2021 Tax Return Documents (DE CARVALHO COSTA RAF - Client Copy) PDF

FOR TAX YEAR 2021
RAFAEL DE CARVALHO COSTA
SevenTax Inc
369 Broadway Ste 101
Everett, MA 02149
(617)818-0379
Department of the Treasury - Internal Revenue Service
Form 9325
(January 2017)
Acknowledgement and General Information for
Taxpayers Who File Returns Electronically
Thank you for participating in IRS e-file.
Taxpayer name
Taxpayer address (optional)

168 JOHNSON ST APT 206
LEOMINSTER, MA 01453
.
1. X Your federal income tax return for 2021 was filed electronically with the IRS Submission
Processing Center. The electronic filing services were provided by SevenTax Inc .
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2. X Your return was accepted on 02-18-2022 using a Personal Identification Number (PIN) as your electronic
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signature. You entered a PIN or authorized the Electronic Return Originator (ERO) to enter or generate a PIN
for you. The Submission ID assigned to your return is XXXXXX2022049q2ngq5c .
3. Your return was accepted on . Allow 4 to 6 weeks for the processing of your return.
The Earned Income Credit or a dependent's exemption on your return may be reduced or disallowed due to a
child's name and social security number mismatch.
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4. Your electronic funds withdrawal payment request was accepted for processing.
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5. Your electronic funds withdrawal payment request was not accepted for processing. Refer to the "If You Owe Tax" section.
6. Your Form 4868, Application for Automatic Extension of Time to File U.S. Individual Income Tax Return, was
accepted on . The Submission ID assigned to your extension
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is .
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DO NOT SEND A PAPER COPY OF YOUR RETURN TO THE IRS.
IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN.
If You Need to Make a Change to Your Return

If you need to make a change or correct the return you filed electronically, you should send a Form 1040X, Amended U.S.
Individual Income Tax Return, to the IRS Submission Processing Center that processes paper returns for your area. The
address is available at www.irs.gov, or you can call the IRS toll-free at 1-800-829-1040.
If You Need to Ask About Your Refund

The IRS notifies your Electronic Return Originator (ERO) when your return is accepted, usually within 48 hours. If your
return was not accepted, the IRS notifies your ERO of the reasons for rejection. If it has been more than three weeks
since the IRS accepted your return and you have not received your refund, go to www.irs.gov and click on "Where's My
Refund?" to view your refund status. Exception: If box 3 above is checked, allow 4 to 6 weeks for processing of your
return. A notice will be sent to you advising of changes to your return.
Also, you can call the TeleTax line at 1-800-829-4477, for automated refund information. You should have available the
first social security number shown on your return, your filing status, and the exact amount of the refund you expect.
TeleTax gives you the date for mailing or depositing your refund. You should receive your refund check within 30 days of
the date given by TeleTax, or within one week of that date, if you chose direct deposit. If you do not receive it by then, or if
TeleTax does not give your refund information, call the Refund Hotline at 1-800-829-1954.
EEA www.irs.gov Form 9325 (Rev. 1-2017)

The IRS uses refunds to cover overdue taxes and notifies you when this occurs. The Fiscal Service offsets refunds
through the Treasury Offset Program to cover past due child support, federal agency non-tax debts such as student loans
and state income tax obligations. Fiscal Service sends you an offset notice if it applies your refund or part of your refund
to non-tax debts. If you have questions about the offset, contact the agency identified in the notice. You may also call the
Treasury Offset Program Call Center at 1-800-304-3107, if you have additional questions.
If You Owe Tax

If your return has a balance due, you must pay the amount you owe by the prescribed due date. If you paid by electronic
funds withdrawal (direct debit) or by credit card, no voucher is needed. The credit card service providers will charge a
convenience fee based on the amount of taxes you are paying. The fees and the type of credit or debit cards accepted
may vary between providers. You will be told the amount of the fee during the transaction and you will be given the option
to either continue or end the transaction. For information on paying your taxes electronically, including by credit or debit
card, go to www.irs.gov/e-pay.
If you are not paying electronically you may use Form 1040-V, Payment Voucher, which you can obtain from your
Electronic Return Originator. If the IRS does not receive your payment by the prescribed due date, you will receive a
notice that requests full payment of the tax due, plus penalties and interest. If you can not pay the amount in full, complete
Form 9465, Installment Agreement Request, which you may file electronically. To apply for an installment agreement
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online, go to www.irs.gov. You may also order Form 9465 by calling 1-800-TAX-FORM (1-800-829-3676). If approved, the
IRS charges a user fee to set up an installment agreement.
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If You Need to Inquire About Your Electronic Funds Withdrawal Payment
You may call 1-888-353-4537 to inquire about the status of your electronic funds withdrawal payment. If there is a change
to the bank account information included on your return, you should call this number to cancel a scheduled payment. You
should have available the social security number of the first person listed on the tax return, the payment amount, and the
bank account number. Cancellation requests must be received no later than 11:59 p.m. E.T. two business days prior to
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the scheduled payment date.
Tax Refund Related Financial Products
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Financial institutions offer a variety of financial products to taxpayers based on their refunds. Contracts for financial
products are between you and the financial institution. The IRS is not associated with the contract. If you have questions
about tax refund related products, contact your Electronic Return Originator or the lender.
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Instructions for Electronic Return Originators
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Line 2 - PIN Presence Indicator - Check box 2 if the taxpayer entered a PIN or authorized the ERO to enter or generate
the PIN for the taxpayer, and the Acknowledgement File PIN Presence Indicator is a "Practitioner PIN," "Self-Select PIN"
or "Online Filer PIN." Form 8879, IRS e-file Signature Authorization, is required if the ERO enters or generates the PIN or
if the Practitioner PIN method is used. Use Form 8453, U.S. Individual Income Tax Transmittal for an IRS e-file
Return, to send required paper forms or supporting documentation listed next to the form check boxes (do not
send Forms W-2, W-2G, or 1099R).
Line 3 - Exception Processing - Check box 3 if the Acknowledgement File Acceptance Code equals "Exception." The
acceptance code indicates that this return has been previously rejected and this subsequent submission still has invalid
data.
Line 4 - Payment Acknowledgement Literal - Check box 4 if the taxpayer requested to use electronic funds withdrawal to
pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field equals "Payment Request
Received."
Line 5 - Payment Acknowledgement Literal - Check box 5 if the taxpayer requested to use electronic funds withdrawal to
pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field does not equal "Payment
Request Received." If box 5 is checked, inform the taxpayer that he/she must pay by check, money order, debit card, or
credit card.
Note: EROs can use the Acknowledgement File information, translated by the transmitter, to complete Form 9325.
EEA www.irs.gov Form 9325 (Rev. 1-2017)

Department of the Treasury-Internal Revenue Service (99)
1040 U.S. Individual Income Tax Return 2021
Form
OMB No. 1545-0074 IRS Use Only-Do not write or staple in this space.
Filing Status X Single 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
RAFAEL DE CARVALHO COSTA XXX-XX-XXXX
If joint return, spouse's first name and middle initial Last name Spouse's social security number
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
168 JOHNSON ST 206 Check here if you, or your
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code spouse if filing jointly, want $3
to go to this fund. Checking a
LEOMINSTER MA 01453 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse
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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
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Age/Blindness 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) Check if qualifies for (see instructions):
number to you
(1) First name Last name Child tax credit Credit for other dependents
If more
than four
dependents,
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see instructions
and check
here
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1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Attach
2a Tax-exempt interest . . . . 2a b Taxable interest . . . . . . . . . 2b
Sch. B if
required.
3a Qualified dividends . . . . . 3a b Ordinary dividends . . . . . . . . 3b
4a IRA distributions . . . . . . 4a b Taxable amount . . . . . . . . . 4b
5a Pensions and annuities . . . 5a b Taxable amount . . . . . . . . . 5b
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Standard 6a Social security benefits . . . 6a b Taxable amount . . . . . . . . . 6b
Deduction for-
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7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . . 7
Single or
Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 8,781
separately,
$12,550 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . . . . . . . 9 8,781
Married filing 10 Adjustments to income from Schedule 1, line 26 ......................... 10 621
jointly or
Qualifying 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . . . . . . . 11 8,160
widow(er),
$25,100
12a Standard deduction or itemized deductions (from Schedule A). . . . . 12a 12,550
Head of b Charitable contributions if you take the standard deduction (see instructions) 12b
household,
$18,800 c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c 12,550
If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A .............. 13
any box under
Standard 14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 12,550
Deduction,
see instructions.
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0-. . . . . . . . . . . . . . . 15 0
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2021)
EEA
Form 1040 (2021) RAFAEL DE CARVALHO COSTA XXX-XX-XXXX Page 2
16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 ... 16 0
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 0
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 0
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . 22 0
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . . . . . . . . 23 1,241
24 Add lines 22 and 23. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 1,241
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a
b Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d
If you have a 26 2021 estimated tax payments and amount applied from 2020 return . . . . . . . . . . . . . . . . 26
qualifying child, 27a Earned income credit (EIC) . . . . . . NO. . . . . . . . . . . . . . . . . 27a
attach Sch. EIC.
Check here if you were born after January 1, 1998, and before
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January 2, 2004, and you satisfy all the other requirements for
taxpayers who are at least age 18, to claim the EIC. See instructions
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b Nontaxable combat pay election . . . . . . . . 27b
c Prior year (2019) earned income . . . . . . . 27c
28 Refundable child tax credit or additional child tax credit from Schedule 8812 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . . . . . 29
30 Recovery rebate credit. See instructions . . . . . . . . . . . . . . . . 30 0
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . . . . . . . . . 31
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32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits . .. 32 0
33 Add lines 25d, 26, and 32. These are your total payments. . . . . . . . . . . . . . . . . . . . 33 0
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Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid. . . . . 34 0
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here ....... 35a 0
Direct deposit? b Routing number c Type: Checking Savings
See instructions.
d Account number
36 Amount of line 34 you want applied to your 2022 estimated tax. . . . 36
e
Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions ..... 37 1,254
You Owe 38 Estimated tax penalty (see instructions) . . . . . . . . . . . . . . . .
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38 13
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. X No
Designee's Phone Personal identification
name no. number (PIN)
Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here If the IRS sent you an Identity
Your signature Date Your occupation
Protection PIN, enter it here
Joint return? (see inst.)
68029 02-18-2022 CLEANING
See instructions.
Spouse's signature. If a joint return, both must sign. Date Spouse's occupation If the IRS sent your spouse an
Keep a copy for
Identity Protection PIN, enter it here
your records.
(see inst.)
Phone no. 617-708-5744 Email address

Preparer's signature Date PTIN Check if:
Paid 04-21-2022 XXXXXXXXX Self-employed
Preparer Preparer's name Krisller Souza Phone no. 617-818-0379
Use Only Firm's name SevenTax Inc
Firm's address 369 Broadway Ste 101
Everett, MA 02149 Firm's EIN 83-2587339
Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2021)
EEA
SCHEDULE 1 OMB No. 1545-0074
(Form 1040) Additional Income and Adjustments to Income
Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. 2021
Attachment
Internal Revenue Service Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 01
Name(s) shown on Form 1040,1040-SR, or 1040-NR Your social security number
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 8,781
4 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach
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Schedule E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
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7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income:
a Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a ( )
b Gambling income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b
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c Cancellation of debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8c
d Foreign earned income exclusion from Form 2555 . . . . . . . . . . . . 8d ( )
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e Taxable Health Savings Account distribution . . . . . . . . . . . . . . . . 8e
f Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . . . . . 8f
g Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8g
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h Prizes and awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8h
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i Activity not engaged in for profit income . . . . . . . . . . . . . . . . . . . 8i
j Stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8j
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 8,781
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040) 2021
EEA
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 . . . . . . . . . . . . . . . . . . . 15 621
16 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . . . . . . . . . . . . . . 16
17 Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19a Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19a
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b Recipient's SSN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Date of original divorce or separation agreement (see instructions) . .
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20 IRA deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23
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23 Archer MSA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24 Other adjustments:
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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
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medals and USOC prize money reported on line 8l . . . . . . . . . . . . 24c
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d Reforestation amortization and expenses . . . . . . . . . . . . . . . . . . 24d
e Repayment of supplemental unemployment benefits under the
Trade Act of 1974 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24e
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 . . . . . . . . . . . . 26 621
EEA Schedule 1 (Form 1040) 2021
SCHEDULE 2 OMB No. 1545-0074
(Form 1040) Additional Taxes
Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. 2021
Attachment
Internal Revenue Service Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 02
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number
Part I Tax
1 Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Excess advance premium tax credit repayment. Attach Form 8962 .......... 2
3 Add lines 1 and 2. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 17 . . 3 0
Part II Other Taxes
4 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1,241
5 Social security and Medicare tax on unreported tip income.
Attach Form 4137 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
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6 Uncollected social security and Medicare tax on wages. Attach
Form 8919 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
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7 Total additional social security and Medicare tax. Add lines 5 and 6 . . . . . . . . . . 7
8 Additional tax on IRAs or other tax-favored accounts. Attach Form 5329 if required 8
9 Household employment taxes. Attach Schedule H . . . . . . . . . . . . . . . . . . . . . . 9
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10 Repayment of first-time homebuyer credit. Attach Form 5405 if required ...... 10
11 Additional Medicare Tax. Attach Form 8959 . . . . . . . . . . . . . . . . . . . . . . . . . . 11
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12 Net investment income tax. Attach Form 8960 ........................ 12
13 Uncollected social security and Medicare or RRTA tax on tips or group-term life
insurance from Form W-2, box 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Interest on tax due on installment income from the sale of certain residential lots
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and timeshares . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
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15 Interest on the deferred tax on gain from certain installment sales with a sales price
over $150,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Recapture of low-income housing credit. Attach Form 8611 ............... 16
(continued on page 2)
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 2 (Form 1040) 2021
EEA
Schedule 2 (Form 1040) 2021 Page 2
Part II Other Taxes (continued)

17 Other additional taxes:
a Recapture of other credits. List type, form number, and
amount 17a
b Recapture of federal mortgage subsidy. If you sold your home in
2021, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . 17b
c Additional tax on HSA distributions. Attach Form 8889 . . . . . . 17c
d Additional tax on an HSA because you didn't remain an eligible
individual. Attach Form 8889 . . . . . . . . . . . . . . . . . . . . . . . 17d
e Additional tax on Archer MSA distributions. Attach Form 8853 . 17e
f Additional tax on Medicare Advantage MSA distributions. Attach
Form 8853 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17f
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g Recapture of a charitable contribution deduction related to a
fractional interest in tangible personal property . . . . . . . . . . . 17g
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h Income you received from a nonqualified deferred compensation
plan that fails to meet the requirements of section 409A . . . . . 17h
i Compensation you received from a nonqualified deferred
compensation plan described in section 457A . . . . . . . . . . . 17i
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j Section 72(m)(5) excess benefits tax ................. 17j
k Golden parachute payments . . . . . . . . . . . . . . . . . . . . . . . 17k
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l Tax on accumulation distribution of trusts .............. 17l
m Excise tax on insider stock compensation from an expatriated
corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17m
n Look-back interest under section 167(g) or 460(b) from Form
e
8697 or 8866 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17n
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o Tax on non-effectively connected income for any part of the
year you were a nonresident alien from Form 1040-NR . . . . . . 17o
p Any interest from Form 8621, line 16f, relating to distributions
from, and dispositions of, stock of a section 1291 fund . . . . . 17p
q Any interest from Form 8621, line 24 . . . . . . . . . . . . . . . . . . 17q
z Any other taxes. List type and amount
17z
18 Total additional taxes. Add lines 17a through 17z ...................... 18
19 Additional tax from Schedule 8812 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Section 965 net tax liability installment from Form 965-A .... 20
21 Add lines 4, 7 through 16, 18, and 19. These are your total other taxes. Enter here
and on Form 1040 or 1040-SR, line 23, or Form 1040-NR, line 23b . . . . . . . . . . 21 1,241
EEA Schedule 2 (Form 1040) 2021
SCHEDULE C Profit or Loss From Business OMB No. 1545-0074
(Form 1040)
Department of the Treasury
(Sole Proprietorship)
Go to www.irs.gov/ScheduleC for instructions and the latest information. 2021
Attachment
Internal Revenue Service (99) Attach to Form 1040, 1040-SR, 1040-NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09
Name of proprietor Social security number (SSN)
A Principal business or profession, including product or service (see instructions) B Enter code from instructions
CLEANING 561720
C Business name. If no separate business name, leave blank. D Employer ID number (EIN) (see instr.)
E Business address (including suite or room no.) 168 JOHNSON ST APT 206
City, town or post office, state, and ZIP code LEOMINSTER, MA 01453
F Accounting method: (1) X Cash (2) Accrual (3) Other (specify)
G Did you "materially participate" in the operation of this business during 2021? If "No," see instructions for limit on losses. . . . . X Yes No
H If you started or acquired this business during 2021, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I Did you make any payments in 2021 that would require you to file Form(s) 1099? See instructions . . . . . . . . . . . . . . . Yes X No
J If "Yes," did you or will you file required Form(s) 1099?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part I Income
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1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on
Form W-2 and the "Statutory employee" box on that form was checked . . . . . . . . . . . . . . . 1 21,463
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2 Returns and allowances ......................................... 2 0
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 21,463
4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3,664
5 Gross profit. Subtract line 4 from line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 17,799
6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions). . . . . . . . . 6
7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 17,799
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Part II Expenses. Enter expenses for business use of your home only on line 30.
8 Advertising . . . . . . . . . 8 601 18 Office expense (see instructions) . . 18 205
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9 Car and truck expenses (see 19 Pension and profit-sharing plans . . 19
instructions) . . . . . . . . 9 5,070 20 Rent or lease (see instructions):
10 Commissions and fees . . . 10 a Vehicles, machinery, and equipment . . 20a
11 Contract labor (see instructions) 11 b Other business property . . . . . 20b
12 Depletion . . . . . . . . . . 12 21 Repairs and maintenance . . . . . 21
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13 Depreciation and section 179 22 Supplies (not included in Part III). . 22
expense deduction (not
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23 Taxes and licenses . . . . . . . . 23
included in Part III) (see
instructions) . . . . . . . . 13 24 Travel and meals:
14 Employee benefit programs a Travel . . . . . . . . . . . . . . 24a
(other than on line 19) . . . 14 b Deductible meals (see
15 Insurance (other than health) 15 instructions) . . . . . . . . . . . 24b
16 Interest (see instructions): 25 Utilities . . . . . . . . . . . . . . 25
a
Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) 26
Other . . . . . . . . . . . . 16b
b 27a Other expenses (from line 48) . . . 27a 3,142
17Legal and professional services 17 b Reserved for future use . . . . . 27b
28Total expenses before expenses for business use of home. Add lines 8 through 27a. . . . . . . . . . . 28 9,018
29Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 8,781
30Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829
unless using the simplified method. See instructions.
Simplified method filers only: Enter the total square footage of (a) your home:
and (b) the part of your home used for business: . Use the Simplified
Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . . . . . . . . . 30
31 Net profit or (loss). Subtract line 30 from line 29.
If a profit, enter on both Schedule 1 (Form 1040), line 3, and on Schedule SE, line 2. (If you
checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3. 31 8,781
If a loss, you must go to line 32.
32 If you have a loss, check the box that describes your investment in this activity. See instructions.
If you checked 32a, enter the loss on both Schedule 1 (Form 1040), line 3, and on Schedule
32a All investment is at risk.
SE, line 2. (If you checked the box on line 1, see the line 31 instructions). Estates and trusts, enter on
32b Some investment is not
Form 1041, line 3.
at risk.
If you checked 32b, you must attach Form 6198. Your loss may be limited.
For Paperwork Reduction Act Notice, see the separate instructions. Schedule C (Form 1040) 2021
EEA
Schedule C (Form 1040) 2021 CLEANING 561720 Page 2
Name(s) SSN
Part III Cost of Goods Sold (see instructions)
33 Method(s) used to
value closing inventory: a X Cost b Lower of cost or market c Other (attach explanation)
34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If "Yes," attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes X No
35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation. . . . . . 35 0
36 Purchases less cost of items withdrawn for personal use ....................... 36
37 Cost of labor. Do not include any amounts paid to yourself ...................... 37
38 Materials and supplies ....................................... 38 3,664
39 Other costs ............................................. 39
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40 Add lines 35 through 39 ....................................... 40 3,664
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41 Inventory at end of year ....................................... 41 0
42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line.4 . . . . . . . . . 42 3,664
Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and
are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file
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Form 4562.
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43 When did you place your vehicle in service for business purposes? (month/day/year) 01-01-2020
44 Of the total number of miles you drove your vehicle during 2021, enter the number of miles you used your vehicle for:
a Business 9,054 b Commuting (see instructions) c Other 8,841
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45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . . . . . . . . . . . X Yes No
46 Do you (or your spouse) have another vehicle available for personal use? ..................... Yes X No
47a Do you have evidence to support your deduction? ................................. X Yes No
b ......................................... X
If "Yes," is the evidence written? Yes No
Part V Other Expenses. List below business expenses not included on lines 8-26 or line 30.
TELEPHONE EXPENSE 786
UNIFORM EXPENSE 305
SMALL TOOLS 2,051
48 Total other expenses. Enter here and on line 27a .......................... 48 3,142
EEA Schedule C (Form 1040) 2021
SCHEDULE SE OMB No. 1545-0074
(Form 1040) Self-Employment Tax
Department of the Treasury Go to www.irs.gov/ScheduleSE for instructions and the latest information. 2021
Attachment
Internal Revenue Service (99) Attach to Form 1040, 1040-SR, or 1040-NR. Sequence No. 17
Name of person with self-employment income (as shown on Form 1040, 1040-SR, or 1040-NR) Social security number of person
RAFAEL DE CARVALHO COSTA with self-employment income XXX-XX-XXXX
Part I Self-Employment Tax
Note: If your only income subject to self-employment tax is church employee income, see instructions for how to report your income
and the definition of church employee income.
A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had
$400 or more of other net earnings from self-employment, check here and continue with Part . I ...................
Skip lines 1a and 1b if you use the farm optional method in Part II. See instructions.
1 a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065),
box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code AH . . . . 1b ( )
Skip line 2 if you use the nonfarm optional method in Part II. See instructions.
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2 Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other than
farming). See instructions for other income to report or if you are a minister or member of a religious order. . . . . . 2 8,781
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3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 8,781
4 a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 . . . . . . . . . 4a 8,109
Note: If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions.
b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here. . . . . . . . . . . . . . . . 4b
c Combine lines 4a and 4b. If less than $400, stop; you don't owe self-employment tax. Exception: If
less than $400 and you had church employee income, enter -0- and continue .................. 4c 8,109
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5 a Enter your church employee income from Form W-2. See instructions for
definition of church employee income . . . . . . . . . . . . . . . . . . . . . . . . . 5a
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b Multiply line 5a by 92.35% (0.9235). If less than $100, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . 5b
6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 8,109
7 Maximum amount of combined wages and self-employment earnings subject to social security tax or
the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2021 . . . . . . . . . . . . . . . . . . . . . . . 7 142,800
8 a Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2)
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and railroad retirement (tier 1) compensation. If $142,800 or more, skip lines
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8b through 10, and go to line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a
b Unreported tips subject to social security tax from Form 4137, line 10 . . . . . . . . . . 8b
c Wages subject to social security tax from Form 8919, line 10 . . . . . . . . . . . . . . 8c
d Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8d
9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11. . . . . . . . . . . . . 9 142,800
10 Multiply the smaller of line 6 or line 9 by 12.4% (0.124). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1,006
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 235
12 Self-employment tax. Add lines 10 and 11. Enter here and on Schedule 2 (Form 1040), line 4 . . . . . . . . . 12 1,241
13 Deduction for one-half of self-employment tax.
Multiply line 12 by 50% (0.50). Enter here and on Schedule 1 (Form 1040),
line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 621
Part II Optional Methods To Figure Net Earnings (see instructions)
Farm Optional Method. You may use this method only if (a) your gross farm income¹ wasn't more than
$8,820, or (b) your net farm profits² were less than $6,367.
14 Maximum income for optional methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 5,880
15 Enter the smaller of: two-thirds (2/3) of gross farm income¹ (not less than zero) or $5,880. Also, include
this amount on line 4b above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits³ were less than $6,367
4
and also less than 72.189% of your gross nonfarm income, and (b) you had net earnings from self-employment
of at least $400 in 2 of the prior 3 years. Caution: You may use this method no more than five times.
16 Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4
17 Enter the smaller of: two-thirds (2 /3) of gross nonfarm income (not less than zero) or the amount on
line 16. Also, include this amount on line 4b above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1 From Sch. F, line 9; and Sch. K-1 (Form 1065), box 14, code B. 3 From Sch. C, line 31; and Sch. K-1 (Form 1065), box 14, code A.
2 From Sch. F, line 34; and Sch. K-1 (Form 1065), box 14, code A-minus the amount 4 From Sch. C, line 7; and Sch. K-1 (Form 1065), box 14, code C.
you would have entered on line 1b had you not used the optional method.
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule SE (Form 1040) 2021
EEA
Form 8879 IRS e-file Signature Authorization
(Rev. January 2021) OMB No. 1545-0074
Department of the Treasury

Internal Revenue Service
ERO must obtain and retain completed Form 8879.
Go to www.irs.gov/Form8879 for the latest information.
2021
Submission Identification Number (SID)
XXXXXX2022049q2ngq5c
Taxpayer's name Social security number

Spouse's name Spouse's social security number
Part I Tax Return Information - Tax Year Ending December 31, 2021 (Enter year you are authorizing.)
Enter whole dollars only on lines 1 through 5.
Note: Form 1040-SS filers use line 4 only. Leave lines 1, 2, 3, and 5 blank.
1 Adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 8,160
2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1,241
3 Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . . . . . . . . . 3
4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
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5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1,254
Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
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Under penalties of perjury, I declare that I have examined a copy of the income tax return (original or amended) I am now authorizing, and to the best of
my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from the income tax
return (original or amended) I am now authorizing. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO)
to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason
for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial
Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for
payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This
authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a
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payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2
business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of
taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the
personal identification number (PIN) below is my signature for the income tax return (original or amended) I am now authorizing and, if applicable, my
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Electronic Funds Withdrawal Consent.
Taxpayer's PIN: check one box only

X I authorize SevenTax Inc to enter or generate my PIN 68029 as my
ERO firm name Enter five digits, but
signature on the income tax return (original or amended) I am now authorizing. don't enter all zeros
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I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only
if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III
below.
Your signature Date
Spouse's PIN: check one box only

I authorize to enter or generate my PIN as my
ERO firm name Enter five digits, but
don't enter all zeros
signature on the income tax return (original or amended) I am now authorizing.
I will enter my PIN as my signature on the income tax return (original or amended) I am now authorizing. Check this box only
if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III
below.
Spouse's signature Date

Practitioner PIN Method Returns Only - continue below
Part III Certification and Authentication - Practitioner PIN Method Only
ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. XXXXXX-17401
Don't enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the electronic individual income tax return (original or amended) I am now
authorized to file for tax year indicated above for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the
requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
ERO's signature Date 04-21-2022

ERO Must Retain This Form - See Instructions
Don't Submit This Form to the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see your tax return instructions. Form 8879 (Rev. 01-2021)
EEA
Overflow Statement
1040 2021
(This page is not filed with the return. It is for your records only.) Page 1
Name(s) as shown on return Tax Identification Number
SCHEDULE C, LINE 1 - GROSS RECEIPTS
_________________________________________________________
DESCRIPTION ______________
AMOUNT
_________________________________________________________
1099NEC - HOUSE OF BAGELS CORP ______________
$ 900
_________________________________________________________
1099-MISC - ART GOURMET CATERING CORP ______________
20,563
TOTAL: ______________
$ 21,463
______________
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OVERFLOW.LD
Earned Income Credit (EIC) - Line 27
Worksheet B
Form 1040 (Keep for your records) 2021
Name(s) as shown on return Tax ID Number

Use this worksheet if you answered "Yes" to Step 5, question 2.
Complete the parts below (Parts 1 through 3) that apply to you. Then, continue to Part 4.
If you are married filing a joint return, include your spouse's amounts, if any, with yours to figure the amounts to
enter in Parts 1 through 3.
Part 1
1a
1a. Enter the amount from Schedule SE, Part I, line 3. 8,781
Self-Employed,
+ 1b
Members of the b. Enter any amount from Schedule SE, Part I, line 4b and line 5a.
Clergy, and
1c
People With c. Combine lines 1a and 1b. = 8,781
Church
1d
Employee d. Enter the amount from Schedule SE, Part I, line 13. - 621
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Income Filing
Schedule SE = 1e
e. Subtract line 1d from line 1c. 8,160
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2. Don’t include on these lines any statutory employee income, any net profit from services performed as a
Part 2
notary public, any amount exempt from self-employment tax as the result of the filing and approval of Form
4029 or Form 4361, or any other amounts exempt from self-employment tax.
a. Enter any net farm profit or (loss) from Schedule F, line 34; and
Self-Employed 2a
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from farm partnerships, Schedule K-1 (Form 1065), box 14, code A*.
NOT Required
To File b. Enter any net profit or (loss) from Schedule C, line 31; and Schedule
+ 2b
Schedule SE
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K-1 (Form 1065), box 14, code A (other than farming)*.
For example, your

net earnings from
self-employment c. Combine lines 2a and 2b. = 2c
were less than $400.
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*If you have any Schedule K-1 amounts, complete the appropriate line(s) of Schedule SE, Part I.
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Reduce the Schedule K-1 amounts as described in the Partner's Instructions for Schedule K-1. Enter
your name and social security number on Schedule SE and attach it to your return.
Part 3
Statutory
Employees 3. Enter the amount from Schedule C, line 1, that you are filing as a
3
Filing statutory employee.
Schedule C
Part 4
4
4. Combine lines 1e, 2c, and 3 This is your total self-employed income. 8,160
All Filers Using
Worksheet B
Need more information or forms? Visit IRS.gov.

WK_EIC2.LD
Auto Expense Worksheet
(Keep for your records) 2021

Profession/Business
CLEANING \
Description HONDA CRV 96

Date placed in service 2020-01-01
Number of miles your vehicle was used for:

Total Business miles driven during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,054
Total Commuting miles driven during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total Other miles driven during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,841
Total Miles driven during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,895
Business Use percentage ..................................... 50.60
Expenses: Total
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Percentage
Section 179 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bonus Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . .
Garage Rent . . . . . . . . . . . . . . . . . . . . . . . . . .
....
....
.....
.....
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Gas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .....
Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .....
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Licenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .....
Oil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .....
Parking Fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rental Fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .....
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Personal Property Tax . . . . . . . . . . . . . . . . . . . . . .... .....
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Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .....
Tires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .....
Tolls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lease Add Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Expenses:
.... .....
.... .....
.... .....
Total Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Standard Mileage Rate Calculation

Business miles . . . . . . . . . . . . . . 9,054 X 0.56 5,070 . . . . . . . . . . . 5,070
Parking fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tolls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .....
Personal Property Tax . . . . . . . . . . . . . . . . . . . . .... .....
Total Standard Mile Rate deduction 5,070
How it is reported:
Depreciation deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Auto Expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,070
Personal Property Taxes, Schedule A, Line 5c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
WK_AUTO.LD
Worksheet for Form 2210, Part III, Section B -
Figure the Penalty

Complete Rate Period 1 of each column before going to the next column; then go to Rate Periods 2, 3, and 4 in the
same manner. If multiple estimated tax payments are applied to the underpayment amount in a column of line 1a,
you’ll need to make more than one computation for that column.
Payment Due Dates
(a) (b) (c) (d)

04/15/21 06/15/21 09/15/21 01/15/22
1a Enter your underpayment from Part III, Section A, line 17 ... 1a 196 196 196 196
1b Date and amount of each payment applied to the underpayment

in the same column. Don't enter more than the underpayment
amount on line 1a for each column (see instructions).
y
Note. Your payments are applied in the order made first to any
underpayment balance in an earlier column until that 04-15-2022 04-15-2022 04-15-2022 04-15-2022
underpayment is fully paid. 1b 196 196 196 196
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Rate Period 1: April 16, 2021 - June 30, 2021
2 Computation starting dates for this period . . . . . . . . . . 2 04/15/21 06/15/21
Days: Days:
3 Number of days from the date on line 2 to the date the amount
on line 1a was paid or 6/30/21, whichever is earlier ...... 3 76 15
C
4 Underpayment Number of days
on line 1a x on line 3
x 0.03
365
tn
4 $ 1 $
Rate Period 2: July 1, 2021 - September 30, 2021
5 Computation starting dates for this period . . . . . . . . . . 5 06/30/21 06/30/21 09/15/21
Days: Days: Days:
e
on line 1a was paid or 9/30/21, whichever is earlier ...... 6 92 92 15
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x 0.03
365
7 $ 1 $ 1 $
Rate Period 3: October 1, 2021 - December 31, 2021
8 Computation starting dates for this period . . . . . . . . . . 8 09/30/21 09/30/21 09/30/21
Days: Days: Days:
on line 1a was paid or 12/31/21, whichever is earlier ...... 9 92 92 92

x 0.03
365
10 $ 1 $ 1 $ 1
Rate Period 4: January 1, 2022 - April 15, 2022
11 Computation starting dates for this period . . . . . . . . . . 11 12/31/21 12/31/21 12/31/21 01/15/22
Days: Days: Days: Days:
on line 1a was paid or 4/15/22, whichever is earlier ...... 12 105 105 105 90

x 0.03
365
13 $ 2 $ 2 $ 2 $ 1
14 Penalty. Add all amounts on lines 4, 7, 10, and 13 in all columns. Enter the total here and on line 19 of Part
III, Section B ................................................... 14 $ 13
WK_2210.LD
Form 8995 Qualified Business Income Deduction OMB No. 1545-2294
Simplified Computation
Attach to your tax return.
2021
Department of the Treasury Attachment
Internal Revenue Service
Go to www.irs.gov/Form8995 for instructions and the latest information. Sequence No. 55
Name(s) shown on return Your taxpayer identification number

Note. You can claim the qualified business income deduction only 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 Schedule C: CLEANING XXX-XX-XXXX 8,160
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ii
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iii
iv
C
2 Total qualified business income or (loss). Combine lines 1i through 1v,
tn
column (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 8,160
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 8,160
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . 5 1,632
6 Qualified REIT dividends and publicly traded partnership (PTP) income or (loss)
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(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 0
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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 0
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . . . . . . . . . . . 10 1,632
11 Taxable income before qualified business income deduction (see instructions) .... 11 (4,390)
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 0
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 13 0
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 0
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 0
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 ( 0)
For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8995 (2021)
EEA
Amount from Form 1040, line 11................................ 8,160

Amount from Form 1040, line 12................................ 12,550
Line 11 above is the difference between these amounts......... (4,390)

QBI Explanation Worksheet
Form 1040 (This page is not filed with the return. It is for your records only.) 2021
Name of business activity Schedule C: CLEANING

As reported As allowed on 1040
after limitations
1. Ordinary business income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . 8,781 8,781

2. Rental income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Royalty income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Section 1231 gain (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Other income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Section 179 deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Other deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8. Deduction for half of SE tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621
9. Self-employed health insurance deduction ..................................
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10. Self-employed pension deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. QBI amount carried to Form 8995 / 8995-A ................................ 8,160
12. W-2 wages carried to Form 8995 / 8995-A ................................
13. UBIA of qualified property carried to Form 8995 / 8995-A ........................
14. Section 199A REIT dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15. 199(A)(g) deduction ............................................
C
16. QBI allocable to cooperative payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17. W-2 wages allocable to cooperative payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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The income amount from line 11 will show on one of the following lines, depending on circumstances:
X Form 8995, line 1
Form 8995-A, line 2
Form 8995-A, Schedule A, line 2
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Form 8995-A, Schedule A, line 16
Form 8995-A, Schedule B, line 3
Form 8995-A, Schedule C, line 1
Note: The Tax Cuts and Jobs Act and the related proposed regulations state that losses or deductions that were disallowed,
suspended, limited, or carried over from taxable years ending before January 1, 2018 (including under sections 465, 469,
704(d), and 1366(d)), are not taken into account in a later taxable year for purposes of computing QBI.
QBI_EXPL.LD
Carryover Worksheet
List of items that will carryover to the 2022 tax return
(This page is not filed with the return. It is for your records only.) 2021
Itemized Deductions Carryover Amount

Contributions subject to 100% of AGI limitations ...................................
Contributions subject to 60% of AGI limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributions subject to 30% of AGI limitations (50% capital gains appreciated property) . . . . . . . . . . . . . . . . .
Contributions subject to 30% of AGI limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributions subject to 20% of AGI limitations (30% capital gains appreciated property) . . . . . . . . . . . . . . . . .
Taxable state and local refunds to Schedule 1 (Form 1040) line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . .
State/local taxes paid in 2022 to flow to the Schedule A ............................... 6
State donations and contributions carryover .....................................
State overpayment applied to next year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Expenses
Office in home operating expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
y
Office in home excess casualty losses and depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Disallowed investment interest expense . . . . . . . . . . . . . . . . AMT Reg. Tax
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Section 179 expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Operating expenses, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use . . . . . . .
Excess depreciation, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use . . . . . . .
Losses
Short-term capital loss . . . . . . . . . . . . . . . . . . . . . . . . . AMT Reg. Tax
Long-term capital loss . . . . . . . . . . . . . . . . . . . . . . . . . AMT Reg. Tax
C
Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . . AMT Reg. Tax
Excess business loss from Form 461 (becomes part of NOL next year) AMT Reg. Tax
tn
Qualified REIT and PTP loss carryover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
QBI loss carryover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nonrecaptured net section 1231 losses from WK_1231C . . . . . . . . AMT Reg. Tax
Credits
Mortgage interest credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Credit for prior year minimum tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Foreign Tax credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMT Reg. Tax
District of Columbia first time home owner's credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Res. energy efficient property credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other
Preparer Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Overpayment applied to next year's estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Estimated Tax Payment 1 Estimated Tax Payment 2
Estimated Tax Payment 3 Estimated Tax Payment 4
Federal tax liability for 2210 calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,241
State tax liability for state 2210 calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
IRA basis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taxpayer Spouse
Disaster distributions taxable in 2022 . . . . . . . . . . . . . . . . Taxpayer Spouse
Disaster distributions taxable in 2023 . . . . . . . . . . . . . . . . Taxpayer Spouse
Excess repayments from 8915-F . . . . . . . . . . . . . . . . . . Taxpayer Spouse
Deferred SE tax to be repaid by 12/31/2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Passive Activity
At Risk Limitations
WK_CARRY.LD
TAX RETURN COMPARISON
2021
2019 / 2020 / 2021
(This page is not filed with the return. It is for your records only.)
Name(s) as shown on return Identifying number
2019 2020 2021 Difference 2020-2021

Filing Status . . . . . . . . . . . . . . Single Single
Number of Dependents . . . . . . . . .
Income
Wages, salaries, tips, etc. . . . . . . .
Taxable interest and dividends . . . .
Taxable state and local refunds . . . .
Alimony. . . . . . . . . . . . . . . .
Business income (loss) . . . . . . . . 5,558 8,781 3,223
Gains (losses) . . . . . . . . . . . .
Pensions and IRA distributions . . . .
Rent and royalty income (loss) . . . .
y
Part, S-corps, trusts income (loss) . . .
Farm income (loss) . . . . . . . . . .
po
Unemployment compensation . . . . .
Total SS benefits received. . . . . . .
Taxable SS benefits. . . . . . . . . .
Other income (loss) . . . . . . . . . .
Total Income . . . . . . . . . . . . . 5,558 8,781 3,223
Adjusted Gross Income
C
Half of self-employment tax . . . . . . 393 621 228
IRA deduction. . . . . . . . . . . . .
tn
Other adjustments . . . . . . . . . .
Total Adjusted Gross Income . . . . 5,165 8,160 2,995
Deductions
Medical deductions . . . . . . . . . .
State and local taxes . . . . . . . . .
e
Interest . . . . . . . . . . . . . . . .
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Contributions . . . . . . . . . . . . .
Employee business expenses . . . . .
Standard or other deductions . . . . . 12,400 12,550 150
Total deductions claimed . . . . . . 12,400 12,550 150
Qualified Business Income Deduction .
Tax and Credits
Taxable Income . . . . . . . . . . .
Tax. . . . . . . . . . . . . . . . . .
Credits . . . . . . . . . . . . . . . .
Self-employment tax . . . . . . . . . 785 1,241 456
Other taxes . . . . . . . . . . . . . .
Total Tax . . . . . . . . . . . . . . . 785 1,241 456
Payments
Withholdings . . . . . . . . . . . . .
Estimated tax payments . . . . . . . .
Earned income credit . . . . . . . . .
Other payments and credits . . . . . .
Estimated tax penalty . . . . . . . . 13 13
Overpayment ............
Overpayment Applied . . . . . . . . .
Refund . . . . . . . . . . . . . . . .
Balance Due . . . . . . . . . . . . . . 785 1,254 469
Marginal tax rate . . . . . . . . . . . . . 10.00 10.00
Effective tax rate . . . . . . . . . . . . .
Auto Mileage Worksheet

Profession/Business
CLEANING \
Description HONDA CRV 96
Date placed in service 01-01-2020
Business Miles Rate of Depreciation allowed

for Standard Mileage Rate
2021 9,054 0.26
y
2020 15,201 0.27
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2019 0.26
2018 0.25
2017 0.25
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2016 0.24
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2015 0.24
2014 0.22
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2013 0.23
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2012 0.23
pre-2011 See Publication 463
Total Business Miles 24,255
This worksheet displays the business miles taken by year for vehicles with the standard mileage rate deduction. When the
vehicle is sold, the amount of the depreciation that is factored into the standard mileage rate should reduce the basis of the
vehicle. If actual expenses were taken on the vehicle, then do no use this worksheet; the depreciation can be found on the
Depreciation Detail Listing ("FED DEPR Schedule" in View/Print mode). Refer to pub 463 for more information on the
standard and actual deduction for vehicles.
WK_AUTO1.LD
Schedule C Comparison
(This page is not filed with the return. It is for your records only.) 2021
Name of proprietor Tax ID Number
Principal business: CLEANING

Business name:
2020 2021 Difference

Income
Gross Receipts or sales . . . . . . . . . . . . . . 24,870 21,463 (3,407)
Returns & allowances . . . . . . . . . . . . . . .
Cost of goods sold . . . . . . . . . . . . . . . . . 4,568 3,664 (904)
Gross profit . . . . . . . . . . . . . . . . . . . . . 20,302 17,799 (2,503)
Other income . . . . . . . . . . . . . . . . . . . .
Gross income 20,302 17,799 (2,503)
Expenses
y
Advertising . . . . . . . . . . . . . . . . . . . . . 255 601 346
Car and truck expenses . . . . . . . . . . . . . . 8,741 5,070 (3,671)
po
Commissions and fees ..............
Contract labor . . . . . . . . . . . . . . . . . . . .
Depletion . . . . . . . . . . . . . . . . . . . . . .
Depreciation & section 179 . . . . . . . . . . . .
Employee benefit programs . . . . . . . . . . . .
Insurance . . . . . . . . . . . . . . . . . . . . . .
C
Mortgage interest . . . . . . . . . . . . . . . . . .
Other interest . . . . . . . . . . . . . . . . . . . .
tn
Legal & Professional services . . . . . . . . . . . 654 (654)
Office expense . . . . . . . . . . . . . . . . . . . 347 205 (142)
Pension & profit-sharing . . . . . . . . . . . . . .
Rent or lease - machinery . . . . . . . . . . . . .
Rent or lease - other property . . . . . . . . . . .
e
Repairs & maintenance . . . . . . . . . . . . . . 694 (694)
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Supplies ......................
Taxes and licenses . . . . . . . . . . . . . . . . .
Travel . . . . . . . . . . . . . . . . . . . . . . . .
Deductible meals . . . . . . . . . . . . . . . . . .
Utilities . . . . . . . . . . . . . . . . . . . . . . . .
Wages . . . . . . . . . . . . . . . . . . . . . . . .
Other expenses . . . . . . . . . . . . . . . . . . . 4,053 3,142 (911)
Total expenses . . . . . . . . . . . . . . . . . . . . 14,744 9,018 (5,726)
Business use of home . . . . . . . . . . . . . . .
Net profit or (loss) . . . . . . . . . . . . . . . . . . . 5,558 8,781 3,223
Allowed on return after

Form 6198 and Form 8582 limitations. . . . . . . . 5,558 8,781 3,223
COMPC.LD
2021 MA1 Filing Instructions
Form filed:
MA1 and supplemental forms and schedules
Filing method:
Your return has been e-filed, do not mail your return
Due date:
04-19-2022
Payment:
$6.00
Transaction method:
Taxpayers may pay online at www.mass.gov/dor or direct-debit

by entering their account information on the return.
However direct-debit is for E-Filing only. Checks must be
payable to Commonwealth of Massachusetts. Form PV must be
included with your remittance. Please write your SSN in the
lower left corner of the check.
2021 Form 1
MA21001011024
Massachusetts Resident Income Tax Return
FOR FULL YEAR RESIDENTS ONLY
For the year January 1-December 31, 2021 or other taxable
Year beginning Ending
y
168 JOHNSON ST APT 206 LEOMINSTER MA 01453
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Fill in if: Amended return Other jurisdiction change Federal amendment Amended return due to IRS BBA Partnership Audit
State Election Campaign Fund: $1 You $1 Spouse TOTAL
Fill in if veteran of Operations Enduring Freedom, Iraqi Freedom, Noble Eagle or Sinai Peninsula You Spouse
Fill in if name change You Spouse
Taxpayer deceased You Spouse
C
Fill in if under age 18 You Spouse
a. Total federal income 8781 Fill in if noncustodial parent
8160
tn
b. Federal adjusted gross income Fill in if filing Schedule TDS
1. Filing status (select one only): X Single Fill in if filing Schedule FCI
Married filing jointly Fill in if reporting crypto currency
Married filing separate return
Head of household You are a custodial parent who has released claim to exemption for child(ren)
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2. Exemptions
4400
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a. Personal exemptions 2a
b. Number of dependents. (Do not include yourself or your spouse.) Enter number x $1,000 = 2b
c. Age 65 or over before 2022 You + Spouse = x $700 = 2c
d. Blindness You + Spouse = x $2,200 = 2d
e. Medical/dental 2e
f. Adoption 2f
g Total exemptions. Add items 2a through 2f. Enter here and on line 18 2g 4400
SIGN HERE. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.
Your signature Date Spouse's signature Date
6177085744
PRIVACY ACT NOTICE AVAILABLE UPON REQUEST
04-21-2022 11:35:31
2021 Form 1, pg. 2
MA21001021024
XXX-XX-XXXX
3. Wages, salaries, tips 3

4. Taxable pensions and annuities 4
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5. Mass. bank interest: a. - b. exemption = 5
6a. Business/profession income/loss 6a 8781
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6b. Farming income/loss 6b
7. Rental, royalty and REMIC, partnership, S corp., trust income/loss 7
8a. Unemployment 8a
8b. Mass. lottery winnings 8b
9. Other income from Schedule X, line 6 9
10. TOTAL 5.0% INCOME 10 8781
C
11a. Amount paid to Soc. Sec. Medicare, R.R., U.S. or Mass. Retirement 11a 1241
11b. Amount your spouse paid to Soc. Sec., Medicare, R.R., U.S. or Mass. Retirement 11b
tn
12. Reserved for future use 12
13. Reserved for future use 13
14. Rental deduction. a. 12000 ÷2= 14 3000
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15. Other deductions from Schedule Y, line 19 15
4241
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16. Total deductions. Add lines 11 through 15 16
17. 5.0% INCOME AFTER DEDUCTIONS. Subtract line 16 from line 10. Not less than "0" 17 4540
18. Exemption amount 18 4400
19. 5.0% INCOME AFTER EXEMPTIONS. Subtract line 18 from line 17. Not less than "0" 19 140
20. INTEREST AND DIVIDEND INCOME 20
21. TOTAL TAXABLE 5.0% INCOME. Add lines 19 and 20 21 140
BE SURE TO INCLUDE THIS PAGE WITH FORM 1, PAGE 1
04-21-2022 11:35:31
2021 Form 1, pg. 3
MA21001031024
XXX-XX-XXXX
22. TAX ON 5.0% INCOME. Note: If choosing the optional 5.85% tax rate, fill in and multiply line 21 and the
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amount in Schedule D, line 21 by .0585 22 6
23. 12% INCOME. Not less than "0." a. x .12 = 23
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24. TAX ON LONG-TERM CAPITAL GAINS. Not less than "0." Fill in if filing Schedule D-IS 24
Fill in if any excess exemptions were used in calculating lines 20, 23 or 24
25. Credit recapture amount (from Credit Recapture Schedule) 25
26. Additional tax on installment sale 26
27. If you qualify for No Tax Status, fill in and enter "0" on line 28
28. TOTAL INCOME TAX. Add lines 22 through 26 28 6
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29. Limited Income Credit 29
30. Income tax due to another state or jurisdiction 30
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31. Other credits from Credit Manager Schedule 31
32. INCOME TAX AFTER CREDITS. Subtract the total of lines 29 through 31 from line 28. Not less than "0" 32 6
33. Voluntary Contributions
a. Endangered Wildlife Conservation 33a
b. Organ Transplant Fund 33b
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c. Massachusetts Public Health HIV and Hepatitis Fund 33c
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d. Massachusetts U.S. Olympic Fund 33d
e. Massachusetts Military Family Relief Fund 33e
f. Homeless Animal Prevention and Care 33f
Total. Add lines 33a through 33f 33
34. Use tax due on Internet, mail order and other out-of-state purchases 34 0
35. Health care penalty a. You + b. Spouse 35
36. Amended return only. Overpayment from original return 36
37. INCOME TAX AFTER CREDITS PLUS CONTRIBUTIONS AND USE TAX. Add lines 32 through 36 37 6
04-21-2022 11:35:31
2021 Form 1, pg. 4
MA21001041024
XXX-XX-XXXX
38. Massachusetts income tax withheld 38
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39. 2020 overpayment applied to your 2021 estimated tax 39
40. 2021 Massachusetts estimated tax payments 40
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41. Payments made with extension 41
42. Amended return only. Payments made with original return. Not less than “0” 42
43. Earned Income Credit. a. Number of qualifying children 0 b. Amount from U.S. return 0 x .30 = 43 0
Note: You cannot claim the Earned Income Credit if your filing status is married filing separately unless you qualify
for an exception (see instructions). Fill in if you qualify for this exception
44. Senior Circuit Breaker Credit 44
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45. Child under age 13, or disabled dependent/spouse credit 45
46. Dependent member(s) of household under age 12, or dependent(s) age 65 or over (not you or your spouse)
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as of December 31, 2021 credit.
Not more than two. a. x $180 = 46
47. Other Refundable Credits 47
48. Excess Paid Family Leave Withholding 48
49. TOTAL. Add lines 38 through 48 49 0
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50. Overpayment. Subtract line 37 from line 49 50
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51. Amount of overpayment you want applied to your 2022 estimated tax 51
52. Refund. Subtract line 51 from line 50. Mail to Massachusetts DOR, PO Box 7000, Boston, MA 02204 52
Direct deposit of refund. Type of account checking

savings
RTN # account #
53. Tax due. Pay online at www.mass.gov/dor/payonline. Mail to: Mass. DOR, PO Box 7003, Boston, MA 02204 53 6
Interest Penalty M-2210 amt. EX enclose
Form M-2210
May the Department of Revenue discuss this return with the preparer shown here?
I do not want preparer to file my return electronically (this may delay your refund) Paid preparer's
Print paid preparer's name Date Check if self-employed SSN/PTIN
KRISLLER SOUZA 04212022 XXXXXXXXX
Paid preparer's signature Paid preparer's phone Paid preparer's EIN
617-818-0379 83-2587339
BE SURE TO INCLUDE THIS PAGE WITH FORM 1, PAGE 1
04-21-2022 11:35:31
2021 Schedule HC
MA21029011024
Schedule HC, Health Care Information, must be completed by all

full-year residents and certain part-year residents (see instructions).
Note: Schedule HC must be enclosed with your Form 1 or Form
1-NR/PY. Failure to do so will delay the processing of your return.
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1a. Date of birth 12031994 1b. Spouse's date of birth 1c. Family size 1
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2. Federal adjusted gross income 2 8160
3. Indicate the time period that you were enrolled in a Minimum Creditable Coverage (MCC) health insurance plan(s). The Form MA 1099-HC from your
insurer will indicate whether your insurance met MCC requirements. Note: MassHealth, Medicare, and health coverage for U.S. Military, including
Veterans Administration and Tri-Care, meet the MCC requirements. If you did not receive a Form MA 1099-HC from your insurer, or you had insurance
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that did not meet MCC requirements, see the special section on MCC requirements in the instructions.
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See instructions if, during 2021, you turned 18, you 3a You: Full-year MCC Part-year MCC No MCC/None
were a part-year resident or a taxpayer was deceased. 3b Spouse: Full-year MCC Part-year MCC No MCC/None
If you filled in the full-year or part-year MCC box, go to line 4. If you filled in No MCC/None, go to line 6.
4. Indicate the health insurance plan(s) that met the Minimum Creditable Coverage (MCC) requirements in which you were enrolled in 2021, as
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shown on Form MA 1099-HC (check all that apply). If you did not receive this form, fill in line(s) 4f and/or 4g and see instructions. Fill in if you were
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enrolled in private insurance and MassHealth or Commonwealth Care and enter your private insurance information in line(s) 4f and/or 4g and go
to line 5.
4a. Private insurance, including ConnectorCare (completes line(s) 4f and/or 4g below) You Spouse
4b. MassHealth. Fill in and go to line 5 X You Spouse
4c. Medicare (including a replacement or supplemental plan). Fill in and go to line 5 You Spouse
4d. U.S. Military (including Veterans Administration and Tri-Care). Fill in and go to line 5 You Spouse
4e. Other program (enter the program name(s) only in lines 4f and/or 4g below). Note: Health Safety Net You Spouse
is not considered insurance or minimum creditable coverage.
4f. Your Health Insurance. Complete if you answered line(s) 4a or 4e and go to line 5.
4g. Spouse's Health Insurance. Complete if you answered line(s) 4a or 4e and go to line 5.
5. If you had health insurance that met MCC requirements for the full-year, including private insurance, MassHealth, Commonwealth Care or ConnectorCare,
you are not subject to a penalty. Skip the remainder of this schedule and continue completing your tax return. Otherwise, go to line 6.
If you had Medicare (including a replacement or supplemental plan), U.S. Military (including Veterans Administration and Tri-Care), or other government
insurance at any point during 2021, you are not subject to a penalty. Skip the remainder of this schedule and continue completing your tax return.
Otherwise, go to line 6.
04-21-2022 11:35:31
Schedule HC Worksheets and Tables 2021
(Keep for your records)
Name(s) as shown on return Your social security number

Schedule HC Worksheet for Line 6: Federal Poverty Level
1. Enter your federal adjusted gross income from Schedule HC, line 2 ..... 1 8160 Table 1: Federal Poverty Level,
2. Enter the income amount that corresponds to your family size (as Annual Income Standards
entered on Schedule HC, line 1c) from the 150% FPL column from
Family size* 150% FPL
Table 1 .............................. 2 19140
If line 1 is less than or equal to line 2, your income in 2021 was at or below 150% of the Federal 1 $19,140
Poverty Level and the penalty does not apply to you in 2021. Fill in the Yes box in line 6 of Schedule
HC, skip the remainder of Schedule HC and continue completing your tax return. 2 $25,860
If line 1 is greater than line 2, your income in 2021 was above 150% of the Federal Poverty Level. Fill 3 $32,580
in the No box in line 6 of Schedule HC and go to line 7 of Schedule HC.
4 $39,300
5 $46,020
6 $55,740
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7 $59,460
8 $66,180
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additional + $ 6,720
*Include only yourself, your spouse (if living in
the same household at any point during the
year), and any dependents as claimed on Form
1, line 2b or Form 1-NR/PY, line 4b. If married
filing separately and living in the same house-
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hold at any point during the year, include all
dependents claimed by you and your spouse.
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MAWK_HCA.LD HC-6
2021 Schedule C
MA21011011024
Massachusetts Profit or Loss From Business
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CLEANING 561720
168 JOHNSON ST APT 206 LEOMINSTER MA 01453
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Accounting method: X Cash Accrual Other (specify) No. of employees
Fill in if you materially participated in the operation of this business during 2021 (see line 33 instructions) X
Fill in if you started or acquired this business during 2021
Fill in if you made any payments in 2021 that would require you to file Form(s) 1099
Fill in if you have any suspended PAL related to this schedule. See instructions and line 36
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Fill in if you claimed the small business exemption from the sales tax on purchases of taxable energy or heating fuel during 2021
Fill in if this income was reported to you on Form W-2 and the “Statutory employee” box on that form was checked
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Fill in if interest or dividend reported on U.S. Schedule C, lines 1 and/or 6
Do not include interest and dividends in Schedule C, lines 1 and 4. Enter this amount here and on Schedule B, line 3. See instructions
1. a. Gross receipts or sales 21463
b. Returns and allowances a-b= 1 21463
2. Cost of goods sold and/or operations 2 3664
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3. Gross profit. Subtract line 2 from line 1 3 17799
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4. Other income 4
5. Total income. Add line 3 and line 4 5 17799
6. Advertising 6 601
7. Bad debts from sales or services 7
8. Car and truck expenses 8 5070
9. a. Commissions and fees
b. Contract Labor a+b= 9
10. Depletion 10
11. Depreciation and Section 179 deduction 11
12. Employee benefit programs 12
13. Insurance 13
04-21-2022 11:35:31
2021 Schedule C, pg. 2
XXX-XX-XXXX MA21011021024
14. Interest
a. mortgage interest paid to financial institutions
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b. other interest a + b = 14
15. Legal and professional services 15
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16. Office expense 16 205
17. Pension and profit-sharing 17
18. Rent or lease a. vehicles, machinery and equipment
b. other business property a + b = 18
19. Repairs and maintenance 19
20. Supplies 20
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21. Taxes and licenses 21
22. Travel 22
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23. a. Total meals
b. Enter 50% of 23a subject to limitations a - b = 23
24. Utilities 24
25. Wages 25
26. Other expenses Statement #517 26 3142
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27. Total expenses. Add lines 6 through 26 27 9018
8781
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28. Tentative profit or loss. Subtract line 27 from line 5 28
29. Expenses for business use of your home 29
30. Abandoned Building Renovation Deduction 30
31. Net profit or loss. Subtract total of line 29 and line 30 from line 28 31 8781
32. Deductible loss. If you have a loss on line 31 it may be limited. See line 33 32 0
33. Description of your investment in this activity. If you filled in 33a enter loss on line 32 and go to 33a. All investment at risk
line 35. If you filled in 33b see instructions for line 32 and go to line 35 33b. Some investment is not at risk
34. Profit from line 31 34 8781
35. Total profit or loss. Combine lines 32 and 34 35 8781
36. Allowable prior-year suspended PAL you are applying 36 0
37. Net profit or loss. Combine line 35 and 36. Enter here and on Form 1, line 6a or Form 1 NR/PY, line 8a 37 8781
04-21-2022 11:35:31
2021 Schedule C, pg. 3
XXX-XX-XXXX MA21011031024
Schedule C-1. Cost of Goods Sold and/or Operations

Method(s) used to value closing inventory: X Cost Lower of cost or market Other (specify)
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Fill in if there was any change in determining quantities, costs or valuations between opening & closing inventory? If Yes, enclose explanation
Fill in and enclose explanation if inventory at beginning of year is different from last year's closing inventory
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1. Inventory at beginning of year 1
2. a. Purchases
b. Items withdrawn for personal use a-b= 2
3. Cost of labor 3
4. Materials and supplies 4 3664
5. Other costs 5
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6. Add lines 1 through 5 6 3664
7. Inventory at end of year 7
3664
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8. Cost of goods sold and/or operations. Subtract line 7 from line 6 8
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04-21-2022 11:35:31
MA SCH C - OTHER EXPENSES Statement #517
2021 PG01
Name(s) shown on return Identifying Number
DESCRIPTION AMOUNT
TELEPHONE EXPENSE 786
UNIFORM EXPENSE 305
SMALL TOOLS 2051
TOTAL 3142
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MASTMCOE.LD
For your records only. 2021 SE Tax
MAWK_SE Self-Employment Tax Worksheet STATE Summary
Name(s) as shown on state return Social Security Number
Part I Self-Employment Tax
Note: If your only income subject to self-employment tax is church employee income, see instructions for how to report your income
and the definition of church employee income.
A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had
$400 or more of other net earnings from self-employment, check here and continue with Part I. . . . . . . . . . . . . . . . . . . .
Skip lines 1a and 1b if you use the farm optional method in Part II. See instructions.
1 a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065),
box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code AH. . . . 1b ( )
Skip line 2 if you use the nonfarm optional method in Part II. See instructions.
2 Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other than
farming). See instructions for other income to report or if you are a minister or member of a religious order . . . . 2 8,781
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3 Combine lines 1a, 1b, and 2 ......................................... 3 8,781
4 a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 . . . . . . . . 4a 8,109
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Note: If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions.
b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here . . . . . . . . . . . . . . . 4b
c Combine lines 4a and 4b. If less than $400, stop; you don't owe self-employment tax. Exception: If
less than $400 and you had church employee income, enter -0- and continue . . . . . . . . . . . . . 4c 8,109
5 a Enter your church employee income from Form W-2. See instructions for
definition of church employee income . . . . . . . . . . . . . . . . . . . . . . . . 5a
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b Multiply line 5a by 92.35% (0.9235). If less than $100, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . 5b
6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 8,109
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7 Maximum amount of combined wages and self-employment earnings subject to social security tax or
the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2021 ..................... 7 142,800
8 a Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2)
and railroad retirement (tier 1) compensation. If $142,800 or more, skip lines
8b through 10, and go to line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a
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b Unreported tips subject to social security tax from Form 4137, line 10 . . . . . . . . . 8b
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c Wages subject to social security tax from Form 8919, line 10 . . . . . . . . . . . . . 8c
d Add lines 8a, 8b, and 8c ........................................... 8d
9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . . . . . . . . . . 9 142,800
10 Multiply the smaller of line 6 or line 9 by 12.4% (0.124) .............................. 10 1,006
11 Multiply line 6 by 2.9% (0.029) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 235
12 Self-employment tax. Add lines 10 and 11. Enter here and on Schedule 2 (Form 1040), line . 4......... 12 1,241
13 Deduction for one-half of self-employment tax.
Multiply line 12 by 50% (0.50). Enter the result here and on Schedule 1 (Form 1040),
line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 621
Part II Optional Methods To Figure Net Earnings (see instructions)
Farm Optional Method. You may use this method only if (a) your gross farm income¹ wasn't more than
$8,820, or (b) your net farm profits² were less than $6,367.
14 Maximum income for optional methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 5,880
15 Enter the smaller of: two-thirds (2/3) of gross farm income¹ (not less than zero) or $5,880. Also, include
this amount on line 4b above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits³ were less than $6,367
and also less than 72.189% of your gross nonfarm income,4 and (b) you had net earnings from self-employment
of at least $400 in 2 of the prior 3 years. Caution: You may use this method no more than five times.
16 Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4
17 Enter the smaller of: two-thirds (2/3) of gross nonfarm income (not less than zero) or the amount on
line 16. Also include this amount on line 4b above ............................... 17
1
From Sch. F, line 9; and Sch. K-1 (Form 1065), box 14, code B. 3
From Sch. C, line 31; and Sch, K-1 (Form 1065), box 14, code A.
2
From Sch. F, line 34; and Sch. K-1 (Form 1065), box 14, code A - minus the amount 4 From Sch. C, line 7; and Sch. K-1 (Form 1065), box 14, code C.
you would have entered on line 1b had you not used the optional method.
MAWK_SE.LD (Copy of Federal SE.LD)

Form M-8453 2021
Massachusetts
Individual Income Tax Declaration Department of
for Electronic Filing Revenue
Please print or type. Privacy Act Notice available upon request. For the year January 1 - December 31, 2021.
Your first name and initial Last name Your Social Security number

If a joint return, spouse's first name and initial Last name Spouse's Social Security number
Present street address (and apartment number)

City/Town/Post Office State Zip Filing status: X Single Married filing jointly
LEOMINSTER MA 01453 Married filing separately Head of household
Part 1. Tax Return Information for Electronic Filing

1 Total 5.0% income (from Form 1, line 10, or Form 1-NR/PY, line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . 1 8781
2 Income tax after credits (from Form 1, line 32, or Form 1-NR/PY, line 36) . . . . . . . . . . . . . . . . . . . . . . . . 2 6
3 Massachusetts use tax (from Form 1, line 34, or Form 1-NR/PY, line 38) . . . . . . . . . . . . . . . . . . . . . . . . 3
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4 Massachusetts income tax withheld (from Form 1, line 38, or Form 1-NR/PY, line 42) . . . . . . . . . . . . . . . . . . 4
5 Refund amount (from Form 1, line 52, or Form 1-NR/PY, line 56) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
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6 Tax due (from Form 1, line 53, or Form 1-NR/PY, line 57) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6
Part 2. Declaration and Signature of Taxpayer
Under pains and penalties of perjury, I declare that I have reviewed the information on my return with the information I have provided to my Electronic
Return Originator and that the amounts above agree with the amounts shown on my 2021 Massachusetts return. To the best of my knowledge and belief
this information is true, correct and complete. I consent that my return, including this declaration and accompanying schedules, forms and statements be
sent to the Massachusetts Department of Revenue by my Electronic Return Originator. I authorize DOR to inform my Electronic Return Originator and/or
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the transmitter when my electronic return has been accepted. In the event that it is rejected, I authorize DOR to identify the reasons for rejection so that
the return can be corrected and re-transmitted. If I have filed a balance due return, I understand that if DOR does not receive full and timely payment of
my tax liability, I will remain liable for the tax liability and all applicable penalties and interest.
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Your signature Date Spouse's signature (if joint return, both must sign) Date
04-21-2022
Part 3. Declaration and Signature of Electronic Return Originator (ERO)
I declare that I have reviewed the above taxpayer's return and that the entries on this M-8453 are complete and correct to the best of my knowledge.
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(Collectors are not responsible for reviewing the taxpayer's return; however, they must ensure that the M-8453 accurately reflects the data on the return.)
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I have obtained the taxpayer's signature before submitting this return to the Massachusetts Department of Revenue. I have provided the taxpayer with
a copy of all forms and information filed with the Massachusetts Department of Revenue. If I am also the paid preparer, under pains and penalties of
perjury I declare that I have examined the above taxpayer's return and accompanying schedules and statements and to the best of my knowledge and
belief, they are true, correct and complete. I declare that I have verified the taxpayer's proof of account and it agrees with the name(s) shown on this form.
This declaration of paid preparer (other than taxpayer) is based on all information of which the preparer has any knowledge. Original Forms M-8453
should not be sent to DOR, but must instead be retained by the ERO on the ERO's business premises for a period of three years from the date the return
to which the M-8453 relates was filed.
ERO's signature and SSN or PTIN Date EIN Check if
XXXXXXXXX 04-21-2022 83-2587339 self-employed
Firm name (or yours, if self-employed) and address City/Town State Zip X Check if also
SEVENTAX INC paid preparer
369 BROADWAY STE 101 EVERETT MA 02149

Part 4. Declaration and Signature of Paid Preparer (if other than ERO)
Under pains and penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of
my knowledge and belief it is true, correct and complete. This declaration of paid preparer (other than taxpayer) is based on all information of which the
preparer has any knowledge.
Paid preparer's signature and SSN or PTIN Date EIN Check if
self-employed
Firm name (or yours, if self-employed) and address City/Town State Zip
04-21-2022 11:35:31
1024
2021
Form M-9325 Massachusetts
Electronic Filing Department of
Revenue
Information Handout
Electronic Filing Program PO Box 7013, Boston, MA 02204
Thank you for participating in the Massachusetts Department of Revenue (MDOR) Electronic
Filing Program. Your state tax return for tax year 2021 is being filed electronically with MDOR
by SEVENTAX INC . Your return was accepted by MDOR on
02-19-2022 .
.
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General Information
Important
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Do not send the paper copies of your return, schedules and supporting documentation to
MDOR, this information is for your records.
If you need to amend your return

If you need to amend or correct the return you filed electronically, go to www.mass.gov/dor/
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amend. Please contact your paid preparer to inquire about filing this form electronically or
the MDOR Customer Service Bureau at (617) 887-MDOR.
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If you are receiving a refund
Your refund check will be mailed to you as soon as we have completed processing your
return. If you have not received your check within 21 days from the date you filed, please
contact the MDOR Customer Service Bureau at (617) 887-MDOR.
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If you owe a balance
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If your electronically filed return showed a balance due, you must pay the amount you
owe on or before April 19, 2022. If your payment is not received by April 19, 2022, you will
be sent a Notice of Assessment (NOA). This notice will show your tax due, plus any
interest and penalty assessments for late payment.
We appreciate your taking advantage of MDOR Electronic Filing. We are continuing to look
for new methods and technologies to make filing your tax returns simple and easy.

LEOMINSTER MA 01453
04-21-2022 11:35:31
State / Local tax payments made after 12/31/2021 that
MAWK_A5 2021
will be deductible on 2022 Federal Schedule A
Name(s) as shown on return Your Social Security Number
A. 2021 Income taxes due that were paid after 12/31/2021

A1. 4th quarter estimate/extension (may be adj. by refund) . . . . . . . . . .
A2. Amount paid with return . . . . . . . . . . . . . . . . . . . . . . . . . 6
A3. Total payments made in 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A. 6
B. Adjustments made to payments
B1. Interest & Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B2. Contributions, Donations, Checkoffs . . . . . . . . . . . . . . . . . . .
B3. Other Tax payments (Use Tax, property tax, tangible tax, etc) . . . . . . .
B4. Total adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.
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C. Total tax payments potentially deductible in 2022 (Line A less line B) ................. C. 6
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MAWK_A5.LD
Three-year State Tax Return Comparison
MA-COMP 2021
Name(s) as shown on return Taxpayer ID Number
[State] Income Tax Return 2019 2020 2021 Difference 2020-2021

Filing Status . . . . . . . . . . . . . . S S
Gross Income. . . . . . . . . . . . . . 5,558 8,781 3,223
Additions . . . . . . . . . . . . . . . .
Subtractions . . . . . . . . . . . . . .
Exemptions . . . . . . . . . . . . . . 4,400 4,400
Standard Deduction . . . . . . . . . . .
Itemized Deduction . . . . . . . . . . .
Deductions . . . . . . . . . . . . . . . 785 4,241 3,456
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Taxable Income. . . . . . . . . . . . . 373 140 (233)
Actual State Income. . . . . . . . . . . 373 140 (233)
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State Income Tax . . . . . . . . . . . . 6 6
Local Taxes . . . . . . . . . . . . . .
Use Tax . . . . . . . . . . . . . . . .
Contributions . . . . . . . . . . . . . .
Income Tax Withheld . . . . . . . . . .
Estimates and Extension payments . . .
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Underpayment Penalty . . . . . . . . .
Overpayment Applied to Next Year . . .
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Refund . . . . . . . . . . . . . . . . .
Balance Due . . . . . . . . . . . . . . 6 6
Marginal tax rate . . . . . . . . . . . . 5.000000 5.000000
Effective tax rate . . . . . . . . . . . . 4.285700 4.285700
lC i e
MA-COMP.LD

2021 Tax Return Documents (DE CARVALHO COSTA RAF - Client Copy) PDF

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2021 Tax Return Documents (DE CARVALHO COSTA RAF - Client Copy) PDF

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FOR TAX YEAR 2021

RAFAEL DE CARVALHO COSTA

369 Broadway Ste 101

Taxpayer address (optional)

If You Need to Make a Change to Your Return

If You Need to Ask About Your Refund

EEA www.irs.gov Form 9325 (Rev. 1-2017)

If You Owe Tax

Tax Refund Related Financial Products

RAFAEL DE CARVALHO COSTA

EEA www.irs.gov Form 9325 (Rev. 1-2017)

Phone no. 617-708-5744 Email address

Part II Adjustments to Income

Part II Other Taxes (continued)

36 Purchases less cost of items withdrawn for personal use ....................... 36

37 Cost of labor. Do not include any amounts paid to yourself ...................... 37

38 Materials and supplies ....................................... 38 3,664

39 Other costs ............................................. 39

a Business 9,054 b Commuting (see instructions) c Other 8,841

47a Do you have evidence to support your deduction? ................................. X Yes No

TELEPHONE EXPENSE 786

UNIFORM EXPENSE 305

SMALL TOOLS 2,051

Department of the Treasury

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

Taxpayer's PIN: check one box only

Your signature Date

Spouse's PIN: check one box only

Spouse's signature Date

ERO's signature Date 04-21-2022

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

SCHEDULE C, LINE 1 - GROSS RECEIPTS

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

For example, your

Need more information or forms? Visit IRS.gov.

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

Description HONDA CRV 96

Number of miles your vehicle was used for:

Business Use percentage ..................................... 50.60

Standard Mileage Rate Calculation

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

(a) (b) (c) (d)

1b Date and amount of each payment applied to the underpayment

10 Underpayment Number of days

13 Underpayment Number of days

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

i Schedule C: CLEANING XXX-XX-XXXX 8,160

Amount from Form 1040, line 11................................ 8,160

Line 11 above is the difference between these amounts......... (4,390)

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

Name of business activity Schedule C: CLEANING

1. Ordinary business income (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . 8,781 8,781

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

Itemized Deductions Carryover Amount

2019 2020 2021 Difference 2020-2021

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX

Description HONDA CRV 96

Date placed in service 01-01-2020

Business Miles Rate of Depreciation allowed

2021 9,054 0.26

pre-2011 See Publication 463

Total Business Miles 24,255

RAFAEL DE CARVALHO COSTA XXX-XX-XXXX