . . . . . . . . .
24c
d Reforestation amortization and expenses
. . . . . . . . . . . . . . . . .
24d
e Repayment of supplemental unemployment benefits under the
Trade Act of 1974
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24e
f Contributions to section 501(c)(18)(D) pension plans
24f
. . . . . . . . . . .
g Contributions by certain chaplains to section 403(b) plans
. . . . . . . .
24g
h Attorney fees and court costs for actions involving certain
unlawful discrimination claims (see instructions) . . . . . . . . . . . . . .
24h
i Attorney fees and court costs you paid in connection with an
award from the IRS for information you provided that helped the
IRS detect tax law violations
. . . . . . . . . . . . . . . . . . . . . . . .
24i
j Housing deduction from Form 2555
. . . . . . . . . . . . . . . . . . . .
24j
k Excess deductions of section 67(e) expenses from Schedule K-1
(Form 1041)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24k
12
13
14
15
16
17
18
19a
0
0
0
0
0
20
0
0
21
z Other adjustments. List type and amount
24z
25
Total other adjustments. Add lines 24a through 24z
. . . . . . . . . . . . . . . . . . . . . . . . .
25
0
26
Add lines 11 through 23 and 25. These are your adjustments to income. Enter
here and on Form 1040 or 1040-SR, line 10, or Form 1040-NR, line 10a
. . . . . . . . . . . . . .
26
0
KIA
Schedule 1 (Form 1040) 2021
SCHEDULE D
(Form 1040)
Department of the Treasury
Internal Revenue Service (99)
Name(s) shown on return
Marci
OMB No. 1545-0074
Capital Gains and Losses
Attach to Form 1040, 1040-SR, or 1040-NR.
Go to www.irs.gov/ScheduleD for instructions and the latest information.
Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10.
2021
Attachment
Sequence No. 12
Your social security number
M Birx
469-98-9898
Did you dispose of any investment(s) in a qualified opportunity fund during the tax year?
Yes X No
If “Yes,” attach Form 8949 and see its instructions for additional requirements for reporting your gain or loss.
Part I
Short-Term Capital Gains and Losses—Generally Assets Held One Year or Less (see instructions)
See instructions for how to figure the amounts to enter on the
lines below.
This form may be easier to complete if you round off cents to
whole dollars.
1a Totals for all short-term transactions reported on Form
1099-B for which basis was reported to the IRS and for
which you have no adjustments (see instructions).
However, if you choose to report all these transactions
on Form 8949, leave this line blank and go to line 1b
.
(d)
Proceeds
(sales price)
1b Totals for all transactions reported on Form(s) 8949 with
Box A checked
. . . . . . . . . . . . . . . . . . . .
2
3
4
5
6
7
(g)
Adjustments
to gain or loss from
Form(s) 8949, Part I,
line 2, column (g)
(e)
Cost
(or other basis)
0
0
(h) Gain or (loss)
Subtract column (e)
from column (d) and
combine the result
with column (g)
0
0
0
0
0
Totals for all transactions reported on Form(s) 8949 with
Box B checked
. . . . . . . . . . . . . . . . . . . .
0
0
0
0
Totals for all transactions reported on Form(s) 8949 with
Box C checked
. . . . . . . . . . . . . . . . . . . .
0
0
0
0
4
0
Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781,
and 8824
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-1
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover
Worksheet in the instructions.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any longterm capital gains or losses, go to Part II below. Otherwise, go to Part III on page 2
. . . . . . . . . . .
Part II
5
6
(
0)
7
0
Long-Term Capital Gains and Losses—Generally Assets Held More Than One Year (see instructions)
See instructions for how to figure the amounts to enter on the
lines below.
This form may be easier to complete if you round off cents to
whole dollars.
(d)
Proceeds
(sales price)
(g)
Adjustments
to gain or loss from
Form(s) 8949, Part II,
line 2, column (g)
(e)
Cost
(or other basis)
(h) Gain or (loss)
Subtract column (e)
from column (d) and
combine the result
with column (g)
8a Totals for all long-term transactions reported on Form
1099-B for which basis was reported to the IRS and for
which you have no adjustments (see instructions).
However, if you choose to report all these transactions
on Form 8949, leave this line blank and go to line 8b .
0
0
8b Totals for all transactions reported on Form(s) 8949 with
Box D checked . . . . . . . . . . . . . . . . . . . .
1,000
4,100

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0
-3,100
0
9
Totals for all transactions reported on Form(s) 8949 with
Box E checked
. . . . . . . . . . . . . . . . . . . .
0
0
0
0
10
Totals for all transactions reported on Form(s) 8949 with
Box F checked
. . . . . . . . . . . . . . . . . . . .
0
0
0
0
11
Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss)
from Forms 4684, 6781, and 8824 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
50,898
12
Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 .
12
13
Capital gain distributions. See the instructions
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
14
Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover
Worksheet in the instructions
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
15
Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on
page 2
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
KIA
For Paperwork Reduction Act Notice, see your tax return instructions.
0
(
0)
47,798
Schedule D (Form 1040) 2021
Schedule D (Form 1040) 2021
Part III
16
Marci
M Birx
469-98-9898
Page 2
Summary
Combine lines 7 and 15 and enter the result
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
47,798
• If line 16 is a gain, enter the amount from line 16 on Form 1040, 1040-SR, or 1040NR, line 7.
Then, go to line 17 below.
• If line 16 is a loss, skip lines 17 through 20 below. Then, go to line 21. Also be sure to complete
line 22.
• If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, 1040-SR, or
1040-NR, line 7. Then go to line 22.
17
Are lines 15 and 16 both gains?
X Yes. Go to line 18.
No. Skip lines 18 through 21, and go to line 22.
18
If you are required to complete the 28% Rate Gain Worksheet (see instructions), enter the
amount, if any, from line 7 of that worksheet
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
0
19
If you are required to complete the Unrecaptured Section 1250 Gain Worksheet (see
instructions), enter the amount, if any, from line 18 of that worksheet
. . . . . . . . . . . . . . . .
19
8,898
20
Are lines 18 and 19 both zero or blank and are you not filing Form 4952?
Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions
for Forms 1040 and 1040-SR, line 16. Don’t complete lines 21 and 22 below.
X No. Complete the Schedule D Tax Worksheet in the instructions. Don’t complete lines 21
and 22 below.
21
If line 16 is a loss, enter here and on Form 1040, 1040-SR, or 1040-NR, line 7, the smaller of:
• The loss on line 16; or
• ($3,000), or if married filing separately, ($1,500)
. . . . . . . . . . . . . . . . . . . . . . . . . .
21 (
)
Note: When figuring which amount is smaller, treat both amounts as positive numbers.
22
Do you have qualified dividends on Form 1040, 1040-SR, or 1040-NR, line 3a?
Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions
for Forms 1040 and 1040-SR, line 16.
No. Complete the rest of Form 1040, 1040-SR, or 1040-NR.
KIA
Schedule D (Form 1040) 2021
Attachment Sequence No. 12A
Form 8949 (2021)
Name(s) shown on return. Name and SSN or taxpayer identification no. not required if shown on Page 1
Marci
M
Page 2
Social security number or taxpayer identification number
Birx
469-98-9898
Before you check Box D, E, or F below, see whether you received any Form(s) 1099-B or substitute statement(s) from your broker. A substitute
statement will have the same information as Form 1099-B. Either will show whether your basis (usually your cost) was reported to the IRS by your
broker and may even tell you which box to check.
Part II
Long-Term. Transactions involving capital assets you held more than 1 year are generally long-term (see
instructions). For short-term transactions, see page 1.
Note: You may aggregate all long-term transactions reported on Form(s) 1099-B showing basis was reported
to the IRS and for which no adjustments or codes are required. Enter the totals directly on Schedule D, line
8a; you aren’t required to report these transactions on Form 8949 (see instructions).
You must check Box D, E, or F below. Check only one box. If more than one box applies for your long-term transactions, complete
a separate Form 8949, page 2, for each applicable box. If you have more long-term transactions than will fit on this page for one or
more of the boxes, complete as many forms with the same box checked as you need.
X (D) Long-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see Note above)
(E) Long-term transactions reported on Form(s) 1099-B showing basis wasn’t reported to the IRS
(F) Long-term transactions not reported to you on Form 1099-B
Adjustment, if any, to gain or loss.
1
(a)
Description of property
(Example: 100 sh. XYZ Co.)
Tandem Diabetic
(b)
Date acquired
(Mo., day, yr.)
(c)
Date sold or
disposed of
(Mo., day, yr.)
11/10/19
10/31/21
(d)
Proceeds
(sales price)
(see instructions)
1,000
If you enter an amount in column (g),
(e)
(h)
enter a code in column (f).
Cost or other basis.
Gain or (loss).
See
the
separate
instruction

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