MGPTaxReturn 2021

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1040 Department of the Treasury—Internal Revenue Service (99)

2021
Form
U.S. Individual Income Tax Return OMB No. 1545-0074 IRS Use Only–Do not write or staple in this space.
Filing Status Single X
Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child's name if the qualifying
one box. person is a child but not your dependent. 
Your first name and middle initial Last name Your social security number
DEAN A GLUESENKAMP
If joint return, spouse's first name and middle initial Last name
KRISTINA M PEREZ
Home address (number and street). If you have a P.O box, see instructions. Apt. no.
Check here if you, or your
spouse if filing jointly, want $3
City, town or post office. If you have a foreign address, also complete spaces below. State ZIP code to go to this fund.Checking a
WASHOUGAL WA 98671 box below will not change
your tax or refund.
Foreign country name Foreign province/state/county Foreign postal code
You Spouse
At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes X No
Standard Someone can claim: You as a dependent Your spouse as a dependent
Deduction Spouse itemizes on a separate return or you were a dual-status alien
You: Were born before January 2, 1957 Are blind Spouse: Was born before January 2, 1957 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4)  if qualifies for (see instructions):
If more (1) First name Last name number to you Child tax credit Credit for other dependents
than four CIRO W GLUESENKAMP SON X
dependents,
see instr.
and check
here 
1 Wages, salaries, tips, etc. Attach Form(s) W-2 1 71,386
Client Copy
....................................................................
Attach
Sch.B if
2a Tax-exempt interest . . . 2a b Taxable interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b 207
required.
3a Qualified dividends . . . . 3a 12 Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . 3b
b 12
4a IRA distributions . . . . . . 4a b Taxable amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b
5a Pensions and annuities . . . 5a b Taxable amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b
6a Soc. sec. ben. . . . . . . . . . . . . 6a b Taxable amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7 2,407
• Single or
Married filing
8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 40,181
separately, 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9 114,193
$12,550
• Married filing 10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 8,600
jointly or
Qualifying
11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  11 105,593
widow(er), 12a Standard deduction or itemized deductions (from Schedule A) . . . . . . . . 12a 28,951
$25,100
b Charitable contributions if you take the standard deduction (see instructions) . . . . . . . . 12b
• Head of
household,
$18,800
c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c 28,951
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 8,036
any box under
14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  14 36,987
15 Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 68,606
see instructions.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2021)
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Form 1040 (2021) DEAN A GLUESENKAMP & KRISTINA M PEREZ Page 2

16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972
3 . ................................................. 16 7,831
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7,831
19 Nonrefundable 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 7,831
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 7,831
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a 15,048
b Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d 15,048
If you have a 26 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
qualifying child, 27a Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27a
attach Sch. EIC.
Check here if you were born after January 1, 1998, and before
January 2, 2004, and you satisfy all other requirements for
taxpayers who are at least 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 Sch. 8812 . . . . . . . . . . . . . . . . . . . . 28 3,600
29 American opportunity credit from Form 8863, line 8 . . . . . . . . . . . . . . . . . . 29
30 Recovery rebate credit. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 4,200
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Client Copy
32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits  32 7,800
33 Add lines 25d, 26, and 32. These are your ................................................  33 22,848
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . . . . . . . . 34 15,017
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . . . . . .  35a 15,017
Direct deposit?  b Routing number  c Type: X Checking Savings
See instructions.  d Account number
36 Amount of line 34 you want applied to your 2022 estimated tax  36
Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions . . . . . .  37
You Owe 38 Estimated tax penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . .  38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  X Yes. Complete below. No
Designee’s Phone Personal identification
name  HOLLY MCCALL no.  503-477-4396 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 taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Joint return?
Protection PIN, enter it here
See instructions. BUSINESS OWNER (see instr.) 
Keep a copy for Spouse's signature. If a joint return, both must sign. Date Spouse's occupation If the IRS sent your spouse an
your records. Identity Protection PIN, enter it here
DIRECTOR (see instr.) 
Phone no. Email address

Preparer's name Preparer's signature Date PTIN Check if:
Paid HOLLY MCCALL HOLLY MCCALL 10/28/22 ********* X Self-employed
Preparer Firm's name  MCCALL TAX & BOOKKEEPING SERVICES, INC. Phone no. 503-477-4396
Use Only 5311 SE POWELL BLVD STE 101
Firm's address  PORTLAND OR 97206-2951 Firm's EIN 
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2021)
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SCHEDULE 1 Additional Income and Adjustments to Income OMB No. 1545-0074
(Form 1040)
Department of the Treasury  Attach to Form 1040, 1040-SR, or 1040-NR.

2021
Attachment
Internal Revenue Service  Go to for instructions and the latest information. Sequence No. 01
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number
DEAN A GLUESENKAMP & KRISTINA M PEREZ
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 40,181
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
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 ( )
e Taxable Health Savings Account distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8e
f Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8f
g Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8g
h Prizes and awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8h
i Activity not engaged in for profit income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8i
j Stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8j
Client Copy
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
o Section 461(l) excess business loss adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8o
p Taxable distributions from an ABLE account (see instructions) . . . . . . . . . . . . . . . . . . . . . . 8p
z Other income. List type and amount 
8z
9 Total other income. Add lines 8a through 8z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or
1040-NR, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 40,181
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040) 2021
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Schedule 1 (Form 1040) 2021 Page 2
Part II Adjustments to Income
11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Certain business expenses of reservists, performing artists, and fee-basis government
officials. Attach Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
17 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 8,600
18 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19a
b Recipient's SSN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
c Date of original divorce or separation agreement (see instructions) . . . . . . . . . . . . . . . . . . 
20 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Archer MSA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Other adjustments:
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
Client Copy
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
z Other adjustments. List type and amount 
24z
25 Total other adjustments. Add lines 24a through 24z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
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 8,600
Schedule 1 (Form 1040) 2021
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SCHEDULE A Itemized Deductions OMB No. 1545-0074

(Form 1040)
Department of the Treasury
 Go to for instructions and the latest information.
 Attach to Form 1040 or 1040-SR. 2021
Attachment
Internal Revenue Service (99) Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 16. Sequence No. 07
Name(s) shown on Form 1040 or 1040-SR Your social security number
Medical Caution: Do not include expenses reimbursed or paid by others.
and 1 Medical and dental expenses (see instructions) . . . . . . . . . . . . . . . . . . . . 1 13,999
Dental 2 Enter amount from Form 1040 or
Expenses 1040-SR, line 11 . . . . . . . . . . . . . . . . . 2 105,593
3 Multiply line 2 by 7.5% (0.075) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7,919
4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 6,080
Taxes You 5 State and local taxes.
Paid a State and local income taxes or general sales taxes. You may
include either income taxes or general sales taxes on line 5a,
but not both. If you elect to include general sales taxes instead
of income taxes, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5a 6,527
b State and local real estate taxes (see instructions) ................. 5b 5,644
c State and local personal property taxes ............................. 5c
d Add lines 5a through 5c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5d 12,171
e Enter the smaller of line 5d or $10,000 ($5,000 if married filing
separately) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5e 10,000
6 Other taxes. List type and amount  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. ...................................................................... 6
7 Add lines 5e and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 10,000
Interest You 8 Home mortgage interest and points. If you didn't use all of your
Paid home mortgage loan(s) to buy, build, or improve your home, see
Client Copy
Caution: Your instructions and check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
mortgage interest a Home mortgage interest and points reported to you on Form 1098.
deduction may be
limited (see See instructions if limited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a 12,581
instructions). b Home mortgage interest not reported to you on Form 1098. See
instructions if limited. If paid to the person from whom you bought the
home, see instructions and show that person’s name, identifying no.,
and address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 ....................................................................
. ...................................................................... 8b
c Points not reported to you on Form 1098. See instructions for
special rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8c
d Mortgage insurance premiums (see instructions) . . . . . . . . . . . . . . . . . . . 8d
e Add lines 8a through 8d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8e 12,581
9 Investment interest. Attach Form 4952 if required. See
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Add lines 8e and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 12,581
Gifts to 11 Gifts by cash or check. If you made any gift of $250 or more,
Charity see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290 ....... 11 290
Caution: If you 12 Other than by cash or check. If you made any gift of $250 or more,
made a gift and
see instructions. You must attach Form 8283 if over $500 . . . . . . . . . 12
got a benefit for it,
see instructions. 13 Carryover from prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Add lines 11 through 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 290
Casualty and 15 Casualty and theft loss(es) from a federally declared disaster (other than net qualified
Theft Losses disaster losses). Attach Form 4684 and enter the amount from line 18 of that form. See
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Other 16 Other—from list in instructions. List type and amount  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Itemized . ........................................................................................................
Deductions 16
Total 17 Add the amounts in the far right column for lines 4 through 16. Also, enter this amount on
Itemized Form 1040 or 1040-SR, line 12a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 28,951
Deductions 18 If you elect to itemize deductions even though they are less than your standard deduction,
check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
For Paperwork Reduction Act Notice, see the Instructions for Forms 1040 and 1040-SR. Schedule A (Form 1040) 2021
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SCHEDULE D Capital Gains and Losses OMB No. 1545-0074

(Form 1040)
 Go to
 Attach to Form 1040, 1040-SR, or 1040-NR.
for instructions and the latest information.
2021
Department of the Treasury Attachment
Internal Revenue Service (99)  Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10. Sequence No. 12
Name(s) shown on return Your social securit number

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 (g) (h) Gain or (loss)
lines below. (d) (e) Adjustments Subtract column (e)
Proceeds Cost to gain or loss from from column (d) and
This form may be easier to complete if you round off cents to (sales price) (or other basis) Form(s) 8949, Part I, combine the result
whole dollars. line 2, column (g) with column (g)
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 . . . . .
1b Totals for all transactions reported on Form(s) 8949 with
checked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,500 1,093 0 2,407
2 Totals for all transactions reported on Form(s) 8949 with
checked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
checked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . . . . . . . . . . . . . . . . . . . . . 4
Client Copy
5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover
Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ( )
7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any long-
term capital gains or losses, go to Part II below. Otherwise, go to Part III on the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2,407
Part II 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 (g) (h) Gain or (loss)
lines below. (d) (e) Adjustments Subtract column (e)
Proceeds Cost to gain or loss from from column (d) and
This form may be easier to complete if you round off cents to (sales price) (or other basis) Form(s) 8949, Part II, combine the result
whole dollars. line 2, column (g) 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 . . . . .
8b Totals for all transactions reported on Form(s) 8949 with
checked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
checked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
checked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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
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
the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 0
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule D (Form 1040) 2021
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Schedule D (Form 1040) 2021 Page 2
Part III Summary
16 Combine lines 7 and 15 and enter the result ............................................................................ 16 2,407
• If line 16 is a gain, enter the amount from line 16 on Form 1040, 1040-SR, or 1040-NR, 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?

Yes. Go to line 18.
X 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
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

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.
Client Copy
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 .............................................................. 21 ( )


• ($3,000), or if married filing separately, ($1,500)
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 Form 1040-NR, line 3a?
X 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.
Schedule D (Form 1040) 2021
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Form 8949 Sales and Other Dispositions of Capital Assets

OMB No. 1545-0074

 Go to for instructions and the latest information. 2021
Attachment
Internal Revenue Service
 File with your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D. 12A
Sequence No.
Name(s) shown on return Social security number or taxpayer identification number

Before you check Box A, B, or C 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 I Short-Term. Transactions involving capital assets you held 1 year or less are generally short-term (see
instructions). For long-term transactions, see page 2.
Note: You may aggregate all short-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 1a; you aren't required to report these transactions on Form 8949 (see instructions).
You check Box A, B, C below. Check only one box. If more than one box applies for your short-term transactions,
complete a separate Form 8949, page 1, for each applicable box. If you have more short-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 (A) Short-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see Note above)
(B) Short-term transactions reported on Form(s) 1099-B showing basis wasn't reported to the IRS
(C) Short-term transactions not reported to you on Form 1099-B
1 Adjustment, if any, to gain or loss.
(e) If you enter an amount in column (g), (h)
(c) (d) Cost or other basis. enter a code in column (f). Gain or (loss).
(a) (b)
Date sold or Proceeds See the Note below See the separate instructions. Subtract column (e)
Description of property Date acquired
disposed of (sales price) and see Column (e) from column (d) and
(Example: 100 sh. XYZ Co.) (Mo., day, yr.) (f) (g)
(Mo., day, yr.) (see instructions) in the separate combine the result
instructions Code(s) from Amount of with column (g)
instructions adjustment
4.000 SH TESLA
08/14/20 01/11/21 3,500 1,093 2,407
Client Copy
2 Add the amounts in columns (d), (e), (g), and (h) (subtract
negative amounts). Enter each total here and include on your
Schedule D, (if above is checked), (if
above is checked), or (if above is checked)  3,500 1,093 0 2,407
Note: If you checked Box A above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an
adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment.
For Paperwork Reduction Act Notice, see your tax return instructions. Form 8949 (2021)
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SCHEDULE E Supplemental Income and Loss OMB No. 1545-0074
(Form 1040)

(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
 Attach to Form 1040, 1040-SR, 1040-NR, or 1041. 2021
Attachment
Internal Revenue Service (99)  Go to for instructions and the latest information. Sequence No. 13
Name(s) shown on return Your social security number

Part I Income or Loss From Rental Real Estate and Royalties Note: If you are in the business of renting personal property, use
Schedule C. See instructions. If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40.
A Did you make any payments in 2021 that would require you to file Form(s) 1099? See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No
B If "Yes," did you or will you file required Form(s) 1099? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
1a Physical address of each property (street, city, state, ZIP code)
A 1506 NE LOMARD ST, PORTLAND, OR 97211
B
C
1b Type of Property 2 For each rental real estate property listed
QJV
(from list below) above, report the number of fair rental and
personal use days. Check the QJV box only
A 7
. ......................... if you meet the requirements to file as a
A 365
B . ......................... qualified joint venture. See instructions. B
C C
Type of Property:
1 Single Family Residence 3 Vacation/Short-Term Rental 5 Land 7 Self-Rental
2 Multi-Family Residence 4 Commercial 6 Royalties 8 Other (describe)
Income: Properties: A B C
3 Rents received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 71,072
4 Royalties received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Expenses:
Client Copy
5 Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Auto and travel (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Cleaning and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Commissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Legal and other professional fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Management fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Mortgage interest paid to banks, etc. (see instructions) . . . . . . . . . . . . . . . . . . . . 12 21,029
13 Other interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 12,495
14 Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 6,234
17 Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Depreciation expense or depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 13,009
19 Other (list)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Total expenses. Add lines 5 through 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 52,767
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties). If
result is a (loss), see instructions to find out if you must
file Form 6198 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 18,305
22 Deductible rental real estate loss after limitation, if any,
on Form 8582 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 ( )( )( )
23a Total of all amounts reported on line 3 for all rental properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23a 71,072
b Total of all amounts reported on line 4 for all royalty properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23b
c Total of all amounts reported on line 12 for all properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23c 21,029
d Total of all amounts reported on line 18 for all properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23d 13,009
e Total of all amounts reported on line 20 for all properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23e 52,767
24 Income. Add positive amounts shown on line 21. Do not include any losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 18,305
25 Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here . . . . . . . . . . . . . . 25 ( )
26 Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result
here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter this amount on
Schedule 1 (Form 1040), line 5. Otherwise, include this amount in the total on line 41 on page 2 ........................ 26 18,305
For Paperwork Reduction Act Notice, see the separate instructions. Schedule E (Form 1040) 2021
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Schedule E (Form 1040) 2021 Attachment Sequence No. 13 Page 2

Name(s) shown on return. Do not enter name and social security number if shown on other side. Your social security number

Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
Part II Income or Loss From Partnerships and S Corporations – Note: If you report a loss, receive a distribution, dispose of
stock, or receive a loan repayment from an S corporation, you must check the box in column (e) on line 28 and attach the required basis
computation. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (f) on
line 28 and attach Form 6198. See instructions.
27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a
passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? If you answered “Yes,”
see instructions before completing this section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No
(b) Enter for (c) Check if (d) Employer (e) Check if (f) Check if
28 (a) Name partnership; foreign identification basis computation any amount is
for S corporation partnership number is required not at risk
A DEANS CAR CARE INC S X

B DEANS CAR CARE INC S X
C
D
Passive Income and Loss Nonpassive Income and Loss
(g) Passive loss allowed (h) Passive income (i) Nonpassive loss allowed (j) Section 179 expense (k) Nonpassive income
(attach Form 8582 if required) from Schedule K-1 (see Schedule K-1) deduction from Form 4562 from Schedule K-1
A 0 10,719
B 0 11,157
C
D
29a Totals 21,876
b Totals
Client Copy
30 Add columns (h) and (k) of line 29a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 21,876
31 Add columns (g), (i), and (j) of line 29b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 ( 0)
32 Total partnership and S corporation income or (loss). Combine lines 30 and 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 21,876
Part III Income or Loss From Estates and Trusts
(b) Employer
33 (a) Name
identification number
A
B
Passive Income and Loss Nonpassive Income and Loss
(c) Passive deduction or loss allowed (d) Passive income (e) Deduction or loss (f) Other income from
(attach Form 8582 if required) from Schedule K-1 from Schedule K-1 Schedule K-1
A
B
34a Totals
b Totals
35 Add columns (d) and (f) of line 34a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Add columns (c) and (e) of line 34b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 ( )
37 Combine lines 35 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)—Residual Holder
(c) Excess inclusion from
(b) Employer (d) Taxable income (net loss) (e) Income from
38 (a) Name
identification number
Schedules Q, line 2c
from Schedules Q, line 1b Schedules Q, line 3b
(see instructions)
39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below . . . . . . . . . . . . . . . . . . . . . . 39
Part V Summary
40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
41 Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Schedule 1 (Form 1040), line 5 . . . . . . . . . . . . . . . . .  41 40,181
42 Reconciliation of farming and fishing income. Enter your gross
farming and fishing income reported on Form 4835, line 7; Schedule K-1
(Form 1065), box 14, code B; Schedule K-1 (Form 1120-S), box 17, code
AD; and Schedule K-1 (Form 1041), box 14, code F. See instructions . . . . . . . . . . . . . . . . 42
43 If you were a real estate professional
(see instructions), enter the net income or (loss) you reported anywhere on Form
1040, Form 1040-SR, or Form 1040-NR from all rental real estate activities in which
you materially participated under the passive activity loss rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
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SCHEDULE 8812 Credits for Qualifying Children OMB No. 1545-0074

(Form 1040) and Other Dependents
.......... 
..........
2021
Department of the Treasury  Attach to Form 1040, 1040-SR, or 1040-NR. 8812 Attachment
Internal Revenue Service (99)  Go to for instructions and the latest information. Sequence No. 47
Name(s) shown on return Your social security number
Part I-A Child Tax Credit and Credit for Other Dependents
1 Enter the amount from line 11 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 105,593
2a Enter income from Puerto Rico that you excluded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Enter the amounts from lines 45 and 50 of your Form 2555 . . . . . . . . . . . . . . . . . . . . . . . . . 2b
c Enter the amount from line 15 of your Form 4563 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c
d Add lines 2a through 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d
3 Add lines 1 and 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 105,593
4a Number of qualifying children under age 18 with the required social security number 4a 1
b Number of children included on line 4a who were under age 6 at the end of 2021 . . 4b 1
c Subtract line 4b from line 4a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4c
5 If line 4a is more than zero, enter the amount from the Line 5 Worksheet; otherwise, enter -0- . . . . . . . . . . . . . . . . . . . . . 5 3,600
6 Number of other dependents, including any qualifying children who are not under
age 18 or who do not have the required social security number . . . . . . . . . . . . . . . . . . . . . 6
Caution: Do not include yourself, your spouse, or anyone who is not a U.S. citizen, U.S. national, or U.S. resident
alien. Also, do not include anyone you included on line 4a.
7 Multiply line 6 by $500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Add lines 5 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 3,600
9 Enter the amount shown below for your filing status.
• Married filing jointly—$400,000
• All other filing statuses—$200,000 9 400,000
Client Copy
. ...........................................................................
10 Subtract line 9 from line 3.
• If zero or less, enter -0-.
• If more than zero and not a multiple of $1,000, enter the next multiple of $1,000. For
example, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc. . ........................ 10 0
11 Multiply line 10 by 5% (0.05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3,600
13 Check all the boxes that apply to you (or your spouse if married filing jointly).
A Check here if you (or your spouse if married filing jointly) had a principal place of abode in the United States
for more than half of 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
B Check here if you (or your spouse if married filing jointly) were a bona fide resident of Puerto Rico for 2021
Part I-B Filers Who Check a Box on Line 13
Caution: If you did not check a box on line 13, do not complete Part I-B; instead, skip to Part I-C.
14a Enter the smaller of line 7 or line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a
b Subtract line 14a from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b 3,600
c If line 14a is zero, enter -0-; otherwise, enter the amount from the Credit Limit Worksheet A . . . . . . . . . . . . . . . . . . . . . . . 14c 0
d Enter the smaller of line 14a or line 14c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14d
e Add lines 14b and 14d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14e 3,600
f Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received
for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the
instructions before entering an amount on this line. If you didn’t receive any advance child tax credit payments
for 2021, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14f 0
Caution: If the amount on this line doesn’t match the aggregate amounts reported to you (and your spouse if
filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
g Subtract line 14f from line 14e. If zero or less, enter -0- on lines 14g through 14i and go to Part III . . . . . . . . . . . . . . . . . . . 14g 3,600
h Enter the smaller of line 14d or line 14g. This is your credit for other dependents. Enter this amount on line
19 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14h
i Subtract line 14h from line 14g. This is your refundable child tax credit. Enter this amount on line 28 of
your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14i 3,600
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 8812 (Form 1040) 2021
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Part I-C Filers Who Do Not Check a Box on Line 13
Caution: If you checked a box on line 13, do not complete Part I-C.
15a Enter the amount from the Credit Limit Worksheet A ................................................................
15a
b Enter the smaller of line 12 or line 15a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15b
Additional child tax credit. Complete Parts II-A through II-C if you meet each of the following items.
1. You are not filing Form 2555.
2. Line 4a is more than zero.
3. Line 12 is more than line 15a.
c If you completed Parts II-A through II-C, enter the amount from line 27; otherwise, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . 15c
d Add lines 15b and 15c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15d
e Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received
for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the
instructions before entering an amount on this line. If you didn’t receive any advance child tax credit payments
for 2021, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15e
Caution: If the amount on this line doesn’t match the aggregate amounts reported to you (and your spouse if
filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
f Subtract line 15e from line 15d. If zero or less, enter -0- on lines 15f through 15h and go to Part III . . . . . . . . . . . . . . . . . . 15f
g Enter the smaller of line 15b or line 15f. This is your nonrefundable child tax credit and credit for other
dependents. Enter this amount on line 19 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15g
h Subtract line 15g from line 15f. This is your additional child tax credit. Enter this amount on line 28 of your
Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15h
Part II-A Additional Child Tax Credit (use only if completing Part I-C)
Caution: If you file Form 2555, do not complete Parts II-A through II-C; you cannot claim the additional child tax credit.
Caution: If you checked a box on line 13, do not complete Parts II-A through II-C; you cannot claim the additional child tax credit.
16a Subtract line 15b from line 12. If zero, skip Parts II-A and II-B and enter -0- on line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16a
b Number of qualifying children under 18 with the required social security number: x $1,400.
Client Copy
Enter the result. If zero, skip Parts II-A and II-B and enter -0- on line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16b
TIP: The number of children you use for this line is the same as the number of children you used for line 4a.
17 Enter the smaller of line 16a or line 16b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18a Earned income (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18a
b Nontaxable combat pay (see instructions) . . . . . . . . 18b
19 Is the amount on line 18a more than $2,500?
No. Leave line 19 blank and enter -0- on line 20.
Yes. Subtract $2,500 from the amount on line 18a. Enter the result . . . . . . . . . . . 19
20 Multiply the amount on line 19 by 15% (0.15) and enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Next. On line 16b, is the amount $4,200 or more?
No. If line 20 is zero, enter -0- on line 15c; Otherwise, skip Part II-B and enter the smaller of line 17 or line
20 on line 27.
Yes. If line 20 is equal to or more than line 17, skip Part II-B and enter the amount from line 17 on line 27.
Otherwise, go to line 21.
Part II-B Certain Filers Who Have Three or More Qualifying Children
21 Withheld social security, Medicare, and Additional Medicare taxes from Form(s) W-2,
boxes 4 and 6. If married filing jointly, include your spouse’s amounts with yours. If
your employer withheld or you paid Additional Medicare Tax or tier 1 RRTA taxes, see
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Enter the total of the amounts from Schedule 1 (Form 1040), line 15; Schedule 2 (Form
1040), line 5; Schedule 2 (Form 1040), line 6; and Schedule 2 (Form 1040), line 13 . . . . . . . . . . . . 22
23 Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 1040 and
1040-SR filers: Enter the total of the amounts from Form 1040 or 1040-SR, line 27a,
and Schedule 3 (Form 1040), line 11. 
1040-NR filers: Enter the amount from Schedule 3 (Form 1040), line 11. 24
25 Subtract line 24 from line 23. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Enter the larger of line 20 or line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Next, enter the smaller of line 17 or line 26 on line 27.
Part II-C Additional Child Tax Credit
27 Enter this amount on line 15c .......................................................................................... 27
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Part III Additional Tax (use only if line 14g or line 15f, whichever applies, is zero)
28a Enter the amount from line 14f or line 15e, whichever applies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28a
b Enter the amount from line 14e or line 15d, whichever applies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28b
29 Excess advance child tax credit payments. Subtract line 28b from line 28a. If zero, stop; you do not owe the
additional tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
30 Enter the number of qualifying children taken into account in determining the annual advance amount you
received for 2021. See your Letter 6419 for this number. If you are missing your Letter 6419, you are filing a joint
return, or you received more than one Letter 6419, see the instructions before entering a number on this line . . . . . . . 30
Caution: If the amount on this line doesn’t match the number of qualifying children reported to you (and your
spouse if filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
31 Enter the smaller of line 4a or line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
32 Subtract line 31 from line 30. If zero, skip to line 40 and enter the amount from line 29; otherwise, continue to
line 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 Enter the amount shown below for your filing status.
• Married filing jointly or Qualifying widow(er)—$60,000
• Head of household—$50,000 
• All other filing statuses—$40,000 . ...................................................... 33
34 Subtract line 33 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
35 Enter the amount from line 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Divide line 34 by line 35. Enter the result as a decimal (rounded to at least three places). If the result is 1.000 or
more, enter 1.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
37 Multiply line 32 by $2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
38 Multiply line 37 by line 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
39 Subtract line 38 from line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
40 Subtract line 39 from line 29. If zero or less, enter -0-. This is your additional tax. If more than zero, enter
this amount on Schedule 2 (Form 1040), line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
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Form 8995 Qualified Business Income Deduction OMB No. 1545-2294
Simplified Computation 2021

Department of the Treasury  Attach to your tax return. Attachment
Name(s) shown on return Your taxpayer identification number
Note. You can claim the qualified business income deduction if you have qualified business income from a qualified trade or
business, real estate investment trust dividends, publicly traded partnership income, or a domestic production activities deduction
passed through from an agricultural or horticultural cooperative. See instructions.
Use this form if your taxable income, before your qualified business income deduction, is at or below $164,900 ($164,925 if married
filing separately; $329,800 if married filing jointly), and you aren't a patron of an agricultural or horticultural cooperative.
1 (a) Trade, business, or aggregation name (b) Taxpayer (c) Qualified business
identification number income or (loss)
i LOMBARD ST 18,305
ii DEANS CAR CARE INC 10,719
iii DEANS CAR CARE INC 11,157
iv
2 Total qualified business income or (loss). Combine lines 1i through 1v,
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column (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 40,181
3 Qualified business net (loss) carryforward from the prior year . . . . . . . . . . . . . . . . . . . . . . . 3 ( )
4 Total qualified business income. Combine lines 2 and 3. If zero or less, enter -0- . . 4 40,181
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 8,036
6 Qualified REIT dividends and publicly traded partnership (PTP) income or (loss)
(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Qualified REIT dividends and qualified PTP (loss) carryforward from the prior
year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ( )
8 Total qualified REIT dividends and PTP income. Combine lines 6 and 7. If zero
or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 0
9 REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 8,036
11 Taxable income before qualified business income deduction (see instructions) . . . . . 11 76,642
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 12
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 76,630
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 15,326
15 Qualified business income deduction. Enter the smaller of line 10 or line 14. Also enter this amount on
the applicable line of your return (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  15 8,036
16 Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . . . . . . . . . . . . . . . . . . . 16 ( 0)
17 Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 6 and 7. If greater than
zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 ( )
For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8995 (2021)
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Form 8867 Paid Preparer’s Due Diligence Checklist

Earned Income Credit (EIC), American Opportunity Tax Credit (AOTC),
Child Tax Credit (CTC) (including the Additional Child Tax Credit (ACTC) and
OMB No. 1545-0074
(Rev. December 2021)
Credit for Other Dependents (ODC)), and Head of Household (HOH) Filing Status Attachment
Internal Revenue Service
 To be completed by preparer and filed with Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS. Sequence No. 70
 Go to for instructions and the latest information.
Taxpayer name(s) shown on return Taxpayer identification number
Enter preparer's name and PTIN
HOLLY MCCALL *********
Part I Due Diligence Requirements
Please check the appropriate box for the credit(s) and/or HOH filing status claimed on the return and complete the related Parts I-V
for the benefit(s) claimed (check all that apply). EIC X CTC/ACTC/ODC AOTC HOH
1 Did you complete the return based on information for the applicable tax year provided by the taxpayer Yes No N/A
or reasonably obtained by you? (See instructions if relying on prior year earned income.) . . . . . . . . . . . . . . . . . . . . . . . . . . . X
2 If credits are claimed on the return, did you complete the applicable EIC and/or CTC/ACTC/ODC
worksheets found in the Form 1040, 1040-SR, 1040-NR, 1040-PR, 1040-SS, or Schedule 8812 (Form
1040) instructions, and/or the AOTC worksheet found in the Form 8863 instructions, or your own
that provides the same information, and all related forms and schedules for each credit
claimed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
3 Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both of
the following.
 Interview the taxpayer, ask questions, and contemporaneously document the taxpayer's responses to
determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing status.
 Review information to determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing
status and to figure the amount(s) of any credit(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
4 Did any information provided by the taxpayer or a third party for use in preparing the return, or
information reasonably known to you, appear to be incorrect, incomplete, or inconsistent? (If "Yes,"
answer questions 4a and 4b. If "No," go to question 5.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
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a Did you make reasonable inquiries to determine the correct, complete, and consistent information? . . . . . . . . . . . . .
b Did you contemporaneously document your inquiries? (Documentation should include the questions
you asked, whom you asked, when you asked, the information that was provided, and the impact the
information had on your preparation of the return.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Did you satisfy the record retention requirement? To meet the record retention requirement, you must
keep a copy of your documentation referenced in question 4b, a copy of this Form 8867, a copy of any
applicable worksheet(s), a record of how, when, and from whom the information used to prepare Form
8867 and any applicable worksheet(s) was obtained, and a copy of any document(s) provided by the
taxpayer that you relied on to determine eligibility for the credit(s) and/or HOH filing status or to figure
the amount(s) of the credit(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
List those documents provided by the taxpayer, if any, that you relied on:
TAXPAYER SUMMARY OF INCOME
6 Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for the
credit(s) and/or HOH filing status and the amount(s) of any credit(s) claimed on the return if his/her
return is selected for audit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
7 Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year? . . . . . . . . . . . . . . . . . . . . X
(If credits were disallowed or reduced, go to question 7a; if not, go to question 8.)
a Did you complete the required recertification Form 8862? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 If the taxpayer is reporting self-employment income, did you ask questions to prepare a complete and
correct Schedule C (Form 1040)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see separate instructions. Form 8867 (Rev. 12-2021)
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Form 8867 (Rev. 12-2021) Page 2
Part II Due Diligence Questions for Returns Claiming EIC (If the return does not claim EIC, go to Part III.)
9a Have you determined that the taxpayer is eligible to claim the EIC for the number of qualifying children Yes No N/A
claimed, or is eligible to claim the EIC without a qualifying child? (If the taxpayer is claiming the EIC
and does not have a qualifying child, go to question 10.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Did you ask the taxpayer if the child lived with the taxpayer for over half of the year, even if the taxpayer
has supported the child the entire year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Did you explain to the taxpayer the rules about claiming the EIC when a child is the qualifying child of
more than one person (tiebreaker rules)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part III Due Diligence Questions for Returns Claiming CTC/ACTC/ODC (If the return does not claim CTC, ACTC,
or ODC, go to Part IV.)
10 Have you determined that each qualifying person for the CTC/ACTC/ODC is the taxpayer's dependent who is Yes No N/A
a citizen, national, or resident of the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
11 Did you explain to the taxpayer that he/she may not claim the CTC/ACTC if the child has not lived with
the taxpayer for over half of the year, even if the taxpayer has supported the child, unless the child’s
custodial parent has released a claim to exemption for the child? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
12 Did you explain to the taxpayer the rules about claiming the CTC/ACTC/ODC for a child of divorced or
separated parents (or parents who live apart), including any requirement to attach a Form 8332 or similar
statement to the return? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
Part IV Due Diligence Questions for Returns Claiming AOTC (If the return does not claim AOTC, go to Part V.)
13 Did the taxpayer provide substantiation for the credit, such as a Form 1098-T and/or receipts for the qualified Yes No
tuition and related expenses for the claimed AOTC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part V Due Diligence Questions for Claiming HOH (If the return does not claim HOH filing status, go to Part VI.)
14 Have you determined that the taxpayer was unmarried or considered unmarried on the last day of the tax year Yes No
and provided more than half of the cost of keeping up a home for the year for a qualifying person? . . . . . . . . . . . . . . . . . . . . . . .
Part VI Eligibility Certification
 You will have complied with all due diligence requirements for claiming the applicable credit(s) and/or HOH filing
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status on the return of the taxpayer identified above if you:
A. Interview the taxpayer, ask adequate questions, contemporaneously document the taxpayer's responses on the return or
in your notes, review adequate information to determine if the taxpayer is eligible to claim the credit(s) and/or HOH filing
status and to figure the amount(s) of the credit(s);
B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for any applicable
credit(s) claimed and HOH filing status, if claimed;
C. Submit Form 8867 in the manner required; and
D. Keep all five of the following records for 3 years from the latest of the dates specified in the Form 8867 instructions under
Document Retention.
1. A copy of this Form 8867.
2. The applicable worksheet(s) or your own worksheet(s) for any credit(s) claimed.
3. Copies of any documents provided by the taxpayer on which you relied to determine the taxpayer's eligibility for the
credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s).
4. A record of how, when, and from whom the information used to prepare this form and the applicable worksheet(s) was
obtained.
5. A record of any additional information you relied upon, including questions you asked and the taxpayer's responses, to
determine the taxpayer's eligibility for the credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s).
 If you have not complied with all due diligence requirements, you may have to pay a penalty for each failure to
comply related to a claim of an applicable credit or HOH filing status (see instructions for more information).
15 Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and Yes No
complete? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
Form 8867 (Rev. 12-2021)
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Form 7203 S Corporation Shareholder Stock and

Debt Basis Limitations
OMB No. 1545-2302
(December 2021)
Name(s) shown on return Identifying number
DEAN A GLUESENKAMP
Name of S corporation Employer identification number
DEANS CAR CARE INC
Stock block (see instructions) 
Part I Shareholder Stock Basis
1 Stock basis at the beginning of the corporation’s tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 65,560
2 Basis from any capital contributions made or additional stock acquired during the tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3a Ordinary business income (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a 10,719
b Net rental real estate income (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3b
c Other net rental income (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3c
d Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3d
e Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3e
f Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3f
g Net capital gains (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3g
h Net section 1231 gain (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3h
i Other income (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3i
j Excess depletion adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3j
k Tax-exempt income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3k
l Recapture of business credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3l
m Other items that increase stock basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3m
4 Add lines 3a through 3m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 10,719
5 Stock basis before distributions. Add lines 1, 2, and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 76,279
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6 Distributions (excluding dividend distributions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 40,311
Note: If line 6 is larger than line 5, subtract line 5 from line 6 and report the result as a capital gain on
Form 8949 and Schedule D. See instructions.
7 Stock basis after distributions. Subtract line 6 from line 5. If the result is zero or less, enter -0-, skip
lines 8 through 14, and enter -0- on line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 35,968
8a Nondeductible expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a 288
b Depletion for oil and gas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b
c Business credits (sections 50(c)(1) and (5)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8c
9 Add lines 8a through 8c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 288
10 Stock basis before loss and deduction items. Subtract line 9 from line 7. If the result is zero or less,
enter -0-, skip lines 11 through 14, and enter -0- on line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 35,680
11 Allowable loss and deduction items. Enter the amount from line 47, column (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 142
12 Debt basis restoration (see net increase in instructions for line 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Other items that decrease stock basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Add lines 11, 12, and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 142
15 Stock basis at the end of the corporation’s tax year. Subtract line 14 from line 10. If the result is
zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 35,538
Part II Shareholder Debt Basis
Section A—Amount of Debt (If more than three debts, see instructions.)
Debt 1 Debt 2 Debt 3
Description Formal note Formal note Formal note Total
X Open account Open account Open account
debt debt debt
16 Loan balance at the beginning of the corporation’s tax
year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Additional loans (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . .
18 Loan balance before repayment. Combine lines 16 and 17
19 Principal portion of debt repayment (this line doesn’t
include interest) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( )( )( )( )
20 Loan balance at the end of the corporation’s tax year.
Combine lines 18 and 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see separate instructions. Form 7203 (12-2021)
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DEAN A GLUESENKAMP
Form 7203 (12-2021) Page 2
Part II Shareholder Debt Basis (continued)
Section B—Adjustments to Debt Basis
Description Debt 1 Debt 2 Debt 3 Total
21 Debt basis at the beginning of the corporation’s tax year . .
22 Enter the amount, if any, from line 17 . . . . . . . . . . . . . . . . . . . . . .
23 Debt basis restoration (see instructions) . . . . . . . . . . . . . . . . . . .
24 Debt basis before repayment. Combine lines 21, 22, and 23
25 Divide line 24 by line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26 Nontaxable debt repayment. Multiply line 25 by line 19 . . . .
27 Debt basis before nondeductible expenses and losses.
Subtract line 26 from line 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
28 Nondeductible expenses and oil and gas depletion
deductions in excess of stock basis . . . . . . . . . . . . . . . . . . . . . . . .
29 Debt basis before losses and deductions. Subtract line
28 from line 27. If the result is zero or less, enter -0- . . . . . . 0
30 Allowable losses in excess of stock basis. Enter the
amount from line 47, column (d) . . . . . . . . . . . . . . . . . . . . . . . . . . .
31 Debt basis at the end of the corporation’s tax year.
Subtract line 30 from line 29. If the result is zero or
0
less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section C—Gain on Loan Repayment
32 Repayment. Enter the amount from line 19 . . . . . . . . . . . . . . . .
33 Nontaxable repayments. Enter the amount from line 26 . . .
34 Reportable gain. Subtract line 33 from line 32 . . . . . . . . . . . . 0
Part III Shareholder Allowable Loss and Deduction Items
(b) Current (b) Carryover (c) Allowable (d) Allowable (e) Carryover
Client Copy
year losses amounts loss from loss from amounts
Description and deductions (column (e)) stock basis debt basis
from the
previous year
35 Ordinary business loss . . . . . . . . . . . . .
36 Net rental real estate loss . . . . . . . . . .
37 Other net rental loss . . . . . . . . . . . . . . . .
38 Net capital loss . . . . . . . . . . . . . . . . . . . . .
39 Net section 1231 loss . . . . . . . . . . . . . .
40 Other loss . . . . . . . . . . . . . . . . . . . . . . . . . .
41 Section 179 deductions . . . . . . . . . . . .
42 Charitable contributions . . . . . . . . . . . . 142 142
43 Investment interest expense . . . . . . .
44 Section 59(e)(2) expenditures . . . . . .
45 Other deductions . . . . . . . . . . . . . . . . . . .
46 Foreign taxes paid or accrued . . . . . .
47 Combine lines 35 through 46 for
each column. Enter the total loss in column (c)
on line 11 and enter the total loss in column
(d) on line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . 142 142
Form 7203 (12-2021)
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Form 7203 S Corporation Shareholder Stock and

Debt Basis Limitations
OMB No. 1545-2302
(December 2021)
Name(s) shown on return Identifying number
KRISTINA M PEREZ
Name of S corporation Employer identification number
DEANS CAR CARE INC
Stock block (see instructions) 
Part I Shareholder Stock Basis
1 Stock basis at the beginning of the corporation’s tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 61,402
2 Basis from any capital contributions made or additional stock acquired during the tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3a Ordinary business income (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a 11,157
b Net rental real estate income (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3b
c Other net rental income (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3c
d Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3d
e Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3e
f Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3f
g Net capital gains (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3g
h Net section 1231 gain (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3h
i Other income (enter losses in Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3i
j Excess depletion adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3j
k Tax-exempt income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3k
l Recapture of business credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3l
m Other items that increase stock basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3m
4 Add lines 3a through 3m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 11,157
5 Stock basis before distributions. Add lines 1, 2, and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 72,559
Client Copy
6 Distributions (excluding dividend distributions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 20,988
Note: If line 6 is larger than line 5, subtract line 5 from line 6 and report the result as a capital gain on
Form 8949 and Schedule D. See instructions.
7 Stock basis after distributions. Subtract line 6 from line 5. If the result is zero or less, enter -0-, skip
lines 8 through 14, and enter -0- on line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 51,571
8a Nondeductible expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a 299
b Depletion for oil and gas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b
c Business credits (sections 50(c)(1) and (5)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8c
9 Add lines 8a through 8c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 299
10 Stock basis before loss and deduction items. Subtract line 9 from line 7. If the result is zero or less,
enter -0-, skip lines 11 through 14, and enter -0- on line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 51,272
11 Allowable loss and deduction items. Enter the amount from line 47, column (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 148
12 Debt basis restoration (see net increase in instructions for line 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Other items that decrease stock basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Add lines 11, 12, and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 148
15 Stock basis at the end of the corporation’s tax year. Subtract line 14 from line 10. If the result is
zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 51,124
Part II Shareholder Debt Basis
Section A—Amount of Debt (If more than three debts, see instructions.)
Debt 1 Debt 2 Debt 3
Description Formal note Formal note Formal note Total
X Open account Open account Open account
debt debt debt
16 Loan balance at the beginning of the corporation’s tax
year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Additional loans (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . .
18 Loan balance before repayment. Combine lines 16 and 17
19 Principal portion of debt repayment (this line doesn’t
include interest) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( )( )( )( )
20 Loan balance at the end of the corporation’s tax year.
Combine lines 18 and 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see separate instructions. Form 7203 (12-2021)
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KRISTINA M PEREZ
Form 7203 (12-2021) Page 2
Part II Shareholder Debt Basis (continued)
Section B—Adjustments to Debt Basis
Description Debt 1 Debt 2 Debt 3 Total
21 Debt basis at the beginning of the corporation’s tax year . .
22 Enter the amount, if any, from line 17 . . . . . . . . . . . . . . . . . . . . . .
23 Debt basis restoration (see instructions) . . . . . . . . . . . . . . . . . . .
24 Debt basis before repayment. Combine lines 21, 22, and 23
25 Divide line 24 by line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26 Nontaxable debt repayment. Multiply line 25 by line 19 . . . .
27 Debt basis before nondeductible expenses and losses.
Subtract line 26 from line 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
28 Nondeductible expenses and oil and gas depletion
deductions in excess of stock basis . . . . . . . . . . . . . . . . . . . . . . . .
29 Debt basis before losses and deductions. Subtract line
28 from line 27. If the result is zero or less, enter -0- . . . . . . 0
30 Allowable losses in excess of stock basis. Enter the
amount from line 47, column (d) . . . . . . . . . . . . . . . . . . . . . . . . . . .
31 Debt basis at the end of the corporation’s tax year.
Subtract line 30 from line 29. If the result is zero or
0
less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section C—Gain on Loan Repayment
32 Repayment. Enter the amount from line 19 . . . . . . . . . . . . . . . .
33 Nontaxable repayments. Enter the amount from line 26 . . .
34 Reportable gain. Subtract line 33 from line 32 . . . . . . . . . . . . 0
Part III Shareholder Allowable Loss and Deduction Items
(b) Current (b) Carryover (c) Allowable (d) Allowable (e) Carryover
Client Copy
year losses amounts loss from loss from amounts
Description and deductions (column (e)) stock basis debt basis
from the
previous year
35 Ordinary business loss . . . . . . . . . . . . .
36 Net rental real estate loss . . . . . . . . . .
37 Other net rental loss . . . . . . . . . . . . . . . .
38 Net capital loss . . . . . . . . . . . . . . . . . . . . .
39 Net section 1231 loss . . . . . . . . . . . . . .
40 Other loss . . . . . . . . . . . . . . . . . . . . . . . . . .
41 Section 179 deductions . . . . . . . . . . . .
42 Charitable contributions . . . . . . . . . . . . 148 148
43 Investment interest expense . . . . . . .
44 Section 59(e)(2) expenditures . . . . . .
45 Other deductions . . . . . . . . . . . . . . . . . . .
46 Foreign taxes paid or accrued . . . . . .
47 Combine lines 35 through 46 for
each column. Enter the total loss in column (c)
on line 11 and enter the total loss in column
(d) on line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . 148 148
Form 7203 (12-2021)
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Form 1040 Tax Return Reconciliation Worksheet 2021

Filing Status: 1 Single X 2 Married filing jointly 3 Married filing separately 4 Head of household* 5 Qualifying widow(er)*
MFS spouse name: *Qualifying person that is a child but not a dependent:
Taxpayer first name and initial Last name Taxpayer social security number
DEAN A GLUESENKAMP
If a joint return, spouse's first name and initial Last name Spouse's social security number
KRISTINA M PEREZ
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
Taxpayer Spouse
City, town or post office, state, and ZIP code.

WASHOUGAL WA 98671
Foreign country name Foreign province/state/county Foreign postal code
At anytime during 2021, did you receive, sell, send, exchange, or otherwise acquire financial interest in any virtual currency? Yes X No
6a X Taxpayer. If someone can claim you as a dependent, do not check box 6a Boxes checked on 6a and 6b . . . . . . . . . . . . . 2
b X Spouse Children on 6c who lived with you . . . . . . . . . . 1
Children on 6c who did not live with you . . . . .
Dependents on 6c not entered above . . . . . . .
Total. Add lines above 3

6c Dependents:  if qualifies for
First name Last name Social security number Relationship to you Child tax credit Other dependents If more than four
CIRO W GLUESENKAMP SON X dependents,
 here
7 7 71,386
Client Copy
Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Income 8a Taxable interest. Attach Schedule B if required ...................................................... 8a 207
(Schedule 1) b Tax-exempt interest. Do not include on line 8a . . . . . . . . . . . . . . . . . . . . 8b
9a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a 12
b Qualified dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b 12
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2,407
14 Other gains or (losses). Attach Form 4797 ........................................................... 14
15a IRA distributions . . . . . . . . . . . . . . 15a b Taxable amount . . . . . . . . . . . . . 15b
16a Pensions and annuities . . . . . . 16a b Taxable amount . . . . . . . . . . . . . 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . . . . . . . 17 40,181
18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20a Social security benefits . . . . . . . . . . 20a b Taxable amount . . . . . . . . . . . . . 20b
21 Other income. List type and amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income . .  22 114,193
23 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Adjusted 24 Certain business expenses of reservists, performing artists, and
Gross fee-basis government officials. Attach Form 2106 or 2106-EZ . . . . . 24
Income 25 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . 25
(Schedule 1) 26 Moving expenses. Attach Form 3903 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27 Deductible part of self-employment tax. Attach Schedule SE . . . . . . 27
28 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . 28
29 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . 29 8,600
30 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
31a Alimony paid b Recipient's SSN  31a
32 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
34 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
35 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 8,600
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  37 105,593
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Form 1040 Tax Return Reconciliation Worksheet, Page 2 2021

Name DEAN A GLUESENKAMP & KRISTINA M PEREZ Tp TIN
38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 105,593
Tax and
Credits
(Schedules 2, 3)
39a Check
if: {
You were born before January 2,1957,
Spouse was born before January 2,1957,
Blind.
Blind.
Total boxes
checked  } 39a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here  39b
Standard
Deduction 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . . . . . . . . . . . 40 28,951
for— a Charitable contributions if you take the standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40b
• People who
check any
41 Subtract line 40 and 40b from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 76,642
box on line 42 Qualified business income deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 8,036
39a or 39b or
who can be 43 Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 68,606
claimed as a
dependent, 44 (see instr.). Check if any from: Form(s)
8814
Form
4972 . ........................ 44 7,831
see 45 Alternative minimum tax (see instructions). Attach Form 6251 45
instructions. .....................................
• All others:
46 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Single or 47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  47 7,831
Married filing
separately, 48 Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . . . . . . . . . . . 48
$12,550 Credit for child and dependent care expenses. Attach Form 2441 . . . 49
49
Married filing
jointly or 50 Education credits from Form 8863, line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Qualifying
widow(er), 51 Retirement savings contributions credit. Attach Form 8880 . . . . . . . . . 51
$25,100 52 Child tax credit/credit for other dependents . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Head of
household, 53 Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . . . . . . . . . . . 53
$18,800
54 Other credits from Form: 3800 8801 54
55 Add lines 48 through 54. These are your total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . .  56 7,831
Other Taxes 57 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
(Schedule 2) 58 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . . . . . . . . . . . 58
59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . . . . . . . . 59
Client Copy
60a Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60a
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60b
61 Taxes from: Form 8959 Form 8960 Instructions; enter code(s) 61
62 Section 965 net tax liability installment from Form 965-A . . . . . . . . . . . . . . . . . . . 62
63 Add lines 56 through 61. This is your ..........................................................  63 7,831
64 Federal income tax withheld from: 64
a Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64a 15,048
b Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64b
c Other forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64c
65 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . 65
Payments 66a Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66a
(Schedule 3) b Nontaxable combat pay election 66b
c Prior year (2019) earned income 66c
67 Additional child tax credit. Attach Schedule 8812 . . . . . . . . . . . . . . . . . . . . . . 67 3,600
68 American opportunity credit from Form 8863, line 8 . . . . . . . . . . . . . . . . 68
69 Recovery rebate credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 4,200
70 Net premium tax credit. Attach Form 8962 . . . . . . . . . . . . . . . . . . . . . . . . . . 70
71 Amount paid with request for extension to file . . . . . . . . . . . . . . . . . . . . . . 71
72 Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . . . . . . . 72
73 Credit for federal tax on fuels. Attach Form 4136 . . . . . . . . . . . . . . . . . . . 73
74 Other payments and refundable credits . . . . . . . . . . . 74
75 Total pymts. Add ln 64, 65,66a, 67-74. 75 22,848
Refund 76 If line 75 is more than line 63, subtract line 63 from line 75. This is the amount you overpaid . . . . . . 76 15,017
77a Amount of line 76 you want refunded to you. If Form 8888 is attached, check here . . . . . . . .  77a 15,017
 b Routing numbe  c Type: X Checking Savings
 d Account number
78 Amount of line 76 you want applied to your 2022 estimated tax  78
Amount 79 Amount you owe. Subtract line 75 from line 63. For details on how to pay, see instructions ...  79
You Owe 80 Estimated tax penalty (see instructions) 80
Int/Pen Date filed Int Fail to file Fail to pay Total
Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? X Yes. Complete below. No Personal identification no. (PIN)
Designee Designee's Name

 HOLLY MCCALL Phone no.  503-477-4396
Taxpayer Daytime phone number Taxpayer: Occupation BUSINESS OWNER IRS Identity Protection PIN
Other Info
Spouse: Occupation DIRECTOR IRS Identity Protection PIN
Taxpayer Spouse Email address

18014 10/28/2022 3:23 PM
Form 1040 Shareholder's Basis Worksheet Page 1 2021

Name Taxpayer Identification Number
DEAN A GLUESENKAMP
Name of Entity DEANS CAR CARE INC EIN
Passive Activity Type NOT PASSIVE K1 Unit 1
Shareholder Stock Basis
1. Beginning of year stock basis. Per IRC 1367(a)(2) do not enter an amount below zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 65,560
Increases to stock basis
2. Capital contributions made or additional stock acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Ordinary business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 10,719
4. Net rental real estate income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Other net rental income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Interest, dividends and royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Net capital gains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Net section 1231 gain and ordinary business gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Tax-exempt interest, other tax-exempt income and recapture credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
10. Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
11. Excess of deductions for depletion over basis of property (other than oil and gas) . . . . . . . . . . . . . . . . 11.
12. Other increases to stock basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Total increases to stock basis. Combine lines 2 through 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 10,719
14. Add line 1 and line 13 and enter the result here . . . . . . . . . . . . . 14. 76,279
Decreases to stock basis
15. Distributions allowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 40,311
16. Subtract line 15 from line 14. If zero or less, enter - 0 - 16. 35,968
17. Losses and deductions applied against stock basis. (See Shareholder Basis Worksheet Page 2) 17. 430
18. Other decreases to stock basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.
Client Copy
19. Amount used to restore loan basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. Total decreases (other than distributions) to stock basis. Combine lines 17 through 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. 430
21. (Subtract line 20 from line 16). Per IRC 1367(a)(2) do not enter an amount below zero . . . . . . . 21. 35,538
Shareholder Loan Basis
Type of Loan: Formal Note Open account debt X
22. Beginning of year loan basis. Per IRC 1367(b)(2)(A) do not enter an amount below zero . . . . . . . . 22.
23. Loans to corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.
24. Loan basis restored from line 19 above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.
25. Other increases to loan basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25.
26. Loan repayments from line 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.
27. Combine lines 22 through 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27. 0
28. Losses and deductions applied against loan basis. (See Shareholder Basis Worksheet Page 2) . 28.
29. Other decreases to loan basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29.
30. Total decreases to loan basis. Add lines 28 and 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30. 0
31. (Subtract line 30 from line 27). Per IRC 1367(b)(2)(A) do not enter an amount below zero . . . . . 31. 0
32. (Add lines 21 and line 31) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32. 35,538
Gain Recognized on Excess Distributions
33. Property distributions reported in Box 16, Code D, Schedule K-1 (1120S) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33. 40,311
34. Stock basis before distributions and loss items (line 14) less gain from the entire disposition of stock reported on line 18. . . 34. 76,279
35. (Subtract line 34 from line 33) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35. 0
Sch D/8949, short-term capital gain Sch D/8949, long-term capital gain
Gain Recognized on Repayment of Shareholder Loan

36. Loan basis at beginning of tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.
37. Basis restored - amount used in prior years to offset losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.
38. Loan basis before loan repayment. Add line 36 and line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.
39. Face amount of shareholder loan at beginning of tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.
40. Loan repayments to shareholder during tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40.
41. Nontaxable return of loan basis. Divide line 38 by line 39 and multiply the result by line 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.
42. (Subtract line 41 from line 40) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.
Sch D/8949, short-term capital gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sch D/8949, long-term capital gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ordinary income on Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18014 10/28/2022 3:23 PM

Name DEAN A GLUESENKAMP Id No.
DEANS CAR CARE INC
Entity Name EIN Passive Activity Type NOT PASSIVE K1 Unit 1
BASIS REDUCED BY NONDEDUCTIBLE ITEMS BEFORE LOSS AND DEDUCTION ITEMS
Loss Allocated to Shareholder Stock and Loan Basis
Suspended Current Total Allowed Disallowed Allowed Disallowed Loss Total
Losses Year Loss Loss Percent Stock Loss Stock Loss Percent Loan Loss Carryforward Allowed Loss
Nondeductible noncapital exp
& oil/gas depletion deduction: 288 288 1.0000 288 288
Losses and deductions:
Ordinary business loss
Net rental real estate loss
Other net rental loss
Short-term capital loss
Long-term capital loss
28% capital loss
Section 1231 loss
4797 - Ordinary loss
Other portfolio loss
1256 contracts and straddles
Other losses - Schedule E
Other losses - 1040 Sch 1
Section 179 expense
Cash contributions 142 142 1.0000 142 142
Cash contributions (30%)
Noncash contributions (50%)
Cap gain prop 50% org (30%)
Cap gain prop (20%)
Portfolio deductions (other)
Investment interest expense
Depletion
Deductions-royalty income
Section 59(e)(2) expenditures
Preproductive period exp.
Reforestation expense ded.
Other deductions
Foreign taxes
Total losses and deductions 142 142 1.0000 142 142
Total nonded and deductible items 430 430 430 430
18014 10/28/2022 3:23 PM

KRISTINA M PEREZ
Name of Entity DEANS CAR CARE INC EIN
Passive Activity Type NOT PASSIVE K1 Unit 2
Shareholder Stock Basis
1. Beginning of year stock basis. Per IRC 1367(a)(2) do not enter an amount below zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 61,402
Increases to stock basis
2. Capital contributions made or additional stock acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Ordinary business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 11,157
4. Net rental real estate income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Other net rental income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Interest, dividends and royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Net capital gains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Net section 1231 gain and ordinary business gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Tax-exempt interest, other tax-exempt income and recapture credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
10. Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
11. Excess of deductions for depletion over basis of property (other than oil and gas) . . . . . . . . . . . . . . . . 11.
12. Other increases to stock basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Total increases to stock basis. Combine lines 2 through 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 11,157
14. Add line 1 and line 13 and enter the result here . . . . . . . . . . . . . 14. 72,559
Decreases to stock basis
15. Distributions allowed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 20,988
16. Subtract line 15 from line 14. If zero or less, enter - 0 - 16. 51,571
17. Losses and deductions applied against stock basis. (See Shareholder Basis Worksheet Page 2) 17. 447
18. Other decreases to stock basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.
Client Copy
19. Amount used to restore loan basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. Total decreases (other than distributions) to stock basis. Combine lines 17 through 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. 447
21. (Subtract line 20 from line 16). Per IRC 1367(a)(2) do not enter an amount below zero . . . . . . . 21. 51,124
Shareholder Loan Basis
Type of Loan: Formal Note Open account debt X
22. Beginning of year loan basis. Per IRC 1367(b)(2)(A) do not enter an amount below zero . . . . . . . . 22.
23. Loans to corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.
24. Loan basis restored from line 19 above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.
25. Other increases to loan basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25.
26. Loan repayments from line 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.
27. Combine lines 22 through 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27. 0
28. Losses and deductions applied against loan basis. (See Shareholder Basis Worksheet Page 2) . 28.
29. Other decreases to loan basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29.
30. Total decreases to loan basis. Add lines 28 and 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30. 0
31. (Subtract line 30 from line 27). Per IRC 1367(b)(2)(A) do not enter an amount below zero . . . . . 31. 0
32. (Add lines 21 and line 31) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32. 51,124
Gain Recognized on Excess Distributions
33. Property distributions reported in Box 16, Code D, Schedule K-1 (1120S) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33. 20,988
34. Stock basis before distributions and loss items (line 14) less gain from the entire disposition of stock reported on line 18. . . 34. 72,559
35. (Subtract line 34 from line 33) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35. 0
Sch D/8949, short-term capital gain Sch D/8949, long-term capital gain
Gain Recognized on Repayment of Shareholder Loan

36. Loan basis at beginning of tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.
37. Basis restored - amount used in prior years to offset losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.
38. Loan basis before loan repayment. Add line 36 and line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.
39. Face amount of shareholder loan at beginning of tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39.
40. Loan repayments to shareholder during tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40.
41. Nontaxable return of loan basis. Divide line 38 by line 39 and multiply the result by line 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.
42. (Subtract line 41 from line 40) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.
Sch D/8949, short-term capital gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sch D/8949, long-term capital gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ordinary income on Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18014 10/28/2022 3:23 PM

Name KRISTINA M PEREZ Id No.
DEANS CAR CARE INC
Entity Name EIN Passive Activity Type NOT PASSIVE K1 Unit 2
BASIS REDUCED BY NONDEDUCTIBLE ITEMS BEFORE LOSS AND DEDUCTION ITEMS
Loss Allocated to Shareholder Stock and Loan Basis
Suspended Current Total Allowed Disallowed Allowed Disallowed Loss Total
Losses Year Loss Loss Percent Stock Loss Stock Loss Percent Loan Loss Carryforward Allowed Loss
Nondeductible noncapital exp
& oil/gas depletion deduction: 299 299 1.0000 299 299
Losses and deductions:
Short-term capital loss
Long-term capital loss
28% capital loss
Section 1231 loss
Other portfolio loss
Section 179 expense
Cash contributions 148 148 1.0000 148 148
Cap gain prop (20%)
Depletion
Preproductive period exp.
Reforestation expense ded.
Other deductions
Foreign taxes
Total losses and deductions 148 148 1.0000 148 148
Total nonded and deductible items 447 447 447 447
18014 10/28/2022 3:23 PM
Form 1040 Broker Reconciliation Worksheet 2021

Name(s) of Account holder Tax a er identification number
DEAN A GLUESENKAMP
Payer's name Account number
ROBINHOOD SECURITIES LLC
Form/Sch Form 1099
Form/Schedule/Worksheet Line No. Name Box No(s) Amount
Schedule B
Part I - Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1099-INT 1, 3, 10
Part II - Ordinary Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1099-DIV 1a 12
Nondividend distributions 1099-DIV 3
Schedule D
Short-term 1099B transactions with no adjustments, basis reported to IRS . . . . . . . . 1a 1099-B
Long-term 1099B transactions with no adjustments, basis reported to IRS . . . . . . . . . 8a 1099-B
Part II - Capital gain distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1099-DIV 2a
28% Rate Capital Gain Worksheet (Schedule D, line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 4 1099-DIV, B 2d, 3
Unrecaptured Section 1250 Gain Worksheet (Schedule D, line 19) 11 1099-DIV 2b
Schedule A
State and local income taxes withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a 1099 ALL 17, 15, 16
Foreign tax deduction 6 1099-INT, DIV 6, 7
Form 1040
Tax-exempt interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a 1099-INT 8
Tax-exempt interest dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a 1099-DIV 11
Qualified dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a 1099-DIV 1b 12
Penalty on early withdrawal of savings (Schedule 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1099-INT 2
Foreign tax credit (Credit claimed without filing Form 1116) (Schedule 3) . . . . . . . . . . 1 1099-INT, DIV 6, 7
Client Copy
Federal income tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b 1099 ALL 4
Section 199A dividends 13 1099-DIV 5
Form 1116
Part II Foreign taxes paid or accrued 8 1099-INT, DIV 6, 7
Form 6251
Interest from specified private activity bonds exempt from regular tax . . . . . . . . . . . . . . 2g 1099-INT 9
Interest dividends from specified private activity bonds exempt from regular tax 2g 1099-DIV 12
Form 8949
Basis reported to IRS
Short-term - 8949 Box A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1099-B 2,407
Short-term - 8949 Box A (column g) - Wash sale loss disallowed * 1 1099-B
Long-term - 8949 Box D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1099-B
Long-term - 8949 Box D (column g) - Wash sale loss disallowed * . . . . . . . . . . . . . . . . . 1 1099-B
Basis not reported to IRS
Short-term - 8949 Box B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1099-B
Short-term - 8949 Box B (column g) - Wash sale loss disallowed * . . . . . . . . . . . . . . . . . 1 1099-B
Long-term - 8949 Box E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1099-B
Long-term - 8949 Box E (column g) - Wash sale loss disallowed * . . . . . . . . . . . . . . . . . 1 1099-B
Not reported on Form 1099-B
Short-term - 8949 Box C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1099-B
Short-term - 8949 Box C (column g) - Wash sale loss disallowed * . . . . . . . . . . . . . . . . . 1 1099-B
Long-term - 8949 Box F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1099-B
Long-term - 8949 Box F (column g) - Wash sale loss disallowed * . . . . . . . . . . . . . . . . . 1 1099-B
Long-term - 8949 Box F - Section 1202 gain exclusion adjustment 1 1099-DIV 2c
Form 6781
Net section 1256 contracts loss election . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part I - Section 1256 Contracts Marked to Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1099-B 11
Form 1099-B adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Net section 1256 contracts loss carry back 6
Form 4952
Investment interest expenses - margin interest 1
* Form 8949 column (g), amount of adjustment, is reported as wash sale loss disallowed for any transaction with a “W” in column (f) Code(s) from instructions. Therefore,
transactions with multiple codes in column (f), may not reflect the true disallowed wash sale loss.
18014 10/28/2022 3:23 PM
Form 1040 Broker Capital Transactions Detail Summary Report 2021

Name(s) shown on return Tax a er Identification Number
Broker Account Name Account No. T/S/J
A ROBINHOOD SECURITIES LLC T
B
C
D
E
Column A Column B Column C Column D Column E Total Col A - E*

Basis reported to the IRS
Short-term - Sch D line 1a
Proceeds +
Basis -
Gain/-Loss = 0
Long-term - Sch D line 8a
Proceeds +
Basis -
Gain/-Loss = 0
Short-term - 8949 Box A / Sch D line 1b
Proceeds + 3,500 3,500
Basis - 1,093 1,093
Adjustment +
Gain/-Loss = 2,407 2,407
Long-term - 8949 Box D / Sch D line 8b
Client Copy
Proceeds +
Basis -
Adjustment +
Gain/-Loss = 0
Basis not reported to the IRS
Short-term - 8949 Box B / Sch D line 2
Proceeds +
Basis -
Adjustment +
Gain/-Loss = 0
Long-term - 8949 Box E / Sch D line 9
Proceeds +
Basis -
Adjustment +
Gain/-Loss = 0
Not reported on 1099B/Substitute statement
Short-term - 8949 Box C / Sch D line 3
Proceeds +
Basis -
Adjustment +
Gain/-Loss = 0
Long-term - 8949 Box F / Sch D line 10
Proceeds +
Basis -
Adjustment +
Gain/-Loss = 0
Account Total
Proceeds + 3,500 3,500
Basis - 1,093 1,093
Adjustment +
Gain/-Loss = 2,407 2,407
*Total column completed on last unit
18014 10/28/2022 3:23 PM
Form 1040 Qualified Dividends and Capital Gain Tax Worksheet 2021
1. Enter the amount from Form 1040, 1040-SR, or 1040-NR, 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. 68,606
2. Enter the amount from Form 1040, 1040-SR, or 1040-NR, line 3a* 2. 12
3. Are you filing Schedule D?*
X Yes. Enter the smaller of line 15 or 16 of Schedule D.
If either line 15 or 16 is a loss, enter -0-
No.Enter the amount from Form 1040, 1040-SR, or  3.
1040-NR, line 7
4. Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 12
5. Subtract line 4 from line 1. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 68,594
6. Enter:
$40,400 if single or married filing separately,
$80,800 if married filing jointly or qualifying widow(er),  ...................... 6. 80,800
$54,100 if head of household.
7. Enter the smaller of line 1 or line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 68,606
8. Enter the smaller of line 5 or line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 68,594
9. Subtract line 8 from line 7. This amount is taxed at 0% . . . . . . . . . . . . . . . . . . . . . . . . . . 9. 12
Client Copy
10. Enter the smaller of line 1 or line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. 12
11. Enter the amount from line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12
12. Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 0
13. Enter:
$445,850 if single,
$250,800 if married filing separately,  ...................... 13. 501,600
$501,600 if married filing jointly or qualifying widow(er),
$473,750 if head of household.
14. Enter the smaller of line 1 or line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. 68,606
15. Add lines 5 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 68,606
16. Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. 0
17. Enter the smaller of line 12 or line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.
18. Multiply line 17 by 15% (0.15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18. 0
19. Add lines 9 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 12
20. Subtract line 19 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. 0
21. Multiply line 20 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. 0
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. 7,831
23. Add lines 18, 21, and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. 7,831
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. 7,837
25. Tax on all taxable income. Enter the smaller of line 23 or line 24. Also include this amount on the entry space on
Form 1040, 1040-SR, or 1040-NR, line 16. If you are filing Form 2555, do not enter this amount on the entry space
on 1040, 1040-SR, or 1040-NR, line 16. Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet . . . 25. 7,831
*If you are filing Form 2555, these lines may be reduced (but not below zero) by your capital gain excess. Please refer to Foreign Earned
Income Tax Worksheets - Excess Capital Gain for detail if the lines have been reduced.
18014 10/28/2022 3:23 PM
Form 1040 General Sales Tax Deduction Worksheet 2021

Name as shown on return Tax a er Identification Number
State of Locality of
WASHINGTON
General Sales Tax from IRS Tables
1. Enter the amount of adjusted gross income (AGI) from Form 1040 or 1040-SR, Line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 105,593
2. Add the nontaxable amounts from Form 1040 or 1040-SR, lines 2b, 4a, 5a, 6a (Exclude rollovers and tax-free Sec. 1035 exchanges) 2.
3. Add the following nontaxable items: nontaxable combat pay, public assistance, veteran's benefits, and workers' compensation.
Also include any amounts which increase spendable income, such as the refundable portion of refundable tax credits
received in 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Add lines 1 through 3, this is income for general sales tax table purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 105,593
5. Enter the amount from the sales tax table in the Schedule A instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 1,093
Part-year residents, complete lines 6 - 8; Full-year residents skip lines 6 - 8
and enter the amount from line 5 on line 9
6. Enter the number of days of residence in state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Total days in year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 365
8. Divide line 6 by line 7 (rounded to at least 3 decimal places) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Multiply line 5 by line 8, this is the deductible general sales tax using the IRS table. 9. 1,093
Local Sales Tax Using IRS Tables

10. Enter the amount from the sales tax table in the Schedule A instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
11. If you are a resident of Alaska, Arizona, Arkansas, Colorado, Georgia, Illinois, Louisiana, Mississippi,
Client Copy
Missouri, New York, North Carolina, South Carolina, Tennessee, Utah, or Virginia, enter
the amount from the applicable Optional Local Sales Tax Table in the Schedule A instructions. . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Enter the local general sales tax rate (exclude statewide local sales tax rate) . . . . . . . . . . . . . 12.
13. Enter the state general sales tax rate (include statewide local sales tax rate) . . . . . . . . . . . . . 13.
14. Divide line 12 by line 13 (rounded to at least 3 decimal places) . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.
15. If you entered an amount on line 11, multiply line 11 by line 12. This is the local sales tax
using the optional local sales tax tables.
If you did not enter an amount on line 11, multiply line 10 by line 14. This is the local sales tax 15.
using the optional state and certain local sales tax tables.
16. Enter the number of days of residence in locality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.
17. Total days in year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. 365
18. Divide line 16 by line 17 (rounded to at least 3 decimal places) . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.
19. Multiply line 15 by line 18. This is the deductible general local sales tax using the IRS tables. . . . . . . . . . . . . . . . . . . . . . . . . . 19.
General Sales Tax Summary
20. Enter the sum of line 9 from all General Sales Tax Deduction Worksheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. 1,093
21. Enter the sum of line 19 from all General Sales Tax Deduction Worksheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.
22. Add lines 20 and 21, this is the total General Sales taxes using the tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. 1,093
23. Enter the actual state and local general sales taxes paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.
24. Enter the greater of line 22 or line 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. 1,093
25. Enter the state and local taxes paid on specified items (major purchases) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.
26. Add lines 24 and 25, this is the deductible General Sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26. 1,093
27. Enter total state and local income taxes paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27. 6,527
Enter the greater of line 26 or 27 on Schedule A, line 5a. If line 26 is greater, mark the Schedule A, line 5a box.
18014 10/28/2022 3:23 PM
Form 1040 Child Tax Credit and Credit for Other Dependents Worksheets 2021
Name Tax a er Identification Number
Line 5 Worksheet
1. Form 8812, line 4b: 1 x $3,600. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 3,600
2. Form 8812, line 4c: x $3,000. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 3,600
4. Form 8812, line 4a: 1
x $2,000. Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 2,000
5. Subtract Line 4 from Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 1,600
6. Enter the smaller of Line 5, or the Limitation Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 1,600
Limitation Reduction: $ 12,500 if MFJ; $ 2,500 if QW; $ 4,375 if HOH; and $ 6,250 for all others.
7. Enter $150,000 if MFJ/QW; $112,500 if HOH; and $75,000 for all others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 150,000
8. Subtract line 7 from Schedule 8812, line 3.
X If zero or less, then enter -0- on line 8.
 ................................ 8. 0
If more than zero and not a multiple of $1,000, then increase to the next multiple of $1,000.
9. Multiply line 8 by 5% (.05). Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. 0
10. Enter the smaller of Line 6 or Line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. 0
11. Subtract Line 10 from Line 3. Enter the result on Schedule 8812, line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3,600
Credit Limit Worksheet A
1. Enter the amount from Form 1040, 1040-SR, or Form 1040NR, line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 7,831
2. Add the amounts from Sch 3, lines 1, 2, 3, 4, and 6l; plus Forms 5695, ln 30; 8910, ln 15; 8936, ln 23; and Sch R, ln 22. Enter the total 2.
3. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 7,831
4. Do you meet all the following conditions?
You are completing Part I-C of Schedule 8812. You are filing Form 2555.
Client Copy
You are claiming one or more of the following credits: Form 8812, line 4a is more than zero.
Form 8396; Form 8839; Form 5695, Part I; Form 8859
X No. Enter-0-. ............................................................ 4. 0

Yes. Enter the amount from the Credit Limit Worksheet B.
5. Subtract line 4 from line 3. Enter the result here and on Schedule 8812, line 14c or 15a, whichever applies . . . . . . . . . . . . . . . . . . . . . . . . . 5. 7,831
Credit Limit Worksheet B
Use this worksheet only if you checked "Yes" on line 4 of the Credit Limit Worksheet A above.
1. Enter the amount from Form 8812, line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. Number of qualifying children under age 18 with the required social security number: x $1,400. Enter the result . . . . . . . . . . . . . 2.
3. Enter the earned income from line 7 of the Child Tax Credit Earned Income Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Is the amount on line 3 more than $2,500?
No. Leave line 4 blank, enter -0- on line 5, and go to line 6. ..................................................... 4.

Yes. Subtract $2,500 from the amount on line 3. Enter the result.
5. Multiply the amount on line 4 by 15% (.15) and enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. On line 2 of this worksheet, is the amount $4,200 or more?
No.
If line 2 or line 5 above is zero, enter the amount from line 1 above on line 14 of this worksheet. Do not complete the rest of this worksheet.
Instead, go back to the Credit Limit Worksheet A and enter -0- on line 4, and complete line 5.
If both line 2 and line 5 are more than zero, leave lines 7 through 10 blank, enter -0- on line 11, go to line 12.
Yes. If line 5 above is equal to or more than line 1 above, leave lines 7 through 10 blank, enter -0- on
line 11, and go to line 12 below. Otherwise go to line 7.
7. If your employer withheld or you paid Additional Medicare Tax or Tier 1 RRTA taxes, use the Additional Medicare Tax and RRTA Tax
Worksheet to figure the amount to enter; otherwise enter the total social security and Medicare taxes withheld from your pay (and
your spouse's if filing a joint return). These taxes should be shown in boxes 4 and 6 of your Form(s) W-2. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Enter the total of the amounts from Schedule 1, line 15 and Schedule 2, lines 5, 6 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Add lines 7 and 8. Enter the total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
10. Enter the amounts from Form 1040/1040-SR, lines 27a and Schedule 3, line 11; 1040-NR, Schedule 3, line 11 . . . . . . . . . . . . . . . . . . . . . . 10.
11. Subtract line 10 from line 9. If the result is zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Enter the larger of line 5 or line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Enter the smaller of line 2 or line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Is the amount on line 13 of this worksheet more than the amount on line 1?
No. Subtract line 13 from line 1. Enter the result. .................................................................... 14.

Yes. Enter -0-.
15. Enter the total of the amounts from Form 8396, line 9, Form 8839, line 16, Form 5695, line 15 and Form 8859, line 3. Enter this
amount on line 4 of the Credit Limit Worksheet A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.
18014 10/28/2022 3:23 PM
Form 1040 K-1 Reconciliation Worksheet - Sch E, B, D, Form 4797 2021

Name DEAN A GLUESENKAMP Taxpayer Identification Number
Entity Name DEANS CAR CARE INC EIN Entity Type S CORPORATION Screen K1 K1 Unit 1
Activity Passive Activity Type NOT PASSIVE Entire disposition of activity
Current Year PY Suspended Disallowed PY Suspended Disallowed PY Suspended Disallowed Tax
Amount Basis Loss Basis Limitation At-risk Loss At-risk Limitation Passive Loss Loss Limitation Return
Ordinary business income/-loss 10,719 10,719

Net rental real estate income/-loss
Other net rental income/-loss
Guaranteed payments
Section 179 expense
Disallowed Section 179 expense
Depletion
Preproductive period expense
Reforestation expense deduct
Other deductions
Unreimbursed expenses
Other inc/loss - Schedule E
Debt financed acquisition
Dependent care benefits
10,719 10,719
Royalties
Depletion
Interest Income
Tax-exempt interest income
Dividend Income
Qualified dividends (1040, Page 2)
Short-term capital gain/-loss

Long-term capital gain/-loss
28% capital gain/-loss
4797 Part I
4797 Part II
Section 179/280F recapture
18014 10/28/2022 3:23 PM
Form 1040 K-1 Reconciliation Worksheet - Form 1040, Sch A, Form 4952 2021
Other portfolio income/-loss

Other income/-loss
Penalty on early withdrawal
Federal income tax withheld

Undistributed capital gains credit
Recapture of low-income housing cr
Recapture of indian employment cr
Recapture of employ child care cr
Recapture of new markets cr
Recapture of alt motor vehicle cr
Recapture of alt fuel veh refueling cr
Cash contributions 142 142

Cap gain prop (20%)
Real estate taxes
State and local tax withheld paid
Foreign taxes
Investment int from 4952

Investment income adjustment
Investment expenses
18014 10/28/2022 3:23 PM
Form 1040 K-1 Reconciliation Worksheet - Form 4684, Sch SE, Misc, Credits 2021
Form 4684 lt loss trade/business

Form 4684 lt loss income producing
Form 4684 long-term gain
Form 4684 st loss income producing
Net earnings from self-employ

Gross farming or fishing inc
Gross nonfarm income
Self-employed medical insurance

Shareholder med ins not on Form W2
Other tax-exempt income
Nondeductible expenses 288 288
Cash & market security distrib
Property distributions 40,311 40,311
Repayment of shareholder loans
Dependent care benefits (Form 2441)
18014 10/28/2022 3:23 PM
Form 1040 K-1 Reconciliation Worksheet - Sch E, B, D, Form 4797 2021

Name KRISTINA M PEREZ Taxpayer Identification Number
Ordinary business income/-loss 11,157 11,157

Net rental real estate income/-loss
Guaranteed payments
Section 179 expense
Depletion
Reforestation expense deduct
Other deductions
Other inc/loss - Schedule E
11,157 11,157
Royalties
Depletion
Interest Income
Dividend Income
Short-term capital gain/-loss

Long-term capital gain/-loss
28% capital gain/-loss
4797 Part I
4797 Part II
Section 179/280F recapture
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Form 1040 K-1 Reconciliation Worksheet - Form 1040, Sch A, Form 4952 2021

Other income/-loss

Cash contributions 148 148

Cap gain prop (20%)
Real estate taxes
Foreign taxes

Investment expenses
18014 10/28/2022 3:23 PM
Form 1040 K-1 Reconciliation Worksheet - Form 4684, Sch SE, Misc, Credits 2021
Form 4684 lt loss trade/business

Form 4684 lt loss income producing
Form 4684 st loss income producing
Net earnings from self-employ

Gross farming or fishing inc

Cash & market security distrib
18014 10/28/2022 3:23 PM
Schedule E Qualified Business Income Calculation Worksheet 2021

Property Description Form/Schedule Unit
LOMBARD ST E 1
1. Schedule E, Page 1, Net rental real estate income or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 18,305
Additions for qualified business income:
2. Form 4797, Ordinary income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
Prior year suspended losses utilized this year:
3. Passive suspended losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. At-Risk suspended losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Section 179 expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Total additions to net profit or (loss). Add lines 2 through 5. .......................................................... 6.
Subtractions for qualified business income

7. Form 4797, Ordinary loss (includes share of net 1231 loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
10. Total subtraction to net profit or (loss). Add lines 7 through 9. ......................................................... 10.
11. Qualified business income for this activity. Line 1 plus line 6 less line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 18,305
Client Copy
Beginning of Year End of Year
Carryovers: Pre -2018 After 2017 Allowed loss Pre -2018 After 2017 QBI Portion of
Passive activity: (A) (B) (C) (D) (E) Allowed Losses
Operating
Form 4797, Part II
Section 1231 loss
At-Risk:
Operating
Form 4797, Part II
Section 1231 loss
Section 179 expense
Other:
Section 179 expense
Amount to Form 8995, line 3 or Schedule C (Form 8995-A), line 2 qualified business loss carryforward
18014 10/28/2022 3:23 PM
Schedule E K-1 Reconciliation Worksheet - Qualified Business Income 2021

Screen K1QBI QBI Items from Basis Limit At-risk Limit Passive Qualified Prior Year Suspended QBI Losses Allowed
Amount Schedule K-1 Adjustment Adjustment Limitation Business Income Passive / 179 Basis At-risk
Ordinary business inc/-loss 10,719 10,719 10,719
Net rental real estate inc/-loss
Royalties
Section 1231 gain (loss)
Section 179 expense
Disallowed Section 179 exp
Other income (loss)
Other income/-loss Form 1040
Reserved
Other deductions
4797 ordinary income / -loss
Depletion
UPE + Debt financed acquisit
Deductible part of SE tax
Self-employed health insurance
Self-employed qualified plans
Ordinary gains on distribution
10,719
Form 8995 or 8995-A Qualified business net (loss) carryforward from prior years
Form 8995, line 3 or Form 8995-A (Schedule C), line 2
Pre -TCJA Post- TCJA Pre -TCJA Post - TCJA Pre -TCJA Post- TCJA
Suspended Loss Carryforwards Passive Passive Basis Basis At-Risk At-Risk Other carryovers
Section 179 expense
Depletion
Section 59(e)(2) expenditure
Preproductive period exp
Reforestation expense ded
Other deductions
Dependent care expense
Section 1231 loss
18014 10/28/2022 3:23 PM
Schedule E K-1 Reconciliation Worksheet - Qualified Business Income 2021

Screen K1QBI QBI Items from Basis Limit At-risk Limit Passive Qualified Prior Year Suspended QBI Losses Allowed
Amount Schedule K-1 Adjustment Adjustment Limitation Business Income Passive / 179 Basis At-risk
Ordinary business inc/-loss 11,157 11,157 11,157
Net rental real estate inc/-loss
Royalties
Section 1231 gain (loss)
Section 179 expense
Disallowed Section 179 exp
Other income (loss)
Other income/-loss Form 1040
Reserved
Other deductions
4797 ordinary income / -loss
Depletion
UPE + Debt financed acquisit
Deductible part of SE tax
Self-employed health insurance
Self-employed qualified plans
Ordinary gains on distribution
11,157
Form 8995 or 8995-A Qualified business net (loss) carryforward from prior years
Form 8995, line 3 or Form 8995-A (Schedule C), line 2
Pre -TCJA Post- TCJA Pre -TCJA Post - TCJA Pre -TCJA Post- TCJA
Suspended Loss Carryforwards Passive Passive Basis Basis At-Risk At-Risk Other carryovers
Section 179 expense
Depletion
Section 59(e)(2) expenditure
Preproductive period exp
Reforestation expense ded
Other deductions
Dependent care expense
Section 1231 loss
18014 10/28/2022 3:23 PM
Form 1040 Rent and Royalty Reconciliation 2021

Name Taxpayer identification number
Property description Unit 1 Ownership Percentage
LOMBARD ST T, S, J J Business Use Percentage
Passive type: ACTIVE PARTICIPATION State OR Personal Use Percentage
1. Physical address: 2. Property Use Information:
Street . . . . . . . . . . . . . . . . 1506 NE LOMARD ST Fair Rental Days . . . . . . . . . . . . . . . . . . . . . .365
City, state, zip . . . . . . . . . . PORTLAND OR 97211 Personal Use Days . . . . . . . . . . . . . . . . . . .
Property type: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SELF-RENTAL QJV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Column A Column B Column C (Column A - B - C)

Vacation
Total Nonbusiness Home / Personal Income / Expenses
Income: Income/Expense Expenses Use Expenses Reported on Schedule E
3. Rents received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71,072 71,072
4. Royalties received . . . . . . . . . . . . . . . . . . . . . . . . . . .
Expenses:
5. Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Auto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Auto and travel (total) . . . . . . . . . . . . . . . . . . . . . . . .
7. Cleaning and maintenance . . . . . . . . . . . . . . . . . .
8. Commissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Legal and other professional fees . . . . . . . . . . .
11. Management fees . . . . . . . . . . . . . . . . . . . . . . . . . . .
Client Copy
Mortgage interest from 1098 . . . . . . . . . . . . . . . . 21,029
Refinancing points on 1098 . . . . . . . . . . . . . . . . .
12. Mortgage interest paid to banks, etc. . . . . . . . . 21,029 21,029
Other mortgage interest . . . . . . . . . . . . . . . . . . . . .
Other interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,495
Refinancing points . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified mortgage insurance . . . . . . . . . . . . . . .
13. Other interest (total) . . . . . . . . . . . . . . . . . . . . . . . . . 12,495 12,495
14. Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15. Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Real estate taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . .
All other taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,234
16. Taxes (total) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,234 6,234
17. Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18. Depreciation expense or depletion . . . . . . . . . . 13,009 13,009
19. Other (list)
20. Total expenses. Add lines 5 through 19 . . . . . . . 52,767 52,767

21. Income or (loss) from rental or royalty properties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,305
18014 10/28/2022 3:23 PM
Form 1040 Self-Employed Health Insurance Deduction Worksheet 2021

Name of person with self-employment income (as shown on Form 1040, 1040-SR, or 1040-NR) Taxpayer Identification Number
DEAN A GLUESENKAMP
Description DEANS CAR CARE INC Form/Schedule K Unit number 1
1. Enter the total amount paid in 2021 for health insurance coverage established under your business (or the S-corporation
in which you were a more-than-2% shareholder) for 2021 for you, your spouse, and your dependents. Your insurance also
can cover your child who was under age 27 at the end of 2021, even if the child was not your dependent. But do not
include the following.
Amounts for any month you were eligible to participate in a health plan subsidized by your or your
spouse's employer or the employer of either your dependent or your child who was under the age
of 27 at the end of 2021.
Any amounts paid from retirement plan distributions that were nontaxable because you are a
retired public safety officer.
Any qualified health insurance coverage payments that you included on Form 8885, line 4, to claim
the HCTC or on Form 14095 to receive a reimbursement of the HCTC during the year.
Any advance monthly payments of the HCTC that your health plan administrator received from the
IRS, as shown on Form 1099-H, Health Coverage Tax Credit (HCTC) Advance Payments
Any qualified health insurance coverage payments you paid for eligible coverage months for
which you received the benefit of the HCTC monthly advance payment program.
Any payments for qualified long-term care insurance (see line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 8,600
2. For coverage under a qualified long-term care insurance contract, enter for each person covered the
smaller of the following amounts.
a) Total payments made for that person during the year.
Client Copy
b) The amount shown below. Use the person's age at the end of the tax year.
$450 ----if that person is age 40 or younger
$850 ----if age 41 to 50
$1,690 ----if age 51 to 60
$4,520 ----if age 61 to 70
$5,640 ----if age 71 or older
Don't include payments for any month you were eligible to participate in a long-term care
insurance plan subsidized by your or your spouse's employer or the employer of either your
dependent or your child who was under the age of 27 at the end of 2021. If more than one person
is covered, figure separately the amount to enter for each person. Then enter the total of those amounts . . . . . . 2.
3. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 8,600
4. Enter your net profit* and any other earned income from the trade or business under which the
insurance plan is established. Don't include Conservation Reserve Program payments exempt from
self-employment tax. If the business is an S Corporation, skip to line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Enter the total of all net profits* from: Schedule C, line 31; Schedule F, line 34; or Sch K-1 (1065),
box 14, Code A; plus any other income allocable to the profitable businesses. Don't include Conservation Reserve
Program payments exempt from self-employment tax. Don't include any net losses shown on these schedules. . . . . . 5.
6. Divide line 4 by line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Multiply Schedule 1, line 15 by the percentage on line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Subtract line 7 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Enter the amount, if any, from Schedule 1, line 16 attributable to the same trade or business in which the health
insurance plan is established . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
10. Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
11. Enter your Medicare wages (Form W-2, box 5) from an S corporation in which you are a more-than-2% shareholder
and in which the health insurance plan is established . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 43,800
12. Enter the amount from Form 2555, line 45, attributable to the amount entered on line 4 or 11 above . . . . . . . . . . . . . . . . . . . 12.
13. Subtract line 12 from line 10 or 11, whichever applies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 43,800
14. Enter the smaller of line 3 or line 13 here and on Schedule 1, line 17
Don't include this amount in figuring any medical expense deduction on Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. 8,600
* If you used either optional method to figure your net earnings from self-employment from any business, do not enter your net profit from the
business. Instead, enter the amount attributable to that business from Schedule SE (Form 1040), Part I, line 4b.
18014 10/28/2022 3:23 PM
Form 1040 Tax Refund Worksheet - 2021 State and Local Refunds 2022

OR
1. 2021 payments paid in 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. 2021 extension paid in 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. 2021 additional payment paid in 2022 . . . . . . . . . . . . . . . . . . . . 3.
4. Total 2021 payments paid in 2022 (sum of lines 1 through 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Total payments on the 2021 return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 6,456
6. Total 2021 overpayment/refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 1,822
7. 2021 refund attributable to tax paid in 2022 (line 4 divided by line 5 multiplied by line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. 2021 state/local tax refund attributable to tax paid in 2021 (line 6 minus line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1,822
1. 2021 payments paid in 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

5. Total payments on the 2021 return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Total 2021 overpayment/refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
8. 2021 state/local tax refund attributable to tax paid in 2021 (line 6 minus line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
1.
2.
3.
2021
2021
2021
Client Copy
payments paid in 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
extension paid in 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
additional payment paid in 2022 . . . . . . . . . . . . . . . . . . . . 3.
1. 2021 payments paid in 2022 ............................. 1.

1. 2021 payments paid in 2022 ............................. 1.

Total of ALL 2021 state/local tax refunds attributable to tax paid in 2022 (sum of lines 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total of ALL 2021 state/local tax refunds attributable to tax paid in 2021 (sum of lines 8; for 2022 Tax Refund Wrk) . . . . . . . . . 1,822
18014 10/28/2022 3:23 PM
Form 1040 Tax Refund Worksheet - No Tax Benefit Derived 2022


2021 State and Local Refunds Not Taxable in 2022 Due to AMT
1. Total refund attributable to 2021 (from total on Wrk 10, Tax Refund Wrk - 2021 State and Local Refunds) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 1,822
2. 2021 regular tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 7,831
3. 2021 AMT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 0
4. 2021 Total Tax (line 2 + line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 7,831
5. 2021 Federal Marginal Tax Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 0.120
6. Tentative no benefit (line 3 divided by line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 0
7. Adjustment (smaller of line 1 or line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 0
8. Recalculated 2021 Itemized Deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 0
9. Recalculated 2021 Taxable Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. 0
10. Recalculated 2021 Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. 0
Recalculated 2021 Tax using Sch D Tax Wrk or QDCGTW
Recalculated 2021 Form 8615 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Recalculated 2021 Schedule J . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Recalculated 2021 AMT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 0
12. New 2021 Total Tax (line 10 + line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 0
13. 2021 state and local refunds not taxable in 2022 due to AMT (equals line 7, if line 12 < or = line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 0
The amount from Line 13 will carry to the 2022 Tax Refund Worksheet
Client Copy
2021 State and Local Refunds Not Taxable in 2022 Due to Zero Tax
1. Total refund attributable to 2021 (from total on Wrk 10, Tax Refund Wrk - 2021 State and Local Refunds) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. 2021 regular tax after credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Recalculated 2021 tax after credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Difference, if any (line 2 - line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. 2021 state and local refunds not taxable in 2022 due to zero tax (equals line 1, if line 4 = zero) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
2021 State and Local Refunds Not Taxable in 2022 Due to Sch A Tax Deduction Limitation
1. 2021 Schedule A line 5d - state and local taxes before limitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1. 12,171
2. Total refund attributable to 2021 (from total on Wrk 10, Tax Refund Wrk - 2021 State and Local Refunds) . . . . . . . . . . . 2. 1,822
3. Difference, if any (line 1 - line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. 10,349
4. 2021 Schedule A line 5e - limited state and local taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4. 10,000
5. Difference, if any (line 3 - line 4) (If line 5 >= zero, refund not taxable, skip to line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5. 349
6. No Taxable Benefit Amount (Combine Line 2 + Line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. 2021 state/local refunds not taxable in 2022 due to Sch A tax limitation (equals (line 2, if line 5 >= zero) or (line 6, if line 6 is > zero)) 7. 1,822
18014 Gluesenkamp, Dean A & Kristina M 10/28/2022 3:23 PM
Federal Statements
Form 1040, Dividend Income
Payer
Ordinary Qualified Section 199A
Dividends Dividends Dividends
ROBINHOOD SECURITIES LLC
$ 12 $ 12 $
TOTAL
$ 12 $ 12 $
Client Copy
Federal Statements
Schedule A, Line 5a - State and Local Taxes
Description Amount
STATE WITHHOLDING ON W-2S $ 6,527
TOTAL INCOME TAXES* 6,527
GENERAL SALES TAX 1,093

TOTAL SALES TAXES 1,093
*INCOME TAXES ARE BEING DEDUCTED
Schedule A, Line 8a - Home Mortgage Interest & Points From Form 1098
Description Amount
FLAGSTAR $ 12,581
TOTAL $ 12,581
Schedule A, Line 11 - Charitable Contributions by Cash or Check

Description Amount
Client Copy
SKAMANIA FAIR BOARD $
BRIDGE OF THE GODS
CASH CONT FROM K-1 - DEANS CAR CARE INC 142
CASH CONT FROM K-1 - DEANS CAR CARE INC 148
TOTAL $ 290
Federal Statements
Deans Car Care Inc

Form W-2, Box 12
Description Amount
EMPLOYEE SALARY REDUCTION SECTION 408(P) CONTRIBUTIONS $ 1,314
TOTAL $ 1,314
Deans Car Care Inc

Form W-2, Box 14 - Other
Description Amount
STATEWIDE TRANSIT TAX: OR $ 42
MEDICAL INSURANCE PREMIUMS 8,600
TOTAL $ 8,642
Client Copy
Federal Statements
Deans Car Care Inc

Form W-2, Box 12
Description Amount
EMPLOYEE SALARY REDUCTION SECTION 408(P) CONTRIBUTIONS $ 5,100
TOTAL $ 5,100
Deans Car Care Inc

Form W-2, Box 14 - Other
Description Amount
STATEWIDE TRANSIT TAX: OR $ 29
TOTAL $ 29
Client Copy
Federal Asset Report
FYE: 12/31/2021 Lombard St
Date Bus Sec Basis

Asset Description In Service Cost % 179 Bonus for Depr PerConv Meth Prior Current
Prior MACRS:
1 Building 2/28/18 474,884 474,884 39 MM S/L 35,007 12,177
3 Improvements 2/28/18 32,450 32,450 39 MM S/L 2,392 832
507,334 507,334 37,399 13,009
Other Depreciation:
2 Land 2/28/18 344,685 344,685 0 -- Land 0 0
Total Other Depreciation 344,685 344,685 0 0
Total ACRS and Other Depreciation 344,685 344,685 0 0
Grand Totals 852,019 852,019 37,399 13,009

Less: Dispositions and Transfers 0 0 0 0
Less: Start-up/Org Expense 0 0 0 0
Net Grand Totals 852,019 852,019 37,399 13,009
Client Copy
Bonus Depreciation Report
Date In Tax Bus Tax Sec Current Prior Tax - Basis

Asset Property Description Service Cost Pct 179 Exp Bonus Bonus for Depr
3 Improvements 2/28/18 32,450 0 0 0 32,450
Grand Total 32,450 0 0 0 32,450
Client Copy
AMT Asset Report
Date Bus Sec Basis

Asset Description In Service Cost % 179 Bonus for Depr PerConv Meth Prior Current
Prior MACRS:
1 Building 2/28/18 474,884 474,884 39 MM S/L 35,007 12,177
3 Improvements 2/28/18 32,450 32,450 39 MM S/L 2,392 832
507,334 507,334 37,399 13,009
Other Depreciation:
2 Land 2/28/18 0 0 0 HY 0 0
Total Other Depreciation 0 0 0 0
Total ACRS and Other Depreciation 0 0 0 0
Grand Totals 507,334 507,334 37,399 13,009

Less: Dispositions and Transfers 0 0 0 0
Net Grand Totals 507,334 507,334 37,399 13,009
Client Copy
Depreciation Adjustment Report
FYE: 12/31/2021 All Business Activities
AMT
Adjustments/
Form Unit Asset Description Tax AMT Preferences
MACRS Adjustments:
E 1 1 Building 12,177 12,177 0
E 1 3 Improvements 832 832 0
13,009 13,009 0
Client Copy
Future Depreciation Report FYE: 12/31/22
Date In
Asset Description Service Cost Tax AMT
Prior MACRS:
1 Building 2/28/18 474,884 12,176 12,176
3 Improvements 2/28/18 32,450 832 832
507,334 13,008 13,008
Other Depreciation:
2 Land 2/28/18 344,685 0 0
Total Other Depreciation 344,685 0 0
Total ACRS and Other Depreciation 344,685 0 0
Grand Totals 852,019 13,008 13,008
Client Copy
18014 10/28/2022 3:23 PM
Form 1040 K1 Detail Summary Report, Page 1 2021

Activity
Passthrough Entity Name EIN Entity Type Passive Activity Type Disposed
A DEANS CAR CARE INC S CORPORATION NOT PASSIVE
B DEANS CAR CARE INC S CORPORATION NOT PASSIVE
C
D
Form / Schedule / Worksheet
Form 1040: A B C D
Other Income: TOTALS:
Other portfolio income (loss) Form 1040, Sch 1, Line 8
Other income (loss) - 1040, Sch 1 Form 1040, Sch 1, Line 8
Net operating loss carryover - regular Form 1040, Sch 1, Line 8
Net operating loss carryover - AMT Form 6251, Line 2f
Prior Year Basis Items Form 1040, Sch 1, Line 8
Basis Adjustment Form 1040, Sch 1, Line 8
Prior Year At-Risk Items Form 1040, Sch 1, Line 8
At-risk adjustment Form 1040, Sch 1, Line 8
PAL adjustment Form 1040, Sch 1, Line 8
PTP adjustment Form 1040, Sch 1, Line 8
Self-employed health insurance deduction:

Self-employed medical insurance Form 1040, Sch 1, Line 16
SE Health Ins Ded Wrk, Line 1
Client Copy
Penalty for early withdrawal of savings:
Penalty for early withdrawal Form 1040, Sch 1, Line 17
Prior Year Basis Losses Form 1040, Sch 1, Line 17
Prior Year At-Risk Losses Form 1040, Sch 1, Line 17

Back up withholding Form 1040, Line 25c
Trust paid fed estimated tax

Form 4562:
Section 179 expenses Form 4562, line 6
Prior Year Basis Losses Form 4562, line 6
Basis Adjustment Form 4562, line 6
Prior Year At-Risk Losses Form 4562, line 6
At-risk adjustment Form 4562, line 6
Section 179 carryover Form 4562, line 10
Business income - basis adjustment Form 4562, line 11
Business income - At-risk adjustment Form 4562, line 11
Miscellaneous Items:
Section 179 exp ded allow in PY Form 4797, Part IV, Line 33
Section 179 recomputed depreciation Form 4797, Part IV, Line 34
Section 280F expense in PY Form 4797, Part IV, Line 33
Section 280F recomputed depreciation Form 4797, Part IV, Line 34
Qualified Business Income Deduction Information:

Section 199A REIT dividends Form 8995, Line 6
Form 8995-A, Line 28
18014 10/28/2022 3:23 PM
Form
1040 K1 Detail Summary Report, Page 3 2021
Passthrough Entity Name EIN Entity Type Passive Activity Type Disposed
A DEANS CAR CARE INC S CORPORATION NOT PASSIVE
B DEANS CAR CARE INC S CORPORATION NOT PASSIVE
C
D
Form / Schedule / Worksheet A B C D
Schedule B: TOTALS:
Interest Schedule B, Line 1
Tax-exempt interest Form 1040, Line 2a
Ordinary dividends Schedule B, Line 5
Qualified dividends Form 1040, Line 2a
Schedule A:
Medical and dental:
Shareholder medical ins - no W2 Schedule A, line 1
Basis adjustment Schedule A, line 1
At-risk adjustment Schedule A, line 1
Taxes:
State/local withholding taxes Schedule A, line 5a
State/local w/h - Sch K1 Basis Adj Schedule A, line 5a
State/local w/h - Sch K1 At-Risk Adj Schedule A, line 5a
Real estate taxes Schedule A, line 5b
RE tax - Sch K1 Basis Adj Schedule A, line 5b
RE tax - Sch K1 At-Risk Adj Schedule A, line 5b
Total foreign taxes paid/accrued
Client Copy
Schedule A, line 6
Foreign taxes - K1 Basis Adj Schedule A, line 6
Foreign taxes - K1 At-Risk Adj Schedule A, line 6
Gifts to Charity:
Cash contributions 142 148 290 Schedule A, line 11
Cash contrib Basis Adj Schedule A, line 11
Cash contrib Risk Adj Schedule A, line 11
Cash contributions (30%) Schedule A, line 11
30% Cash contrib Basis Adj Schedule A, line 11
30% Cash contrib Risk Adj Schedule A, line 11
Noncash contribution (50%) Schedule A, line 12
50% Noncash contrib Basis Adj Schedule A, line 12
50% Noncash contrib Risk Adj Schedule A, line 12
Noncash contribution (30%) Schedule A, line 12
30% Noncash contrib Basis Adj Schedule A, line 12
30% Noncash contrib Risk Adj Schedule A, line 12
50% Cap Gain (30%) Schedule A, line 12
50% Cap Gain 30% Basis Adj Schedule A, line 12
50% Cap Gain 30% Risk Adj Schedule A, line 12
Capital gain property (20%) Schedule A, line 12
20% Contrib Basis Adj Schedule A, line 12
20% Contrib Risk Adj Schedule A, line 12
Other Itemized Deductions:

Portfolio deduction not misc Schedule A, line 16
Basis Adjustment Schedule A, line 16
At-Risk Adjustment Schedule A, line 16
Estate tax deduction Schedule A, line 16
Excess deductions - 67(e) expense Form 1040, Sch 1, line 22
Excess deductions - other itemized Schedule A, line 16

18014 10/28/2022 3:23 PM
Form 1040 Salaries & Wages Report 2021

T/S Employer Federal Wages Federal Withheld Soc Sec Wages
A T DEANS CAR CARE INC 42,486 5,040 43,800
B S DEANS CAR CARE INC 28,900 10,008 34,000
C
D
E
F
G
H
I
J
K
L
M
Taxpayer 42,486 5,040 43,800

Spouse 28,900 10,008 34,000
Totals 71,386 15,048 77,800
Soc Sec Withheld Medicare Wages Medicare Withheld Soc Sec Tips Allocated Tips Dep Care Ben Other, Box 14
A 2,716 43,800 635 8,642
B 2,108 34,000 493 29
Client Copy
C
D
E
F
G
H
I
J
K
L
M
Taxpayer 2,716 43,800 635 8,642

Spouse 2,108 34,000 493 29
Totals 4,824 77,800 1,128 8,671
State State Wages State Withheld Name of Locality Local Wages Local Withheld
A OR 42,486 3,456
B OR 28,900 3,000
C
D
E
F
G
H
I
J
K
L
M
Taxpayer 42,486 3,456

Spouse 28,900 3,000
Totals 71,386 6,456
18014 10/28/2022 3:23 PM
Form 1040 Two Year Comparison Report - Schedule E Page 1 2020 & 2021
Property description Unit
LOMBARD ST 1
Income 2020 2021 Differences

1. Total rents and royalties received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 49,899 71,072 21,173
Expenses
2. Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Auto and travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Cleaning and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Commissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Legal and other professional fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Management fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Mortgage interest paid to banks, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. 21,656 21,029 -627
10. Other interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. 12,983 12,495 -488
11. Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 5,498 6,234 736
14. Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.
15. Depreciation expense or depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 13,008 13,009 1
16. Other expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.
17. Total expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. 53,145 52,767 -378
Client Copy
Profit/(loss)
18. Income or (loss) from rental real estate or royalty properties . . 18. -3,246 18,305 21,551
19. Deductible rental real estate loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. -3,246 3,246
Carryover
20. Vacation home operating expenses carryover to next year . . . . . . . . 20.
21. Vacation home excess casualty & depreciation carryover to next yr 21.
18014 10/28/2022 3:23 PM
Form 1040 Recovery Rebate Credit Worksheet 2021

Filing Status MFJ Dependents on 1040/SR page 1 with:
1040/1040-SR Line 11 (AGI) 105,593 a. Social security numbers a. 1
EIP 3: Tp/Joint 0 b. Adoption taxpayer id no. (ATIN) b.
Spouse c. Line a + b. Total qualifying dependents c. 1
Total EIP 3 reported on line 13 below 0 d. Multiply line c by $1,400, enter on line 7 below d. 1,400
1. Can you be claimed as a dependent on another person's 2021 return? If filing a joint return, go to line 2.
No. Go to line 2.
Yes. STOP You can't take the credit. Don't complete the rest of this worksheet and don't enter any amount on line 30.
2. Does your 2021 return include a social security number* that was issued on or before the due date of your 2021 return (including extensions)
for you and, if filing joint return, your spouse?
X Yes. Go to line 6. No. If you are filing a joint return, go to line 3. If you aren't filing a joint return, go to line 5.
3. Was at least one of you a member of the U.S. Armed Forces at any time during 2021, and does at least one of you
have a social security number* that was issued on or before the due date of your 2021 return (including extensions)?
Yes. Your credit is not limited. Go to line 6. No. Go to line 4.
4. Does one of you have a social number* that was issued on or before the due date of your 2021 return (including extensions)?
Yes. Your credit is limited. Go to line 6. No. Go to line 5.
5. Do you have any dependents listed in the Dependents section on page 1 of Form 1040 or 1040-SR for whom you entered a social security number*
that was issued on or before the due date of your 2021 return (including extensions) or an adoption taxpayer identification number?
Yes. Enter zero on line 6 and go to line 7.
No. STOP You can't take the credit. Don't complete the rest of this worksheet and don't enter any amount on line 30.
Client Copy
6. Enter:
$1,400 if single, head of household, married filing separately, or qualifying widow(er)
$1,400 if if married filing jointly and you answered "Yes" to question 4, or
$2,800 if married filing jointly and you answered "Yes" to question 2 or 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 2,800
7. Multiply $1,400 by the number of dependents listed in the Dependents section on page 1 of Form 1040 or
1040-SR for whom you entered a social security number* that was issued on or before the due date of
your 2021 return (excluding extensions) or an adoption taxpayer identification number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 1,400
8. Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 4,200
9. Is the amount on line 11 of Form 1040 or 1040-SR more than the amount shown below for your filing status?
Single or Married filing separately - $75,000
Married filing jointly or qualifying widow(er) - $150,000
Head of household - $112,500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
Yes. Enter the amount from line 11 of Form 1040 or 1040-SR and go to line 10
X No. Enter the amount from line 8 on line 12 and skip lines 10 and 11
10. Is line 9 more than the amount shown below for your filing status?
Single or married filing separately - $80,000
Head of household - $120,000
Yes. STOP You can’t take the credit. Don’t complete the rest of this worksheet and
don't enter any amount on line 30
No. Subtract line 9 from the amount shown above for your filing status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
11. Divide line 10 by the amount shown below for your filing status. Enter the result as a decimal (rounded to at least
2 places).
Single or married filing separately - $5,000
Head of household - $7,500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Multiply line 8 by line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 4,200
13. Enter the amount, if any, of the EIP 3 that was issued to you. If filing a joint return, include the amount, if any, of
your spouse’s EIP 3. You may refer to Notice 1444-C or your tax account information at IRS.gov/Account for the
amount to enter here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 0
14. Recovery rebate credit. Subtract line 13 from line 12. If zero or less, enter -0-. If line 13 is more than line 12,
you don’t have to pay back the difference. Enter the result here and, if more than zero, on line 30 of Form 1040 or
1040-SR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. 4,200
*A valid social security number is one that is valid for employment in the United States and is issued before the due date of your 2021 return (including extensions).
18014 10/28/2022 3:23 PM
Form 1040 Tax Return History Report - Page 1 2021

Name DEAN A GLUESENKAMP & KRISTINA M PEREZ Taxpayer Identification Number
2018 2019 2020 2021 2022 PROJECTED
Filing Status MFJ MFJ MFJ MFJ MFJ
Salaries and wages . . . . . . . . . . . . . . . . . . . 38,121 39,382 68,533 71,386 71,386
Interest income . . . . . . . . . . . . . . . . . . . . . . . . 92 207 207
Dividend income . . . . . . . . . . . . . . . . . . . . . . . 12 12
Business income/loss . . . . . . . . . . . . . . . . 16,748
Capital gains/losses . . . . . . . . . . . . . . . . . . 2,407
Other gains/losses . . . . . . . . . . . . . . . . . . .
IRA distributions, pensions, annuities . .
Rent, royalty, farm rental income . . . . . . 5,507 -191 -3,246 18,305 40,181
Partnership/S corp income . . . . . . . . . . . . 60,983 56,900 22,389 21,876 *
Estate or trust income . . . . . . . . . . . . . . . . . *
Farm income/loss . . . . . . . . . . . . . . . . . . . . .
Other income/loss . . . . . . . . . . . . . . . . . . . . . 478
Total income . . . . . . . . . . . . . . . . . . . . . . . . 121,837 96,091 87,768 114,193 111,786
Total adjustments . . . . . . . . . . . . . . . . . . . . . 1,183 187 8,600 8,600
Adjusted gross income . . . . . . . . . . . . . . 120,654 96,091 87,581 105,593 103,186
Allowable itemized deductions . . . . 24,137 23,649 23,117 28,951 29,131
Standard deduction . . . . . . . . . . . . . . . . . . . . 24,000 24,400 24,800 ** 25,100 ** 25,900
Itemized or standard deduction taken 24,137 24,400 24,800 28,951 29,131
Exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Taxable income before Qual Bus Inc Ded 96,517 71,691 62,781 76,642 74,055
Qual Bus Inc Ded 16,411 11,342 3,829 8,036
Taxable income . . . . . . . . . . . . . . . . . . . . . . 80,106 60,349 58,952 68,606 74,055
* Amts in the projected col generate from the federal Tax Projection Wrk (TPW); this field is incl in the total Sch E income/loss amt on the TPW. ** Incl Charitable Contribution w/standard deduction.
18014 10/28/2022 3:23 PM
Form 1040 Tax Return History Report - Page 2 2021

Name DEAN A GLUESENKAMP & KRISTINA M PEREZ Taxpayer Identification Number
2018 2019 2020 2021 2022 PROJECTED
Taxable income . . . . . . . . . . . . . . . . . . . . . . . 80,106 60,349 58,952 68,606 74,055
Tax on taxable income and Form 8962 . 9,507 6,851 6,682 7,831 8,474
Alternative minimum tax . . . . . . . . . . . . . . . . .
Total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,000
Net tax liability . . . . . . . . . . . . . . . . . . . . . . . . . 9,507 6,851 6,682 7,831 6,474
Self-employment taxes . . . . . . . . . . . . . . . . . 2,366
Other taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,416
Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,289 6,851 6,682 7,831 6,474
Income tax withheld . . . . . . . . . . . . . . . . . . . . . 8,839 14,080 14,463 15,048 15,048
Estimated tax payments . . . . . . . . . . . . . . . . .
Other payments . . . . . . . . . . . . . . . . . . . . . . . . . 7,800
Total payments . . . . . . . . . . . . . . . . . . . . . . . . . 8,839 14,080 14,463 22,848 15,048
Total due/-refund . . . . . . . . . . . . . . . . . . . . . . . 5,450 -7,229 -7,781 -15,017 -8,574
Penalties and interest . . . . . . . . . . . . . . . . . . . 67
Net tax due/-refund . . . . . . . . . . . . . . . . . . . . . 5,517 -7,229 -7,781 -15,017 -8,574
Refund applied to estimated tax payments
Refund received . . . . . . . . . . . . . . . . . . . . . . . . . -7,229 -7,781 -15,017
Marginal tax rate . . . . . . . . . . . . . . . . . . . . . . . % 22.0 % 12.0 % 12.0 % 12.0 % 12.0 %
Effective tax rate . . . . . . . . . . . . . . . . . . . . . . . % 18.0 % 11.0 % 11.0 % 11.0 % 9.0 %
18014 10/28/2022 3:23 PM
Form 1040 Reconciliation Worksheet - Taxable Income & Tax 2021

Tax brackets are rates applied to specific levels of taxable income. Various rates apply to different portions of the total taxable income. Type of income,
further determines the rate applied. Marginal Tax Rate is the tax paid on the highest level of taxable income. This worksheet details how tax is calculated on
ordinary income and capital gain income, the percentage of taxable income, marginal tax rate and the tax method used.
Filing Status MARRIED FILING JOINTLY Tax Pct Total Tax (ln 27) divided Total Taxable Income (ln 19) 11.0 %
Tax Method QUALIFIED DIVIDENDS & CAPITAL GAIN TAX WORKSHEET
Tax using ordinary and capital gains rates exceeds tax using only ordinary rates. Taxable income is taxed only using ordinary rates:
Tax using capital gains rates Tax using Ordinary rates Tax savings
Marginal Amount of Income

Taxable Amount Tax Rate Tax on Taxable Income Marginal Tax Rate - Income Range to Next Tax Bracket
Ordinary Income . . . . . . 68,594 12.0 % 7,831 $19,900 - $81,050 12,456
Capital Income . . . . . . . 12 0.0 % $0 - $81,050 81,038
Capital Income - 1250 . %
Capital Income - 1202 . %
*Tax on taxable ordinary income under $100,000 is determined using IRS Tax Tables that impose the same amount of tax on taxable income within $50
intervals. Therefore, the column (b) Tax may not be calculated as column (a) times the applicable line tax rate.
Income taxed at ordinary rates (a) Taxable Income (b) Tax*

1. 10% rate . . . MAXIMUM 1a. 19,900 1b. 1,993
Client Copy
. . . . . . . . . TAXABLE
. . . . . . . . . INCOME
. . . . . . . .PER
. . . . THIS
. . . . .BRACKET:
. . . . . . . . . .$19,900
....................................
2. 12% rate . . . MAXIMUM
. . . . . . . . . TAXABLE
. . . . . . . . . INCOME
. . . . . . . .PER
. . . . THIS
. . . . .BRACKET:
. . . . . . . . . .$61,150
.................................... 2a. 48,694 2b. 5,838
3. 22% rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a. 3b.
4. 24% rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a. 4b.
5. 32% rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a. 5b.
6. 35% rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a. 6b.
7. 37% rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a. 7b.
8. Total ordinary taxable income and ordinary tax. Add lines 1 through 7 . . . . . . . . . . . . . . . . 8a. 68,594 8b. 7,831
Income taxed at capital gains rates
9. 0% capital gains rate . . . . MAXIMUM
. . . . . . . . . TAXABLE
. . . . . . . . . INCOME
. . . . . . . .PER
. . . .THIS
. . . . .BRACKET:
. . . . . . . . . $80,800
........................ 9a. 12 9b. 0
10. 15% capital gains rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10a. 10b.
11. 20% capital gains rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11a. 11b.
12. 25% capital gains rate . . . . . . . . . . . . . . . . . . . . .Unrecaptured
. . . . . . . . . . .Section
. . . . . . .1250
. . . . Gain
........................... 12a. 12b.
13. 28% capital gains rate . . . . . . . . . . . . . . . . . . . . .Small business stock, collectibles
................................................. 13a. 13b.
14. Total taxable capital gains and capital gains tax. Add lines 9 through 13 14a. 12 14b.
Total taxable income

15. Total ordinary taxable income. Enter the amount from line 8a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 68,594
16. Total capital gains taxable income. Enter the amount from line 14a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. 12
17. Add lines 15 and 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. 68,606
18. Enter the net foreign exclusion amount from the Foreign Earned Income Tax Worksheet, line 2c. . . . . . . . . . . . . . . . . . . . . . . . . . 18.
19. Taxable income reported on 1040/1040SR, line 15, (1040NR, line 15). Subtract line 18 from line 17. . . . . . . . . . . . . . . . . . . . . . 19. 68,606
Total tax
20. Total ordinary tax. Enter the amount from line 8b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. 7,831
21. Total capital gains tax. Enter the amount from line 14b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.
22. Tax on child's interest and dividend. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.
23. Tax on lump-sum distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.
24. Other taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.
25. Add lines 20 through 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25. 7,831
26. Enter the tax allocated to the net exclusion amount from the Foreign Earned Income Tax Worksheet, line 5. . . . . . . . . . . . . . . 26.
27. Total tax reported on 1040/1040SR, line 16, (1040NR, line 16). Subtract line 26 from line 25. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27. 7,831
18014 10/28/2022 3:23 PM
Oregon Individual Return Summary

Tax Year 2021
DEAN A GLUESENKAMP KRISTINA M PEREZ
Income, Adjustments, and Deductions

Total income .................................................................................................................... 102,967
Additions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtractions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102,967
Itemized X or Standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,980
Other deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Taxable income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78,957
Tax, Payments, and Credits
Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,012
Installment sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,012
Nonrefundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623
Net income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,389
Income tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,456
Estimate and extension payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Refundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755
Total payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,211
Amount due/-refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -1,822
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Overpayment applied to 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Oregon 529 plan deposit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Net amt due/-refund before int/pen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -1,822
Amount Due /-Refund
Underpayment of estimates penalty ............................................................................................
Late filing interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Failure to file penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Failure to pay penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net amount due/-refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -1,822
Miscellaneous Information 2022 Estimates
Tax form ............... 40N 1st qtr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residency type, taxpayer . NONRESIDENT 2nd qtr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Residency type, spouse NONRESIDENT 3rd qtr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Direct debit withdrawal date . . . . . . . . . . . . . . . . . 4th qtr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amended return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total estimates .........................................
Nonresident/Part-year percentage . . . . . . . . . . . . . 97.500 % ..........
Marginal tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.750 %
Effective tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.825 %
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2021 Form OR-40-N Oregon Department of Revenue
Oregon Individual Income Tax Return for Nonresidents
Page 1 of 11 • Use UPPERCASE letters.• Use blue or black ink. • Print actual size (100%). • Don't submit photocopies or use staples.
Fiscal year ending date (MM/DD/YYYY) Space for 2-D barcode—do not write in box below
X Extension filed
Form OR-24
Amended return.
If amending for an NOL, tax Federal Form 8379
year the NOL was generated:
NOL tax year (YYYY) Federal Form 8886
Disaster relief
Calculated with “as if” federal return Military
Short-year tax election Employment

exception
First name Initial Date of birth (MM/DD/YYYY)
DEAN A **/**/1985
Last name
GLUESENKAMP
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Social Security number (SSN)
First time using this SSN (see instructions) Applied for ITIN Deceased
Spouse’s first name Initial Spouse’s date of birth (MM/DD/YYYY)
KRISTINA M **/**/1988
Spouse’s last name
PEREZ
Spouse’s Social Security number (SSN)
First time using this SSN (see instructions) Applied for ITIN Deceased
Current address
City State ZIP code
WASHOUGAL WA 98671
Country Phone
Filing status (check only one box)
1. Single 2. X Married filing jointly 3. Married filing separately (enter spouse’s information )
4. Head of household (with qualifying dependent) 5. Qualifying widow(er) with dependent child
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Last name Social Security number (SSN)
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Note: Reprint page 1 if you make changes to this page.
Exemptions
6a. Credits for yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a. 1
Check boxes that apply: X Regular Severely disabled Someone else can claim you as a dependent.
6b. Credits for your spouse: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b. 1
Check boxes that apply: X Regular Severely disabled Someone else can claim you as a dependent.
Dependents. List your dependents in order from youngest to oldest. If more than three, check this box and include Schedule OR-ADD-DEP.
Dependent 1: First name Initial Dependent 1: Last name
CIRO W GLUESENKAMP
Dependent 1: Date of birth (MM/DD/YYYY) Dependent 1: Social Security number (SSN) Code *
Copy
Dependent 1: Check if child
SD has a qualifying disability
Dependent 2: First name ent 2: Last name
has a qualifying disability
Dependent 3: First name Initial Dependent 3: Last name
has a qualifying disability
*Dependent relationship code (see instructions).
6c. Total number of dependents .......................................................................................................... 6c. 1
6d. Total number of dependent children with a qualifying disability (see instructions) .................................................... 6d. 0
6e. Total exemptions. Add 6a through 6d .......................................................................................... Total 6e. 3
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Income Federal column (F) Oregon column (S)
7. Wages, salaries, and other pay for work from federal Form 1040 or 1040-SR, line 1. Include all Forms W-2.
7F. 71,386.00 7S. 71,386.00
8. Interest income from Form 1040 or 1040-SR, line 2b.
8F. 207.00 8S.
9. Dividend income from Form 1040 or 1040-SR, line 3b.
9F. 12.00 9S.
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10. State and local income tax refunds from federal Schedule 1, line 1.
10F. 10S.
11. Alimony received from federal Schedule 1, line 2a.
11F. 11S.
12. Business income or loss from federal Schedule 1, line 3.
12F. 12S.
13. Capital gain or loss from Form 1040 or 1040-SR, line 7.
13F. 2,407.00 13S.
14. Other gains or losses from federal Schedule 1, line 4.
14F. 14S.
15. IRA distributions from Form 1040 or 1040-SR, line 4b.
15F. 15S.
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Federal column (F) Oregon column (S)

16. Pensions and annuities from Form 1040 or 1040-SR, line 5b.
16F. 16S.
17. Schedule E income or loss from federal Schedule 1, line 5.
17F. 40,181.00 17S. 40,181.00
18. Farm income or loss from federal Schedule 1, line 6.
18F. 18S.
19.
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Social Security benefits from Form 1040 or 1040-SR, line 6b; and unemployment and other income from federal Schedule 1, lines 7 and 9.
19F. 19S.
20. Total income. Add lines 7 through 19.
20F. 114,193.00 20S. 111,567.00
Adjustments
21. IRA or SEP and SIMPLE contributions, from federal Schedule 1, lines 16 and 20.
21F. 21S.
22. Education deductions from federal Schedule 1, lines 11 and 21.
22F. 22S.
23. Moving expenses from federal Schedule 1, line 14.
23F. 0.00 23S. 0.00
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Federal column (F) Oregon column (S)

24. Deduction for self-employment tax from federal Schedule 1, line 15.
24F. 24S.
25. Self-employed health insurance deduction from federal Schedule 1, line 17.
25F. 8,600.00 25S. 8,600.00
26. Alimony paid from federal Schedule 1, line 19a.
26F. 26S.
27F.
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27. Total adjustments from Schedule OR-ASC-NP, Section A.
0.00 27S. 0.00
28. Total adjustments. Add lines 21 through 27.
28F. 8,600.00 28S. 8,600.00
29. Income after adjustments. Line 20 minus line 28.
29F. 105,593.00 29S. 102,967.00
Additions
30. Total additions from Schedule OR-ASC-NP, Section B.
30F. 30S.
31. Income after additions. Add lines 29 and 30.
31F. 105,593.00 31S. 102,967.00
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Subtractions Federal column (F) Oregon column (S)
32. Social Security and tier 1 Railroad Retirement Board benefits included on line 19F.
32F.
33. Total subtractions from Schedule OR-ASC-NP, Section C.
33F. 33S.
34. Income after subtractions. Line 31 minus lines 32 and 33.
34F. 105,593.00 34S. 102,967.00
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35. Oregon percentage (see instructions; not more than 100.0%).
Percentage
35. 97.5 %
Deductions and modifications
36. Amount from line 34S .............................................................. 36. 102,967.00
37. Oregon itemized deductions. Enter your Oregon itemized deductions from
Schedule OR-A, line 23. If you are not itemizing your deductions, enter 0 . . . . . . . . 37. 24,595.00
38. Standard deduction. Enter your standard deduction (see instructions) .......... 38.
You were: 38a. 65 or older 38b. Blind Your spouse was: 38c. 65 or older 38d. Blind
39. Enter the larger of line 37 or 38 .................................................... 39. 24,595.00
40. 2021 federal tax liability (see instructions) ....................................... 40. 31.00
41. Total modifications from Schedule OR-ASC-NP, Section D ....................... 41.
42. Deductions and modifications multiplied by the Oregon percentage

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42. 24,010.00
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43. Charitable art donation (see instructions) .......................................... 43.
44. Total deductions and modifications. Add lines 42 and 43 . . . . . . . . . . . . . . . . . . . . . . . . . . 44. 24,010.00
45. Oregon taxable income. Line 36 minus line 44. If line 44 is more than
line 36, enter 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45. 78,957.00
Oregon tax
46. Tax. Check the appropriate box if you’re using an alternative method to
calculate your tax (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46. 6,012.00
46a. Schedule OR-FIA-40-N 46b. Worksheet FCG 46c. X Schedule OR-PTE-NR
47.
48.
Interest on certain installment sales
Total tax before credits. Add lines 46 and 47

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...............................................
......................................
47.
48. 6,012.00
Standard and carryforward credits
49. Exemption credit (see instructions) ................................................ 49. 623.00
50. Total standard credits from Schedule OR-ASC-NP, Section E .................... 50.
51. Total standard credits. Add lines 49 and 50 ....................................... 51. 623.00
52. Tax minus standard credits. Line 48 minus line 51. If line 51 is more than
line 48, enter 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52. 5,389.00
53. Total carryforward credits claimed this year from Schedule OR-ASC-NP, Section F.
Line 53 can’t be more than line 52 (see Schedule OR-ASC and
OR-ASC-NP Instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.
54. Tax after standard and carryforward credits. Line 52 minus line 53 ............... 54. 5,389.00
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55. Total credit recaptures claimed this year from Schedule OR-ASC-NP, Section G 55.
56. Tax after credit recaptures. Line 54 plus line 55 ................................... 56. 5,389.00
Payments and refundable credits
57. Oregon income tax withheld. Include a copy of your Forms W-2 and 1099 ..... 57. 6,456.00
58. Amount applied from your prior year’s tax refund .................................. 58.
59. Estimated tax payments for 2021. Include all payments you made prior to the
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filing date of this return, including real estate transactions. Do not include the
amount you already reported on line 58 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59.
60. Tax payments from a pass-through entity ......................................... 60.
61. Earned income credit (see instructions) ........................................... 61.
62. Kicker (Oregon surplus credit). Enter your kicker credit amount (see instructions).
If you elect to donate your kicker to the State School Fund, enter 0 and
see line 78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62. 755.00
63. Total refundable credits from Schedule OR-ASC-NP, Section H .................. 63.
64. Total payments and refundable credits. Add lines 57 through 63 . . . . . . . . . . . . . . . . . . 64. 7,211.00
Tax to pay or refund

65. Overpayment of tax. If line 56 is less than line 64, you overpaid.
Line 64 minus line 56 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65. 1,822.00
66. Net tax. If line 56 is more than line 64, you have tax to pay.
Line 56 minus line 64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.
67. Penalty and interest for filing or paying late (see instructions) ..................... 67.
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68. Interest on underpayment of estimated tax. Include Form OR-10 ................ 68.
Exception number from Form OR-10, line 1: 68a. Check box if you annualized: 68b.
69. Total penalty and interest due. Add lines 67 and 68 ............................... 69.
70. Net tax including penalty and interest.

Line 66 plus line 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . This is the amount you owe. 70. 0.00
71. Overpayment less penalty and interest.

Line 65 minus line 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . This is your refund. 71. 1,822.00
72. Estimated tax. Fill in the portion of line 71 you want applied to your open
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estimated tax account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.
73. Charitable checkoff donations from Schedule OR-DONATE, line 30 .............. 73.
74. Oregon 529 college savings plan deposits from Schedule OR-529
(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.
75. Total. Add lines 72 through 74. The total can’t be more than your refund
on line 71 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.
76. Net refund. Line 71 minus line 75 ...................... This is your net refund. 76. 1,822.00
Direct deposit
77. For direct deposit of your refund, see instructions. Check the box if the final deposit destination is outside the United States:
Type of account:
Account information:
X Checking or Routing number: Account number:
Savings
Kicker donation
78. If you elect to donate your kicker to the State School Fund, check this box. .... 78a.
Complete the kicker worksheet, located in the instructions, and enter the
amount here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . This election is irrevocable. 78b.
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Sign here. Under penalty of false swearing, I declare that the information in this return is true, correct, and complete.
Your signature
X
Date (MM/DD/YYYY)
Spouse’s signature
X
Date (MM/DD/YYYY)
Signature of preparer other than taxpayer
X HOLLY MCCALL
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Date (MM/DD/YYYY) Phone Preparer license number
10/28/2022 503-477-4396 ********

Preparer first name Initial Preparer last name
HOLLY MCCALL
Preparer address
5311 SE POWELL BLVD STE 101

City State ZIP code
PORTLAND OR 97206-2951
Signing this return does not grant your preparer the right to represent you or make decisions on your behalf. For more information, see the instructions for
the form on our website.
Important: Include a copy of your federal Form 1040, 1040-SR, 1040-X, or 1040-NR. We may adjust your return without it.
Pay the amount due (shown on line 70)

• Online: www.oregon.gov/dor.
• By mail: Payable to the Oregon Department of Revenue. Write “2021 Oregon Form OR-40-N” and the last four digits of your SSN or ITIN on your
check or money order. Include your payment with this return. Don’t use Form OR-40-V payment voucher if you’re mailing payment with your return.
Mail your return

• Non-2-D barcode. If the large 2-D barcode box on the first page of this form is blank:
– Mail tax-due returns to: Oregon Department of Revenue, PO Box 14555, Salem OR 97309-0940.
– Mail refund and no-tax-due returns to: Oregon Department of Revenue, PO Box 14700, Salem OR 97309-0930.
• 2-D barcode. If the large 2-D barcode box on the first page of this form is filled in:
– Mail tax-due returns to: Oregon Department of Revenue, PO Box 14720, Salem OR 97309-0463.
– Mail refund and no-tax-due returns to: Oregon Department of Revenue, PO Box 14710, Salem OR 97309-0460.
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Amended statement. Complete this Section only if you’re amending your 2021 return or filing with a new SSN.
If filing an amended return, use this space to explain what you’re changing. Include the return line numbers and the reason for each change. If your
filing status has changed, explain why. Include all supporting forms and schedules when you file your amended return, even if you haven’t changed
anything on them.
If filing with a new SSN, enter your former identification number.
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2021 Schedule OR-A Oregon Department of Revenue
Oregon Itemized Deductions
Last name
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Social Security number (SSN)
Read instructions carefully before completing. If you itemize, you must include this schedule with your Oregon return.
Medical and dental expenses

Caution! Don’t include expenses reimbursed or paid by others.
1. Medical and dental expenses (see instructions) ................................... 1. 13,999.00
2. Federal adjusted gross income (AGI). Enter the amount from Form OR-40, line 7;
or Form OR-40-N or OR-40-P, line 29F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 105,593.00
3. AGI threshold. Multiply line 2 by 7.5% (0.075) ..................................... 3. 7,919.00
4. Medical and dental expense deduction. Line 1 minus line 3. If line 3 is more
6,080.00
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than line 1, enter 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
Taxes you paid
5. State and local income taxes. Don’t include Oregon income tax! ............... 5.
6. Real estate taxes (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 5,644.00
7. Personal property taxes ............................................................ 7.
8. Reserved ........................................................................... 8.
9. Total income and property taxes. Add lines 5 through 8. Don’t enter more than
$10,000 ($5,000 if married filing separately) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. 5,644.00
10. Other taxes. List type and amount: ................................................ 10.
11. Taxes paid deduction. Add lines 9 and 10 ....................................... 11. 5,644.00
Continued on next page
150-101-007
(Rev. 08-23-21, ver. 01) 19482101011022
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2021 Schedule OR-A Oregon Department of Revenue
Interest you paid
12. Mortgage interest and points reported to you on federal Form 1098 . . . . . . . . . . . . . . . 12. 12,581.00
13. Mortgage interest not reported to you on federal Form 1098 ...................... 13.
14. Points not reported to you on federal Form 1098 .................................. 14.
15. Mortgage insurance premiums (see instructions) .................................. 15.
16. Investment interest, (see instructions) ............................................. 16.
17. Interest paid deduction. Add lines 12 through 16 ................................ 17. 12,581.00
Gifts to charity
18. Gifts by cash or check (see instructions)

Client Copy
.......................................... 18. 290.00
19. Gifts other than by cash or check, (see instructions) .............................. 19.
20. Carryover from prior year .......................................................... 20.
21. Total gifts to charity. Add lines 18 through 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. 290.00
Other miscellaneous deductions
22. List type and amount. Important! Don’t include employee business
expenses, tax preparation fees, or other deductions subject to the
2 percent of AGI limitation (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.
Oregon itemized deductions
23. Add lines 4, 11, 17, 21, and 22. Enter the amount from line 23 on Form OR-40,
line 16; or Form OR-40-N or OR-40-P, line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. 24,595.00
150-101-007
(Rev. 08-23-21, ver. 01) 19482101021022
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2021 Schedule OR-PTE-NR Office use only

Page 1 of 2, 150-101-367 Oregon Department of Revenue 18142101011022
(Rev. 08-18-21, ver. 01)
Qualified Business Income Reduced
Tax Rate Schedule for Oregon Nonresidents
Submit original form–do not submit photocopy
First name Initial Last name Social Security number (SSN)
DEAN A GLUESENKAMP
Spouse first name (if joint return) Initial Spouse last name Spouse SSN if joint return
KRISTINA M PEREZ
To qualify for the reduced tax rate, you must complete both sections and submit this form with your Oregon Form OR-40-N.
Section A—Qualifying business information

List each qualifying sole proprietorship (SP), S corporation (SC), or partnership (P) along with the business code number (or NAICS
code), number of qualifying employees, entity type, nonpassive income (or loss), and Section 179 expenses attributable to each
qualifying business. Only list businesses that qualify. See instructions for more information.
Business code no. No. of qualifying employees
1. Qualifying business name FEIN
DEANS CAR CARE INC 5
Entity type: a. Nonpassive loss b. Section 179 expense c. Nonpassive income
SC (SP, SC, or P only) 11,157.00
FEIN Business code no. No. of qualifying employees
2. Qualifying business name
DEANS CAR CARE INC 5
Client y
Entity type: a. Nonpassive loss ense c. Nonpassive income
SC (SP, SC, or P only) 10,719.00
usines No. of qualifying employees
3. Qualifying business name

(SP, SC, or P only)
Qualifying business name FEIN Business code no. No. of qualifying employees
4.

(SP, SC, or P only)
Business code no. No. of qualifying employees

5. Qualifying business name FEIN

(SP, SC, or P only)
6. Total for each column a. Nonpassive loss total b. Section 179 expense total c. Nonpassive income total
(a), (b), and (c): 21,876.00
7. Enter the amount from line 6c .................................. 7. 21,876.00
8. Add lines 6a and 6b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Line 7 minus line 8 ............................................... 9. 21,876.00
If line 9 is 0 or less, you can’t use the reduced tax rate. Return to the Form OR-40-N, line 46, and complete the rest of the form. If line
9 is more than 0, enter this amount on line 2b of the Tax worksheet in Section B on page 2.
–You must include this schedule with your Oregon Form OR-40-N–
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2021 Schedule OR-PTE-NR

Page 2 of 2, 150-101-367 Oregon Department of Revenue 18142101021022
(Rev. 08-18-21, ver. 01)
Use the following worksheet to calculate your tax. See the instructions for information on completing the worksheet.
Section B—Tax worksheet

Complete each applicable line to determine your tax.
1. Enter Oregon taxable income from Form OR-40-N, line 45 . . . . . 1a. 78,957.00
2. Enter the total qualifying income from line 9 of Section A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b. 21,876.00
3. Line 1a minus line 2b. Don’t enter less than 0 . . . . . . . . . . . . . . . . . . 3a. 57,081.00
4. Enter the amount of the depreciation addition from
Form OR-40-N, line 30S, that is attributable to qualifying
businesses on lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a. 4b.
5. Line 3a minus line 4a. Don’t enter less than 0 . . . . . . . . . . . . . . . . . . 5a. 57,081.00
6. Line 2b plus line 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b. 21,876.00
7. Enter the amount of the depreciation subtraction from
Form OR-40-N, line 33S, that is attributable to qualifying
businesses on lines 7a and 7b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a. 7b.
8. Line 5a plus line 7a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a. 57,081.00
9. Line 6b minus line 7b. Don’t enter less than 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b. 21,876.00
10. Tax for income on line 8a (see instructions).
This is your tax on nonqualifying income. . . . . . . . . . . . . . . . . . . . . . 10a. 4,481.00
Client Copy
11. Tax for income on line 9b using tax rate chart B in the instructions.
This is your tax on qualifying income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11b. 1,531.00
12. Line 10a plus line 11b.
This is your total tax with the reduced rate for
qualifying income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12a. 6,012.00
13. Tax for income on line 1a (see instructions) . . . . . . . . . . . . . . . . . . 13a. 6,395.00
14. Enter the lesser of line 12a or line 13a . . . . . . . . . . . . . . . . . . . . . . . . 14a. 6,012.00
If line 12a is less than 13a, enter the amount from line 14a on line 46 of Form OR-40-N and check box 46c. If line 13a is less than 12a,
it isn't more beneficial for you to use the reduced tax rate. Enter the amount from line 13a on line 46 of Form OR-40-N and complete
the rest of the return.
Note: You can’t amend to revoke or make the election after your original return is filed unless you file an amended return on or before
the original due date of April 18, 2022, or if filing on extension, October 17, 2022. If you amend after the due date for the return,
including extensions, you must use the tax on line 12a of the Tax worksheet even if line 13a is less.
–You must include this schedule with your Oregon Form OR-40-N–
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Form 40 Oregon Federal Tax Liability Worksheet 2021


Part A: Federal Tax Subtraction
1. Federal tax liability after credits * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 7,831

2. Nonrefundable CTC (Form 1040, line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 7,831
4. Excess advance premium tax credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Subtract line 4 from line 3. If zero or less, enter zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 7,831
6. Tax on qualified retirement plans and any recapture taxes included on the federal return * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 7,831
8. Child tax credit (Schedule 8812, line 14e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3,600
9. Refundable education credit * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
10. Sum of all 2021 tax rebates (economic stimulus payments) received from the federal government . . . . . . . . . . . . . . . . . . . . . 10. 4,200
11. Total premium tax credit * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Refundable credit for child and dependent care expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Add lines 8 through 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. 7,800
14. Subtract line 13 from line 7. If zero or less, enter zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. 31
15. Maximum allowable tax liability subtraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 7,050
16. Enter the smaller of line 14 or 15 here, this is the federal tax liability subtraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. 31
Part B: Federal Tax Paid for a Prior Year
1.
2.
3.
Client Copy
Maximum allowable tax liability subtraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Federal tax liability subtraction from Part A, line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 2 from line 1. If zero or less, enter zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
2.
3.
0
0
0
4. Federal tax paid in 2021 for a prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Enter the smaller of line 3 or 4 here and on Form OR-ASC (subtraction code 309) or
Form OR-ASC-NP (modification code 602) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 0
Part C: Foreign tax subtraction
1. Maximum allowable tax liability subtraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0

2. Federal tax liability subtraction from Part A, line 11 plus Part B line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 0
3. Subtract line 2 from line 1. If zero or less, enter zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 0
4. Foreign tax paid, but not more than $3,000 ($1,500 if married/RDP filing separately) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Enter the smaller of line 3 or line 4 here and on Form OR-ASC (subtraction code 311) or
Form OR-ASC-NP (modification code 603) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 0
* For registered domestic partner returns the amount of federal tax liability comes from the return filed with the IRS not the "As if" return.
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Form 40 Oregon K-1 Reconciliation Worksheet - Schedule E, B, D, Form 4797

(For part-year and nonresident taxpayers)
2021
Ordinary business income or -loss 10,719 10,719

Net rental real estate income or -loss
Other net rental income or -loss
Guaranteed payments
Section 179 expense
Depletion
Reforestation expense deduction
Other deductions
Other income or loss - Schedule E
10,719 10,719
Royalties
Depletion
Interest Income
Dividend Income
Short-term capital gain or -loss

Long-term capital gain or -loss
28% capital loss
Section 1256 contracts and straddles
Form 4797 Part I

Form 4797 Part II
Sections 179 and 280F recapture
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Form 40 Oregon K-1 Reconciliation Worksheet - Form 1040, Schedule A, Form 4952, 8903
2021

Other income/-loss

Cash contributions (50%/60%) 142 142

Cap gain prop (20%)
Real estate taxes
Foreign taxes

Investment expenses
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Form 40 Oregon K-1 Reconciliation Worksheet - Form 4684, Schedule SE, Misc, Credits
2021
Form 4684 Lt loss trade/business

Form 4684 Lt loss income producing
Form 4684 St loss income producing
Net earnings from self-employment

Gross farming or fishing income

Cash and marketable security distrib
18014 10/28/2022 3:23 PM
Form 40 Oregon K-1 Reconciliation Worksheet - Schedule E, B, D, Form 4797

2021
Ordinary business income or -loss 11,157 11,157

Net rental real estate income or -loss
Other net rental income or -loss
Guaranteed payments
Section 179 expense
Depletion
Reforestation expense deduction
Other deductions
Other income or loss - Schedule E
11,157 11,157
Royalties
Depletion
Interest Income
Dividend Income
Short-term capital gain or -loss

Long-term capital gain or -loss
28% capital loss
Section 1256 contracts and straddles
Form 4797 Part I

Form 4797 Part II
Sections 179 and 280F recapture
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Form 40 Oregon K-1 Reconciliation Worksheet - Form 1040, Schedule A, Form 4952, 8903
2021

Other income/-loss

Cash contributions (50%/60%) 148 148

Cap gain prop (20%)
Real estate taxes
Foreign taxes

Investment expenses
18014 10/28/2022 3:23 PM
Form 40 Oregon K-1 Reconciliation Worksheet - Form 4684, Schedule SE, Misc, Credits
2021
Form 4684 Lt loss trade/business

Form 4684 Lt loss income producing
Form 4684 St loss income producing
Net earnings from self-employment

Gross farming or fishing income

Cash and marketable security distrib
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Form 40 Oregon Surplus Credit Worksheet 2021


Taxpayer/Joint Spouse
1. Tax liability from 2020 return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 4,352

2. Credit for income taxes paid to another state from 2020 return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Total 2020 tax after credit for taxes paid to another state (Subtract line 2 from line 1) . . . . . . . . . 3. 4,352
4. Percentage of AGI (x.xx) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 1.00 1.00
5. Share of tax after credit for taxes paid to another state (Multiply line 3 by line 4) . . . . . . . . . . . . . . 5. 4,352
6. Oregon surplus credit percentage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 0.173 0.173
7. Credit amount (Multiply line 5 by line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 755
8. Total Credit (Add amounts from line 7, Taxpayer and Spouse columns) 8. 755
Client Copy
OR Asset Report
Date Basis OR OR Federal Difference

Asset Description In Service Cost for Depr Prior Current Current Fed - OR
Prior MACRS:
1 Building 2/28/18 474,884 474,884 35,007 12,177 12,177 0
3 Improvements 2/28/18 32,450 32,450 2,392 832 832 0
507,334 507,334 37,399 13,009 13,009 0
Other Depreciation:
2 Land 2/28/18 344,685 344,685 0 0 0 0
Total Other Depreciation 344,685 344,685 0 0 0 0
Total ACRS and Other Depreciation 344,685 344,685 0 0 0 0
Grand Totals 852,019 852,019 37,399 13,009 13,009 0

Less: Dispositions 0 0 0 0 0 0
Less: Start-up/Org Expense 0 0 0 0 0 0
Net Grand Totals 852,019 852,019 37,399 13,009 13,009 0
Client Copy
OR Future Depreciation Report FYE: 12/31/22
Date In
Asset Description Service Cost OR
Prior MACRS:
1 Building 2/28/18 474,884 12,176
3 Improvements 2/28/18 32,450 832
507,334 13,008
Other Depreciation:
2 Land 2/28/18 344,685 0
Total Other Depreciation 344,685 0
Total ACRS and Other Depreciation 344,685 0
Grand Totals 852,019 13,008
Client Copy
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Form 40 Oregon Interest and Dividend Reconciliation Report 2021

DEAN A GLUESENKAMP
Description Resident Amount PY/NR Amount
TAXABLE INTEREST INCOME
ADVANTIS CREDIT UNION 103 0
CONSOLIDATED FEDERAL CREDIT UNION 104 0
TOTAL TAXABLE INTEREST INCOME.................. 207 0
TAXABLE ORDINARY DIVIDEND INCOME
MISCELLANEOUS DIVIDEND 12 0
TOTAL TAXABLE ORDINARY DIVIDEND INCOME......... 12 0
Client Copy
Page 1 Of 1
Summary Resident Amount PY/NR Amount
TOTAL TAXABLE INTEREST INCOME 207 0
TOTAL TAXABLE ORDINARY DIVIDEND INCOME 12 0
Note: Report does not include income from Form 8814 or allocated instate amounts from Form 8621.
18014 10/28/2022 3:23 PM
Form 40N Oregon Nonresident Two Year Comparison Report 2020 & 2021

2020 2021 Differences
87,581 105,593 18,012
Income
1. Total federal income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

2. Total Oregon income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 76,674 102,967 26,293
3. Income allocation factor 3. 87.50 % 97.50 %
4. Oregon source income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 76,674 102,967 26,293
5. Itemized or standard deduction . . . . . . . . . . . . . . . . . . . . . . . . 5. 18,494 24,595 6,101
6. Other deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 3,082 31 -3,051
7. Deductions before allocation . . . . . . . . . . . . . . . . . . . . . . . . 7. 21,576 24,626 3,050
8. Deductions after allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 18,879 24,010 5,131
9. Other deductions not allocated . . . . . . . . . . . . . . . . . . . . . . . . . 9.
Tax
10. Total deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. 18,879 24,010 5,131

11. Taxable income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 57,795 78,957 21,162
12. Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 4,352 6,012 1,660
13. Other taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Nonrefundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. 368 623 255
15. Net tax 15. 3,984 5,389 1,405
16. Income tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. 6,215 6,456 241
17. Other payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.
18. Estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.
Payments
19. Refundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 755 755

20. Total payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. 6,215 7,211 996
Client Copy
21. Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.
22. Penalties and interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.
23. Net tax due/-refund 23. -2,231 -1,822 409
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FORM SP-2021
COMBINED TAX RETURN FOR INDIVIDUALS
MULTNOMAH COUNTY BUSINESS INCOME TAX
CITY OF PORTLAND BUSINESS LICENSE TAX
2021 CALENDAR YEAR | DUE DATE: APRIL 18, 2022
File online at Pro.Portland.gov
TAX YEAR
From: 1/1/2021 to 12/31/2021 OFFICIAL USE ONLY
ACCOUNT # SOCIAL SECURITY NUMBER NAICS
532400
NAME
PEREZ GLUSENKAMP ENTERPRISES LLC
MAILING ADDRESS Check if changed CITY STATE/PROV ZIP CODE
1506 NE LOMBARD ST PORTLAND OR 97211
INITIAL RETURN FINAL RETURN AMENDED RETURN EXTENSION FILED
PART I - GROSS INCOME
1. Multnomah County gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 71,072

2. Total gross income from all Schedules C, D, E, and F in all locations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 71,072
3. Multnomah County apportionment percentage (line 1 ÷ line 2) (Cannot be more than 1.0) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.000000
4. City of Portland gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 71,072
5. Total gross income reported on line 2 (if different see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 71,072
6. City of Portland apportionment percentage (line 4 ÷ line 5) (Cannot be more than 1.0) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.000000
Annual Exemption Request: (see instructions)
X Multnomah County
City of Portland
Reason:
Reason:
2 Client Copy
GROSS BUSINESS INCOME FROM ALL SOURCES IS < $100,000
PART II - NET INCOME
7. Net income or (loss) from Federal Schedule C (Attach all Schedule Cs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8. Net income or (loss) from Federal Schedule F (Attach all Schedule Fs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9. Deductible SE tax and Oregon modifications (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SEE STMT 1
..................... 9 -8,600
10. Net income or (loss) from Federal Schedule B and Schedule D (Attach Schedule B and D) . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11. Net income or (loss) from Federal Schedule E (Attach all Schedule Es) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 18,305
12. Taxes based on or measured by net income add-back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13. Adjusted net income (sum of line 7 through line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 9,705
PART III - MULTNOMAH COUNTY BUSINESS INCOME TAX
14. Multnomah County modifications (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15. Multnomah County net business income (sum of line 13 and line 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16. Owner's compensation deduction (Number of owners: 1 X 2) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ( )
17. Multnomah County subject net income (sum of line 15 and line 16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18. Multnomah County apportioned net income (line 17 x line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19. Net operating loss deduction (max 75% of line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 ( )
20. Income subject to tax (sum of line 18 and line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21. Multnomah County Business Income tax (line 20 x tax rate of 2%) MINIMUM $100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Page 1 of 2, SP-2021 Rev. 01/25/2022

18014 10/28/2022 3:23 PM
PEREZ GLUSENKAMP ENTERPRISES LLC
PART IV - CITY OF PORTLAND BUSINESS LICENSE TAX
22. City of Portland modifications (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

23. City of Portland net business income (sum of line 13 and line 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 9,705
24. Owner’s compensation deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 ( 7,279 )
25. City of Portland subject net income (sum of line 23 and line 24) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2,426
26. City of Portland apportioned net income (line 25 x line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2,426
27. Net operating loss deduction (max 75% of line 26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 ( )
28. Income subject to tax (sum of line 26 and line 27) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2,426
29. City of Portland Business License tax (line 28 x tax rate of 2.6%) MINIMUM $100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 100
30. Heavy Vehicle Use tax (HVT) (see HVT Schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
31. Residential Rental Registration fee (attach City Schedule R) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
32. Total of City of Portland taxes and fees (sum of line 29 through line 31) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 100
PART V - TAX DUE / REFUND
33. Total business taxes and fees (sum of line 21 and line 32) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 100
34. Late payment or late filing penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
35. Underpayment penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36. Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
37. Quarterly estimated payments and other prepayments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 ( )
38. If the sum of lines 33-37 is negative, this is the amount you overpaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 ( )
39. Please enter the amount from line 38 you want:
a. Refunded to you (for direct deposit of your refund, file your tax return online at Pro.Portland.gov) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39a
Client Copy
b. Applied to tax year 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39b
40. If the sum of lines 33-37 is positive, this is the amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 100
PART VI - SIGNATURE
The undersigned declares that the information given on this report is true. The undersigned is authorized to act as a representative of
the filer. Filers of incomplete returns may be subject to civil penalties of up to $500.
Signature of Taxfiler Date
Taxfiler Email Taxfiler Phone Number
Signature of Preparer HOLLY MCCALL Date 10/28/22

Preparer's Name MCCALL TAX & BOOKKEEPING SERVICES, INC. Preparer Phone Number 503-477-4396
Mail completed tax return (with supporting tax pages and payment, if applicable) to:
Revenue Division
111 SW Columbia St. Suite 600
Portland, OR 97201-5840
Phone (503) 823-5157 |FAX (503) 823-5192 | TDD (503) 823-6868
Page 2 of 2, SP-2021 Rev. 01/25/2022

Oregon Statements
Statement 1 - Form SP - Oregon Modifications
Total
Description Amount
SELF EMPLOYMENT HEALTH INSURANCE $ -8,600
TOTAL $ -8,600
Client Copy
1
18014 10/28/2022 3:23 PM
Oregon Combined Report For Individuals (SP) Return Summary

Tax Year 2021
Portland Multnomah
Total income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,426

Income subject to tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,426
Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Late filing interest and penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Balance due/ -overpayment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 100
Total balance due/ -refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Overpayment applied to 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net amount due/-refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Client Copy
2022 Estimates
1st qtr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2nd qtr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3rd qtr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4th qtr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total estimates .......................................

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18014 10/28/2022 3:23 PM

1040 Department of the Treasury—Internal Revenue Service (99)

Form 1040 (2021) DEAN A GLUESENKAMP & KRISTINA M PEREZ Page 2

name  HOLLY MCCALL no.  503-477-4396 number (PIN) 

Phone no. Email address

SCHEDULE 1 Additional Income and Adjustments to Income OMB No. 1545-0074

Department of the Treasury  Attach to Form 1040, 1040-SR, or 1040-NR.

SCHEDULE A Itemized Deductions OMB No. 1545-0074

SCHEDULE D Capital Gains and Losses OMB No. 1545-0074

Name(s) shown on return Your social securit number

1a Totals for all short-term transactions reported on Form

8a Totals for all long-term transactions reported on Form

DEAN A GLUESENKAMP & KRISTINA M PEREZ

16 Combine lines 7 and 15 and enter the result ............................................................................ 16 2,407

17 Are lines 15 and 16 both gains?

• The loss on line 16; or .............................................................. 21 ( )

No. Complete the rest of Form 1040, 1040-SR, or 1040-NR.

Schedule D (Form 1040) 2021

Form 8949 Sales and Other Dispositions of Capital Assets

Department of the Treasury

DEAN A GLUESENKAMP & KRISTINA M PEREZ

SCHEDULE E Supplemental Income and Loss OMB No. 1545-0074

Department of the Treasury

DEAN A GLUESENKAMP & KRISTINA M PEREZ

Schedule E (Form 1040) 2021 Attachment Sequence No. 13 Page 2

DEAN A GLUESENKAMP & KRISTINA M PEREZ

A DEANS CAR CARE INC S X

SCHEDULE 8812 Credits for Qualifying Children OMB No. 1545-0074

Form 8995 Qualified Business Income Deduction OMB No. 1545-2294

Simplified Computation 2021

2 Total qualified business income or (loss). Combine lines 1i through 1v,

Form 8867 Paid Preparer’s Due Diligence Checklist

Form 7203 S Corporation Shareholder Stock and

Form 7203 S Corporation Shareholder Stock and

Form 1040 Tax Return Reconciliation Worksheet 2021

City, town or post office, state, and ZIP code.

Dependents on 6c not entered above . . . . . . .

Total. Add lines above 3

Form 1040 Tax Return Reconciliation Worksheet, Page 2 2021

Designee Designee's Name

Taxpayer Spouse Email address

Form 1040 Shareholder's Basis Worksheet Page 1 2021

Gain Recognized on Repayment of Shareholder Loan

Form 1040 Shareholder's Basis Worksheet Page 2 2021

Form 1040 Shareholder's Basis Worksheet Page 1 2021

Gain Recognized on Repayment of Shareholder Loan

Form 1040 Shareholder's Basis Worksheet Page 2 2021

Form 1040 Broker Reconciliation Worksheet 2021

Form 1040 Broker Capital Transactions Detail Summary Report 2021

Column A Column B Column C Column D Column E Total Col A - E*

DEAN A GLUESENKAMP & KRISTINA M PEREZ

Form 1040 General Sales Tax Deduction Worksheet 2021

Local Sales Tax Using IRS Tables

General Sales Tax Summary

Form 1040 K-1 Reconciliation Worksheet - Sch E, B, D, Form 4797 2021

Ordinary business income/-loss 10,719 10,719

Short-term capital gain/-loss

Other portfolio income/-loss

Federal income tax withheld

Cash contributions 142 142

Investment interest expense

Form 4684 lt loss trade/business