Tax Return 2019

1040 Tax Return Summary 2019
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Taxpayer Spouse
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Cesario Natividad JR Haydee N Natividad
XXX-XX-8489 XXX-XX-3006
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32010 NW Wascoe St
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North Plains, OR 97133
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2019 Federal Return Information Prepared: 03-29-2020
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Filing Status: Married Filing Jointly

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Wages, Salaries, Tips, etc.: $ 189,309
Total Income: $ 189,361
Total Adjustments: $ 3,300
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Adjusted Gross Income: $ 186,061

Total Deductions: $ 41,611
QBI Amount: $ 0
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Taxable Income: $ 144,450
Tax (before credits): $ 23,496
Total Non-Refundable Credits: $ 0
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Tax (after credits): $ 23,496
Earned Income Credit: $ 0
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Total Payments & Refundable Credits:$ 21,176

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Amount You Overpaid: $ 0
Your Tax Refund: $ 0
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Refund You Applied to 2020:
Amount of Tax Owed (balance due): $
$ 0
2,320
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Tax Rate (percentage): 22
State Return Information Resident State: OR

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State AGI Taxable Income Tax Refund Balance Due
OR $ 186,061 $ 143,695 $ 12,023 $ 3,245

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Form Department of the Treasury-Internal Revenue Service (99)
1040 U.S. Individual Income Tax Return 2019 OMB No. 1545-0074 IRS Use Only-Do not write or staple in this space.
Filing Single X Married filing jointly Married filing separately (MFS)
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Status Head of household (HOH) Qualifying widow(er) (QW)
Check only one If you checked the MFS box, enter the name of spouse. If you checked the HOH or QW box, enter the child's
box.
name if the qualifying person is a child but not your dependent.
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Your first name and middle initial Last name Your social security number
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Cesario Natividad JR 562-61-8489
If joint return, spouse's first name and middle initial Last name Spouse's social security number
Haydee N Natividad 361-60-3006

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
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32010 NW Wascoe St
Check here if you, or your spouse if filing
jointly, want $3 to go to this fund.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Checking a box below will not change your
tax or refund.
North Plains, OR 97133 You Spouse
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Foreign country name Foreign province/state/county Foreign postal code If more than four dependents,
see inst. & check here
Standard Someone can claim: You as a dependent Your spouse as a dependent
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Deduction Spouse itemizes on a separate return or you were a dual-status alien
You: Were born before January 2, 1955 Are blind
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Age/Blindness
Spouse: Was born before January 2, 1955 Is blind
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Dependents (see instructions): (4) check if qualifies for (see inst.):
(2) Social security number (3) Relationship to you
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(1) First name Last name Child tax credit
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Credit for other dependents
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1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . 1 189,309

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2a Tax-exempt interest . . . . . . 2a b Taxable interest . . . . . . . 2b 52
Standard 3a Qualified dividends . . . . . . . 3a b Ordinary dividends. . . . . . 3b
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Deduction
4a IRA distributions . . . . . . . . 4a b Taxable amount . . . . . . . 4b
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Single or Married
filing separately,
c Pensions and annuities . . . . 4c d Taxable amount . . . . . . . 4d
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$12,200
5a Social security benefits. . . . . 5a b Taxable amount . . . . . . . 5b
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jointly or
Qualifying
widow(er),
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7a
Capital gain or (loss). Attach Schedule D if required. If not required, check here
Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a

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$24,400
b Add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a. This is your total income ........... 7b 189,361
Head of
household, 8a Adjustments to income from Schedule 1, line 22 . . . . . . . . . . . . . . . . . . . . . . . 8a 3,300
$18,350
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b Subtract line 8a from line 7b. This is your adjusted gross income ........... 8b 186,061
If you checked
any box under
9 Standard deduction or itemized deductions (from Schedule A) 9 41,611
Standard
Deduction,
see instructions.
10 Qualified business income deduction. Attach Form 8995 or Form 8995-A. . . 10
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11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11a 41,611

b Taxable income. Subtract line 11a from line 8b. If zero or less, enter -0- . . . . . . . . . 11b 144,450
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2019)
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Form 1040 (2019) Cesario & Haydee N Natividad JR 562-61-8489 Page 2
12a Tax (see instructions). Check if any from:

1 Form(s) 8814 2 Form 4972 3 12a 23,496
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b Add Schedule 2, line 3, and line 12a and enter the total . . . . . . . . . . . . . . 12b 23,496
13a Child tax credit or credit for other dependents . . . . . . . . 13a
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b Add Schedule 3, line 7, and line 13a and enter the total . . . . . . . . . . . . . . 13b 0
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14 Subtract line 13b from line 12b. If zero or less, enter -0- . . . . . . . . . . . . . . . . 14 23,496
15 Other taxes, including self-employment tax, from Schedule 2, line 10 . . . . . . . . 15
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A16 Add lines 14 and 15. This is your total tax ..................... 16 23,496
17 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . . 17 21,176
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18 Other payments and refundable credits:
If you have
a qualifying
child, attach
a Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . 18a
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Sch. EIC.
If you have
b Additional child tax credit. Attach Schedule 8812 . . . . . . . 18b
nontaxable
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combat pay, c American opportunity credit from Form 8863, line 8 . . . . . . 18c
see
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instructions. d Schedule 3, line 14. . . . . . . . . . . . . . . . . . . . . . . . . . 18d
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e 18e
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Add lines 18a through 18d. These are your total other payments and refundable credits
19 Add lines 17 and 18e. These are your total payments ............ 19 21,176
Refund 20
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A 20
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If line 19 is more than line 16, subtract line 16 from line 19. This is the amount you overpaid. . . . . .
21 a Amount of line 20 you want refunded to you. If Form 8888 is attached, check here 21a
Direct deposit? b Routing number c Type: Checking Savings
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See
instructions. d Account number
22 Amount of line 20 you want applied to your 2020 estimated tax. . . . 22
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Amount 23 Amount you owe. Subtract line 19 from line 16. For details on how to pay, see instructions
...... 23 2,320
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You Owe
24 Estimated tax penalty (see instructions) . . . . . . . . . . . 24
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Third Party Do you want to allow another person (other than your paid preparer) to discuss this return with the IRS? See instructions. Yes.Complete below.
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Designee X No
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(Other than
paid preparer)
Sign
Designee's
name
Phone
no.
Personal identification
number (PIN)
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of
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my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information
Here of which preparer has any knowledge.
Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
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Joint return? Project Manager (see inst.)
See instructions.
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
Identity Protection PIN, enter it here
your records.
Project Manager08 (see inst.)
Phone no. 408-799-7992 Email address
Check if:
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Preparer's signature Date PTIN

Paid 3rd Party Designee
Preparer Preparer's name Phone no. Self-employed
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Use Only Firm's name

Firm's address
Firm's EIN
Go to www.irs.gov/Form1040SR for instructions and the latest information. Form 1040 (2019)
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SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
(Form 1040 or 1040-SR)
Attach to Form 1040 or 1040-SR.
2019
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Department of the Treasury Attachment
Internal Revenue Service Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 01
Name(s) shown on Form 1040 or 1040-SR Your social security number
Cesario & Haydee N Natividad JR 562-61-8489
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At any time during 2019, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any
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virtual currency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes ........................ 1
2a Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
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b
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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
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5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .............. 5
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
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8 Other income. List type and amount
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9 Combine lines 1 through 8. Enter here and on Form 1040 or 1040-SR, line 7a .................... 9 0
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Part II Adjustments to Income
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10 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
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11 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach
Form 2106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Health savings account deduction. Attach Form 8889 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3,300
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13 Moving expenses for members of the Armed Forces. Attach Form 3903 . . . . . . . . . . . . . . . . . . . . . . 13
14 Deductible part of self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
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16 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
17 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18a
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b Recipient's SSN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Date of original divorce or separation agreement (see instructions)
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19 IRA deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
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20 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
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22 Add lines 10 through 21. These are your adjustments to income. Enter here and on Form 1040 or
1040-SR, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
For Paperwork Reduction Act Notice, see your tax return instructions.
3,300
Schedule 1 (Form 1040 or 1040-SR) 2019
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SCHEDULE A Itemized Deductions OMB No. 1545-0074
(Form 1040 or 1040-SR) Go to www.irs.gov/ScheduleA for instructions and the latest information.
(Rev. January 2020)
Attach to Form 1040 or 1040-SR.
2019
Attachment
Department of the Treasury
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
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Name(s) shown on Form 1040 or 1040-SR Your social security number

Medical Caution: Do not include expenses reimbursed or paid by others.
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and 1 Medical and dental expenses (see instructions) . . . . . . . . . . . . . . . . 1
Dental
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2 Enter amount from Form 1040 or 1040-SR, line 8b . . 2
Expenses 3 Multiply line 2 by 7.5% (0.075) . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . . . . . . . . . . . . . 4
Taxes You 5 State and local taxes.
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Paid
A 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,
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check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a 13,391
b State and local real estate taxes (see instructions) . . . . . . . . . . . . . . 5b 3,881
c State and local personal property taxes . . . . . . . . . . . . . . . . . . . 5c
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d Add lines 5a through 5c . . . . . . . . . . . . . . . . . . . . . . . . . . . 5d 17,272
e Enter the smaller of line 5d or $10,000 ($5,000 if married filing
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separately) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5e 10,000
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6 Other taxes. List type and amount
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7 Add lines 5e and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 10,000
Interest 8 Home mortgage interest and points. If you didn't use all of your home
You Paid mortgage loan(s) to buy, build, or improve your home, see
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Caution: Your
mortgage interest instructions and check this box ....................
deduction may be a Home mortgage interest and points reported to you on Form 1098.
limited (see
instructions). See instructions if limited . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a 16,767
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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.,
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and address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8b
c Points not reported to you on Form 1098. See instructions for special
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d Mortgage insurance premiums (see instructions) . . . . . . . . . . . . . . .
e Add lines 8a through 8d . . . . . . . . . . . . . . . . . . . . . . . . . . .
8c
8d
8e 16,767
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9 Investment interest. Attach Form 4952 if required. See instructions ...... 9

10 Add lines 8e and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 16,767
Gifts to 11 Gifts by cash or check. If you made any gift of $250 or more, see
Charity
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instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 14,844
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 14,844
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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
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Other 16 Other - from list in instructions. List type and amount

Itemized
Deductions 16
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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 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 41,611
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 or 1040-SR) 2019
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2019 Form 1040-V Payment Voucher and Filing Instructions
Cesario & Haydee N Natividad JR
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Due date:
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07-15-2020
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Balance due:
$2,320
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Transaction method:
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To pay by check or money order, write "2019 Form 1040," your
name, address, SSN or ITIN, and daytime phone number on the
payment, make it payable to "United States Treasury," and
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mail with Form 1040-V to the address below. To pay using
your bank account (at no extra cost to you), go to
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IRS.gov/Payments. To pay by credit or debit card (for a

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fee), go to 1040paytax.com.
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Mail-to address:
Internal Revenue Service
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P.O. Box 802501

Cincinnati, OH 45280-2501
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Taxpayer records:
Amount paid ____________________
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Check number ____________________
Date mailed ____________________
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Form 1040-V (2019)

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Detach Here and Mail With Your Payment and Return
1040-V
Form
OMB No. 1545-0074

Payment Voucher
2019
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Internal Revenue Service (99) Do not staple or attach this voucher to your payment or return.
1 Your social security number (SSN) 2 If a joint return, SSN shown second 3 Amount you are paying by check or
(if a joint return, SSN shown first on your return) on your return money order. Make your check or
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money order payable to "United

562-61-8489 361-60-3006 States Treasury" 2,320
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Cesario & Haydee N Natividad JR Internal Revenue Service

32010 NW Wascoe St P.O. Box 802501
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North Plains, OR 97133 Cincinnati, OH 45280-2501

For Paperwork Reduction Act Notice, see your tax return instructions.
562618489 KU NATI 30 0 201912 610

Computation of Regular Tax
(Keep for your records) 2019
Name(s) as shown on return Tax ID Number
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Statement for line 12a of Form 1040
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Tax Rate Schedule for Married Filing Joint Filing Status
If taxable income is of the
but not % on amount
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over
A over pay plus excess over
0 19,400 0.00 10% 0
19,400 78,950 1,940.00 12% 19,400
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78,950 168,400 9,086.00 22% 78,950
168,400 321,450 28,765.50 24% 168,400
321,450 408,200 65,497.50 32% 321,450
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408,200 612,350 93,257.50 35% 408,200
612,350 . . . . . 164,709.50 37% 612,350
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$9,086.00 + (($144,450.00 - $78,950.00) x 22.0%) = $23,496
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Tax from Tax Rate Schedule $ 23,496
$ 23,496 Tax computed using only available method
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TAX_COMP.LD
OMB No. 1545-0074
Form 8889 Health Savings Accounts (HSAs)
2019
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Attach to Form 1040, 1040-SR, or Form 1040-NR. Attachment
Internal Revenue Service Go to www.irs.gov/Form8889 for instructions and the latest information. Sequence No. 52
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Social security number of HSA
beneficiary. If both spouses have
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Cesario & Haydee N Natividad JR HSAs, see instructions 562-61-8489
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Before you begin: Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required.
Part I HSA Contributions and Deduction. See the instructions before completing this part. If you are filing jointly
and both you and your spouse each have separate HSAs, complete a separate Part I for each spouse.
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1
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Check the box to indicate your coverage under a high-deductible health plan (HDHP) during 2019 (see
instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Self-only X Family
2 HSA contributions you made for 2019 (or those made on your behalf), including those made from
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January 1, 2020, through April 15, 2020, that were for 2019. Do not include employer contributions,
contributions through a cafeteria plan, or rollovers (see instructions) ....................... 2 3,700
3 If you were under age 55 at the end of 2019 and, on the first day of every month during 2019, you
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were, or were considered, an eligible individual with the same coverage, enter $3,500 ($7,000 for
family coverage). All others, see the instructions for the amount to enter . . . . . . . . . . . . . . . . . . . . . 3 7,000
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4 Enter the amount you and your employer contributed to your Archer MSAs for 2019 from Form 8853,
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lines 1 and 2. If you or your spouse had family coverage under an HDHP at any time during 2019, also
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include any amount contributed to your spouse's Archer MSAs . . . . . . . . . . . . . . . . . . . . . . . . . . 4
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5 Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 7,000
6 Enter the amount from line 5. But if you and your spouse each have separate HSAs and had family
coverage under an HDHP at any time during 2019, see the instructions for the amount to enter .......... 6 7,000
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7 If you were age 55 or older at the end of 2019, married, and you or your spouse had family coverage
under an HDHP at any time during 2019, enter your additional contribution amount (see instructions) . . . . . . . . 7
8 Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 7,000
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9 Employer contributions made to your HSAs for 2019 . . . . . . . . . . . . . . . . . . . 9 3,700
10 Qualified HSA funding distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 3,700
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12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3,300
13 HSA deduction. Enter the smaller of line 2 or line 12 here and on Schedule 1 (Form 1040 or
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1040-SR), line 12, or Form 1040-NR, line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3,300

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Caution: If line 2 is more than line 13, you may have to pay an additional tax (see instructions).
Part II HSA Distributions. If you are filing jointly and both you and your spouse each have separate HSAs, complete
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14a Total distributions you received in 2019 from all HSAs (see instructions) .....................
b Distributions included on line 14a that you rolled over to another HSA. Also include any excess
14a 2,299
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contributions (and the earnings on those excess contributions) included on line 14a that were
withdrawn by the due date of your return (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b
c Subtract line 14b from line 14a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14c 2,299
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15 Qualified medical expenses paid using HSA distributions (see instructions) . . . . . . . . . . . . . . . . . . . . 15 2,299
16 Taxable HSA distributions. Subtract line 15 from line 14c. If zero or less, enter -0-. Also, include this
amount in the total on Schedule 1 (Form 1040 or 1040-SR), line 8, or Form 1040-NR, line 21. Enter
“HSA” and the amount on the line next to the box . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 16 0
17a If any of the distributions included on line 16 meet any of the Exceptions to the Additional
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20% Tax (see instructions), check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Additional 20% tax (see instructions). Enter 20% (0.20) of the distributions included on line 16 that
are subject to the additional 20% tax. Also include this amount in the total on Schedule 2 (Form 1040
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or 1040-SR), line 8, or Form 1040-NR, line 60. Check box c on Schedule 2 (Form 1040 or 1040-SR),
line 8, or box b on Form 1040-NR, line 60. Enter “HSA” and the amount on the line next to the box ........ 17b
For Paperwork Reduction Act Notice, see your tax return instructions. Form 8889 (2019)
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Explanation of Schedule A, line 5e
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This worksheet shows the breakdown of which state and local taxes are actually being deducted on federal Schedule A when the state and
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local taxes are limited to $10,000 ($5,000 if married filing separately.)
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Total paid Allow ed amount
1. Real estate taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,881 3,881
2. Personal property taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0
3. State and local income taxes ................................. 13,391 6,119
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4. Sales tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0
5. Add amounts in right column of lines 1-4. Enter this amount on Schedule A, line 5e ................. 10,000
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WK_SALT.LD
Estimated Tax Worksheet for Next Year
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1. Wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
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2. Interest and Dividend income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
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3. Capital gain income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Taxable IRA/Pension income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Taxable Social Security income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
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7.
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Other income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Total income (add lines 1 thru 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Adjustments to income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
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10. Adjusted gross income (subtract line 9 from line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
11a. Itemized deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11a.
11b. Standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11b.
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12. Taxable income (subtract the larger of line 11a or 11b from line 10) . . . . . . . . . . . . . . . . . . .. . . . . 12.
13. Estimated Section 199A deduction for qualified trade or business income . . . . . . . . . . . . . . . . . . . . 13.
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14. Projected taxable income (subtract line 13 from line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.
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15. Projected Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.
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16. Alternative Minimum Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.
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17. Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.
18a. Child Tax Credit and Other Dependent Credit . . . . . . . . . . . . . . . . . . . . 18a.
18b. Other projected Credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18b.
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18c. Total projected credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18c.

19. Subtract line 18d from line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. Projected SE Tax - Taxpayer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.
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21. Projected SE Tax - Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.
22. Other taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.
23a. Add lines 19 through 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23a.
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b. Earned income credit, additional child tax credit, fuel tax credit, net premium tax credit,
refundable American opportunity credit, and refundable credit from Form 8885 . . . . . . . . . . . . . . . . 23b.
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c. Total 2020 estimated tax. Subtract line 23b from line 23a. If zero or less enter -0- . . . . . . . . . . . . . . . 23c.
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24a. Multiply line 23c by 90% (66 2/3% for farmers and fishermen) . . . . . . . . . . . . 24a.
b. Required annual payment based on prior year's tax (see instructions) .110%
. . . . . . . 24b. 25,846
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c.
25.
26.
Required annual payment to avoid a penalty. Enter the smaller of line 24a or 24b . . . . . . . . . . . . . 24c.
Projected Withholding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.
Projected Net Tax (subtract line 25 from line 24c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.
25,846
21,176
4,670
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Estimates will be computed on $4,670. This is line 26.

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Use screen ETA to provide accurate estimates of next year’s income,
deductions, and credits. If screen ETA is used, lines 1-24a of
this worksheet will be autofilled.
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Investment Income for the
Form 1040 or Earned Income Credit
1040-SR (Keep for your records) 2019
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Interest and Dividends
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1. Enter any amount from Form 1040 or 1040-SR, line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 52
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2. Enter any amount from Form 1040 or 1040-SR, line 2a, plus any amount on Form 8814, line 1b . . . . . . . . . . 2.
3. Enter any amount from Form 1040 or 1040-SR, line 3b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Enter the amount from Schedule 1 (Form 1040 or 1040-SR), line 8, that is from Form 8814 if you are filing that form to
report your child's interest and dividend income on your return. (If your child received an Alaska Permanent
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Fund dividend, use Worksheet 2, on the next page, to figure the amount to enter on this line.) .......... 4.
Capital Gain Net Income
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5. Enter the amount from Form 1040 or 1040-SR, line 6. If the amount on that line
is a loss, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Enter any gain from Form 4797, Sales of Business Property, line 7. If the
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amount on that line is a loss, enter -0-. (But, if you completed lines 8 and
9 of Form 4797, enter the amount from line 9 instead.) . . . . . . . . . . . . . . . . 6.
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7. Subtract line 6 of this worksheet from line 5 of this worksheet. (If the result is less than zero,
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enter -0-.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
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Royalties and Rental Income From Personal Property
8. Enter any royalty income from Schedule E, line 4, plus any income from the rental of
personal property shown on Form 1040 or 1040-SR, Schedule 1, line 8, minus any
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expenses from Schedule E, line 20, related to royalty income, plus any expenses
from the rental of personal property deducted on Form 1040, Schedule 1, line 22
(If the result is less than zero, enter -0-.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
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Passive Activities
9. Enter the total of any net income from passive activities (such as income
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included on Schedule E, lines 26, 29a (col. (g)), 34a (col. (d)), or 40) and the
total of any losses from passive activities (included on Schedule E, lines
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26, 29b (col. (f)), 34b (col. (c)), or 40). (See instructions below for line 9.)
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(if zero or less, enter -0-.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. 0
10. Adjustment from EIC screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
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11. Add the amounts on lines 1, 2, 3, 4, 7, 8, 9 and 10. Enter the total. This is your Investment Income
12. Is the amount on line 14 more than $3,600?
Yes. You can't take the credit.
. . . . . . . . 11. 52
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X No. Go to Step 3 of the Form 1040 and 1040-SR instructions for line 18a to find out if you can take the credit
(unless you are using this publication to find out if you can take the credit; in that case, go to Rule 7, next).
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Instructions for line 9. In figuring the amount to enter on line 9, don't take into account any royalty income (or loss)
included on line 26 of Schedule E or any amount included in your earned income. To find out if the income on line 26 or line 40 of
Schedule E is from a passive activity, see the Schedule E instructions. If any of the rental real estate income (or loss) included on
Schedule E, line 26, isn't from a passive activity, print "NPA" and the amount of that income (or loss) on the dotted line next to line 26.
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Projected State and Local Income Tax Refund
Worksheet For 2020
This amount will carry to next year's screen 3.
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Caution: The Tax Cut and Jobs Act (TCJA) implemented changes that affect the standard deductions and the taxable state refund
calculations provided on this worksheet. These calculations cannot be confirmed until the IRS releases guidance for tax
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year 2019. Be certain to verify any amounts flowing from this worksheet to returns in tax year 2019.
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Worksheet 1 - 2019 Schedule A as filed
1a. Enter the total amount from Schedule A, line 5a. If Wks SALT was produced, enter line 3, "Allowed amount" . . . . 1a. 6,119
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1b. Enter the amount from Schedule A, line 5, that does not affect the federal income tax calculation if the taxpayer
has a state refund and is subject to AMT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b. 0
1c. Subtract line 1b from line 1a. This is the maximum amount from Schedule A, line 5e, that can be taxable on next
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year's tax return per the Tax Benefit Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c. 6,119
Worksheet 2 - 2019 Schedule A recomputed using original Schedule A line 5a less state refunds
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1. Enter total state taxes actually paid in 2019 from Schedule A, line 5a ....................... 1. 13,391
2. Enter state refund that will be received on 2020 Form 1099-G from the state WK_REF, line F ........... 2. 3,245
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3. Subtract line 2 from line 1. Total state and local taxes that would have been reported on Schedule A, line 5a, if
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it reflected only the portion of the total state and local taxes paid that were due .................. 3. 10,146
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Worksheet 3 - Difference
1. Enter the amount from line 1c, worksheet 1 above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 6,119
2. Enter the amount from line 3, worksheet 2 above ................................. 2. 10,146
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3. Subtract line 2 from line 1. This is the maximum amount of the total refund that is taxable in 2020 ..... 3. (4,027)
If line 3 is -0- or less, STOP. None of your state refund is taxable.
If line 3 is greater than -0-, complete worksheet 4 below to determine how much of your state refund is taxable.
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Worksheet 4 - State and Local Income Tax Refund Worksheet
1. Enter the amount from line 3, worksheet 3 above ................................. 1.
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2. Enter your total allowable itemized deductions from your 2019 Schedule A line 17 ................. 2.
Note. If your 2019 filing status was MFS and your spouse itemized deductions
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in 2019, skip lines 3, 4, and 5, and enter the amount from line 2 on line 6 below.
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3. Enter the amount shown below for the filing status claimed on your 2019 Form 1040 or 1040-SR.
Enter: $12,200(S) / $24,400(MFJ) / $12,200(MFS) / $18,350(HOH) . . . . . . . . . . . . . . . . . . . . . . . . . 3.
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4. If you were over 65, add 1. If MFJ and your spouse was over 65, add 1
If you were blind, add 1. If MFJ and spouse was blind, add 1.
Multiply the total computed above by:
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$1,300 if your 2019 filing status was MFJ or MFS or QW;

$1,650 if your 2019 filing status was single or HOH ............................. 4.
5. Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
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6. Is the amount on line 5 less than the amount on line 2?
No. STOP None of your refund is taxable.
Yes. Subtract line 5 from line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Enter the smaller of line 1 or line 6 . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 7.
8. Taxable income for 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
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9. Taxable part of your refund. If line 8 is zero or more, enter the amount from line 7. If line 8 is less than zero, add lines
7 and 8, and enter the result but not less than zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
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Worksheet 5 - State and Local Income Tax and General State Sales Tax Computation
1. 2019 State Income Tax Deduction from Schedule A, Line 5a or WK_SALT line 3 .................. 1.
2. 2019 General sales tax deduction that could have been claimed instead of state income tax ............ 2.
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3. Difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Taxable part of your refund from line 9 of worksheet 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Lesser of line 3 or 4, this is the maximum taxable portion of your state refund . . . . . . . . . . . . . . . . . . . . 5.
WK_REFNY.LD
1040 Overflow Statement 2019
Name(s) as shown on return Your Social Security Number
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Schedule A, Line 5a - STATE AND LOCAL INCOME TAXES
___________________________________________________
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_________________________________________________________
Description ______________
Amount
Form W-2 - AM Technical Solutions $ 5,152
Form W-2 - Jones Lang Lasalle Americas Inc ______________
8,239
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A Total: ______________
$ 13,391
______________
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OVERFLOW.LD
Federal Income Tax Withheld 2019 PG01
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Description Amount
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W2 - AM Technical Solutions 7,489
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W2 - Jones Lang Lasalle Americas Inc 13,687
_________
Total Withholdings 21,176
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WITHHELD.LD
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Summary of Estimates 2020
Name(s) as shown on return Your SSN/EIN
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Federal
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Form: 1040-ES
Payment Schedule
Due Date 07-15-2020 06-15-2020 09-15-2020 01-15-2021 Total
Total Installment Amount 1,170 1,170 1,170 1,170 4,680
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Overpayment Applied
A 0 0 0 0 0
Net Installment Due 1,170 1,170 1,170 1,170 4,680
Taxpayer Records
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Amount Actually Paid
Date Paid
Check #/Confirmation
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ES_SUM1.LD
2020 Form 1040-ES Estimated Tax Voucher and Filing Instructions
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Due date:
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07-15-2020
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Balance due:
$1,170
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Transaction method:
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To pay by check or money order, write "2020 Form 1040-ES,"
your name, address, SSN or ITIN, and daytime phone number on
the payment, make it payable to "United States Treasury,"
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and mail to the address below. To pay using your bank
account (at no extra cost to you), go to IRS.gov/Payments.
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To pay by credit or debit card (for a fee), go to

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1040paytax.com.
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Other information:
Detach the voucher below along the line and mail the voucher
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with your payment. Do not staple or attach the payment to

the voucher.
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Mail-to address:
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P.O. Box 802502
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Taxpayer records:
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Check number
Date mailed
____________________
____________________
____________________
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(Cut here)
Form 1040-ES (OCR)
2020 Calendar year -
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Payment Due April 15, 2020
Internal Revenue Service OMB No. 1545-0074 Estimated Tax Voucher
Make your check or money order payable to "United States Treasury." Amount of estimated tax you are
Enter your SSN and "2020 Form 1040-ES" on your payment. paying by check or money order. 1,170
If your name, address, or SSN is incorrect, see instructions.
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
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562618489 KU NATI 30 0 202012 430

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Due date:
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06-15-2020
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Balance due:
$1,170
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Transaction method:
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1040paytax.com.
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Other information:
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the voucher.
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Mail-to address:
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P.O. Box 802502
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Check number
Date mailed
____________________
____________________
____________________
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(Cut here)
Form 1040-ES (OCR)
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Payment Due June 15, 2020
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562618489 KU NATI 30 0 202012 430

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Due date:
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09-15-2020
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Balance due:
$1,170
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Transaction method:
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1040paytax.com.
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Other information:
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the voucher.
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Mail-to address:
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P.O. Box 802502
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Check number
Date mailed
____________________
____________________
____________________
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(Cut here)
Form 1040-ES (OCR)
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Payment Due Sept. 15, 2020
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562618489 KU NATI 30 0 202012 430

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Due date:
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01-15-2021
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Balance due:
$1,170
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Transaction method:
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1040paytax.com.
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Other information:
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the voucher.
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Mail-to address:
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P.O. Box 802502
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Taxpayer records:
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Check number
Date mailed
____________________
____________________
____________________
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(Cut here)
Form 1040-ES (OCR)
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Payment Due Jan. 15, 2021
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1024
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562618489 KU NATI 30 0 202012 430

2019 Form OR-40 Office use only
Page 1 of 4, 150-101-040 Oregon Department of Revenue 00461901011024
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(Rev. 09-19-19 ver. 01)
Oregon Individual Income Tax Return for Full-year Residents
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Submit original form - do not submit photocopy
Fiscal year ending: Space for 2-D barcode - do not write in box below
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Amended return. If amending for an NOL,
tax year the NOL was generated:
Calculated using "as if" federal return.
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Short-year tax election. Federal disaster relief.
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Extension filed. Federal Form 8886.
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Form OR-24.
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First name Initial Last name Social Security no. (SSN)
First time using Applied
Deceased this SSN (see for ITIN
CESARIO NATIVIDAD JR 562-61-8489 instructions)
N
A
N
Spouse’s first name Initial Spouse’s last name Spouse’s SSN

First time using Applied
Deceased this SSN (see for ITIN
HAYDEE N NATIVIDAD 361-60-3006 instructions)
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Current mailing address Date of birth (mm/dd/yyyy) Spouse's date of birth
32010 NW WASCOE ST 06/24/1965 08/29/1965

City State ZIP code Country Phone
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NORTH PLAINS OR 97133 (408) 799-7992
Filing status (check only one box)
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Exemptions Total
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1. Single. 6a.Credits for yourself: X Regular Severely disabled . . 6a. 1
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2.
3.
X Married filing jointly.
Married filing separately (enter spouse’s information above).

Check box if someone else can claim you as a dependent.
6b.Credits for spouse: X Regular Severely disabled . . 6b. 1
N
N
4. Head of household (with qualifying dependent). Check box if someone else can claim your spouse as a dependent.
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5. Qualifying widow(er) with dependent child.
Dependents. List your dependents in order from youngest to oldest. If more than four, check this box and include Schedule OR-ADD-DEP
with your return.
Dependent's date Check if child with
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First name Last name Code* Dependent's SSN of birth (mm/dd/yyyy) qualifying disability
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N
*Dependent relationship code (see instructions).

6c. Total number of dependents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6c.
6d. Total number of dependent children with a qualifying disability (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6d.
6e. Total exemptions. Add 6a through 6d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total. 6e. 02
1024
2019 Schedule OR-A Office use only
D
(Rev. 12-24-19 ver. 02)
Oregon Itemized Deductions
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G
Submit original form - do not submit photocopy.
First name Initial Last name Social Security number (SSN)
CESARIO Natividad JR 562-61-8489

Spouse's first name Initial Spouse's last name Spouse's SSN
N
HAYDEE
A N NATIVIDAD 361-60-3006
Read instructions carefully before completing this schedule.
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Medical and dental expenses
Caution! Don't include expenses reimbursed or paid by others.
1. Medical and dental expenses (see instructions) . . . . . . . . . . . . . . . . . 1.
LI ID
2. Federal adjusted gross income (AGI). Enter the amount
from Form OR-40, line 7 or Form OR-40-N or OR-40-P,
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line 29F . . . . . . . . . . . . . . . . . . . . . . 2.
F
3. AGI threshold. Multiply line 2 by 7.5% (0.075) . . . . . . . . . . . . . . . . . . 3.
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4. Medical and dental expense deduction. Subtract line 3
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from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
Taxes you paid
N
A
N
5. State and local income taxes. Don't include Oregon

income tax! . . . . . . . . . . . . . . . . . . . . 5. 74.00
6. Real estate taxes (see instructions) . . . . . . . . . 6. 3,881.00
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7. Personal property taxes . . . . . . . . . . . . . . . 7.
8. Reserved . . . . . . . . . . . . . . . . . . . . . . 8.
9. Total income and property taxes. Add lines 5 through 8.
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Don't enter more than $10,000 ($5,000 if married filing separately) ...... 9. 3,955.00
10. Other taxes. List type and amount:
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10.
F
11. Taxes paid deduction. Add lines 9 and 10 ................................. 11. 3,955.00
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Interest you paid
12.
13.
Mortgage interest and points reported to you on federal Form 1098 . . . . . . . . 12.
Mortgage interest not reported to you on federal Form 1098 . . . . . . . . . . . 13.
16,767.00
N
N
14. Points not reported to you on federal Form 1098 . . . . . . . . . . . . . . . . . 14.

15. Mortgage insurance premiums (see instructions) . . . . . . . . . . . . . . . . 15.
16. Investment interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . 16.
16,767.00
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17. Interest paid deduction. Add lines 12 through 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17.
Gifts to charity
18. Gifts by cash or check (see instructions) . . . . . . . . . . . . . . . . . . . . 18. 14,844.00
19. Gifts other than by cash or check (see instructions) . . . . . . . . . . . . . . . 19.
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20. Carryover from prior year . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.

21. Total gifts to charity. Add lines 18 through 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. 14,844.00
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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).
N
22.
Oregon itemized deductions

23. Add lines 4, 11, 17, 21, and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. 35,566.00
Enter the amount from line 23 on Form OR-40, line 16; Form OR-40-N or OR-40-P, line 37.
1024 -You must include this schedule with your Oregon income tax return-
Oregon
Federal Tax Liability
Worksheet 2019
(Keep for your records)
D
Name(s) as shown on return Your social security number
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1. Enter your federal tax liability from Form 1040 or 1040-SR, line 14; Form 1040NR, line 53; or
G
Form 1040-NR-EZ, line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 23,496
2. Enter your excess advance premium tax credit from Form 1040 or 1040-SR, Schedule 2, line 2; or
Form 1040-NR, line 44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
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A
3. Line 1 minus line 2. (If less than -0-, enter -0-.) . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 3. 23,496
4. Enter your additional tax on retirement plans from Form 1040 or 1040-SR, Schedule 2, line 6; or Form
I
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1040-NR, line 57; your first-time homebuyer credit recapture; any recapture taxes you included as
"other taxes" on Form 1040 or 1040-SR, Schedule 2, line 8, or Form 1040NR, line 60; and the amount
on Form 1040-NR, line 54 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
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5. Add lines 3 and 4 ............................................ 5. 23,496
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F
6. Enter your American Opportunity credit from Form 1040 or 1040-SR, line 18c ............... 6.
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7. Enter your total premium tax credit from Form 8962, line 24 ....................... 7.
8. Add lines 6 and 7 ............................................ 8.
N
A
N
9. Line 5 minus line 8. (If less than -0-, enter -0-) ............................. 9. 23,496
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10. Enter your maximum allowable tax liability subtraction from Table 7. Don't enter less than -0-
or more than $6,800 ($3,400 if your filing status is married filing separately) . . . . . . . . . . . . . . . 10. 6,800
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11. Enter the smaller of line 9 or line 10. This is your federal tax liability subtraction ............. 11. 6,800
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Caution: Don't include any of the following on line 4:

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Self-employment tax.
Social Security and Medicare tax on tips.
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Advance earned income credit payments.
Household employment taxes.
N
N
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FO TO
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ORTAX_WK.LD
2019 Form OR-40
D
(Rev. 09-19-19 ver. 01)
Name SSN
CESARIO NATIVIDAD JR 562-61-8489
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Note: Reprint page 1 if you make changes to this page.
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Taxable income
7. Federal adjusted gross income from federal Form 1040 or 1040-SR, line 8b; 1040-NR, line 35;
1040-NR-EZ, line 10; or 1040-X, line 1C (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 186,061.00
N
A
8. Total additions from Schedule OR-ASC, section 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Income after additions. Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. 186,061.00
I
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Subtractions
10. 2019 federal tax liability. See instructions for the correct amount: $0-$6,800................. 10. 6,800.00
LI ID
11. Social Security included on federal Form 1040 or 1040-SR, line .5b. . . . . . . . . . . . . . . . . . . . . . . 11.
12. Oregon income tax refund included in federal income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
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13. Total subtractions from Schedule OR-ASC, section 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.

F
14. Total subtractions. Add lines 10 through 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. 6,800.00
179,261.00
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15. Income after subtractions. Line 9 minus line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.
Deductions
L
N
A
N
16. Oregon itemized deductions. Enter your Oregon itemized deductions from Schedule OR-A, line 23. If you
are not itemizing your deductions, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. 35,566.00
17. Standard deduction. Enter your standard deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . 17. 4,545.00
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You were: 17a. 65 or older 17b. Blind Your spouse was: 17c. 65 or older 17d. Blind
LI ID
18. Enter the larger of line 16 or 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18. 35,566.00
19. Oregon taxable income. Line 15 minus line 18. If line 18 is more than line 15, enter -0- . . . . . . . . . . . . . 19. 143,695.00
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FO T
F
Oregon tax
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FI AL Schedule OR-FIA-40 20b. Worksheet OR-FCG 20c.

. . . .20.
20. Tax. Check the appropriate box if you're using an alternative method to calculate your tax (see instructions)
20a. Schedule OR-PTE-FY

12,435.00
N
N
21. Interest on certain installment sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.

22. Total tax before credits. Add lines 20 and 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. 12,435.00
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Standard and carryforward credits
23. Exemption credit. If the amount on line 7 is $100,000 or less, multiply your total exemptions on
line 6e by $206. Otherwise, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. 412.00
FO T
24. Political contribution credit. See limits in instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.

25. Total standard credits from Schedule OR-ASC, section 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.
26. Total standard credits. Add lines 23 through 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26. 412.00
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27. Tax minus standard credits. Line 22 minus line 26. If line 26 is more than line 22, enter -0-. . . . . . . . . . . . 27. 12,023.00
28. Total carryforward credits claimed this year from Schedule OR-ASC, section 4. Line 28 can’t be more
than line 27 (see Schedule OR-ASC instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28.
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29. Tax after standard and carryforward credits. Line 27 minus line 28 . . . . . . . . . . . . . . . . . . . . . . 29. 12,023.00
1024
2019 Form OR-40
D
(Rev. 09-19-19 ver. 01)
Name SSN
IL LI
G
Payments and refundable credits
30. Oregon income tax withheld. Include a copy of your Forms W-2 and 1099 ................... 30. 13,317.00
31. Amount applied from your prior year's tax refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.
N
A
32. Estimated tax payments for 2019. Include all payments you made prior to the filing date of this return.
Do not include the amount already reported on line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.
33. Earned income credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33.
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34. 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 51. . . . . . . . . . . . 34. 1,951.00
LI ID
35. Total refundable credits from Schedule OR-ASC, section 5 . . . . . . . . . . . . . . . . . . . . . . . . . . 35.
36. Total payments and refundable credits. Add lines 30 through 35 . . . . . . . . . . . . . . . . . . . . . . . . 36. 15,268.00
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F
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Tax to pay or refund
L
37. Overpayment of tax. If line 29 is less than line 36, you overpaid. Line 36 minus line . 29
............. 37. 3,245.00
38. Net tax. If line 29 is more than line 36, you have tax to pay. Line 29 minus line . 36. . . . . . . . . . . . . . . 38.
39. Penalty and interest for filing or paying late (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . 39.
N
A
N
40. Interest on underpayment of estimated tax. Include Form OR-10 ........................ 40.
Exception number from Form OR-10, line 1: 40a. Check box if you annualized: 40b.
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41. Total penalty and interest due. Add lines 39 and 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.
42. Net tax including penalty and interest. Line 38 plus line 41 . . . . . . . . . . . This is the amount you owe. 42.
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43. Overpayment less penalty and interest. Line 37 minus line 41 . . . . . . . . . . . . . . This is your refund. 43. 3,245.00
44. Estimated tax. Fill in the portion of line 43 you want applied to your open estimated tax account 44.
I
..........
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45. Charitable checkoff donations from Schedule OR-DONATE, line 30 . . . . . . . . . . . . . . . . . . . . . . 45.

F
46. Political party $3 checkoff. Party code: 46a. You. 46b. Spouse . . . . . . . . . . 46.
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FI AL
47.
48.
49.
Oregon 529 college savings plan deposits from Schedule OR-529 (see instructions) . . . . . . . . . . . . . .
Total. Add lines 44 through 47. Total can't be more than your refund on line 43 . . . . . . . . . . . . . . . . .
Net refund. Line 43 minus line 48 . . . . . . . . . . . . . . . . . . . . . . . . . . This is your net refund.
47.
48.
49. 3,245.00
N
N
Direct deposit
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50. For direct deposit of your refund, see instructions. Check the box if the final deposit destination is outside the United States:
Type of account: Checking or Savings
Routing number:
FO T
Account number:
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Kicker donation
51. Kicker donation. If you elect to donate your kicker to the State School Fund, check this box: 51a.
Complete the kicker worksheet, located in the instructions, and enter the amount here.
N
This election is irrevocable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51b.
1024
2019 Form OR-40
D
(Rev. 09-19-19 ver. 01)
Name SSN
IL LI
G
Sign here. Under penalty of false swearing, I declare that the information in this return is true, correct, and complete.
Your signature Date
N
A
Spouse's signature (if filing jointly, both must sign) Date
X
Signature of preparer other than taxpayer Preparer phone Preparer license number, if professionally prepared
I
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X
Preparer address City State ZIP code
LI ID
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 Tax Information Authorization and Power of Attorney for Representation form on our website.
FO T
F
Important: Include a copy of your federal Form 1040, 1040-SR, 1040-X, 1040-NR, or 1040-NR-EZ. Without this information, we may adjust your
G
O
return.
L
Make your payment (if you have an amount due on line 42)
Online payments: Visit our website at www.oregon.gov/dor.
N
A
N
Mailing your payment: Make your check or money order payable to the Oregon Department of Revenue. Write "2019 Oregon Form OR-40"
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 the Form OR-40-V
payment voucher unless you’re sending us a separate payment.
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Send in your return
Non-2-D barcode. If the 2-D barcode area on the front of this return is blank:
LI ID
- 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.
I
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2-D barcode. If the 2-D barcode area on the front of this return is filled in:
F
- 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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FI AL
Amended statement. Complete this section only if you’re amending your 2019 return or filing with a new SSN.
N
N
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
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anything on them.
If filing with a new SSN, enter your former identification number.

FO TO
N
1024
2019 Taxable State / Local Refund
ORWK_REF 2019
Carries to Federal worksheet WK_REF19 to determine total Taxable Refunds
D
A. State / Local Refund
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A1. Bottom line on return, after state adjustments . . . . . . . . . . . . . 3,245
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A2. Adjustments to Line A1 . . . . . . . . . . . . . . . . . . . . . . . .
A3. Total Adjusted State/Local Refund . . . . . . . . . . . . . . . . . . . . . (Line A1 Less A2) A. 3,245
B. Applied amounts
N
A
B1. Total Contributions, Donation, Checkoffs . . . . (Will carry to 2020 Sch A)
B2. Penalty and/or interest . . . . . . . . . . . . . . . . . . . . . . . .
B3. Overpayment applied to 2020 . . . . . . . (Will carry to 2020 ES screen)
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B4. Other Tax (Use tax, Property tax,Tangible tax, etc) . . . . . . . . . . .
B5. Total applied amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Total of B1 thru B4) B.
LI ID
C. Subtotal: State / Local Refund plus Applied amounts ............... (Line A plus line B) C. 3,245
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D. Payments
F
D1. Tax withheld/2019 payments deducted on Schedule A . . . . . . . . . . 13,317
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D2. 4th quarter estimate and extension paid in 2020 . . . . . . . . . . . . .
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D3. Total payments applied to 2019 State / Local tax return . . . . . . . . . . . . (Total of D1 thru D2) D. 13,317
E. Allocation of Payments
N
A
N
E1. Percent of payments made in 2019 . . . . . . . . . . (D1 divided by D3) 1.0000

E2. Line C multiplied by line E1. . . . . . . . . . . . . . . . . . . . . . . 3,245
E3. Percent of payments made in 2020 . . . . . . . . . . (D2 divided by D3)
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E4. Line C multiplied by line E3 . . . . . . . . . . . . . . . . . . . . . .
LI ID
F. Potential Taxable State / Local Refund .. (Lesser of E2 or D1, BUT NOT LESS THAN ZERO) F. 3,245
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G. Taxes paid in 2020 deductible on 2020 Schedule A

F
G1. 4th quarter estimate and extension paid in 2020 . . . . . . (From line D2)
G2. Balance of refund that did not carry to the 1040, line 10 . . . (From line E4)
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FI AL G3. Adjusted taxes paid in 2020 allowed to carry to 2020 Sch A . . . . . . . . . . (Line G1 less line G2) G. 0
N
N
Subject to tax benefit rules

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FO TO
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ORWK_REF.LD

Tax Return 2019

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Tax Return 2019

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1040 Tax Return Summary 2019

Filing Status: Married Filing Jointly

Adjusted Gross Income: $ 186,061

Total Payments & Refundable Credits:$ 21,176

Tax Rate (percentage): 22

State Return Information Resident State: OR

OR $ 186,061 $ 143,695 $ 12,023 $ 3,245

Filing Single X Married filing jointly Married filing separately (MFS)

Haydee N Natividad 361-60-3006

Credit for other dependents

1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . 1 189,309

Other income from Schedule 1, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a

11a Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11a 41,611

12a Tax (see instructions). Check if any from:

Preparer's signature Date PTIN

Use Only Firm's name

Cesario & Haydee N Natividad JR 562-61-8489

Cesario & Haydee N Natividad JR 562-61-8489

9 Investment interest. Attach Form 4952 if required. See instructions ...... 9

Other 16 Other - from list in instructions. List type and amount

IRS.gov/Payments. To pay by credit or debit card (for a

Internal Revenue Service

P.O. Box 802501

Amount paid ____________________

Form 1040-V (2019)

OMB No. 1545-0074

money order payable to "United

Cesario & Haydee N Natividad JR Internal Revenue Service

North Plains, OR 97133 Cincinnati, OH 45280-2501

562618489 KU NATI 30 0 201912 610

$ 23,496 Tax computed using only available method

1040-SR), line 12, or Form 1040-NR, line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3,300

FI AL a separate Part II for each spouse.

20% Tax (see instructions), check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18c. Total projected credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18c.

Estimates will be computed on $4,670. This is line 26.

Interest and Dividends

Capital Gain Net Income

$1,300 if your 2019 filing status was MFJ or MFS or QW;

Cesario & Haydee N Natividad JR 562-61-8489

To pay by credit or debit card (for a fee), go to

with your payment. Do not staple or attach the payment to

Internal Revenue Service

Cesario & Haydee N Natividad JR

North Plains, OR 97133 Cincinnati, OH 45280-2502

562618489 KU NATI 30 0 202012 430

To pay by credit or debit card (for a fee), go to

with your payment. Do not staple or attach the payment to

Internal Revenue Service

Cesario & Haydee N Natividad JR

North Plains, OR 97133 Cincinnati, OH 45280-2502

562618489 KU NATI 30 0 202012 430

To pay by credit or debit card (for a fee), go to

with your payment. Do not staple or attach the payment to

Internal Revenue Service

Cesario & Haydee N Natividad JR

North Plains, OR 97133 Cincinnati, OH 45280-2502

562618489 KU NATI 30 0 202012 430

To pay by credit or debit card (for a fee), go to

with your payment. Do not staple or attach the payment to

Internal Revenue Service

Cesario & Haydee N Natividad JR

North Plains, OR 97133 Cincinnati, OH 45280-2502

562618489 KU NATI 30 0 202012 430