Request for Fee Waiver | uscis Form 1-912 Department of Homeland Security (OMB No, 115.0116 U.S, Citizenship and Immigration Services Expires 09002022 “Application Receipted At (Select only one box) Cl uscis Field Office (luscis Service Center Cy Fee Waiver Approved [_] Fee Waiver Denied C1 Fee Waiver Approved 7] Fee Waiver Denied Date: Date: Date: Date: > START HERE - Type or print in black ink, {you need extra space to complete any section ofthis request or if you would like to provide additional information about your circumstances, use the space provided in Part 11, Additional Information, Complete and submit as many copies of Part 11., as necessary, with your request, | Select atleast one basis or more for which you may qualify and provide supporting documentation for any basis you sel eed to qualify and provide documentation for one basis for U.S, Citizenshi lec. You only ip and lmmigration Services (USCIS) to grant your fee waiver, Ifyou choose, you may select more than one basis; you must provide supporting documentation for each basis you want considered, 1. [J 1am, my spouse is, or the head of household living in my household is curently receiving a means-tested benefit. (Complete Parts 2, - 4. and Parts 7, - 10,) 2. [Xl My household income is at or below 150 percent of the Federal Poverty Guidelines, (Complete Parts 2.-3,, Part S,and 7. - 10.) 3.) Ihave financial hardship, (Complete Parts 2.-3. and Parts 10) Provide information about yourself iy the parent or legal guardian filing on ‘ou are the person requesting a fee waiver for petition or application you are filing. Ifyou are behalf of a child or person with a physical disability or developmental or mental impeiement, provide information about the child or person for whom you are filing this form. 1. Full Name Family Name (Last Name) Given Name (First Name) Middle Name [Torres Other Names Used (ifany) List all other names you have used including nicknames, aliases and maiden name. Family Naine Last Name) Given Name (First Name) Middle Name 3. Allen Registration Number (A-Number) ifany) 4, USCIS Online Account Number (i any) mA > 5, Date of Binh (mm/da 6 US. Sosil Seourty Number (itany) > Form 1-912. Edition 3/10/21 Page 1 of 11Ks es | cei ii 7. Marital Stats © Single, Never Married [XJ Married (J Divorced O Widowed [1] Marriage Annulled © Separated 1) Other Explainy L Forms Being Filed SS ! ‘Total Number of Forms (including self) If you selected ftem Number I. in Part 1., complete this section, 1. Ifyou, your spouse, or the head of household (including parent if the child is under 21 years of age) living with you is receiving any means-tested benefits list the information inthe table below and attach supporting documentation. Ifyou are the parent oF ‘egal guardian fling on behalf of a child or person with a physical disability or developmental or mental impairment, provide information about the child or person for whom you are filing this form if he or she is receiving a means-tested benefit iii iii Minin ea Full Name of Person | Relationship | Name of Agency ‘Type of | Date Beneft | Date Benefit Expires Receiving the Benefit | to You Awarding Benefit Benefit | was Awarded | (or must be renewed) 1. Employment Status Employed (fulltime, parttime, C] Unemployed or [J Retired [1] Other (Explain) seasonal, self-employed) Not Employed 4 Form 1912. Edition 03/10/21 Page 2of 112. Ifyouare currently unemployed, are you currenty receiving unemployment benefits? Oye (No ‘A. Date you became unemployed (um/ddlyyyy) Ifyou are married or separated, does your spouse live in your household? Yes C]No A. Ifyou answered "No" to Item Number 3., does your spouse provide any financial support to your Oves (no household? 4. Are you the person providing the primary financial support for your household? OYes No Ifyou answered "Yes" to item Number 4,, type or print your name on the line marked "sei" in the table below. I you answered "No" to Item Number 4. type or print your name on the line marked “self inthe table below and add the head of houscholes name on the line below yours. Full-time |! any income earned by this ‘Student, | PefS0n counted towards the household income? ser | [Yes [INo| ikl ves CJNo| [Yes LJNo Seep [xl Yes CJNo [C1] Yes IXINo| XlYes_L]No ives Gino |) ¥es No] Lives Li No ea Cives (kINo [Liver No] Ces Total Household Size (including self)| 4 Relationship Birth to You Married Provide information about your income and the income of all family members counted as part of your household. You must lst all amounts in US. dollars. 8. Your Annual Income 8 I 6. Annual Income of All Family Members Provide the annual income of al family members counted as part of your household as listed in Item Number 4, (Do not include ‘the amount provided in Item Number 5,) s | 7. Total Additional Income or Financial Support s [ Provide the total annual amount you receive in additional income or financial support from a source outside of your household. (Do not include the amount provided in Item Numbers 5. or 6.) You must add all of the additional income and financial support ‘mounts and put the tota! amount in the space provided. Type or print "0" in the total box ifthere are none. Select the type of additional income or financial support that you receive and provide documentation. CyParental Support) satatonat Spenés)Unemplyment Benefits Financial Supor From Adult Children, spousal supp atineny) 3 Royates Csocin security Bent RePEndens, Other People Living inthe Ci chite support (Pensions [Veteran's Benefits) Other Explain Form'-912 Edition oaiont Page Sof 18. Tota Housel come (ate noun fom lem Numbers, 6, a7) az" | . Hias anything changed since the date you filed your Federal tax returns? (For example, your marital status, EX] Yes Ono income, or number of dependents.) \fyou answered "Ves" to Item Number 9., provide an explanation below. Provide documentation ifavailable, You may also Use this space to provide any additional information about your circumstances that you would like USCIS to consider. Currently I work ata different care home as a CNA than what is listed in my taxes. I have included proof of my ome._My income varies based on my hours. 1 am a full time CNA. My pay averages at & SO nunc. Ifyou selected Item Number 3. in Part 1, complete this section, 41, Ifyou or any family members have a situation that has caused you to incur expenses, debs, or loss of income, describe the situation inthe box below. Specify the amounts of the expenses, debts, and income losses in as much detall as possible, Examples may include medical expenses, job loss, eviction, and homelessness, v a : wow A : t. 4 B + Ifyou have cash or assets that you can quickly convert to cash, tist those inthe table below. For example, bank accounts, stocks, ‘or bonds. (Do not include retirement accounts.) Type of. iue (U.S. Dollars) ‘Total Value of Assets Form [912 Eaition 03/1071 Page oF 113. Total Monthly Expenses and Liabilities Provide the total monthly srmount of your expenses and libilties. You must add all ofthe expense and lability amounts and ype ¢ print the total am ount inthe space provided. Type oF print 0” inthe total box if there are none. Select the types of expenses or liabilities you have each month and provide evidence of monthly payments, where possible C1 Rent and/or Mortgage — [] Loans and/or Credit Cards ("] Other O Food OD Car Payment CO utittes i Commuting Costs CG chite andior Eder Care] Medicat Expenses O insurance Gi School Expenses NOTE: Read the Penalties section ofthe Form I-912 Instructions before completing this part, Each person applying fora fee waiver request must complet, sign, and date Form I-912 and provide the required documentation, Tis includes femily members identified in Part 3. Signature flelds for family members are atthe end ofthis part. [fan individual is Under 14 years of age, a parent or legal guardian may sign the request on their behalf. USCIS rejects any Form 1-912 that isnot signed by all individuals requesting a fee waiver and may deny a request that does not provide required documentation, Selest the box for either Item A. or B. in Item Number 1. Ifapplicabe, select the box for Item Number 2, 1. Requestor's Statement Regarding the Interpreter J can read and understand English, and { have read and understand ‘every question and instruction on this request and my answer to every question. 8. CJ Theintrprternamed in Part 9, read tome every question and instruction om this request and my answer to evety question in | language in whic | am fluent, and! understood Bey 2. Requests Statement Regarding the Preparer if apliable) ER] Atmy request, the preparer named in Part 10, [Sima Alizadeh Prepared this request for me based only upon informatTon I providedor alfon 3. Requestor's Daytime Telephone Number 4. Requestor's Mobile Telophone Number (if any) pss Email Address (if any) Copies of my documents | have submitted are exact photocopies of unaltered, original documents, and | understand that USCIS may ‘require that! submit original documents to USCIS at a later date. Furthermore, | authorize the release of any information from any of ‘my records that USCIS may need to determine my eligibility forthe immigration benefit | seek | further authorize release of information contained in this request, in supporting documents, and in my USCIS recards to other entities and persons where nevessary for the administration and enforcement of US. immigration laws. | certify, under penalty of perjury, that | provided or authorized all ofthe information in my request, | understand all of the {information contained in, and submitted with, my request, and that all of this information is complete, true, and correct, Form (-912 Edition 03/1071 Page Sof 11WARNING: If you knowingly and willfully falsify oF conceal a material factor submit a false document with your Fomm I-912, USCIS will deny your fee waiver request and may deny any other immigration benefit. In addition, you may face severe penalties Provided by law and may be subject to criminal prosecution. iii 6 Requestor’ Si ature Date of Signature (mm/ddl Fearn fos/26/2021 NOTE TO ALL REQUESTORS: If you do not completely fil out this requestor fail to submit required documents listed in the Instructions, USCIS may deny your request. NOTE: Each family member must type or prt thelr full name and signin the spaces below. You can find additional family ‘members’ signature spaces in Item Numbers 7. 10, below. All family members identified in Part 3. must sign and date Form I-912. | certify thatthe information provided by the requestor in Part 7, applies to me. 7. amily Member 1 Family Member's Name Family Members Signature Date of Signature (mnvddiyyyy) 8, Family Member 2 Family Members Name Family Member's Signature Date of Signature (mmvdeyyyy) 9, Family Member 3 Family Member's Name Family Member's Signature Date of Signature (mmiddiyyyy) 10, Family Member 4 Family Member's Name + Family Member's Signature Date of Signature (mm/ddyyyy) J 11, Family Member $ amily Member's Name ‘amily Members Signature Date of Signature (mm/ddiyyyy) Form -912. Edition O30 Page 60f 11| | NOTE: Read the Penalties section ofthe Form I-912 Instructions before completing tis pat 1F the information provided by the requestor in Part 7. isnot applicable to 2 family member identified in Part 3, (for example, the family member used an interpreter or speaks 8 different language) that individual should complete Part 8. USCIS rejects any Porn 1-912 that snot signed by all individuals requesting a fee waiver. ‘Select the box for either Item A. or B. in Item Number 1, {fapplicable, select the box for Item Number 2, 1. Family Members gant Reprig te nero : i. A. (1 Lean read and understand English, and {have read and understand every question and instruction on this request and my answer to every question. The interpreter named in Part 9, read to me every question and instruction on this request and my answer to every ‘question in -# language in which Iam fluent, and | understood everything. 2, Family Members Statement Regarding the Preparer for 7 Atmmy requeit, the preparer named in Part 10, iy Prepared this request for me based only upon information T provided Or autora 3. Family Member's Daytime Telephone Number 4 Family Member's Mobile Telephone Number (if any) 5. Family Member's Email Address (if any) Copies of any documents! have submitted are exact photocopies of unaltered, original documents, and | understand that USCIS may ‘equite that | submit original documents to USCIS ata later date, Furthermore, I authorize the release of ery information from any of ‘iy records that USCIS may need to determine my eligibility for the immigration benefit | seek. this request, in supporting documents, and in my USCIS records to other entities ration and enforcement of U.S. immigration laws. | certify, under penalty of perjury, that | provided or authorized all of the information in my request, ! understand ell of the information Contained in, and submitted with, my request, and that all of this information is complete, true, and correct. 6, Family Members Signature Date of Signature (mm/ddlyyyy) NOTE TO ALL FAMILY MEMBERS: Ifyou do not completely ill out this request or fail to submit required documents listed in the Instructions, USCIS may deny your request Form 1912 Edition 03/1071 Page Toft1. Did any petson filing this request use an interpreter? Yes, (complete this section) [) No (skip to Part 10.) 2. Was the same interpreter used fo all individuals requesting a fee waiver (as listed in Part 3.)? Ol ves 1 No NOTE for Family Members: Ifyou used different interpreter than the one used by the requestor, make addtional copies of Part 9, Provide the following information, indicate the family member for whom he or she interpreted, and include te pages with your ‘completed Form 912, Provide the following information about the interpreter for 3. Interpreters Family Name (Last Name) Interpreters Given Nanie (First Name) 4. Interpreters Business or Organization Name (if a S. Street Number and Name ‘Apt. Ste, Fir. Number oo0a Clty or Town, State ZIP Code Province Postal Code Country. 6, Interpreter's Daytime Telephone Number 7. Interpreter's Mobile Telephone Number (if any) 8. Interpreters Email Address (if any) ‘ETE STE se: | certify, under penalty of perjury, that | am fluent in English and which isthe same language specified in Part 7., tem B, in Item Nam ead to this requestor in The WdentfTedTanguage every question and instruction on this request and his or her answer to every question. The requestor informed me that he or she understands every instruction, question, ‘ind answer on the request, including the Applicant's Certification, and has verified the accuracy of every answer, aes eae Pe mT 9. Interpreters Signature Date of Signature (mmidd/yyyy) Form-912.Edhion 371021 Page 8 of IT1. Did any person prepare this request on your behalf? A ves, (complete this section) C] No; skip 2, Was the same preparer used for all individuals requesting & fee waiver (as listed in Part 3.)? D Yes © No NOTE for Family Members: If you used a different preparer than the one used by the requestor, provide the following information, and include the pages with your completed Form 1-912, Prevéethe ove iataon tou te + (I rs) Preparers Family Name (Last Name) Preparers Given Name (Fist Name) [Alizadeh Sima’ 4 Preparers Business or Organiaation Name (if an ars Equality Center San Jose Street Number and Name Apt Ste, Fle, Number 1635 ‘The Alameda OO we City or Town State ZIP Code [Sen Jose Ica] fsi26 Province 7 Code country [United States Preparers Daytine Telephone Number 7. Preparers Mobile Telephone Number (if sny) 4% Vel (o4os~ [ 9. A.C] Tamnot an atomey or acredited representative but have prepared this request on behalf ofthe requestor and with the requstors consent 8. WR Lam an atorney oracreited representative and my representation ofthe requestor in his case Clextends [Y¢Goes not extend beyond the preparation of this request ‘NOTE: Ifyou are an attorney or accredited representative, you may be obliged to submit a ‘completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, ‘or G-281, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines of the United States, with this request. Form 1912 Edition 03/1021 Page 9 of tTBy my signature, | ceri), under penalty of perjury, that 1 prepared this request at the request ofthe requestor. The requestor then reviewed this completed request and informed me that he ot she understands allo f the information contained in, and submitted with, bis or her request, including the Applicant's Certification, and tha ll ofthis information is complete, true, and correct. completed this request based only on information thatthe requestor provided to me or authorized me to obtain or use, ented J, [66 ate Io7| Form L912 Edition ox/to7t. Page 10 of ITIfyou need extra space to provide any additional information within this request, tse the space below. \what is provided, you may make copies ofthis page to complete and file with this requestor attach a your name and A-Number Your answer refers, 1 iis Name (Last Name Given Name (First Name 3. AL Pago Number ‘any) at the top ofeach sheet; indicate the Page Number, B, Part Numnber C. tem Number ] It'you need more space than separate sheet of paper. Include Part Number, and Item Number to which Middle Name frorres 4A. PageNumber __B, PartNumber Item Number 1 l 5. A. PageNumber __B, Part Number C. tem Number 6 AL Page Number Part Number tem Number Form L912 Editon o3/t0/2t Page 11 of ITIRS Ue Ony-Co nat wreath apn, Deemer cine Tasni—neralRowr Serice (88) £1040 U.S. Individual Income Tax Return [2020 Ne. 1546-0078 Filing Status [} single) Maried fing city) Married fling separately (MF) ' BQ] Head of household HOH) Qualiying widower (QW) Gheekconly Ifyou checked the MFS box, enter the name of your spouse. I you checked the HOH or QW box, enor the child's name if the qualiying baad person Isa child but not your dependent Your Tatoo oe i ca Yor aT aT i e ‘Chock hare ifyou, or your Sen aT Eat SSS ieaTaohms [ear ——or x — re rr pt SAN JOSE ca 95116 'box below wil not charge Ce Cospane ‘Atany time during 2020, did you receive, sell, send, exchango, or otherwise aoquire any nancial interest in any vitual curency? L]Yes [No Standard — Someone can claim: C] You asa dependent L] Vour pause as a dependent Deduction C) Soouss itemizes on a separate retumn or you were a dus-status alion ‘Age/Biindness You: [] Were bom before January 2.1956 C]Arebind Spo Was bom before January2, 1866 1 i bling Dependents (ee sition) ised Ci Featonhin | (0 ¥ ales revctor] foo At asta on Toye. | _ciadianouat [at rane ders ban tour sm 0. Ed ————=— E ‘and check 0 oO here> C) a a LL Woes, laa Tp oa, Aah FarmgW=2 Toe PLD aaa aseon aa” Taxcoxem intrest 2 b Taxablintrot 2 Sch 8 ba Qual dvdends 3a b Ordinary idends 20 ae" IRA dstrbulons aa b Taxable arount | Pensions and ant on b Taxable aunt % 5 Social socury benefits 0 b Taxable amount [oo | rsece "| 7 Capital gin or (oss) Atach Schedule D required nat roquired check here >of tT TESS | 0 oterinoome tom Schedule 1, tne. 8 a Frying Add lines 1, 2b, Sb, 4b, 6b, 6b, 7, and 8, This is your total income > fo 21,821 sMorestirg | 40. Adjustments oincome Gating From Schedule 1, line 22 100 HERS” |b chartaioconrbutonsityou take te standard deducton Soo rstustns [HOB chest € Aa nas 10 and 100, These ae your total adjustments income > ive ‘asia Subtract ke 106 trom ne 8, Thi is your adustd gross income > Ge aaa symueteses “92 Standerd deduction oritemized deductions thom Schedule 17 36.650. Snowe (Qualified businass income deduction. Attach Form 8996 or Form 8995-8 13 Datucton. | 44 Add tines 12 and 13, Z 4 78, 650. 15 _ Taxable income, Svat in 1 fron 1. 260 oss. eter-0 15 For Disolosure, rivasy Ao, and Paperwork Reduction Act Notice, see separate nstuctions Fam 1040 eneForm 1040 (2020) Poe? 1) Taba onaine ooatayiotone Ta aa m7 ae 18 Add lines 16 and.17 . M8 318. 18 Child tax credit or credit for other dependents 19 318, . 22 pie! ne 2 mine 18.2 oF, ct eho. 23” Dither taxes, including selt-employmenttax, from Schedule 2,ine 10... z 2 D. 1 Posed neomotoe ital on a Femigiee asn| 12,251. pee te = Otters fe inauctons) i Ads nee be trough ae - ms] 2,151. [Fiqpesg "La roe entte ar paymris and an app Yon 219 ein a eee samen ld xv Ata Stee St2 me erie | 29 American opportunity cre from Form 8868, ine 8... 29 82 Addie brought. Thve ao yatta ober payments andrtinatiasedla Fae] 7,085, Rotind tenon trig atc fori Tips anangva owned [at [#836 @5a_Amount of ling 84 you want refynded to youn! Foun 8888 is >D [a5 9,636. Oireet deposit? —®S Routing numbsr | See instructions. yo pecount number Amount — 37 Subtract line 33 from line 24. This is the amount you owe now > | 37 You Owe Note: Schedule H and Schedule SE filers, line 37 may not represent all of the taxes you owe for fio 2020. See Schedule 3, ine 12e, and its instructions for detail, instustions 38 _Estimated tax penalty (see instructions). > | 38 | Designes’ instbelone pee © Bes. complete below, CINo oe Tt) (400) mmm: —_Pitenliaaenon Here ‘Your signature Date ‘Your oosupation {fo IRS sent you en iseriy nn cna toma Paid entarcrn Roorrouee [snrareth ROORIGUEE 05726/2421|po0c10223 | Glsorepenes Ceara, _tmsnane » RODRIGUEZ INCOME TAX SERVICES Phere no. (408) 274-3039 Font oomet SITE SYLVEN DR SAN JOSE CR SBIAD Fae aaees {Soo wick gonFomt 040 fone fons ard the tot information, BAA Rev 4 PRO rem 1040 cas)SCHEDULE EIC Earned Income Credit (OMB No, 1545-0074 (Form t040 Qualifying Child Information 2020 > Compote ‘and ettech to Form 1040 or 1040.SR only i youhave @ Ospetrente Tey | qualifying eile Acre Inala Sve | » Go to wars gov/SohedueEC or the latest information Sexo. 48 own ona 4 Your socal ecu arbor i + See the instructions for Farm 1040 or 1040-SR, line 27, to make sure that (a) you can take the BIC, and (b) Before you begin: oe seuenaoy ® - Benoni on in | andcl ery mumbo 2 ap wi ech acl ey xd Crete ine we rey oy cor i yur Thesoe ho sal steers alte Si Seay ae CaO "You cal he EI for ci who dd ive with you jor more han af of te ear. YANG iysssiesc errs hnghyrm arnt eit yuna Seton te crap 0 se See water tae + Hell ake us longer to process your return and issue your refund if you do not fll inal ines that apply for eack qualifying chil ualifying Child Information Child 1 Child 2 Child 3 Child's name Frans Tatras] Fostrane Tastrana | Pratrare Tastrara I you have more than three qualifying children, you have to list oniy three (0 get the maximum erat ieee Child’s SSN ‘The child must have an SSN as delped in the instructions for Form 1040 or * 1040-SR, line 27, unless the child Was 4 bam and ied in 2020 yur child was bm and ied in 2020 aid Ud ol have an SSN, enter “Died” on tis ie and attach a copy of the eil's bh eotete, death cerifiet, or hospital medal ecards showing a lve birth, —- 8. Chile's yoar of bith oor MND. veneer : ~ ‘a Was the child underage 24a the end of 2000, taco and young tes Yo (or Yes, [_] No. Yes, No. Ye No. Your spouse, if filing Jointly) Goto Go to line 4b. | Goto Go to line 4b. | Goto Go to line 4b. line Ine. tne Aigabled during any par of 20207 Yes. No. Yes. No, Yes. No. bas the child permanently and cotally [ Goto _‘Thechildisnotal Goto The child ismota| Go The eblld isnot a line. qualtyingehil. | line S. qualifying child. | tine 5. qualifying child 5 Child's relationship to you (forexample, son, daughter, grandchild ice, nephew, eligible fonrehld.cte) | som 6 Number of months child lived with you in the United States during 2020 oe me | aa ammo os return instructions. AASCHEDULE 8812 (Form 1040) Additional Child Tax Credit Decarmer Tasty > Attach to Form 1040, 1040-SR, oF 1040-NR, (OWS No, 1546-0074 Peiment feos, | ® Go to wmwirs.gov/Schedule88t2 for inatructions and te latest information, ‘scr 47 amet stow on tur vee seoary number AlFilers Caution: Tyou fe Form 2665, stop here; you cannot Gaim the acdional Ghia Tax credit 1 If you ae rquied to use the worksheet in Pub, 972, enter the amount from line 10 ofthe Child Tax Credit and Credit for Other Dependents Worksheet inthe pulieation. Otherwise, eter the amount from line 8 of your Chil Tax Cree and Credit for Other Dependents Worksheet. (See the isrotions for Porms 1040 and 1040. SR, line 19, othe insirutions foe Form 1040-NR, ine 19.) 1 2,500. 2 Bntorthe amount from ine 19 of your Form 1040, Form 1040-$R, of Focm 1040-NR z 318, 3. Subtract line 2 from line 1. If zero, stop here; you cannot claim this credit [3 2,182. 4 Numberat qualiying ciéren under 7 withthe required soil sesury number 181400 Enter the reault Ifzero, stop here; you cannot clei this eri : 4 2,400. ‘TIP: The numberof eilden you use Cor this ine isthe same aa Che numberof eidren you ysed or line Toft Chit Tax Credit and Creat for Other Dependets Worksheet : S$ _Eir the smaller of tine 3 ones . s 2, 400 6% Bared income (se instructions) : Ate Nontaxable combat pay (se nsrvdons) -. [w 7 stheamount on fine 6a more than $2,500? 1 No. Leave tne 7 blank and enter 0: ine 8 Yes. Subtract $2,500 rom the amount online 6 Ente the elt 8 Molkply the ammount on ine 7 hy 15% (0.15) and enter the result Certain Filers Who Have Three or More Qualliying Chiaren ° Next. On fine isthe amount $4,200 or more? BY No. ie lin 8 is zero, stop here; you cannot claim his ere. Otherwise, skip Pat I ape the smaller of line Sor ine 8 0 line 15. . C1 Yes IF tine 8 is equal wo or more than line, skip Part land enter the amu from line fon line 15 Otherwise, got ine 3 1 Withheld social security, Medicare, end Additional Medicare taxes fram Form(s) W-2, boxes 4 and 6, If maried fling joiuy, include your spouse's amounts with yours, If your employer withheld or you paid Additional Medicare Tax o ier | RRTA toes, see instructions. 9 10 ier he total of tho amount from Schedule 1 (Form 1040), tne 14, and Schule 2 (Porm 1040), tine, ps any taxes that you idetfed using code "UT" and entered on Schedule 2 (Form 1040), ine 8 : 0 11 Ado ines 9 and 10 : i 121040 and Ener the tal ofthe amounts fom Form 1040 or 1040, tne {0408R ers: nt hele Fre 104) He 1. } 1O40-NR files: Ente: the amount rom Schedule 3 (Form 1040), tine 10 2 18. Subst ine 72 fromm ine 11. 20 o ss, enter -O- Ta 14 Bnterthe larger of ine 8 or ine 13 : id Next er the smaller of line Sor line 14 0 ine 13 [EMMI Adaltional Child Tax Creait 15 This is your additional child tax ereait 7 Ls] 1,400. Be tise Eom ie Fr Ii 2 or Bn (eee ea For Paperwork Reduction Act Notice, 5 ‘your tax return instructions. gaa Revowzaa1 PRO ‘Schedule 8812 (Form 1040) 2020 :