US 1040 Main Information Sheet 2021

Taxpayer Spouse
PRINTED 04/04/2022
SSN 517-87-5331 770-97-3633
FLORENCIO GONZALEZ-PEREZ Birth 11/14/1981 01/21/1986
MARICELA GARCIA CORNEJO Death
Day Phone 919-477-6058
4301 BENNETT MEMORIAL RD Evening 919-477-6058
DURHAM NC 27705 Cell or Fax 919-697-1537
PIN 75331 73633

Email
Taxpayer Occupation SELF EMPLOYED HOUSEWIFE
Spouse Occupation
Filing Status MARRIED FILING JOINT

FLORENCIO GONZALEZ GARCIA 08/10/2009 683-20-8376 SON 12 1

ERNESTO GONZALEZ-GARCIA 03/29/2011 687-24-1714 SON 12 1
GABRIEL GONZALEZ-GARCIA 11/16/2013 757-98-7472 SON 12 1

Preparer ID: Preparation Fee: Date: 03/31/2022

Preparer: ALEJANDRO JOAQUIN Time in return 19 min.

Recap of 2021 Income Tax Return

Earned Income . . . . . . . . 65,500 Federal Tax . . . . . . . . . . . 10,357

Federal AGI . . . . . . . . . . . 132,259 Withholding . . . . . . . . . . . 3,931
Taxable Income . . . . . . . . 85,727 Refund/(Due) . . . . . . . . . . -3,480
EIC . . . . . . . . . . . . . . . . . . Tax Bracket . . . . . . . . . . . 22.0 %

State . . . . . . . . . . . . . . NC
Tax . . . . . . . . . . . . . . . 5,815
Withholding . . . . . . . . 2,214
Refund/Due . . . . . . . . -3,701
State . . . . . . . . . . . . . .
Tax . . . . . . . . . . . . . . .
Withholding . . . . . . . .
Refund/Due . . . . . . . .

Al fimar este apartado declaro que me han explicado y he entendido cada uno
de mis creditos y deducciones tomados. Si es requerido yo puedo presentar
pruebas ante IRS o el Estado correspondiente.

Walmart
Bank Product Information Advance Only Check Direct Deposit Debit Card
Direct2Cash
Qualifying refund . . . . . . . .
Fees . . . . . . . . . . . . . . . . . . .
Net refund . . . . . . . . . . . . . .
Advance . . . . . . . . . . . . . . . .
Federal disbursement . . . .
State disbursement . . . . . .
Check one . . . . . . . . . . . . . .

© 2021 Universal Tax Systems, Inc. and/or its affiliates and licensors. All rights reserved. US104001
 US Child Tax Credit, and credit for other dependents Federal Extension Payment, and Carryovers Worksheet 2021
202
Name: FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331
SSN:
Amount paid with Federal extension (Form 4868 or 2350) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Carryovers from 2021 to 2022
1 Section 179 expense disallowed, Form 4562, accumulative total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Net operating loss from 2021 only, Form 1045. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount carried forward from 2020. Listed on Form 1040, line 21, or Form 1040NR, line 21 . . .
3 2021 charitable contributions. Organization limit:
Cash Cash or other property Capital Gain
60% 50% 30% 30% 20%

4 Investment interest expense, Form 4952, accumulative total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Foreign tax credit from 2021 only, Form 1116. Enter amount carried back, if any . . . . .

2019 2020 2021

6 Mortgage interest credit, Form 8396. . . . . . . . . . . . . . . .
7 DC first-time homebuyer credit, Form 8859 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Prior year minimum tax credit, Form 8801, cumulative total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 AMT limited qualified electric vehicle credit from 2021 only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Nonrecaptured net section 1231 losses
2017 2018 2019 2020 2021
1,299
11 Qualified business net loss from 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount carried forward from 2020. Enter as a positive amount . . . . . . . . . . . . . . . . . . .
12 Total qualified REIT dividends and PTP loss from 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount carried forward from 2020. Enter as a positive amount . . . . . . . . . . . . . . . . . . .
Reminder - Schedule SE tax was deferred on the 2020 tax return and is required to be repaid. These repayments
amounts are not included in the 2021 or 2022 tax return. Repayments can be made through www.irs.gov/payments
This amount should have been repaid by 12/31/2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
This amount must be repaid by 12/31/2022. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

© 2021 Universal Tax Systems, Inc. and/or its affiliates and licensors. All rights reserved. USW10403
 1040 2021
Department of the Treasury—Internal Revenue Service (99)
U.S. Individual Income Tax Return OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

Filing Status Single X Married filing jointly Married filing separately (MFS) Head of household (HOH) Qualifying widow(er) (QW)
Check only If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child's name if the qualifying person is
one box. a child but not your dependent
Your first name and middle initial Last name Your social security number
FLORENCIO GONZALEZ-PEREZ 517-87-5331
If joint return, spouse's first name and middle initial Last name Spouse's social security number
MARICELA GARCIA CORNEJO 770-97-3633
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
4301 BENNETT MEMORIAL RD Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
DURHAM NC 27705 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

At any time during 2021, did you receive, sell, exchange, or otherwise dispose of any financial interest in any virtual currency? Yes X No

Standard Someone can claim: You as a dependent Your spouse as a dependent

Deduction Spouse itemizes on a separate return or you were a dual-status alien

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) if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four FLORENCIO GONZALEZ GARCIA 683-20-8376 SON X
dependents, ERNESTO GONZALEZ-GARCIA 687-24-1714 SON X
see instructions
GABRIEL GONZALEZ-GARCIA 757-98-7472 SON X
and check
here
1 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . 1 65,500
Attach 2a Tax-exempt interest . . . . . . 2a b Taxable interest . . . . . . . . . . . . 2b
Sch. B if 3a Qualified dividends . . . . . . . 3a b Ordinary dividends. . . . . . . . . . . . . 3b
required. 4a IRA distributions . . . . . . . . 4a b Taxable amount . . . . . . . . . . . 4b
5a Pensions and annuities . . . . . 5a b Taxable amount . . . . . . . . . . . 5b
Standard 6a Social security benefits . . . . 6a b Taxable amount . . . . . . . . . . . 6b
Deduction for—
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 66,759
separately,
$12,550 9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . . . . . . . . . . . . . . 9 132,259
• Married filing
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
jointly or
Qualifying 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . 11 132,259
widow(er),
$25,100 12a Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . . . . 12a 25,100
• Head of b Charitable contributions if you take the standard deduction (see instructions) . . . . . . . 12b
household,
$18,800 c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c 25,100
• If you checked
any box under
13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . . . . . . . . . . . . . 13 21,432
Standard 14 Add lines 12c and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 46,532
Deduction,
see instructions. 15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 15 85,727

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2021)
BCA
Form 1040 (2021) FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331 Page 2
16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . . 16 10,357
17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 10,357
19 Nonrefundable child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . . . . . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 10,357
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . . . . . . . . . . . . . . . 23
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 10,357
25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a 3,931
b Form(s) 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d 3,931
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
January 2, 2004, and you satisfy all the other requirements for
taxpayers who are at least age 18, to claim the EIC. See instructions . . . . . .

b Nontaxable combat pay election . . . . . . . . . . . . . 27b

c Prior year (2019) earned income . . . . . . . . . . . . 27c
28 Refundable child tax credit or additional child tax credit from Schedule 8812 . . . . . . . . 28 3,000
29 American opportunity credit from Form 8863, line 8 . . . . . . . . . . . . . . . . . 29
30 Recovery rebate credit. See instructions . . . . . . . . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . 31
32 Add lines 27a and 28 through 31. These are your total other payments and refundable credits . . . . . . . . . . . . 32 3,000
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . . . . . . . . . . . . . 33 6,931
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . . . . . . . . . . . . . 34
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . . . . . . . . . . . 35a
Direct deposit? c Type: Checking Savings
b Routing number
See instructions.
d Account number
36 Amount of line 34 you want applied to your 2022 estimated tax . . . . . . . . . . . 36
Amount 37 Amount you owe. Subtract line 33 from line 24. For details on how to pay, see instructions . . . . . . . . . . . . . . 37 3,480
You Owe 38 Estimated tax penalty (see instructions) . . . . . . . . . . . . . . . . . . . . 38 54
Third Party Do you want to allow another person to discuss this return with the IRS?
Designee See 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 Your signature Date Your occupation If the IRS sent you an Identity Protection
PIN, enter it
Joint return? SELF EMPLOYED here (see inst.)
See instructions. Spouse's signature. If a joint return, both must sign. Date Spouse's occupation If the IRS sent you an Identity Protection
Keep a copy for PIN, enter it
your records. HOUSEWIFE here (see inst.)

Phone no. 919-477-6058 Email address

Preparer's name Preparer's signature Date PTIN Check if:
Paid Self-employed
ALEJANDRO JOAQUIN 03/31/2022 P02232010
Preparer
Firm's name LA CONTABLE INC Phone no. 919-471-1300
Use Only Firm's address 3013 GUESS RD DURHAM NC 27705 Firm's EIN 46-3676165
Go to www.irs.gov/Form1040 for instructions and the latest information. US1040$2 Form 1040 (2021)
SCHEDULE 1 OMB No. 1545-0074
Additional Income and Adjustments to Income
(Form 1040)
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
FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . . 1
2a Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Date of original divorce or separation agreement (see instructions)
3 Business income or (loss). Attach Schedule C . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 -1,299
5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach
Schedule E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 68,058
6 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Other income:
a Net operating loss . . . . . . . . . . . . . . . . . . . . . . . . . . 8a ( )
b Gambling income . . . . . . . . . . . . . . . . . . . . . . . . . . 8b
c Cancellation of debt . . . . . . . . . . . . . . . . . . . . . . . . . 8c
d Foreign earned income exclusion from Form 2555 . . . . . . . . . . . . . 8d ( )
e Taxable Health Savings Account distribution . . . . . . . . . . . . . . . 8e
f Alaska Permanent Fund dividends . . . . . . . . . . . . . . . . . . . 8f
g Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8g
h Prizes and awards . . . . . . . . . . . . . . . . . . . . . . . . . . 8h
i Activity not engaged in for profit income . . . . . . . . . . . . . . . . . 8i
j Stock options . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8j
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 66,759
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 1 (Form 1040) 2021
BCA
 Detach Here and Mail With Your Payment and Return

Department of the Treasury

Internal Revenue Service 2021 Form 1040-V Payment Voucher
Use this voucher when making a payment with Form 1040 Amount you are paying Dollars
Do not staple this voucher or your payment to Form 1040 by check or money order 3,480
Make your check or money order payable to the "United States Treasury"
Write your Social Security Number (SSN) on your check or money order
1045
10

FLORENCIO GONZALEZ-PEREZ & MARICELA Internal Revenue Service

4301 BENNETT MEMORIAL RD PO BOX 1214
DURHAM NC 27705 Charlotte NC 28201-1214

517875331 RH GONZ 30 0 202112 610

Schedule E (Form 1040) 2021 Attachment Sequence No. 13 Page 2
Name(s) shown on return. Do not enter name and social security number if shown on other side. Your social security number
FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331
Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
Part II Income or Loss From Partnerships and S Corporations — Note: If you report a loss, receive a distribution, dispose of
stock, or receive a loan repayment from an S corporation, you must check the box in column (e) on line 28 and attach the required basis
computation. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (f) on
line 28 and attach Form 6198. See instructions.
27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a
passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? If you answered "Yes,"
see instructions before completing this section. . . . . . . . . . . . . . . . . . . . . . . . Yes No
(b) Enter P for (c) Check if (d) Employer (e) Check if (f) Check if
28 (a) Name partnership; S foreign identification basis computation any amount is
for S corporation partnership number is required not at risk
A GONZALEZ PAINTERS AND CONTRAC S 47-3529356
B GREEN RIVER PROPERTIES INC s 81-1985898
C
D
Passive Income and Loss Nonpassive Income and Loss
(g) Passive loss allowed (h) Passive income (i) Nonpassive loss (j) Section 179 expense (k) Nonpassive income
(attach Form 8582 if required) from Schedule K-1 from Schedule K-1 deduction from Form 4562 from Schedule K-1
A 49,301
B 13,002 5,755
C
D
29a Totals 13,002 55,056
b Totals
30 Add columns (h) and (k) of line 29a . . . . . . . . . . . . . . . . . . . . . . . . . . 30 68,058
31 Add columns (g), (i), and (j) of line 29b . . . . . . . . . . . . . . . . . . . . . . . . . 31 ( )
32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. . . . . . . . . 32 68,058
Part III Income or Loss From Estates and Trusts
(b) Employer
33 (a) Name
identification number
A
B
Passive Income and Loss Nonpassive Income and Loss
(c) Passive deduction or loss allowed (d) Passive income (e) Deduction or loss (f) Other income from
(attach Form 8582 if required) from Schedule K-1 from Schedule K-1 Schedule K-1
A
B
34a Totals
b Totals
35 Add columns (d) and (f) of line 34a . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Add columns (c) and (e) of line 34b . . . . . . . . . . . . . . . . . . . . . . . . . . 36 ( )
37 Total estate and trust income or (loss). Combine lines 35 and 36. . . . . . . . . . . . . . 37
Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)—Residual Holder
(c) Excess inclusion from
(b) Employer (d) Taxable income (net loss) (e) Income from
38 (a) Name
identification number
Schedules Q, line 2c
from Schedules Q, line 1b Schedules Q, line 3b
(see instructions)

39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below . . 39
Part V Summary
40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below . . . . . . . . . 40
41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Schedule 1 (Form 1040), line 5 . . . . . . . 41 68,058
42 Reconciliation of farming and fishing income. Enter your gross
farming and fishing income reported on Form 4835, line 7; Schedule K-1
(Form 1065), box 14, code B; Schedule K-1 (Form 1120-S), box 17, code
AD; and Schedule K-1 (Form 1041), box 14, code F. See instructions . . . . 42
43 Reconciliation for real estate professionals. If you were a real estate professional
(see instructions), enter the net income or (loss) you reported anywhere on Form
1040, Form 1040-SR, or Form 1040-NR from all rental real estate activities in which
you materially participated under the passive activity loss rules . . . . . . . . . . . . 43
BCA Schedule E (Form 1040) 2021
SCHEDULE 8812 Credits for Qualifying Children OMB No. 1545-0074

and Other Dependents

(Form 1040)
Attach to Form 1040, 1040-SR, or 1040-NR.
2021
Department of the Treasury Attachment
Go to www.irs.gov/Schedule8812 for instructions and the latest information. Sequence No. 47
Internal Revenue Service (99)
Name(s) shown on return Your social security number

FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331

Part I-A Child Tax Credit and Credit for Other Dependents
1 Enter the amount from line 11 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . 1 132,259
2a Enter income from Puerto Rico that you excluded . . . . . . . . . . . . . . . . . . 2a
b Enter the amounts from lines 45 and 50 of your Form 2555 . . . . . . . . . . . . . . 2b
c Enter the amount from line 15 of your Form 4563 . . . . . . . . . . . . . . . . . . 2c
d Add lines 2a through 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d
3 Add lines 1 and 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 132,259
4a Number of qualifying children under age 18 with the required social security number . . . . . 4a 3
b Number of children included on line 4a who were under age 6 at the end of 2021 . . . . . . 4b
c Subtract line 4b from line 4a . . . . . . . . . . . . . . . . . . . . . . . . . . 4c 3
5 If line 4a is more than zero, enter the amount from the Line 5 Worksheet; otherwise, enter -0- . . . . . . . . 5 9,000
6 Number of other dependents, including any qualifying children who are not under age
18 or who do not have the required social security number . . . . . . . . . . . . . . . 6
Caution: Do not include yourself, your spouse, or anyone who is not a U.S. citizen, U.S. national, or U.S. resident
alien. Also, do not include anyone you included on line 4a.
7 Multiply line 6 by $500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Add lines 5 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9,000
9 Enter the amount shown below for your filing status.
• Married filing jointly—$400,000
• All other filing statuses—$200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 400,000
10 Subtract line 9 from line 3.
• If zero or less, enter -0-.
• If more than zero and not a multiple of $1,000, enter the next multiple of $1,000. For
example, if the result is $425, enter $1,000; if the result is $1,025, enter $2,000, etc. . . . . . . . . . . 10
11 Multiply line 10 by 5% (0.05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . 12 9,000
13 Check all the boxes that apply to you (or your spouse if married filing jointly).
A Check here if you (or your spouse if married filing jointly) had a principal place of abode in the United
States for more than half of 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
B Check here if you (or your spouse if married filing jointly) were a bona fide resident of Puerto Rico for 2021
Part I-B Filers Who Check a Box on Line 13
Caution: If you did not check a box on line 13, do not complete Part I-B; instead, skip to Part I-C.
14a Enter the smaller of line 7 or line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a
b Subtract line 14a from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b 9,000
c If line 14a is zero, enter -0-; otherwise, enter the amount from the Credit Limit Worksheet A . . . . . . . . . 14c
d Enter the smaller of line 14a or line 14c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14d
e Add lines 14b and 14d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14e 9,000
f Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received
for 2021. See your Letter(s) 6419 for the amounts to include on this line. If you are missing Letter 6419, see the
instructions before entering an amount on this line . . . . . . . . . . . . . . . . . . . . . . . . . . 14f 6,000
Caution: If the amount on this line doesn't match the aggregate amounts reported to you (and your spouse if
filing jointly) on your Letter(s) 6419, the processing of your return will be delayed.
g Subtract line 14f from line 14e. If zero or less, enter -0- on lines 14g through 14i and go to Part III . . . . . . . . 14g 3,000
h Enter the smaller of line 14d or line 14g. This is your credit for other dependents. Enter this amount on line
19 of your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . 14h
i Subtract line 14h from line 14g. This is your refundable child tax credit. Enter this amount on line 28 of
your Form 1040, 1040-SR, or 1040-NR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14i 3,000
For Paperwork Reduction Act Notice, see your tax return instructions. Schedule 8812 (Form 1040) 2021
BCA
 US 8812 Child Tax Credit / Credit for Other Dependents Worksheets 2021
Name: FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331
SSN:

Line 5 Worksheet

1 Multiply Schedule 8812, line 4b, by $3,600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Multiply Schedule 8812, line 4c, by $3,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,000
3 Add line 1 and line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,000
4 Multiply Schedule 8812, line 4a, by $2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,000
5 Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,000
6 Applicable amount based on the filing status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,500
7 Smaller of line 5 or 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,000
8 Applicable amount based on the filing status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150,000
9 Subtract line 8 from Schedule 8812, line 3, rounded up to the next $1,000 . . . . . . . . . . . . . . . . . . . . . . . . .
10 Multiply line 9 by 5% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11 Smaller of line 7 or line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Subtract line 11 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,000
Credit Limit Worksheet A

1 Amount from Form 1040 or Form 1040-NR, line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,357

2 Amount from: Schedule 3, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule 3, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule 3, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule 3, line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule 3, line 6l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 5695, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 8910, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 8936, line 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule R, line 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,357
Complete the Credit Limit Worksheet B only if you meet all of the following.
You are completing Part l-C of Schedule 8812
You are claiming the mortgage interest credit (Form 8936), adoption credit (form 8839), residential energy efficient
property credit (Form 5695, Part 1), or District of Columbia first-time homebuyer credit (Form 8859).
You are not filing Form 2555
Line 4a of Schedule 8812 is more than zero.
4 Amount from Credit Limit Worksheet B, if required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,357
Credit Limit Worksheet B

1 Amount from Schedule 8812, line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Number of qualifying children under 18 with the required social security number multiplied by $1,400 . . . . . . . . . . .
3 Earned income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Subtract $2,500 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Multiply line 4 by 15% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Is the amount on line 2 $4,200 or more?
No. if line 2 or line 5 above is zero, the amount from line 1 is entered on line 14.
Yes. If line 5 is equal to or more than line 1, skip lines 7 though 11 and go to line 12. Otherwise, go to line 7.
7 Social security or RR tier 1 plus Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Total of Schedule 1, line 15; Schedule 2, line 5; Schedule 2, line 6; and Schedule 2, line 13 . . .
9 Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Total of Form 1040, line 27a and Schedule 3, line 11 . . . . . . . . . . . . . . . . . . . . . . .
11 Subtract line 10 from line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Larger of line 5 or line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Smaller of line 2 or line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 Subtract line 13 from line 1, but not less than -0 . . . . . . . . . . . . . . . . . . . . . . . . . .
15 Total of adoption credit, mortgage interest credit, DC first-time homebuyer credit, and
residential energy credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
© Universal Tax Systems, Inc. and/or its affiliates and licensors. All rights reserved
 Sales of Business Property
Form 4797 (Also Involuntary Conversions and Recapture Amounts
OMB No. 1545-0184

2021
Under Sections 179 and 280F(b)(2))
Department of the Treasury Attach to your tax return. Attachment
Internal Revenue Service Go to www.irs.gov/Form4797 for instructions and the latest information. Sequence No. 27
Name(s) shown on return Identifying number
FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331
1a Enter the gross proceeds from sales or exchanges reported to you for 2021 on Form(s) 1099-B or 1099-S (or
substitute statement) that you are including on line 2, 10, or 20. See instructions . . . . . . . . . . . . . . 1a
b Enter the total amount of gain that you are including on lines 2, 10, and 24 due to the partial dispositions of
MACRS assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b
c Enter the total amount of loss that you are including on lines 2 and 10 due to the partial dispositions of MACRS
assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c
Part I Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From
Other Than Casualty or Theft—Most Property Held More Than 1 Year (see instructions)
(e) Depreciation (f) Cost or other
2 (a) Description (b) Date acquired (c) Date sold (d) Gross allowed or basis, plus (g) Gain or (loss)
Subtract (f) from the
of property (mo., day, yr.) (mo., day, yr.) sales price allowable since improvements and
sum of (d) and (e)
acquisition expense of sale

FROM K-1 -1,299

3 Gain, if any, from Form 4684, line 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Section 1231 gain from installment sales from Form 6252, line 26 or 37 . . . . . . . . . . . . . . . . . 4
5 Section 1231 gain or (loss) from like-kind exchanges from Form 8824 . . . . . . . . . . . . . . . . . . 5
6 Gain, if any, from line 32, from other than casualty or theft . . . . . . . . . . . . . . . . . . . . . . 6
7 Combine lines 2 through 6. Enter the gain or (loss) here and on the appropriate line as follows . . . . . . . . 7 -1,299
Partnerships and S corporations. Report the gain or (loss) following the instructions for Form 1065,
Schedule K, line 10, or Form 1120-S, Schedule K, line 9. Skip lines 8, 9, 11, and 12 below.

Individuals, partners, S corporation shareholders, and all others. If line 7 is zero or a loss, enter the
amount from line 7 on line 11 below and skip lines 8 and 9. If line 7 is a gain and you didn't have any prior year
section 1231 losses, or they were recaptured in an earlier year, enter the gain from line 7 as a long-term capital
gain on the Schedule D filed with your return and skip lines 8, 9, 11, and 12 below.
8 Nonrecaptured net section 1231 losses from prior years. See instructions . . . . . . . . . . . . . . . . 8

9 Subtract line 8 from line 7. If zero or less, enter -0-. If line 9 is zero, enter the gain from line 7 on line 12 below.
If line 9 is more than zero, enter the amount from line 8 on line 12 below and enter the gain from line 9 as a
long-term capital gain on the Schedule D filed with your return. See instructions . . . . . . . . . . . . . . 9
Part II Ordinary Gains and Losses (see instructions)
10 Ordinary gains and losses not included on lines 11 through 16 (include property held 1 year or less):

11 Loss, if any, from line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 ( 1,299 )

12 Gain, if any, from line 7 or amount from line 8, if applicable . . . . . . . . . . . . . . . . . . . . . . 12
13 Gain, if any, from line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Net gain or (loss) from Form 4684, lines 31 and 38a . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Ordinary gain from installment sales from Form 6252, line 25 or 36 . . . . . . . . . . . . . . . . . . . 15
16 Ordinary gain or (loss) from like-kind exchanges from Form 8824 . . . . . . . . . . . . . . . . . . . . 16
17 Combine lines 10 through 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 -1,299
18 For all except individual returns, enter the amount from line 17 on the appropriate line of your return and skip
lines a and b below. For individual returns, complete lines a and b below.
a If the loss on line 11 includes a loss from Form 4684, line 35, column (b)(ii), enter that part of the loss here. Enter
the loss from income-producing property on Schedule A (Form 1040), line 16. (Do not include any loss on
property used as an employee.) Identify as from "Form 4797, line 18a." See instructions . . . . . . . . . . . 18a
b Redetermine the gain or (loss) on line 17 excluding the loss, if any, on line 18a. Enter here and on Schedule 1
(Form 1040), Part I, line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18b -1,299
For Paperwork Reduction Act Notice, see separate instructions. Form 4797 (2021)
BCA
Form 6251 Alternative Minimum Tax—Individuals OMB No. 1545-0074

2021
Go to www.irs.gov/Form6251 for instructions and the latest information.
Department of the Treasury Attachment
Internal Revenue Service (99) Attach to Form 1040, 1040-SR, or 1040-NR. Sequence No. 32
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number

FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331

Part I Alternative Minimum Taxable Income (See instructions for how to complete each line.)
1 Enter the amount from Form 1040 or 1040-SR, line 15, if more than zero. If Form 1040 or 1040-SR, line 15,
is zero, subtract line 14 of Form 1040 or 1040-SR from line 11 of Form 1040 or 1040-SR and enter the result
here. (If less than zero, enter as a negative amount.) . . . . . . . . . . . . . . . . . . . . . . . 1 85,727
2a If filing Schedule A (Form 1040), enter the taxes from Schedule A, line 7; otherwise, enter the amount from
Form 1040 or 1040-SR, line 12a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a 25,100
b Tax refund from Schedule 1 (Form 1040), line 1 or line 8z . . . . . . . . . . . . . . . . . . . . . 2b ( )
c Investment interest expense (difference between regular tax and AMT) . . . . . . . . . . . . . . . . 2c
d Depletion (difference between regular tax and AMT) . . . . . . . . . . . . . . . . . . . . . . . . 2d
e Net operating loss deduction from Schedule 1 (Form 1040), line 8a. Enter as a positive amount . . . . . . . 2e
f Alternative tax net operating loss deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f ( )
g Interest from specified private activity bonds exempt from the regular tax . . . . . . . . . . . . . . . . 2g
h Qualified small business stock, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . 2h
i Exercise of incentive stock options (excess of AMT income over regular tax income) . . . . . . . . . . . 2i
j Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A) . . . . . . . . . . . . . . 2j
k Disposition of property (difference between AMT and regular tax gain or loss) . . . . . . . . . . . . . . 2k -2,364
l Depreciation on assets placed in service after 1986 (difference between regular tax and AMT) . . . . . . . 2l 1,699
m Passive activities (difference between AMT and regular tax income or loss) . . . . . . . . . . . . . . . 2m
n Loss limitations (difference between AMT and regular tax income or loss) . . . . . . . . . . . . . . . 2n
o Circulation costs (difference between regular tax and AMT) . . . . . . . . . . . . . . . . . . . . . 2o
p Long-term contracts (difference between AMT and regular tax income) . . . . . . . . . . . . . . . . 2p
q Mining costs (difference between regular tax and AMT) . . . . . . . . . . . . . . . . . . . . . . 2q
r Research and experimental costs (difference between regular tax and AMT) . . . . . . . . . . . . . . 2r
s Income from certain installment sales before January 1, 1987 . . . . . . . . . . . . . . . . . . . . 2s ( )
t Intangible drilling costs preference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2t
3 Other adjustments, including income-based related adjustments . . . . . . . . . . . . . . . . . . . 3
4 Alternative minimum taxable income. Combine lines 1 through 3. (If married filing separately and line 4 is
more than $752,800, see instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 110,162
Part II Alternative Minimum Tax (AMT)
5 Exemption.
IF your filing status is . . . AND line 4 is not over . . . THEN enter on line 5 . . .
Single or head of household . . . . . $ 523,600 . . . . . . . $ 73,600
Married filing jointly or qualifying widow(er) 1,047,200 . . . . . . . 114,600
Married filing separately . . . . . . 523,600 . . . . . . . 57,300 . . . 5 114,600
If line 4 is over the amount shown above for your filing status, see instructions.
6 Subtract line 5 from line 4. If more than zero, go to line 7. If zero or less, enter -0- here and on lines 7, 9,
and 11, and go to line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 If you are filing Form 2555, see instructions for the amount to enter.
If you reported capital gain distributions directly on Form 1040 or 1040-SR, line 7; you reported
qualified dividends on Form 1040 or 1040-SR, line 3a; or you had a gain on both lines 15 and
16 of Schedule D (Form 1040) (as refigured for the AMT, if necessary), complete Part III on the . . 7
back and enter the amount from line 40 here.
All others: If line 6 is $199,900 or less ($99,950 or less if married filing separately), multiply
line 6 by 26% (0.26). Otherwise, multiply line 6 by 28% (0.28) and subtract $3,998 ($1,999 if
married filing separately) from the result.
8 Alternative minimum tax foreign tax credit (see instructions) . . . . . . . . . . . . . . . . . . . . 8
9 Tentative minimum tax. Subtract line 8 from line 7 . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Add Form 1040 or 1040-SR, line 16 (minus any tax from Form 4972), and Schedule 2 (Form 1040), line 2.
Subtract from the result Schedule 3 (Form 1040), line 1 and any negative amount reported on Form 8978,
line 14 (treated as a positive number). If zero or less, enter -0-. If you used Schedule J to figure your tax on
Form 1040 or 1040-SR, line 16, refigure that tax without using Schedule J before completing this line. See 10,357
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 AMT. Subtract line 10 from line 9. If zero or less, enter -0-. Enter here and on Schedule 2 (Form 1040), line 1 . 11
For Paperwork Reduction Act Notice, see your tax return instructions. Form 6251 (2021)
BCA
 Paid Preparer's Due Diligence Checklist
Form 8867 Earned Income Credit (EIC), American Opportunity Tax Credit (AOTC),
Child Tax Credit (CTC) (including the Additional Child Tax Credit (ACTC) and
OMB No. 1545-0074

(Rev. December 2021)

Credit for Other Dependents (ODC)), and Head of Household (HOH) Filing Status
Attachment
To be completed by preparer and filed with Form 1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS.
Department of the Treasury Sequence No. 70
Internal Revenue Service Go to www.irs.gov/Form8867 for instructions and the latest information.
Taxpayer name(s) shown on return Taxpayer identification number

FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331

Enter preparer's name and PTIN

ALEJANDRO JOAQUIN P02232010

Part I Due Diligence Requirements
Please check the appropriate box for the credit(s) and/or HOH filing status claimed on the return and complete the related Parts I–V
for the benefit(s) claimed (check all that apply). EIC X CTC/ACTC/ODC AOTC HOH
1 Did you complete the return based on information for the applicable tax year provided by the taxpayer Yes No N/A
or reasonably obtained by you? (See instructions if relying on prior year earned income.) . . . . . X
2 If credits are claimed on the return, did you complete the applicable EIC and/or CTC/ACTC/ODC
worksheets found in the Form 1040, 1040-SR, 1040-NR, 1040-PR, 1040-SS, or Schedule 8812 (Form
1040) instructions, and/or the AOTC worksheet found in the Form 8863 instructions, or your own
worksheet(s) that provides the same information, and all related forms and schedules for each credit
claimed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
3 Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both
of the following.
• Interview the taxpayer, ask questions, and contemporaneously document the taxpayer's responses
to determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing status.
• Review information to determine that the taxpayer is eligible to claim the credit(s) and/or HOH filing
status and to figure the amount(s) of any credit(s) . . . . . . . . . . . . . . . . . . . . X
4 Did any information provided by the taxpayer or a third party for use in preparing the return, or
information reasonably known to you, appear to be incorrect, incomplete, or inconsistent? (If "Yes,"
answer questions 4a and 4b. If "No," go to question 5.) . . . . . . . . . . . . . . . . . . X
a Did you make reasonable inquiries to determine the correct, complete, and consistent information? .
b Did you contemporaneously document your inquiries? (Documentation should include the questions
you asked, whom you asked, when you asked, the information that was provided, and the impact the
information had on your preparation of the return.) . . . . . . . . . . . . . . . . . . . .
5 Did you satisfy the record retention requirement? To meet the record retention requirement, you must
keep a copy of your documentation referenced in question 4b, a copy of this Form 8867, a copy of any
applicable worksheet(s), a record of how, when, and from whom the information used to prepare Form
8867 and any applicable worksheet(s) was obtained, and a copy of any document(s) provided by the
taxpayer that you relied on to determine eligibility for the credit(s) and/or HOH filing status or to figure
the amount(s) of the credit(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
List those documents provided by the taxpayer, if any, that you relied on:
W2,K1,IRS LETTERS

6 Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for the
credit(s) and/or HOH filing status and the amount(s) of any credit(s) claimed on the return if his/her
return is selected for audit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
7 Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year? . . . X
(If credits were disallowed or reduced, go to question 7a; if not, go to question 8.)
a Did you complete the required recertification Form 8862? . . . . . . . . . . . . . . . . . .
8 If the taxpayer is reporting self-employment income, did you ask questions to prepare a complete and
correct Schedule C (Form 1040)? . . . . . . . . . . . . . . . . . . . . . . . . . . . X
For Paperwork Reduction Act Notice, see separate instructions. Form 8867 (Rev. 12-2021)
BCA
Form 8867 (Rev. 12-2021)
FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331 Page 2
Part II Due Diligence Questions for Returns Claiming EIC (If the return does not claim EIC, go to Part III.)
9a Have you determined that the taxpayer is eligible to claim the EIC for the number of qualifying children Yes No N/A
claimed, or is eligible to claim the EIC without a qualifying child? (If the taxpayer is claiming the EIC
and does not have a qualifying child, go to question 10.) . . . . . . . . . . . . . . . .
b Did you ask the taxpayer if the child lived with the taxpayer for over half of the year, even if the taxpayer
has supported the child the entire year? . . . . . . . . . . . . . . . . . . . . . . . . .
c Did you explain to the taxpayer the rules about claiming the EIC when a child is the qualifying child of
more than one person (tiebreaker rules)? . . . . . . . . . . . . . . . . . . . . . . . .
Part III Due Diligence Questions for Returns Claiming CTC/ACTC/ODC (If the return does not claim CTC, ACTC,
or ODC, go to Part IV.)
10 Have you determined that each qualifying person for the CTC/ACTC/ODC is the taxpayer's dependent Yes No N/A
who is a citizen, national, or resident of the United States? . . . . . . . . . . . . . . . . . X
11 Did you explain to the taxpayer that he/she may not claim the CTC/ACTC if the child has not lived with
the taxpayer for over half of the year, even if the taxpayer has supported the child, unless the child's
custodial parent has released a claim to exemption for the child? . . . . . . . . . . . . . . . X
12 Did you explain to the taxpayer the rules about claiming the CTC/ACTC/ODC for a child of divorced or
separated parents (or parents who live apart), including any requirement to attach a Form 8332 or
similar statement to the return? . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
Part IV Due Diligence Questions for Returns Claiming AOTC (If the return does not claim AOTC, go to Part V.)
13 Did the taxpayer provide substantiation for the credit, such as a Form 1098-T and/or receipts for the qualified Yes No
tuition and related expenses for the claimed AOTC? . . . . . . . . . . . . . . . . . . . . . . . .
Part V Due Diligence Questions for Claiming HOH (If the return does not claim HOH filing status, go to Part VI.)
14 Have you determined that the taxpayer was unmarried or considered unmarried on the last day of the tax year Yes No
and provided more than half of the cost of keeping up a home for the year for a qualifying person? . . . . .
Part VI Eligibility Certification
You will have complied with all due diligence requirements for claiming the applicable credit(s) and/or HOH filing
status on the return of the taxpayer identified above if you:
A. Interview the taxpayer, ask adequate questions, contemporaneously document the taxpayer's responses on the return or
in your notes, review adequate information to determine if the taxpayer is eligible to claim the credit(s) and/or HOH filing
status and to figure the amount(s) of the credit(s);
B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for any applicable
credit(s) claimed and HOH filing status, if claimed;
C. Submit Form 8867 in the manner required; and
D. Keep all five of the following records for 3 years from the latest of the dates specified in the Form 8867 instructions
under Document Retention.
1. A copy of this Form 8867.
2. The applicable worksheet(s) or your own worksheet(s) for any credit(s) claimed.
3. Copies of any documents provided by the taxpayer on which you relied to determine the taxpayer's eligibility for the
credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s).
4. A record of how, when, and from whom the information used to prepare this form and the applicable worksheet(s) was
obtained.
5. A record of any additional information you relied upon, including questions you asked and the taxpayer's responses, to
determine the taxpayer's eligibility for the credit(s) and/or HOH filing status and to figure the amount(s) of the credit(s).
If you have not complied with all due diligence requirements, you may have to pay a penalty for each failure to
comply related to a claim of an applicable credit or HOH filing status (see instructions for more information).
15 Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and Yes No
complete? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
Form 8867 (Rev. 12-2021)
Form 8995 Qualified Business Income Deduction OMB No. 1545-2294

Simplified Computation 2021

Department of the Treasury Attach to your tax return. 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

FLORENCIO GONZALEZ-PEREZ & MARICELA 517-87-5331

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 GONZALEZ PAINTERS AND CONTRACTORS 47-3529356 6,574,853

ii

iii

iv

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

column (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 6,574,853
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 6,574,853
5 Qualified business income component. Multiply line 4 by 20% (0.20) . . . . . . . . . . . . . . 5 1,314,971
6 Qualified REIT dividends and publicly traded partnership (PTP) income or
(loss) (see instructions) . . . . . . . . . . . . . . . . . . . . . . 6
7 Qualified REIT dividends and qualified PTP (loss) carryforward from the prior
year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ( )
8 Total qualified REIT dividends and PTP income. Combine lines 6 and 7. If zero
or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . 8
9 REIT and PTP component. Multiply line 8 by 20% (0.20) . . . . . . . . . . . . . . . . . . . 9
10 Qualified business income deduction before the income limitation. Add lines 5 and 9 . . . . . . . 10 1,314,971
11 Taxable income before qualified business income deduction (see instructions) 11 107,159
12 Net capital gain (see instructions) . . . . . . . . . . . . . . . . . . 12
13 Subtract line 12 from line 11. If zero or less, enter -0- . . . . . . . . . . 13 107,159
14 Income limitation. Multiply line 13 by 20% (0.20) . . . . . . . . . . . . . . . . . . . . . . 14 21,432
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 21,432
16 Total qualified business (loss) carryforward. Combine lines 2 and 3. If greater than zero, enter -0- . . 16 ( )
17 Total qualified REIT dividends and PTP (loss) carryforward. Combine lines 6 and 7. If greater than
zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 ( )
For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8995 (2021)
BCA
Form 8879
(Rev. January 2021) US8879$1
IRS e-file Signature Authorization
OMB No. 1545-0074

Department of the Treasury

ERO must obtain and retain completed Form 8879.
Internal Revenue Service Go to www.irs.gov/Form8879 for the latest information.

Submission Identification Number (SID)

00568583 4
Taxpayer's name Social security number
FLORENCIO GONZALEZ-PEREZ 517-87-5331
Spouse's name Spouse's social security number
MARICELA GARCIA CORNEJO 770-97-3633
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 132,259
2 Total tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 10,357
3 Federal income tax withheld from Form(s) W-2 and Form(s) 1099 . . . . . . . . . . . . . . . . 3 3,931
4 Amount you want refunded to you . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Amount you owe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 3,480
Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
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
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
Electronic Funds Withdrawal Consent.
Taxpayer's PIN: check one box only
X I authorize LA CONTABLE INC to enter or generate my PIN 75331
ERO firm name Enter five digits, but
don't enter all zeros
as my 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.
Your signature Date 03/31/2022

Spouse's PIN: check one box only

X I authorize LA CONTABLE INC to enter or generate my PIN 73633
ERO firm name Enter five digits, but
don't enter all zeros
as my 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 03/31/2022

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. 56858327705
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 LA CONTABLE INC Date 03/31/2022

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)
BCA
D-400 (62) 8-23-21 2021 Individual Income Tax Return DOR
< Staple All Pages of Your North Carolina Department of Revenue Use
Only
Return and W-2s Here NCD400$1 Amended Return
21 and ending
For calendar year 2021, or fiscal year beginning Are you a veteran? Yes No X
FLORENCIO GONZALEZ-PEREZ & MARICELA Is your spouse a veteran? Yes No X
4301 BENNETT MEMORIAL RD Your SSN: 517875331 Were you granted an automatic extension to file your
DURHAM NC 27705 DURHA Spouse's SSN: 770973633 2021 federal income tax return, e.g., Form 1040?
Filing Status 1. Single X 2. Married Filing Jointly 3. Married Filing Separately Yes No
4. Head of Household 5. Qualifying Widow(er) Year spouse died:
Were you a resident of N.C. for the entire year? Yes X No Return for deceased taxpayer. Date of death:
Was your spouse a resident for the entire year? Yes X No Return for deceased spouse. Date of death:
N.C. Education Endowment Fund: You may contribute to the N.C. Education Endowment Fund by making a contribution or designating some or all of
your overpayment to the Fund. To make a contribution, enclose Form NC-EDU and your payment of $ 0 . To designate your
overpayment to the Fund, enter the amount of your designation on Page 2, Line 31. (See instructions for information about the Fund.)
Select box if you, or if married filing jointly, your spouse were out of the country on April 15, 2022, and a U.S. citizen or resident.
Select box if return is filed and signed by Executor, Administrator, or Court-Appointed Personal Representative.

FS 2 PP Y DT N OC N TPRES Y SPRES Y VT N SVT N

GONZ 4301 27705 DS N EA N TD SD FDEXT N

FLORENCIO GONZALEZ-PEREZ 517875331 DURHA

MARICELA GARCIA CORNEJO 770973633 NC 27705

4301 BENNETT MEMORIAL RD DURHAM

06 132259 16 0 26C 0

07 0 18 Y 0 26E 100
09 0 20A 2214 EU

10A 3 20B 0 27 3701

10B 0 21A 0 29 0
11 S Y I N 21B 0 30 0

11 21500 21C 0 31 0
13 00000 21D 0 32 0

14 110759 26A 3601 34 0

15 5815 26B 0
TN 9194776058 PN 9194711300 PP 463676165

Sign Return Below Refund Due 0 X Payment Due 3701

I declare and certify that I have examined this return and accompanying schedules and statements, and to Check here if you authorize the North Carolina Department of Revenue
the best of my knowledge and belief, they are true, correct, and complete. to discuss this return and attachments with the paid preparer below.

919-477-6058
Your Signature Date Spouse's Signature (If filing joint return, both must sign.) Date Contact Phone No. (Include area code)
PAID PREPARER USE ONLY If prepared by a person other than taxpayer, this certification is based on all information of which the preparer has any knowledge.

03/31/2022 919-471-1300 46-3676165

Paid Preparer's Signature Date Preparer's Contact Phone Number (Include area code) Preparer's FEIN, SSN, or PTIN

If REFUND, mail return to: N.C. DEPT. OF REVENUE, P.O. BOX R, RALEIGH, NC 27634-0001
If you ARE NOT due a refund, mail return, any payment, and D-400V to: N.C. DEPT. OF REVENUE, P.O. BOX 25000, RALEIGH, NC 27640-0640
D-400 2021 Page 2 (62)
(6
Last Name (First 10 Characters) GONZALEZ-P Your Social Security Number 517875331
D-400 Line-by-Line Information

6. Federal Adjusted Gross Income 6. 132259

7. Additions to Federal Adjusted Gross Income 7. 0
8. Add Lines 6 and 7 8. 132259
9. Deductions From Federal Adjusted Gross Income 9. 0
10. Child Deduction
a. Enter the number of qualifying children for whom you were allowed a federal child tax credit 10a. 3
b. Enter the amount of the child deduction 10b. 0
11. N.C. Standard Deduction 11. Y
11. N.C. Itemized Deduction 11. N
11. Deduction amount 11. 21500
12. a. Add Lines 9, 10b, and 11 12a. 21500
b. Subtract amount on Line 12a from Line 8 12b. 110759
13. Part-year Residents and Nonresidents Taxable Percentage 13. 0.0000
14. N.C. Taxable Income 14. 110759
15. N.C. Income Tax 15. 5815
16. Tax Credits 16. 0
17. Subtract Line 16 from Line 15 17. 5815
18. Consumer Use Tax 18. 0
You certify that no Consumer Use Tax is due Y
19. Add Lines 17 and 18 19. 5815

North Carolina Income Tax Withheld

20a. Your tax withheld 20a. 2214

20b. Spouse's tax withheld 20b. 0

Other Tax Payments

21a. 2021 estimated tax 21a. 0

21b. Paid with extension 21b. 0
21c. Partnership 21c. 0
21d. S Corporation 21d. 0
22. Amended Returns Only - Previous payments 22. 0
23. Total Payments 23. 2214
24. Amended Returns Only - Previous refunds 24. 0
25. Subtract Line 24 from Line 23 25. 2214
26a. Tax Due 26a. 3601
26b. Penalties 26b. 0
26c. Interest 26c. 0
26d. Add Lines 26b and 26c and enter the total on 26d 26d. 0
EU Exception to Underpayment of Estimated Tax EU
26e. Interest on the Underpayment of Estimated Income Tax 26e. 100
27. Pay this Amount 27. 3701
28. Overpayment 28. 0

Amount of Refund to Apply to:

29. Amount of Line 28 to be applied to 2022 Estimated Income Tax 29. 0

30. N.C. Nongame and Endangered Wildlife Fund 30. 0
31. N.C. Education Endowment Fund Complete Form NC-EDU to make a NC Education Endowment Fund contribution 31. 0
32. N.C. Breast and Cervical Cancer Control Program 32. 0
33. Add Lines 29 through 32 33. 0
34. Amount to be Refunded 34. 0

This page must be filed with the first page of this form.
 Instructions for Form D-400V, Payment Voucher
What Is Form D-400V and Why
Should You Use It?
It is a statement you send with your
payment of a balance due on Form
D-400. Using Form D-400V allows the
Department to process your payment
more accurately and efficiently. We
strongly encourage you to use Form
D-400V. (Do not use Form D-400V
when making a payment of a balance
due on an amended Form D-400. Use
Form D-400V Amended.)
Making an Online Payment
To pay your tax via our online payment
portal please visit www.ncdor.gov or
use your mobile device to scan the QR
code below.
D-400V (62) Individual Income Payment Voucher
9-16-08
517875331 GONZ
FLORENCIO GONZALEZ-PEREZ
4301 BENNETT MEMORIAL RD
DURHAM NC
Taxpayer/Paid Preparer:
Date: Phone:
20214 5178753314 0000000 06408
Benefits of Paying Taxes Online Cut across the dotted line and send
the completed voucher and your
Secure and convenient check or money order.
Schedule payments in advance
What if You File Electronically?
Bank drafts (free), MasterCard or
Visa ($2 convenience fee for every
If you choose to file electronically
$100 paid)
and have a balance due, follow your
Your payment will be processed transmitter's or preparer's instructions
efficiently and you will receive for making your payment.
receipt of payment.
Important Reminders
Preparing and Sending Your
Payment
Do not use this payment voucher
if you pay your tax online.
Make your check or money order
payable in U.S. dollars to the NC Do not staple, tape, paper clip or
Department of Revenue. Note: otherwise attach your check or
The Department will not accept a
money order to the voucher.
check, money order, or cashier's
check unless it is drawn on a U.S.
Do not fold the voucher or check.
(domestic) bank and the funds are
payable in U.S. dollars.
Do not use this voucher to pay
Make sure your name and address quarterly estimated tax.
appear on your check or money
order. Do not use a photocopy of the
voucher.
Enter "Tax Year and Form D-400,"
your daytime phone number, and Do not use another person's
your SSN on your check or money
voucher.
order. If you are filing a joint return,
enter the SSN shown first on your
return. Do not send cash.
Cut Here
North Carolina Department of Revenue
4301 27705 770973633
MARICELA GARCIA CORNEJO
For Calendar Year 2021 AMOUNT OF THIS PAYMENT
This must match the amount shown
27705 on your check or money order.
$ 3701.00
Mail to:
NCDOR, PO Box 25000,
Raleigh, NC 27640-0640
 (62) D-422
2-22 2021 Underpayment of
Estimated Tax by Individuals
Name(s) shown on tax return
FLORENCIO GONZALEZ-PEREZ & MARICELA
GENERAL INSTRUCTIONS
Purpose of Form. Use this form to see if you owe interest for underpaying
your estimated tax and, if you do, to determine the amount of interest you owe.
Who Must Pay Underpayment Interest. In general, you may owe
underpayment interest if the total of your North Carolina income tax withheld
and timely estimated tax payments do not equal at least the smaller of:
90% of your 2021 tax, or
100% of your 2020 tax. (Your 2020 tax return must cover a 12-month
period)
Exceptions. You do not have to pay interest on the underpayment of
estimated income if any of the following exceptions apply:
The total tax shown due on your 2021 tax return minus the amount
of tax credits and North Carolina tax withheld is less than $1,000. To
determine whether the total tax is less than $1,000, complete Part I,
Lines 1 through 6.
You did not have any individual income tax liability for 2020. For
purposes of this exception, an individual income tax liability means
the amount of tax shown due on the return less any tax credits.
If you are a farmer or commercial fisherman and your gross income
from farming (including oyster farming) or fishing is at least two-thirds
of your gross income from all sources for 2020 or 2021 and you file
your 2021 North Carolina income tax return (Form D-400) and pay
the entire amount of tax shown due by March 1, 2022, you do not owe
interest for underpaying estimated tax. Important: If this exception
applies, you must enter the letter F in the exception box located next
to Line 26e of Form D-400 to avoid receiving an assessment for
underpayment of estimated tax.
SPECIFIC INSTRUCTIONS
Part I. – Required Annual Payment. All taxpayers required to file this form
must complete Lines 1 through 8 to determine your required annual payment.
(For a definition of required annual payment, see G.S. 105-163.15(d)) .
Line 7. If you filed a 2020 Form D-400, subtract the amount of tax credits
entered on Line 16 from the tax due entered on Line 15. If you were
required to file a return for 2020 but did not, or if your 2020 tax year was
less than 12 months, don't complete Line 7. Instead, enter the amount
from Line 4 on Line 8.
Part II. – Short Method. If you can use the short method, complete Lines
9 through 15 to determine the amount of interest on the underpayment
of estimated tax. You can use the short method if:
Part I. Required Annual Payment
1. North Carolina income tax (From 2021 Form D-400, Line 15)
2. Tax credits (From 2021 Form D-400, Line 16)
3. Line 1 minus Line 2
4. Multiply Line 3 by 90% (.90) or 66 2/3% (.6667) for farmers and commercial fishermen
5. North Carolina income tax withheld (From 2021 Form D-400, Lines 20a plus 20b)
6. Line 3 minus Line 5. If less than $1,000, stop; do not complete this form. You do not owe interest.
7. 2020 North Carolina income tax (From 2020 Form D-400, Line 15 minus Line 16)
8. Required annual payment. Enter the smaller of Line 4 or Line 7.
Note: If Line 5 is equal to or more than Line 8, stop . You do not owe interest.
Do not file this form with your return. Keep it for your records.
Social Security Number
517875331
You made no estimated tax payments for 2021 (or your only estimated
tax payments were withheld North Carolina income tax),or
You paid the same amount of estimated tax on each of the four
payment due dates.
Part III. – Regular Method. If you are not eligible to use the short method,
complete Lines 16 through 27 to determine the amount of interest on the
underpayment of estimated tax.
Section A – Figure Your Underpayment.
Line 16. Enter on Line 16, columns (a) through (d), the amount of your
required installment for the due date shown in each column heading.
For most taxpayers, this is one-fourth of the required annual payment
shown in Part I, Line 8. However, if your income varies during the year,
it may be to your benefit to determine your required installments by
using the annualized income installment method. (See Form D-422A,
2021 Annualized Income Installment Worksheet. For details, visit
www.ncdor.gov .) Note: If you annualize your income for any payment
period, you must annualize it for all periods.
Line 17. Enter on Columns (a) through (d), the amount of estimated
tax paid and the North Carolina income tax withheld for each payment
period. For North Carolina tax withheld, you are considered to have paid
one-fourth of these amounts on each payment due date unless you can
show otherwise. Include in Column (a) any overpayment from your 2020
tax return that you elected to apply to your 2021 estimated tax. If you
file your 2021 return and pay the tax due by January 31, 2022, include
on Column (d) the amount of tax you paid with your return.
Line 23. If Line 23 is zero for all payment periods, you do not owe
interest for underpaying estimated tax.
Section B – Figure the Interest on Underpayment.
Line 25. Columns (a) and (b). Determine the number of days after the
due date of an installment through the date the estimated tax was paid, or
through April 15, 2022, whichever is earlier (regardless of which installment
the payment was for). Your payments are applied in the order made first to
any underpayment balance in an earlier column until that underpayment is
fully paid. For example: If Column (a), Line 23 shows an underpayment, any
later payment of estimated tax is considered to have been applied to the
amount shown in Column (a), Line 23 to the extent there is an underpayment.
If April 15, 2022 is earlier, enter 365, 304, 212, and 90
respectively in columns (a), (b), (c), and (d).
1. 5815
2.
3. 5815
4. 5234
5. 2214
6. 3601
7.
8. 5234
 FLORENCIO GONZALEZ-PEREZ & MARICELA 517875331
Form D-422 (62) Reverse
Part II. Short Method - Read the instructions before completing Lines 9 through 15. The Short
Method cannot be used in all circumstances.
9. Enter the amount, if any, from Part I, Line 5 9.

10. Enter the total amount, if any, of estimated tax payments you made 10.

11. Add Lines 9 and 10 11.

12. Total underpayment for year. Line 8 minus Line 11.
(If zero or less, stop; you do not owe interest) 12.

13. Multiply Line 12 by .03320; enter the result 13.

14. If the amount on Line 12 was paid on or after 4/15/22, enter -0-.
If paid before 4/15/22, make the following computation to find the amount to enter on Line 14.
Amount Number of days paid before
on Line 12 X 4/15/22 X .00014 14.

15. Interest on the underpayment. (Line 13 minus Line 14. Enter the result here and on Form D-400, Line 26e.) 15.

Part III. Regular Method

Payment Due Dates
(If the payment due date falls on a Saturday, Sunday or holiday,
Section A - Figure Your Underpayment the payment is due on or before the next business day.)
(a) (b) (c) (d)
4/15/21 6/15/21 9/15/21 1/15/22
16. Divide Line 8 by 4 and enter the result in each column. Exception: If you
use the annualized income installment method, complete Form D-422A, 16.
2021 Annualized Income Installment Worksheet, and check this box. 1309 1308 1309 1308
17. Estimated tax paid and North Carolina income tax withheld. For
Column (a) only, enter the amount from Line 17 on Line 21. (If
Line 17 is equal to or more than Line 16 for each payment period,
stop; you do not owe interest.) Complete Lines 18 through
24 of one column before going to the next column. 17. 554 553 554 553
18. Enter amount, if any, from Line 24 of previous column 18.

19. Add Lines 17 and 18 19. 553 554 553

20. Add amounts on Lines 22 and 23 of the previous
column and enter the result 20. 755 1510 2265
21. Subtract Line 20 from Line 19 and enter the result. If zero or less,
enter zero. (For Column (a) only, enter the amount from Line 17.) 21. 554
22. Remaining underpayment from previous period. If the
amount on Line 21 is -0-, subtract Line 19 from Line 20
and enter the result. Otherwise, enter -0-. 22. 202 956 1712
23. Underpayment. If Line 16 is larger than or equal to Line 21,
subtract Line 21 from Line 16 and enter the result. Enter -0- on Line
18 of the next column and go to Line 19. Otherwise, go to Line 24. 23. 755 1308 1309 1308
24. Overpayment. If Line 21 is larger than Line 16, subtract Line 16
from Line 21 and enter the result. Then go to Line 18 of next column. 24.

Section B - Figure the Interest on Underpayment (Complete Lines 25 and 26 of one column before going to the next column)
April 15, 2021 - April 15, 2022 4/15/21 6/15/21 9/15/21 1/15/22
25. Number of days after the date shown above Line 25 through the date Days: Days: Days: Days:
the amount on Line 23 was paid or 4/15/22, whichever is earlier. 25. 90
26. Underpayment Number of days
on Line 23 X on Line 25 X .05
(see instructions) 365 26. $ $ $ $ 9
27. Interest on the underpayment (Add the amounts on Line 26 for each column. Enter the result
27.
here and on Form D-400, Line 26e.) SEE ATTACHED $ 100
 NC Worksheet for Underpayment of Estimated Tax 2021
202
Name: FLORENCIO GONZALEZ-PEREZ & MARICELA SSN: 517875331
Date Amount Balance due
of of after
payment payment payment Days Penalty
First quarter
Required amount . . . . . . . . . . . . . . . . . . . . . . 1,309.
1st quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 04/15/2021 554. 755.
2nd quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 06/15/2021 755.
3rd quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 09/15/2021 755.
4th quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/15/2022 755.
Final payment . . . . . . . . . . . . . . . . . . . . . . . . . 04/15/2022 755. 365 38.
Total penalty due for first quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38.
Second quarter
Required amount . . . . . . . . . . . . . . . . . . . . . . 1,308.
1st quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 04/15/2021 1,308.
2nd quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 06/15/2021 553. 755.
3rd quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 09/15/2021 755.
4th quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/15/2022 755.
Final payment . . . . . . . . . . . . . . . . . . . . . . . . . 04/15/2022 755. 304 31.
Total penalty due for second quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.
Third quarter
Required amount . . . . . . . . . . . . . . . . . . . . . . 1,309.
1st quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 04/15/2021 1,309.
2nd quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 06/15/2021 1,309.
3rd quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 09/15/2021 554. 755.
4th quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/15/2022 755.
Final payment . . . . . . . . . . . . . . . . . . . . . . . . . 04/15/2022 755. 212 22.
Total penalty due for third quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.
Fourth quarter
Required amount . . . . . . . . . . . . . . . . . . . . . . 1,308.
1st quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 04/15/2021 1,308.
2nd quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 06/15/2021 1,308.
3rd quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 09/15/2021 1,308.
4th quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/15/2022 553. 755.
Final payment . . . . . . . . . . . . . . . . . . . . . . . . . 04/15/2022 755. 90 9.
Total penalty due for fourth quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.

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