Tax Accounting

see attachment

Donna and Chris Hoser have been married for three years. Donna works as a nurse at Tarleton Memorial Hospital. Chris is a full-time student at Southwest Texas State University (STSU) and also works part-time during the summer at Tarleton Hospital. Chris’ birthdate is January 12, 1996, and Donna’s birthdate is November 4, 1998. Donna and Chris each received a W-2 form from Tarleton Memorial Hospital Corp. (see separate tab).

Donna and Chris received Forms 1099-INT, 1099-OID, and 1099-DIV (see separate tab).

Chris is an excellent student at STSU. He was given a $1,750 scholarship by the university to help pay educational expenses. The scholarship funds were used by Chris for tuition and books.

Chris entered the Compositors Expanse Residence (CER) sweepstakes and ended up winning $10,000. Chris took advantage of the no-purchase-required option and paid nothing to join the sweepstakes. He received a 1099-MISC (not shown) reporting the prize.

Donna is a valued employee at the hospital. Her supervisor gave her two tickets to a single game of the nearby professional football team that were worth $100 each. The hospital also sent Donna flowers valued at $40 when her mother passed away during 2022.

Chris has a 4-year-old son, Robert R. Hoser, from a prior marriage that ended in divorce in 2019. During 2022, he paid his ex-wife $300 per month in child support. Robert is claimed as a dependent by Chris’s ex-wife.

During 2022, Chris’ aunt died. The aunt, in her will, left Chris $15,000 in cash. Chris deposited this money in the Lone Star State Bank savings account.

Required:
Complete the Hoser’s federal tax return for 2022 on Form 1040, Schedule 1, and the Qualified Dividends and Capital Gain Tax Worksheet. The Hoser’s had health coverage for the entire year. They do not want to make any contribution to the presidential election campaign. Make any other realistic assumptions about any missing data.
If an amount box does not require an entry or if an amount is zero, enter “0”. Enter amounts as positive numbers. If required, round amounts to the nearest dollar.

Donna and Chris’ earnings and income tax withholdings are reported on the following W-2 forms from Tarleton Memorial Hospital Corp.:

a Employee’s social security number

465-74-3322

OMB No. 1545-0008

Safe, accurate,
FAST! Use

IRS
e ~ file

Visit the IRS website at

www.irs.gov/efile

Employer identification number (EIN)

31-1238977

Wages, tips, other compensation

50,198.00

Federal income tax withheld

4,020.30

Employer’s name, address, and ZIP code

Tarleton Memorial Hospital Corp.
412 N. Belknap Street
Stephenville, TX 76401

Social security wages

50,198.00

Social security tax withheld

3,112.28

Medicare wages and tips

50,198.00

Medicare tax withheld

727.87

Social security tips

Allocated tips

Control number

Dependent care benefits

Employee’s first name and initial

Donna Hoser
1313 W. Washington St
Stephenville, TX 76401

Last name

Suff.

Nonqualified plans

12a

See instructions for box 12

C
o
d
e

48.00

Statutory employee	Retirement plan	Third-party sick pay
◻	◻	◻

12b

C
o
d
e

5,700.00

Other

FSA $2,850

12c

C
o
d
e

12d

C
o
d
e

Employee’s address and ZIP code

15 State

Employer’s state ID number

State wages, tips, etc.

State income tax

Local wages, tips, etc.

Local income tax

Locality name

Form
W-2

Wage and Tax
Statement

2022

Department of the Treasury—Internal Revenue Service

Copy B–To Be Filed With Employee’s FEDERAL Tax Return.

This information is being furnished to the Internal Revenue Service.

a Employee’s social security number

465-57-9935

OMB No. 1545-0008

Safe, accurate,
FAST! Use

IRS
e ~ file

Visit the IRS website at

www.irs.gov/efile

Employer identification number (EIN)

31-1238977

Wages, tips, other compensation

3,200.00

Federal income tax withheld

150.00

Employer’s name, address, and ZIP code

Tarleton Memorial Hospital Corp.
412 N. Belknap Street
Stephenville, TX 76401

Social security wages

3,200.00

Social security tax withheld

198.40

Medicare wages and tips

3,200.00

Medicare tax withheld

46.40

Social security tips

Allocated tips

Control number

Dependent care benefits

Employee’s first name and initial

Chris Hoser
1313 W. Washington St
Stephenville, TX 76401

Last name

Suff.

Nonqualified plans

12a

See instructions for box 12

C
o
d
e

Statutory employee	Retirement plan	Third-party sick pay
◻	◻	◻

12b

C
o
d
e

Other

12c

C
o
d
e

12d

C
o
d
e

Employee’s address and ZIP code

15 State

Employer’s state ID number

State wages, tips, etc.

State income tax

Local wages, tips, etc.

Local income tax

Locality name

Form
W-2

Wage and Tax
Statement

2022

Department of the Treasury—Internal Revenue Service

Copy B–To Be Filed With Employee’s FEDERAL Tax Return.

This information is being furnished to the Internal Revenue Service.

Donna and Chris received the following Form 1099-INT, Form 1099-OID and Form 1099-DIV:

◻ CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Lone Star State Bank 1000 N. Wolfe Nursery Rd. Stephenville, TX 76401	Payer’s RTN (optional)	OMB No. 1545-0112 2022 Form 1099-INT	Interest Income
	1 Interest income $ 623.63
	2 Early withdrawal penalty	Copy B For Recipient This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
PAYER’S TIN	RECIPIENT’S TIN	$
		3 Interest on U.S. Savings Bonds and Treas. obligations
33-1234556	465-74-3322	$
RECIPIENT’S name Donna and Chris Hoser	4 Federal income tax withheld $	5 Investment expenses $
Street address (including apt. no.) 1313 W. Washington Street	6 Foreign tax paid $	7 Foreign country or U.S. possession
City or town, state or province, country, and ZIP or foreign postal code Stephenville, TX 76401	8 Tax-exempt interest $	9 Specified private activity bond interest $
	10 Market discount	11 Bond premium
		FATCA filing requirement	$	$
		◻	12 Bond premium on Treasury obligations $	13 Bond premium on tax-exempt bond $
Account number (see instructions)	14 Tax-exempt and tax credit bond CUSIP no.	15 State	16 State identification no.	17 State tax withheld $
				$

Form
1099-INT

(keep for your records)

www.irs.gov/Form1099INT

Department of the Treasury – Internal Revenue Service

◻ CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Stephenville Indep. School District 2655 West Overhill Drive Stephenville, Texas 76401	1 Original issue discout for the year* $	OMB No. 1545-0110 2022 Form 1099-OID	Original Issue Disount
	* This may not be the correct figure to report on your income tax return. See instructions on the back.
	2 Other periodic interest $		Copy B For Recipient This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
PAYER’S TIN	RECIPIENT’S TIN	3 Early withdrawal penalty $	4 Federal income tax withheld $
13-3229985	465-74-3322	5 Market discount $	6 Acquisition premium $
RECIPIENT’S name Donna Hoser	7. Description STEPHENVILLE TEX INDPTS CUSIP 859128HW3 0% DUE 02/15/23

Street address (including apt. no.)
1313 W. Washington Street
City or town, state or province, country, and ZIP or foreign postal code
Stephenville, TX 76401	8 Original issue discount on U.S Treasury Obligations* $	9 Investment expenses $
		FATCA filing requirement ◻	10 Bond premium $	11 Tax-exempt OID $ 122.00
Account number (see instructions)	12 State	13 State identification no	14 State tax withheld $
			$

Form
1099-OID Rev (10-2019)

(keep for your records)

www.irs.gov/Form1099OID

Department of the Treasury – Internal Revenue Service

◻ CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Ozark Corporation 900 South Orange Ave. Springfield, MO 62126	1a Total ordinary dividends $ 320.00	OMB No. 1545-0110 2022 Form 1099-DIV	Dividends and Distributions
	1b Qualified dividends $ 320.00
	2a Total capital gain distr. $	2b Unrecap. Sec. 1250 gain $	Copy B For Recipient This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
PAYER’S TIN	RECIPIENT’S TIN	2c Section 1202 gain $	2d Collectibles (28%) gain $
33-1122335	465-57-9935	2e Section 897 ordinary dividends $	2f Section 897 capital gain $
RECIPIENT’S name Chris Hoser	3 Nondividend distributions $	4 Federal income tax withheld $
	5 Section 199A dividends	6 Investment expenses

Street address (including apt. no.)		$
1313 W. Washington Street	7 Foreign tax paid	8 Foreign country or U.S. possession
City or town, state or province, country, and ZIP or foreign postal code	$
Stephenville, TX 76401	9 Cash liquidation distributions $	10 Noncash liquidation distributions $
		11 FATCA filing requirement ◻	12 Exempt-interest dividends $	13 Specified private activity bond interest dividends $
Account number (see instructions)	14 State	15 State identification no	16 State tax withheld $
			$

Form
1099-DIV

(keep for your records)

www.irs.gov/Form1099DIV

Department of the Treasury – Internal Revenue Service

1.

Complete the Hoser’s Schedule 1.

SCHEDULE 1
(Form 1040)

Department of the Treasury Internal Revenue Service

Additional Income and Adjustments to Income

▶ Attach to Form 1040, 1040-SR, or 1040-NR.
▶ Go to

www.irs.gov/Form1040

for instructions and the latest information.

OMB No. 1545-0074

2022

Attachment
Sequence No.
01

Name(s) shown on Form 1040, 1040-SR, or 1040-NR

Donna and Chris Hoser

Your social security number

465-74-3322

Part I

Additional Income

1	Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1
2a	Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	2a
b	Date of original divorce or separation agreement (see instructions) ►
3	Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	3
4	Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	4
5	Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . . . . . . . . . . .	5
6	Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	6
7	Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	7
8	Other income:
a	Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8a	()
b	Gambling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8b
c	Cancellation of debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8c
d	Foreign earned income exclusion from Form 2555 . . . . . . . . . . . . . . . . . . . . . . .	8d	()
e	Income from Form 8853 . . . . . . . . . . . . . . . . . . . . . . . . . . .	8e
f	Income from Form 8889 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8f
g	Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8g
h	Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8h
i	Prizes and awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8i	fill in the blank c4f5eaf99005069_1
j	Activity not engaged in for profit income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8j
k	Stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8k
l	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 . . . . . . . . . . . . . . . . . . . . .	8l
m	Olympic and Paralympic medals and USOC prize money (see instructions) . . . . . .	8m
n	Section 951(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8n
o	Section 951A(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . .	8o
p	Section 461(l) excess business loss adjustment . . . . . . . . . . . . . . . . . . . . . . . . .	8p
q	Taxable distributions from an ABLE account (see instructions) . . . . . . . . . . . . . . .	8q
r	Scholarship and fellowship grants not reported on Form W-2 . . . . . . . . . . . . . . .	8r
s	Nontaxable amount of Medicaid waiver payments included on Form 1040, line 1a or 1d . . . . . . . . . . . . . . . . . . .	8s	()
t	Pension or annuity from a nonqualifed deferred compensation plan or a nongovernmental section 457 plan . . . . . . . . . . . .	8t
u	Wages earned while incarcerated . . . . . . . . . . . . .	8u
z	Other income. List type and amount: ►
		8z
9	Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	9	fill in the blank c4f5eaf99005069_2
10	Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8 . . . . . . . . . . .	10	fill in the blank c4f5eaf99005069_3

For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 71479F

Schedule 1 (Form 1040) 2022

Complete the Hoser’s Form 1040.

Form

1040

Department of the Treasury—Internal Revenue Service (99)

U.S. Individual Income Tax Return

2022

OMB No. 1545-0074

IRS Use Only

Filing Status
Your first name and middle initial Donna	Last name Hoser	Your social security number 465-74-3322
If joint return, spouse’s first name and middle initial Chris	Last name Hoser	Spouse’s social security number 465-57-9935
Home address (number and street). If you have a P.O. box, see instructions. 1313 W. Washington Street	Apt. no.	Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund.
City, town, or post office. If you have a foreign address, also complete spaces below. Stephenville	State TX	ZIP code 76401
Foreign country name	Foreign province/state/country	Foreign postal code

At any time during 2022, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency?

Standard Deduction

Someone can claim:

Age/Blindness

You:

Spouse:

Dependents If more than four dependents, see instructions and check here ► ◻	(see instructions):	(2) Social security number	(3) Relationship to you	(4) ✓ if qualifies for (see instructions):
	(1) First name	Last name			Child tax credit	Credit for other dependents
				◻	◻
				◻	◻
				◻	◻
				◻	◻

Income Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld. If you did not get a Form W-2, see instructions.	1a	Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . . . . . . . . .	1a	fill in the blank f1a4f3fcd014fbb_7
	b	Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . . . . . . .	1b
	c	Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . . . . . . . . . .	1c
	d	Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . .	1d
	e	Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . . . . .	1e
	f	Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . . . . . . .	1f
	g	Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1g
	h	Other earned income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1h
	i	Nontaxable combat pay election (see instructions) . . . .	i
	z	Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1z	fill in the blank f1a4f3fcd014fbb_8
Attach Sch. B if required.
	2a	Tax-exempt interest . .	2a	fill in the blank f1a4f3fcd014fbb_9	b	Taxable interest . . . . . . . . . .	2b	fill in the blank f1a4f3fcd014fbb_10
	3a	Qualified dividends . .	3a	fill in the blank f1a4f3fcd014fbb_11	b	Ordinary dividends . . . . .	3b	fill in the blank f1a4f3fcd014fbb_12
	4a	IRA distributions . .	4a		b	Taxable amount . . . . . . . . . .	4b
	5a	Pensions and annuities	5a		b	Taxable amount . . . . . . . . . .	5b
Standard Deduction for– · Single or Married filing separately, $12,950 · Married filing jointly or Qualifying widow(er), $25,900 · Head of household, $19,400 · If you checked any box under Standard Deduction, see instructions.	6a	Social security benefits	6a		b	Taxable amount . . . . . . . . . .	6b
	c	If you elect to use the lump-sum election method, check here (see instructions) . ◻
	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	fill in the blank f1a4f3fcd014fbb_13
	9	Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . ►	9	fill in the blank f1a4f3fcd014fbb_14
	10	Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . . . . . . . . . . .	10
	11	Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . . . . . ►	11	fill in the blank f1a4f3fcd014fbb_15
	12	Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . . . . . . . . .	12	fill in the blank f1a4f3fcd014fbb_16
	13	Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . . . . .	13
	14	Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	14	fill in the blank f1a4f3fcd014fbb_17
	15	Subtract line 14 from line 11. This is your taxable income . . . . .	15	fill in the blank f1a4f3fcd014fbb_18

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 11320B

Form
1040 (2022)

Form 1040 (2022)

Page
2

Tax and Credits	16	Tax (see instructions). Check if any from Form(s): 1 ◻ 8814 2 ◻ 4972 3 ◻ . .	16	fill in the blank f1a4f3fcd014fbb_19
	17	Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	17
	18	Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	18	fill in the blank f1a4f3fcd014fbb_20
	19	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	fill in the blank f1a4f3fcd014fbb_21
	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	fill in the blank f1a4f3fcd014fbb_22
Payments	25	Federal income tax withheld from: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
	a	Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	25a	fill in the blank f1a4f3fcd014fbb_23
	b	Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	25b
	c	Other forms (see instructions) . . . . . . . . . . . . . . . . . . . . . .	25c
	d	Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	25d	fill in the blank f1a4f3fcd014fbb_24
If you have a qualifying child, attach Sch. EIC.	26	2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . . . . .	26
	27	Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . . .	27
	28	Additional child tax credit from Schedule 8812 . . . . . . . . . . . . . . . . .	28
	29	American opportunity credit from Form 8863, line 8 . . . . . . . .	29
	30	Reserved for future use . . . . . . . . . . . . . . . .	30
	31	Amount from Schedule 3, line 15 . . . . . . . . . . . . . . . . . . . . .	31
	32	Add lines 27, 28, 29 and 31. These are your total other payments and refundable credits . . ►	32
	33	Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . . . . . . . . ►	33	fill in the blank f1a4f3fcd014fbb_25

Refund

If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you
overpaid . . .

fill in the blank f1a4f3fcd014fbb_26

35a

Amount of line 34 you want
refunded to you. If Form 8888 is attached, check here ► ◻

35a

fill in the blank f1a4f3fcd014fbb_27

Direct deposit?

►
b

Routing number

►
c Type: ◻ Checking ◻ Savings

See instructions.

►
d

Account number

Amount of line 34 you want
applied to your 2023 estimated tax . . ►

Amount
You Owe

Subtract line 33 from line 24. This is the
amount you owe. For details on how to pay, go to

www.irs.gov/Payments

or see instructions . . . . . . . . . . . . . . . . . . . . . . . ►

Estimated tax penalty (see instructions) . . . . . . . . . . . . . . ►

Third Party Designee

Do you want to allow another person to discuss this return with the IRS? See instructions. ►

▢
Yes. Complete below.
▢
No

Designee’s
name ►

Phone
no. ►

Personal identification
number (PIN) ►

Sign
Here

Joint return? See instructions. Keep a copy for your records.

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.

►

Your signature

Date

Your occupation

Nurse

If the IRS sent you an Identity Protection PIN, enter it here
(see inst.) ►

Spouse’s signature. If a joint return,
both must sign.

Date

Spouse’s occupation

Student

If the IRS sent your spouse an Identity Protection PIN, enter it here
(see inst.) ►

Phone no.

Email address

Paid Preparer Use Only	Preparer’s name	Preparer’s signature	Date	PTIN	Check if: ◻ Self-employed
	Firm’s name ►	Phone no.
	Firm’s address ►	Firm’s EIN ►

Go to

www.irs.gov/Form1040

for instructions and the latest information.

Form
1040 (2022)

Complete the Hoser’s Qualified Dividends and Capital Gain Tax Worksheet.

Donna and Chris Hoser

Qualified Dividends and Capital Gain Tax Worksheet—Line 16

*Before you begin:*	✔	See the earlier instructions for line 16 to see if you can use this worksheet to figure your tax.
	✔	Before completing this worksheet, complete Form 1040 or 1040-SR through line 15.
	✔	If you don’t have to file Schedule D and you received capital gain distributions, be sure you checked the box on Form 1040 or 1040-SR, line 7.

1.	Enter the amount from Form 1040 or 1040-SR, line 15. However, if you are filing Form 2555 (relating to foreign earned income), enter the amount from line 3 of the Foreign Earned Income Tax Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1.	fill in the blank fa0df4037feefa3_1
2.	Enter the amount from Form 1040 or 1040-SR, line 3a* . . . .	2.	fill in the blank fa0df4037feefa3_2
3.	Are you filing Schedule D?*
	◻ Yes	Enter the smaller of line 15 or 16 of Schedule D. If either line 15 or 16 is blank or a loss, enter -0-.	}	3.	fill in the blank fa0df4037feefa3_3
	☒ No	Enter the amount from Form 1040 or 1040-SR, line 7.
4.	Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . .	4.	fill in the blank fa0df4037feefa3_4
5.	Subtract line 4 from line 1. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . .	5.	fill in the blank fa0df4037feefa3_5
6.	Enter:
	$41,675 if single or married filing separately,	}
	$83,350 if married filing jointly or qualifying widow(er),		. . . . . . . . . . .	6.	fill in the blank fa0df4037feefa3_6
	$55,800 if head of household.
7.	Enter the smaller of line 1 or line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	7.	fill in the blank fa0df4037feefa3_7
8.	Enter the smaller of line 5 or line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8.	fill in the blank fa0df4037feefa3_8
9.	Subtract line 8 from line 7. This amount is taxed at 0% . . . . . . . . . . . . . . . . . . .	9.	fill in the blank fa0df4037feefa3_9
10.	Enter the smaller of line 1 or line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	10.	fill in the blank fa0df4037feefa3_10
11.	Enter the amount from line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	11.	fill in the blank fa0df4037feefa3_11
12.	Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	12.	fill in the blank fa0df4037feefa3_12
13.	Enter:
	$459,750 if single,	}
	$258,600 if married filing separately,		. . . . . . . . . . . . .	13.	fill in the blank fa0df4037feefa3_13
	$517,200 if married filing jointly or qualifying widow(er),
	$488,500 if head of household.
14.	Enter the smaller of line 1 or line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	14.	fill in the blank fa0df4037feefa3_14
15.	Add lines 5 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	15.	fill in the blank fa0df4037feefa3_15
16.	Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . .	16.	fill in the blank fa0df4037feefa3_16
17.	Enter the smaller of line 12 or line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	17.	fill in the blank fa0df4037feefa3_17
18.	Multiply line 17 by 15% (0.15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	18.	fill in the blank fa0df4037feefa3_18
19.	Add lines 9 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	19.	fill in the blank fa0df4037feefa3_19
20.	Subtract line 19 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	20.	fill in the blank fa0df4037feefa3_20
21.	Multiply line 20 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	21.	fill in the blank fa0df4037feefa3_21
22.	Figure the tax on the amount on line 5. If the amount on line 5 is less than $100,000, use the Tax Table to figure the tax. If the amount on line 5 is $100,000 or more, use the Tax Computation Worksheet . . . . . . . . . .	22.	fill in the blank fa0df4037feefa3_22
23.	Add lines 18, 21, and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	23.	fill in the blank fa0df4037feefa3_23
24.	Figure the tax on the amount on line 1. If the amount on line 1 is less than $100,000, use the Tax Table to figure the tax. If the amount on line 1 is $100,000 or more, use the Tax Computation Worksheet . . . . . . . .	24.	fill in the blank fa0df4037feefa3_24
25.	Tax on all taxable income. Enter the smaller of line 23 or 24. Also include this amount on the entry space on Form 1040 or 1040-SR, line 16. If you are filing Form 2555, don’t enter this amount on the entry space on Form 1040 or 1040-SR, line 16. Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet . . . .	25.	fill in the blank fa0df4037feefa3_25
* If you are filing Form 2555, see the footnote in the Foreign Earned Income Tax Worksheet before completing this line.

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1. Complete the Hoser’s Schedule 1.

SCHEDULE 1
(Form 1040)

Department of the Treasury Internal Revenue Service

Additional Income and Adjustments to Income

▶ Attach to Form 1040, 1040-SR, or 1040-NR.
▶ Go to

www.irs.gov/Form1040

for instructions and the latest information.

OMB No. 1545-0074

2022

Attachment
Sequence No.
01

Name(s) shown on Form 1040, 1040-SR, or 1040-NR

Donna and Chris Hoser

Your social security number

465-74-3322

Part I

Additional Income

1	Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1
2a	Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	2a
b	Date of original divorce or separation agreement (see instructions) ►
3	Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	3
4	Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	4
5	Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . . . . . . . . . . .	5
6	Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	6
7	Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	7
8	Other income:
a	Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8a	()
b	Gambling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8b
c	Cancellation of debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8c
d	Foreign earned income exclusion from Form 2555 . . . . . . . . . . . . . . . . . . . . . . .	8d	()
e	Income from Form 8853 . . . . . . . . . . . . . . . . . . . . . . . . . . .	8e
f	Income from Form 8889 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8f
g	Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8g
h	Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8h
i	Prizes and awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8i	fill in the blank c4f5eaf99005069_1
j	Activity not engaged in for profit income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8j
k	Stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8k
l	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 . . . . . . . . . . . . . . . . . . . . .	8l
m	Olympic and Paralympic medals and USOC prize money (see instructions) . . . . . .	8m
n	Section 951(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8n
o	Section 951A(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . .	8o
p	Section 461(l) excess business loss adjustment . . . . . . . . . . . . . . . . . . . . . . . . .	8p
q	Taxable distributions from an ABLE account (see instructions) . . . . . . . . . . . . . . .	8q
r	Scholarship and fellowship grants not reported on Form W-2 . . . . . . . . . . . . . . .	8r
s	Nontaxable amount of Medicaid waiver payments included on Form 1040, line 1a or 1d . . . . . . . . . . . . . . . . . . .	8s	()
t	Pension or annuity from a nonqualifed deferred compensation plan or a nongovernmental section 457 plan . . . . . . . . . . . .	8t
u	Wages earned while incarcerated . . . . . . . . . . . . .	8u
z	Other income. List type and amount: ►
		8z
9	Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	9	fill in the blank c4f5eaf99005069_2
10	Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8 . . . . . . . . . . .	10	fill in the blank c4f5eaf99005069_3

For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 71479F

Schedule 1 (Form 1040) 2022

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1.
Complete the Hoser’s Schedule 1.

SCHEDULE 1
(Form 1040)

Department of the Treasury Internal Revenue Service

Additional Income and Adjustments to Income

▶ Attach to Form 1040, 1040-SR, or 1040-NR.
▶ Go to

www.irs.gov/Form1040

for instructions and the latest information.

OMB No. 1545-0074

2022

Attachment
Sequence No.
01

Name(s) shown on Form 1040, 1040-SR, or 1040-NR

Donna and Chris Hoser

Your social security number

465-74-3322

Part I

Additional Income

1	Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1
2a	Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	2a
b	Date of original divorce or separation agreement (see instructions) ►
3	Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	3
4	Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	4
5	Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . . . . . . . . . . .	5
6	Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	6
7	Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	7
8	Other income:
a	Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8a	()
b	Gambling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8b
c	Cancellation of debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8c
d	Foreign earned income exclusion from Form 2555 . . . . . . . . . . . . . . . . . . . . . . .	8d	()
e	Income from Form 8853 . . . . . . . . . . . . . . . . . . . . . . . . . . .	8e
f	Income from Form 8889 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8f
g	Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8g
h	Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8h
i	Prizes and awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8i	fill in the blank c4f5eaf99005069_1
j	Activity not engaged in for profit income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8j
k	Stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8k
l	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 . . . . . . . . . . . . . . . . . . . . .	8l
m	Olympic and Paralympic medals and USOC prize money (see instructions) . . . . . .	8m
n	Section 951(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8n
o	Section 951A(a) inclusion (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . .	8o
p	Section 461(l) excess business loss adjustment . . . . . . . . . . . . . . . . . . . . . . . . .	8p
q	Taxable distributions from an ABLE account (see instructions) . . . . . . . . . . . . . . .	8q
r	Scholarship and fellowship grants not reported on Form W-2 . . . . . . . . . . . . . . .	8r
s	Nontaxable amount of Medicaid waiver payments included on Form 1040, line 1a or 1d . . . . . . . . . . . . . . . . . . .	8s	()
t	Pension or annuity from a nonqualifed deferred compensation plan or a nongovernmental section 457 plan . . . . . . . . . . . .	8t
u	Wages earned while incarcerated . . . . . . . . . . . . .	8u
z	Other income. List type and amount: ►
		8z
9	Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	9	fill in the blank c4f5eaf99005069_2
10	Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8 . . . . . . . . . . .	10	fill in the blank c4f5eaf99005069_3

For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 71479F

Schedule 1 (Form 1040) 2022

Complete the Hoser’s Form 1040.

Form

1040

Department of the Treasury—Internal Revenue Service (99)

U.S. Individual Income Tax Return

2022

OMB No. 1545-0074

IRS Use Only

Filing Status
Your first name and middle initial Donna	Last name Hoser	Your social security number 465-74-3322
If joint return, spouse’s first name and middle initial Chris	Last name Hoser	Spouse’s social security number 465-57-9935
Home address (number and street). If you have a P.O. box, see instructions. 1313 W. Washington Street	Apt. no.	Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund.
City, town, or post office. If you have a foreign address, also complete spaces below. Stephenville	State TX	ZIP code 76401
Foreign country name	Foreign province/state/country	Foreign postal code

At any time during 2022, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency?

Standard Deduction

Someone can claim:

Age/Blindness

You:

Spouse:

Dependents If more than four dependents, see instructions and check here ► ◻	(see instructions):	(2) Social security number	(3) Relationship to you	(4) ✓ if qualifies for (see instructions):
	(1) First name	Last name			Child tax credit	Credit for other dependents
				◻	◻
				◻	◻
				◻	◻
				◻	◻

Income Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld. If you did not get a Form W-2, see instructions.	1a	Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . . . . . . . . .	1a	fill in the blank f1a4f3fcd014fbb_7
	b	Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . . . . . . .	1b
	c	Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . . . . . . . . . .	1c
	d	Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . .	1d
	e	Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . . . . .	1e
	f	Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . . . . . . .	1f
	g	Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1g
	h	Other earned income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1h
	i	Nontaxable combat pay election (see instructions) . . . .	i
	z	Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1z	fill in the blank f1a4f3fcd014fbb_8
Attach Sch. B if required.
	2a	Tax-exempt interest . .	2a	fill in the blank f1a4f3fcd014fbb_9	b	Taxable interest . . . . . . . . . .	2b	fill in the blank f1a4f3fcd014fbb_10
	3a	Qualified dividends . .	3a	fill in the blank f1a4f3fcd014fbb_11	b	Ordinary dividends . . . . .	3b	fill in the blank f1a4f3fcd014fbb_12
	4a	IRA distributions . .	4a		b	Taxable amount . . . . . . . . . .	4b
	5a	Pensions and annuities	5a		b	Taxable amount . . . . . . . . . .	5b
Standard Deduction for– · Single or Married filing separately, $12,950 · Married filing jointly or Qualifying widow(er), $25,900 · Head of household, $19,400 · If you checked any box under Standard Deduction, see instructions.	6a	Social security benefits	6a		b	Taxable amount . . . . . . . . . .	6b
	c	If you elect to use the lump-sum election method, check here (see instructions) . ◻
	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	fill in the blank f1a4f3fcd014fbb_13
	9	Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . ►	9	fill in the blank f1a4f3fcd014fbb_14
	10	Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . . . . . . . . . . .	10
	11	Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . . . . . ►	11	fill in the blank f1a4f3fcd014fbb_15
	12	Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . . . . . . . . .	12	fill in the blank f1a4f3fcd014fbb_16
	13	Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . . . . .	13
	14	Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	14	fill in the blank f1a4f3fcd014fbb_17
	15	Subtract line 14 from line 11. This is your taxable income . . . . .	15	fill in the blank f1a4f3fcd014fbb_18

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 11320B

Form
1040 (2022)

Form 1040 (2022)

Page
2

Tax and Credits	16	Tax (see instructions). Check if any from Form(s): 1 ◻ 8814 2 ◻ 4972 3 ◻ . .	16	fill in the blank f1a4f3fcd014fbb_19
	17	Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	17
	18	Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	18	fill in the blank f1a4f3fcd014fbb_20
	19	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	fill in the blank f1a4f3fcd014fbb_21
	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	fill in the blank f1a4f3fcd014fbb_22
Payments	25	Federal income tax withheld from: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
	a	Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	25a	fill in the blank f1a4f3fcd014fbb_23
	b	Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	25b
	c	Other forms (see instructions) . . . . . . . . . . . . . . . . . . . . . .	25c
	d	Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	25d	fill in the blank f1a4f3fcd014fbb_24
If you have a qualifying child, attach Sch. EIC.	26	2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . . . . .	26
	27	Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . . .	27
	28	Additional child tax credit from Schedule 8812 . . . . . . . . . . . . . . . . .	28
	29	American opportunity credit from Form 8863, line 8 . . . . . . . .	29
	30	Reserved for future use . . . . . . . . . . . . . . . .	30
	31	Amount from Schedule 3, line 15 . . . . . . . . . . . . . . . . . . . . .	31
	32	Add lines 27, 28, 29 and 31. These are your total other payments and refundable credits . . ►	32
	33	Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . . . . . . . . ►	33	fill in the blank f1a4f3fcd014fbb_25

Refund

If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you
overpaid . . .

fill in the blank f1a4f3fcd014fbb_26

35a

Amount of line 34 you want
refunded to you. If Form 8888 is attached, check here ► ◻

35a

fill in the blank f1a4f3fcd014fbb_27

Direct deposit?

►
b

Routing number

►
c Type: ◻ Checking ◻ Savings

See instructions.

►
d

Account number

Amount of line 34 you want
applied to your 2023 estimated tax . . ►

Amount
You Owe

Subtract line 33 from line 24. This is the
amount you owe. For details on how to pay, go to

www.irs.gov/Payments

or see instructions . . . . . . . . . . . . . . . . . . . . . . . ►

Estimated tax penalty (see instructions) . . . . . . . . . . . . . . ►

Third Party Designee

Do you want to allow another person to discuss this return with the IRS? See instructions. ►

▢
Yes. Complete below.
▢
No

Designee’s
name ►

Phone
no. ►

Personal identification
number (PIN) ►

Sign
Here

Joint return? See instructions. Keep a copy for your records.

►

Your signature

Date

Your occupation

Nurse

If the IRS sent you an Identity Protection PIN, enter it here
(see inst.) ►

Spouse’s signature. If a joint return,
both must sign.

Date

Spouse’s occupation

Student

If the IRS sent your spouse an Identity Protection PIN, enter it here
(see inst.) ►

Phone no.

Email address

Paid Preparer Use Only	Preparer’s name	Preparer’s signature	Date	PTIN	Check if: ◻ Self-employed
	Firm’s name ►	Phone no.
	Firm’s address ►	Firm’s EIN ►

Go to

www.irs.gov/Form1040

for instructions and the latest information.

Form
1040 (2022)

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A-4 Appendix A

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A-5Tax Rate Schedules and Tax Table

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A-6 Appendix A

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A-7Tax Rate Schedules and Tax Table

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A-8 Appendix A

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A-9Tax Rate Schedules and Tax Table

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A-10 Appendix A

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A-11Tax Rate Schedules and Tax Table

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A-12 Appendix A

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A-13Tax Rate Schedules and Tax Table

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A-14 Appendix A

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A-15Tax Rate Schedules and Tax Table

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Complete the Hoser’s Qualified Dividends and Capital Gain Tax Worksheet.

Donna and Chris Hoser

Qualified Dividends and Capital Gain Tax Worksheet—Line 16

*Before you begin:*	✔	See the earlier instructions for line 16 to see if you can use this worksheet to figure your tax.
	✔	Before completing this worksheet, complete Form 1040 or 1040-SR through line 15.
	✔	If you don’t have to file Schedule D and you received capital gain distributions, be sure you checked the box on Form 1040 or 1040-SR, line 7.

1.	Enter the amount from Form 1040 or 1040-SR, line 15. However, if you are filing Form 2555 (relating to foreign earned income), enter the amount from line 3 of the Foreign Earned Income Tax Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	1.	fill in the blank fa0df4037feefa3_1
2.	Enter the amount from Form 1040 or 1040-SR, line 3a* . . . .	2.	fill in the blank fa0df4037feefa3_2
3.	Are you filing Schedule D?*
	◻ Yes	Enter the smaller of line 15 or 16 of Schedule D. If either line 15 or 16 is blank or a loss, enter -0-.	}	3.	fill in the blank fa0df4037feefa3_3
	☒ No	Enter the amount from Form 1040 or 1040-SR, line 7.
4.	Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . .	4.	fill in the blank fa0df4037feefa3_4
5.	Subtract line 4 from line 1. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . .	5.	fill in the blank fa0df4037feefa3_5
6.	Enter:
	$41,675 if single or married filing separately,	}
	$83,350 if married filing jointly or qualifying widow(er),		. . . . . . . . . . .	6.	fill in the blank fa0df4037feefa3_6
	$55,800 if head of household.
7.	Enter the smaller of line 1 or line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	7.	fill in the blank fa0df4037feefa3_7
8.	Enter the smaller of line 5 or line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	8.	fill in the blank fa0df4037feefa3_8
9.	Subtract line 8 from line 7. This amount is taxed at 0% . . . . . . . . . . . . . . . . . . .	9.	fill in the blank fa0df4037feefa3_9
10.	Enter the smaller of line 1 or line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	10.	fill in the blank fa0df4037feefa3_10
11.	Enter the amount from line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	11.	fill in the blank fa0df4037feefa3_11
12.	Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	12.	fill in the blank fa0df4037feefa3_12
13.	Enter:
	$459,750 if single,	}
	$258,600 if married filing separately,		. . . . . . . . . . . . .	13.	fill in the blank fa0df4037feefa3_13
	$517,200 if married filing jointly or qualifying widow(er),
	$488,500 if head of household.
14.	Enter the smaller of line 1 or line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	14.	fill in the blank fa0df4037feefa3_14
15.	Add lines 5 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	15.	fill in the blank fa0df4037feefa3_15
16.	Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . .	16.	fill in the blank fa0df4037feefa3_16
17.	Enter the smaller of line 12 or line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	17.	fill in the blank fa0df4037feefa3_17
18.	Multiply line 17 by 15% (0.15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	18.	fill in the blank fa0df4037feefa3_18
19.	Add lines 9 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	19.	fill in the blank fa0df4037feefa3_19
20.	Subtract line 19 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	20.	fill in the blank fa0df4037feefa3_20
21.	Multiply line 20 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	21.	fill in the blank fa0df4037feefa3_21
22.	Figure the tax on the amount on line 5. If the amount on line 5 is less than $100,000, use the Tax Table to figure the tax. If the amount on line 5 is $100,000 or more, use the Tax Computation Worksheet . . . . . . . . . .	22.	fill in the blank fa0df4037feefa3_22
23.	Add lines 18, 21, and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	23.	fill in the blank fa0df4037feefa3_23
24.	Figure the tax on the amount on line 1. If the amount on line 1 is less than $100,000, use the Tax Table to figure the tax. If the amount on line 1 is $100,000 or more, use the Tax Computation Worksheet . . . . . . . .	24.	fill in the blank fa0df4037feefa3_24
25.	Tax on all taxable income. Enter the smaller of line 23 or 24. Also include this amount on the entry space on Form 1040 or 1040-SR, line 16. If you are filing Form 2555, don’t enter this amount on the entry space on Form 1040 or 1040-SR, line 16. Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet . . . .	25.	fill in the blank fa0df4037feefa3_25
* If you are filing Form 2555, see the footnote in the Foreign Earned Income Tax Worksheet before completing this line.

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