Recibo de Radicación IRS

Año
2019
Forma
1040-SS

RADICADO ELECTRONICAMENTE
Fecha de Radicación Electrónica
2020-02-06 20:48:14

Información de Pago

Numero de Ruta

Número de Cuenta de Banco

Tipo de Cuenta

Cantidad de Pago

Fecha de Pago

Teléfono de Contacto
9392555840

NUMERO DE CONFIRMACION:: 1006322020037d046408 FECHA:2020-02-06 20:48:14AST

Form 1040-SS U.S. Self-Employment Tax Return (Including the Additional Child Tax
Credit for Bona Fide Residents of Puerto Rico)
OMB No. 1545-0090

Department of the Treasury

U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, or Puerto Rico.
For the year Jan. 1–Dec. 31, 2019, or other tax year beginning , 2019, and ending , 20 . 2019
Internal Revenue Service Go to www.irs.gov/Form1040SS for instructions and the latest information.
Your first name and initial Last name Your social security number
elizabeth santiago diaz 583-97-9101
If a joint return, spouse’s first name and initial Last name Spouse’s social security number
Please type or print

Present home address (number, street, and apt. no., or rural route)
urbanizacion el torito calle 6 e 22

RADICADO ELECTRONICAMENTE
City, town or post office, commonwealth or territory, and ZIP code
cayey PR 00736
Foreign country name Foreign province/state/county Foreign postal code

Part I Total Tax and Credits

1 Filing status. Check the box for your filing status (see instructions).
Single
Married filing jointly
Married filing separately. Enter spouse’s social security no. above and full name here.
2 Qualifying children. Complete only if you are a bona fide resident of Puerto Rico and you are claiming the additional child
tax credit (see instructions).
(b) Child’s (c) Child’s
(a) First name Last name social security number relationship to you
Kellyanis N Bowen Santiago 599-84-9076 DAUGHTER
Elymarie Lopez Santiago 599-92-5647 DAUGHTER
Dereck M Colon Santiago 599-78-9164 NEPHEW

3 Self-employment tax from Part V, line 12 . . . . . . . . . . . . . . . . . . . . 3 0

4 Household employment taxes (see instructions). Attach Schedule H (Form 1040 or 1040-SR) . . . 4
5 Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . . . . 5 0
6 Total tax. Add lines 3 through 5 (see instructions) . . . . . . . . . . . . . . . . . 6 0
7 2019 estimated tax payments (see instructions) . . . . . . . . . . 7
8 Excess social security tax withheld (see instructions) . . . . . . . . 8 0
9 Additional child tax credit from Part II, line 3 . . . . . . . . . . . 9 3884
10 Health coverage tax credit. Attach Form 8885 . . . . . . . . . . . 10 0
11 Total payments and credits (see instructions) . . . . . . . . . . . . . . . . . . 11 3884
12 If line 11 is more than line 6, subtract line 6 from line 11. This is the amount you overpaid . . . . 12 3884
13a Amount of line 12 you want refunded to you. If Form 8888 is attached, check here . . . . 13a 3884

b Routing Number 0 2 1 5 0 2 0 1 1 c Type: Checking Savings

d Account Number 3 3 9 0 8 2 7 9 9

14 Amount of line 12 you want applied to 2020 estimated tax . . . . . 14

15 Amount you owe. If line 6 is more than line 11, subtract line 11 from line 6. For details on how to pay,
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 0
Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No
Third Party Personal Identification
Designee’s Phone
Designee name no. Number (PIN)

Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
and belief, they are true, correct, and complete. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has
Here any knowledge.
Joint Return? Your signature Date Daytime phone number If the IRS sent you an Identity Protection PIN, enter
See instructions. FIRMADO ELECTRONICAMENTE 2020-02-06 9392555840 it here (see inst.) 3 0 0 4 5 3
Keep a copy
Spouse’s signature. If a joint return, both must sign. Date
for your
records.
Print/Type preparer’s name Preparer’s signature Date PTIN
Paid Check if
self-employed
Preparer
Firm’s name Firm’s EIN
Use Only
Firm’s address Phone no.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Cat. No. 17184B Form 1040-SS (2019)

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Form 1040-SS (2019) Page 2
Part II Bona Fide Residents of Puerto Rico Claiming Additional Child Tax Credit—See instructions.
Caution: You must have three or more qualifying children to claim the additional child tax credit.

1 Income derived from sources within Puerto Rico . . . . . . . . . . . . . . . . . . 1 49379

2 Withheld social security, Medicare, and Additional Medicare taxes from Puerto Rico Form(s) 499R-2/
W-2PR (attach copy of form(s)). If married filing jointly, include your spouse’s amounts with yours . 2 3884
3 Additional child tax credit. Use the worksheet in the instructions to figure the amount to enter here
and in Part I, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3884
Part III Profit or Loss From Farming—See the Instructions for Schedule F (Form 1040 or 1040-SR).

RADICADO ELECTRONICAMENTE
Name of proprietor Social security number

Note: If you are filing a joint return and both you and your spouse had a profit or loss from a farming business, see Joint returns and
Business Owned and Operated by Spouses in the instructions for more information.
Section A—Farm Income—Cash Method
Complete Sections A and B. (Accrual method taxpayers, complete Sections B and C, and Section A, line 11.)
Don't include sales of livestock held for draft, breeding, sport, or dairy purposes (see instructions).
1 Sales of livestock and other items you bought for resale . . . . . . . 1
2 Cost or other basis of livestock and other items reported on line 1 . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Sales of livestock, produce, grains, and other products you raised . . . . . . . . . . . . 4
5a Total cooperative distributions (Form(s) 1099-PATR) 5a 5b Taxable amount 5b
6 Agricultural program payments received . . . . . . . . . . . . . . . . . . . . . 6
7 Commodity Credit Corporation (CCC) loans reported under election (or forfeited) . . . . . . . 7
8 Crop insurance proceeds . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . . . 9
10 Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Gross farm income. Add amounts in the right column for lines 3 through 10. If accrual method
taxpayer, enter the amount from Section C, line 50 . . . . . . . . . . . . . . . . 11
Section B—Farm Expenses—Cash and Accrual Method
Don't include personal or living expenses (such as taxes, insurance, or repairs on your home) that didn't produce farm income.
Reduce the amount of your farm expenses by any reimbursements before entering the expenses below.
12 Car and truck expenses 25
Pension and profit-sharing plans
(see instructions) . . . . . 12 . . . . . . . . . . . 25
13 Chemicals . . . . . . . 13 26 Rent or lease:
14 Conservation expenses . . . 14 a Vehicles, machinery, and
15 Custom hire (machine work) . . 15 equipment . . . . . . . . 26a
16 Depreciation and section 179 b Other (land, animals, etc.) . . . 26b
expense deduction not claimed 27 Repairs and maintenance . . . 27
elsewhere (Attach Form 4562 if 28 Seeds and plants purchased . . 28
required.) . . . . . . . . 16 29 Storage and warehousing . . 29
17 Employee benefit programs 30 Supplies purchased . . . . 30
other than on line 25 . . . . 17 31 Taxes . . . . . . . . . 31
18 Feed purchased . . . . . . 18 32 Utilities . . . . . . . . . 32
19 Fertilizers and lime . . . . . 19 33 Veterinary, breeding, and
20 Freight and trucking . . . . 20 medicine . . . . . . . . 33
21 Gasoline, fuel, and oil . . . . 21 34 Other expenses (specify):
22 Insurance (other than health) . 22 a 34a
23 Interest (see instructions): b 34b
a Mortgage (paid to banks, etc.) . 23a c 34c
b Other . . . . . . . . . 23b d 34d
24 Labor hired . . . . . . . 24 e 34e
35 Total expenses. Add lines 12 through 34e . . . . . . . . . . . . . . . . . . . 35
36 Net farm profit or (loss). Subtract line 35 from line 11. Enter the result here and in Part V, line 1a . 36
Form 1040-SS (2019)

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Additional Child Tax Credit Worksheet—Part II, Line 3 Keep for Your Records
1. Do you have three or more qualifying children under age 17 with the required SSN?
No. Stop. You can't claim the credit.
Yes. Go to line 2.
2. Number of qualifying children _______3 × $1,400. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 4200

3. Enter the amount from Part II, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 49379

4. Enter the amount shown below for your filing status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 200000

RADICADO ELECTRONICAMENTE
• Married filing jointly – $400,000
• All other filing statuses – $200,000
5. Is the amount on line 3 more than the amount on line 4?

■No. Leave line 5 blank. Enter the amount from line 2 on line 11, and go to line 12.
Yes. Subtract line 4 from line 3. If the result isn't a multiple of $1,000, increase it to the next
multiple of $1,000 (for example, increase $425 to $1,000, increase $1,025 to $2,000, etc.) . . . . . . 5.
6. Multiply the amount on line 5 by 5% (.05). Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.

7. Number of qualifying children from line 2 x $2,000. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . 7.

8. Number of other dependents, including children who are not under age 17 ________ x $500.
Enter the result. See the Line 8 instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.

9. Add lines 7 and 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.

10. Is the amount on line 9 more than the amount on line 6?
No. Stop. You can't claim the credit.
Yes. Subtract line 6 from line 9. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.

11. Enter the smaller of line 2 or line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 4200

12. Enter the total, if any, of:

• One-half of Part V, line 12, self-employment tax plus
• One-half of the Additional Medicare Tax you paid on self-employment income (Form 8959,
line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 0

13. Enter the total of any:

• Amount from Part II, line 2, plus
• Employee social security and Medicare tax on tips not reported to employer from Form 4137
and shown on the dotted line next to Part I, line 6, plus
• Uncollected employee social security and Medicare tax on wages from Form 8919 shown on
the dotted line next to Part I, line 6, plus
• Uncollected employee social security tax and Medicare tax on tips and group-term life
insurance (see instructions for Part I, line 6) shown on the dotted line next to Part I, line 6, plus
• Amount on Form 8959, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 3884

14. Add lines 12 and 13. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. 3884

15. Enter the amount, if any, of Additional Medicare Tax withheld (Form 8959, line 22) . . . . . . . . . . . . 15. 0

16. Subtract line 15 from line 14. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. 3884

17. Enter the amount, if any, from Part I, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. 0

18. Is the amount on line 16 more than the amount on line 17?
No. Stop. You can't claim the credit.
Yes. Subtract line 17 from line 16. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18. 3884

19. Additional child tax credit. Enter the smaller of line 11 or line 18 here and on Form 1040-SS, Part II,
line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 3884

SS-8 Instructions for Form 1040-SS (2019)

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